Integrated Optic Surface Plasmon Resonance Measurements in a Borosilicate Glass Substrate

The surface plasmon resonance (SPR) technique is a well-known optical method that can be used to measure the refractive index of organic nano-layers adsorbed on a thin metal film. Although there are many configurations for measuring biomolecular interactions, SPR-based techniques play a central role in many current biosensing experiments, since they are the most suited for sensitive and quantitative kinetic measurements. Here we give some results from the analysis and numerical elaboration of SPR data from integrated optics experiments in a particular borosilicate glass, chosen for its composition offering the rather low refractive index of 1.4701 at 633 nm wavelength. These data regard the flow over the sensing region (metal window) of different solutions with refractive indexes in the range of interest (1.3÷1.5) for the detection of contaminants in aqueous solutions. After a discussion of the principles of SPR, of the metal window design optimization by means of optical interaction numerical modeling, and of waveguide fabrication techniques, we give a description of system setup and experimental results. Optimum gold film window thickness and width in this guided-wave configuration has been for the first time derived and implemented on an integrated optic prototype device. Its characterization is given by means of the real time waveguide output intensity measurements, which correspond to the interaction between the sensing gold thin film window and the flowing analyte. The SPR curve was subsequently inferred. Finally, a modified version of the device is reported, with channel waveguides arranged in a Y-junction optical circuit, so that laser source stability requirements are lowered by a factor of 85 dB, making possible the use of low cost sources in practical applications.

Genetic analysis of feline panleukopenia viruses from cats with gastroenteritis

Thirty-nine parvovirus strains contained in faecal samples collected in Italy (n=34) and UK (n=5) from cats with feline panleukopenia were characterized at the molecular level. All viruses were proven to be true feline panleukopenia virus (FPLV) strains by a minor groove binder probe assay, which is able to discriminate between FPLV and the closely related canine parvovirus type 2. By using sequence analysis of the VP2 gene, it was found that the FPLV strains detected in Italy and UK were highly related to each other, with a nucleotide identity of 99.1–100 and 99.4–99.8 % among Italian and British strains, respectively, whereas the similarities between all the sequences analysed were 98.6–100 %. Eighty-eight variable positions were detected in the VP2 gene of the field and reference FPLV strains, most of which were singletons. Synonymous substitutions (n=57) predominated over non-synonymous substitutions (n=31), and the ratio between synonymous and non-synonymous substitutions (dN/dS) was 0.10, thus confirming that evolution of FPLV is driven by random genetic drift rather than by positive selection pressure. Some amino acid mutations in the VP2 protein affected sites that are thought to be responsible for antigenic and biological properties of the virus, but no clear patterns of segregation and genetic markers, were identified, confirming that FPLV is in evolutionary stasis.

Krukenberg tumour of the ovary: a case report with light microscopy, immunohistochemistry and electron microscopy study

A rare case of a 46-year-old woman with bilateral Krukenberg tumours is reported. Histologically, oedematous ovarian stroma was infiltrated by signet-ring cells arranged singly, in cords or in nests. Immunoreactivity for cytokeratin-7, carcinoembryonic antigen as well as histochemical positivity for mucins demonstrated the epithelial nature of the tumour. The gastric primary site was suggested by the cytoplasmic immunoreactivity for MUC-5AC and by ultrastructural evidence of gastric differentiation in signet-ring cells such as mucous granules with eccentric dense cores and intracellular microcysts, lined by sparse microvilli. Gastric biopsy, performed after pathological diagnosis, revealed a signet-ring cell carcinoma similar to that in the ovaries, confirming the gastric origin of the Krukenberg tumour. Because none of the individual immunohistochemical markers used for tissue identification is both site specific and site sensitive, electron microscopy in combination with immunohistochemistry is a valuable tool for the pathologist in the diagnosis of the tissue origin of a Krukenberg tumour.

Do aspartate and asparagine acute supplementation influence the onset of fatigue in intense exercise?

AIM

Oxaloacetic acid represents a fundamental intermediary in the metabolism of energy substrate. Asparagine and aspartate constitute precursor compounds of this substance. Therefore, they could affect tricarbossilic acids cycle. Besides, it was suggested that supplementation with aspartate and asparagine determines a muscular glycogen sparing during strenuous physical exercise, even if the real effectiveness remain controversial. The aim of the present pilot study was to evaluate the hypothesis that a supplementation with oxaloacetate precursors, precisely aspartate and asparagine, could improve sport performance during high intensity endurance exercise.

METHODS

We recruited 15 male trained athletes, aged from 20 to 30 years (mean age: 24.13+/-3.87 years), practicing triathlon. We administered them placebo or aspartate (7 g) and asparagine (7 g) mixture, using a double blind technique, before performing an exhaustion stress test on cycloergometer carried out to 90% of each athlete's maximum oxygen consumption, previously determined.

RESULTS

We evaluated lactatemia through earlobe punctures at the end of warming up, at the maximum effort and at recovery time (3 min, 5 min, 10 min, 15 min, 30 min). Furthermore, subjects were submitted to three blood samples from brachial artery in order to assess the glycemia (before the exercise, at the end of the exercise, and 30 min after the end of the exercise).

CONCLUSION

The analysis of these parameters and the results of the ergometric tests after amino acids assumption indicate that acute supplementation with aspartate and asparagine do not significantly affect physical performance in athletes practicing high intensity exercises, and that acute administration of aspartate does not cause a sparing of muscle glycogen concentration.

Escherichia coli O26 in minced beef: prevalence, characterization and antimicrobial resistance pattern

Verocytotoxin-producing Escherichia coli (VTEC) non-O157 serogroups are among the most important emerging food-borne pathogen groups. In particular, the O26 serogroup is able to cause a large spectrum of illnesses in humans which have a significant public health impact as they may range from haemorrhagic colitis (HC) to haemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). It is known that VTEC organisms are associated with animal reservoirs, i.e. ruminants, and foods of animal origin, especially undercooked meat and raw milk, are often involved in outbreaks. In this study, 250 minced beef samples collected at retail outlets in southern Italy were tested for the presence of E. coli O26 and the isolates were characterized and studied for their antimicrobial resistance properties. Three minced beef samples (1.2%) tested positive for E. coli O26; one isolate per positive sample was characterized. One isolate harboured the genes encoding for virulence factors intimin (eaeA) and enterohaemolysin (hlyA), while none presented verocytotoxin-encoding genes (stx1 and stx2) and all were negative at the verotoxicity assay. All the isolates showed resistance properties to at least four antimicrobial agents tested and two were multi-drug resistant (MDR). Although no verocytotoxin-encoding genes were found in the isolates, the presence of potentially pathogenic E. coli O26 strains in minced beef points to the need for proper hygiene during meat production to reduce the risk of food-borne illnesses and transmission of MDR organisms via foods to humans. This paper is the first report on the presence and characterization of E. coli O26 in minced beef marketed in Italy.

Evolution of physiological and haematological parameters with training load in elite male road cyclists: a longitudinal study

AIM

The aim of this study was to describe and evaluate physiological parameters as a control tool for the monitoring of training in a group of elite cyclists during one season of training.

METHODS

The study is divided into two periods (winter or ''volume'' mesocycle and spring or ''intensity'' mesocycle) between the tests that they carried out in the laboratory, consisting of a ramp test to exhaustion (work load increases 25 W X min(-1)) and a maximal lactate steady state (MLSS) test on a cycle ergometer. Macronutrients and hematological variables were recorded during the test periods as were the volume and the intensity of training sessions during the whole period of the study.

RESULTS

The physiological data were similar to those previously reported for professional cyclists (approximately 450 Watts, approximately 78 mL x kg(-1) x min(-1)) and the values for the MLSS also agree with previous studies (approximately 250 Watts). Subjects improved the first ventilatory threshold (VT(1)) (approximately 52% to approximately 60% VO(2max)) and the second ventilatory threshold (VT(2)) (approximately 82% to approximately 87% VO(2max)) after the first period of training even though its low intensity focused on the performance of VT(1) (77% training in ''zone 1'', under VT(1)). The MLSS improved after the first period (approximately 225 to approximately 250 Watts) and remained high in the second (approximately 255 Watts). High levels of creatine kinase (approximately 230 U x L(-1)) and urea (37 mg x L(-1)) were found, also a decrease in hemoglobin values (approximately 15.4 to approximately 14.7g x dL(-1)).

CONCLUSION

The high level reached by the subjects after the first period of training suggests that two effort tests could be enough to plan training. On the other hand, the decrease in some red blood cell and nutrition parameters suggests that there should be greater control over them during the season.

Methicillin-resistant Staphylococcus aureus (MRSA) in foods of animal origin product in Italy

Methicillin-resistant Staphylococcus aureus (MRSA) strains are a global health concern. The present study regarded 160 S. aureus strains that had been isolated from 1634 foodstuff samples of animal origin in a previous survey conducted in Italy during 2003-2005. The strains were characterized by detecting the mecA gene, the production of type A to D staphylococcal enterotoxins (SEs), and studying their resistance properties against several antibiotics; their ecological origin was determined by biotyping. Of the 160 analyzed S. aureus strains six (3.75%) were mecA positive and derived from six different samples; four isolates were from bovine milk and two from dairy products (pecorino cheese and mozzarella cheese). Two strains isolated from milk belonged to the non-host-specific biovar while the others to the ovine biovar. The strain isolated from mozzarella cheese belonged to the non-host-specific biovar and the strain isolated from pecorino cheese to the ovine biovar. All the MRSA strains isolated were enterotoxigenic; two strains synthesized SEA/SED two SED and one SEC. All the strains showed resistance to at least one of the antibiotics tested but none was resistant to glycopeptides.

Low prevalence of Listeria monocytogenes in foods from Italy

Listeria monocytogenes is an important foodborne pathogen that causes gastrointestinal disorders, and, especially in immunocompromised people, serious extraintestinal diseases, such as septicemia and meningitis, as well as abortion in pregnant women. Many foods, from both plant and animal origin, have been involved in listeriosis outbreaks. This article reports the results of a 12-year survey (1993 through 2004) on the presence of L. monocytogenes in several kinds of food marketed in Italy. Of 5,788 analyzed samples, 121 (2.1%) were contaminated with L. monocytogenes. The highest prevalence was found in smoked salmon (10.6%) and in poultry meat samples (8.5%) and the lowest in red meat (0.3%). L. monocytogenes was not found in 154 samples of fresh seafood products. Fifty-two isolates were also serotyped by the agglutination method. The most common serotypes detected in the 52 strains tested were 1/2a (36.5%), followed by 1/2c (32.8%), 1/2b (13.5%), 4b (11.5%), 3a (3.8%), and 3b (1.9%). The results of the present study showed low levels of L. monocytogenes in the analyzed samples. A total of 61.5% of the 52 L. monocytogenes strains analyzed belonged to serotypes 1/2a, 1/2b, and 4b, namely the serovars that are most commonly involved in extraintestinal human listeriosis outbreaks. In the ready-to-eat samples, these three serotypes were 40.0% (1/2a), 17.1% (1/2b), and 14.3% (4b). This finding highlights the need to implement strict hygienic measures during the production, distribution, and sale of foods to reduce the risk of foodborne listeriosis in humans to an acceptable level.

Occurrence, characterization and antimicrobial resistance of enterotoxigenic Staphylococcus aureus isolated from meat and dairy products

Staphylococcus aureus is considered to be one of the leading causes of food-borne illnesses. Milk, dairy products and meats are often contaminated with enterotoxigenic strains of this bacterium. Foodstuff contamination may occur directly from infected food-producing animals or may result from poor hygiene during production processes, or the retail and storage of foods, since humans may carry the microorganism. The number of S. aureus strains that exhibits antimicrobial-resistance properties has increased, together with the potential risk of transmitting the same properties to the human microflora via foods or inducing infections hard to be treated. This paper reports the results of a 3-year survey (2003-2005) on the occurrence of S. aureus in meat and dairy products. Of 1634 samples examined, 209 (12.8%) were contaminated with S. aureus. A total of 125 enterotoxigenic S. aureus strains were biotyped and their antimicrobial resistance pattern tested. Most of the isolated strains produced SED (33.6%), followed by SEA (18.4%), SEC (15.2%), SEB (6.4%) and belonged mainly to the Human ecovar (50.4%), followed by Ovine (23.2%), Non-Host-Specific (17.6%), Bovine (7.2%) and Poultry-like (1.6%) ecovars. Finally, the 68.8% analysed strains showed antimicrobial resistance properties at least at one of antibiotics tested. Human biotype showed antimicrobial resistance at more than one antibiotic than the other biotypes (p<0.05). The results provided evidence that the presence of enterotoxigenic and antimicrobial resistant strains of S. aureus has become remarkably widespread in foods. This calls for better control of sources of food contamination and of the spread of antimicrobial-resistance organisms.

A peculiar pattern of expression of the transferrin receptor (CD71) by reticulocytes in patients given recombinant human erythropoietin (rHuEPO): a novel marker for abuse in sport?

To overcome the limitation of the currently adopted direct method to detect recombinant Human Erythropoietin (rHuEpo) abuse in sport, indirect analysis of blood parameters are increasingly used as part of the anti-doping strategies. The aim of the present work is to identify whether immunophenotype modifications on erythroid cells may be indicative of previous rHuEPO administration. The study was conducted on dialyzed patients under treatment with rHuEPO (DPT). Dialyzed patients without rHuEPO therapy (DP) and volunteer donors (H) were used as controls. The analysis of erythroid cells immunophenotype, performed using a multiparametric flow cytometry technique, showed a peculiar pattern of CD71 expression following rHuEPO treatment. In particular CD71 showed an increased expression in mature and intermediate reticulocytes and a surprisingly decreased expression in immature reticulocytes. In conclusion, the analysis of reticulocyte maturation stages with TO/CD71 double staining may be considered as a valid alternative indirect method for the detection of rHuEPO abuse.

Cervical intraepithelial neoplasia: risk factors for persistence and recurrence in adolescents

One of the most common sexually transmitted infections in adolescents is human papillomavirus. These infections can occur in one or multiple areas of the female genitalia but the vulva is usually the initial site of implantation for HPV. We carried out a long-term follow-up study of adolescents to evaluate the incidence of single or multiple lesions in the lower genital tract, the correlation between sexual behaviour and their localisation and behavioural risk factors for persistence and recurrence of HPV lesions and cervical intraepithelial lesion (CIN). We interviewed 268 women aged 12-21 years who had previously had cytology and/or physical examination suspicious for HPV infection. We asked them information about their lifestyle, sexual behaviour, work, personal or family history of genital warts and school attendance. Those who smoked more than five cigarettes a day were considered "smokers". We have no specific data about oral contraception although we know that none of the patients had used oral contraceptives for more than two years. Two hundred and thirty-four young women between the ages of 12 and 21 years were included in the study. The diagnostic schedule for a complete evaluation included exo- and endocervical cytology, colposcopy and directed biopsy. We found that in 126 out of 234 (53.8%) adolescents using contraceptives, only 85 (36.3%) had used a condom. The sites most frequently affected by lesions were the vulva, perianus and perineum (194/234; 82.9%), and the cervix (125/234; 53.4%). Vaginal lesions were detected in only 29/234 patients (12.3%). In 161 patients, sexual habits, age at first intercourse (p = 0.68), frequency of intercourse (p = 0.49) and number of lifetime partners (p = 0.27) as well as age (p = 0.26) played a role in transmission and incidence of HPV infection but not in the location of the lesions. This could be due to coexistent clinical and subclinical multiple infections as well as transmission via intercourse or from other sources, including tampons. HPV infection is detected by abnormal pap test, but the low correlation with colposcopic and histological findings in this study justify the support of other examinations such as colposcopy and punch biopsy for diagnosis. Moreover more attention should be paid to the psychological aspect of diagnoses and treatment of adolescents compared to older women as there was a high rate of patients lost in our study: 75/234 (32.05%) before LASER surgery and 55/159 (34.59%) during follow-up. Only 12-45% of sexually active adolescent girls had obtained Pap smear screening. In our study we found no correlation between treatment failure and cigarette smoking or between the use of oral contraceptives and persistence/recurrence after LASER surgery.

Prevalence, Molecular Characterization and Antimicrobial Resistance of Thermophilic Campylobacter Isolates from Cattle, Hens, Broilers and Broiler Meat in South-eastern Italy

Eleven cattle farms, 8 layer farms, 7 broiler farms and 30 broiler meat samples were investigated in south-eastern Italy throughout 2003 to evaluate the prevalence, the molecular type and antimicrobial resistance of thermophilic Campylobacters. A total of 398 samples were analysed. One Campylobacter isolate for each positive faecal swab and three isolates per positive broiler meat sample were selected for further analysis. Multiplex PCR was performed for species-level identification and PCR-RFLP of the flagellin A gene for genotyping. Resistance to 14 antimicrobials was studied in 188 Campylobacter isolates. Prevalence of campylobacters was high both on farms (100%) and in food samples (73%). On 4/11 cattle farms and on 10/15 poultry farms more than one species was isolated. The presence of more than one genotype was found on 8/11 cattle farms, on 10/15 poultry farms and in 8/22 Campylobacter-positive food samples. High rates of resistance to quinolone were observed: 9/31 (29%) C. jejuni bovine isolates, 4/22 (18%) C. jejuni poultry isolates, and 14/26 (54%) C. coli poultry isolates. Resistance to sulphamethoxazole-trimethoprim was also observed frequently: 18/26 (69%) of the avian C. coli strains, 25/31 (80%) of the C. jejuni strains isolated from poultry and 15/22 (68%) of those isolated from cattle were resistant. There was a significant difference between the rate of resistance to macrolides of C. coli and C. jejuni isolated in poultry, which amounted to 23% and 3%, respectively. This study provided data on the prevalence and antimicrobial resistance of thermophilic campylobacters in south-eastern Italy and confirmed that flaA-typing is an efficient tool to study the epidemiology of Campylobacter strains in short-term investigations.

The ischiatic region: normal and MRI anatomy

AIM

The aim of this study was to describe the anatomy correlated to the normal magnetic resonance imaging (MRI) images of the proximal thigh region and the ischial tuberosity.

METHODS

MRI coronal and axial sequences were obtained from 20 asymptomatic volunteers (10 male and 10 female) aged 20 to 38 years (mean age: 28 years), and then they were compared with 2 anatomical dissections and 7 cryosections of 6 cadaver thighs.

RESULTS

The anatomical specimens were directly correlated with MRI scans. From the comparison it could be seen how the axial MRI sequences well outlined the sciatic nerve, usually observed oval in shape with moderate signal intensity, and thus easily detectable from other surrounding organs. Other structures were also identified by axial images: the ischial tuberosity, the proximal origin of the hamstring muscles arising from the ischium and the related bursae, the gluteus maximus and its bursa, the quadratus femoris and its inconstant bursa, a triangular adipose body and vessels. Coronal scans also showed well the hamstring muscles, both in length and thickness.

CONCLUSIONS

Both MRI images and cadaver dissections showed the ischial tuberosity as an interesting intersection area that could be delimited as follows: on the dorsal border the gluteus maximus and its bursa, on the dorso-medial side the hamstring muscle origin, and on the antero-lateral side the quadratus femoris muscle with its inconstant bursa and the ischial tuberosity. These anatomical and MRI descriptions are very useful to give a contribution to the right explanation of sciatic symptoms caused by those sports specifically overloading the hamstring muscles. Frequently, in fact, in these athletes a sciatic syndrome arise drawing the physician's attention to the lumbosacral joint or to the sciatic nerve course near the piriformis muscle. Another very important site where the sciatic symptoms can rise, indeed, could also be found in the hamstring muscle region, where the nerve run under the gluteus maximus beside the ischiatic bone. Athletes who manifest notorious muscle overload in this anatomical region usually show sciatic pain symptoms that are not to be related with pathologies of the lumbosacral junction nor to relationships of the sciatic nerve with the piriformis muscle but rather to relationships that this nerve acquires with either gluteal muscles as well as with muscles of the underneath ischiatic region.

Survival of Helicobacter pylori in artificially contaminated ultrahigh temperature and pasteurized milk

Helicobacter pylori (H. pylori) is a very important bacterial pathogen of humans which may cause gastrointestinal illnesses ranging from gastric and duodenal ulcers to neoplastic diseases such as MALToma and gastric cancer. Transmission via contaminated food is still uncertain but several authors believe this can realistically occur and milk may act as a vehicle of infection. This paper reports the results of H. pylori survival trials in pasteurized and ultrahigh temperature (UHT) milks artificially contaminated and aerobically stored at 4 degrees C. The results obtained showed that the four strains used in this study (H. pylori nat 18-19-20 and H. pylori ATCC 43504), had a progressive reduction in bacterial load with a median survival of 9 days in pasteurized milk and 12 days in UHT milk, with approximate average of initial inoculum of 10(5) and 10(6)cfu/ml, respectively. These findings are very important to clarify the route of transmission of H. pylori to humans via food and for implementation of a correct risk analysis for food safety purposes.

Vibrio parahaemolyticus, Vibrio vulnificus and microorganisms of fecal origin in mussels (Mytilus galloprovincialis) sold in the Puglia region (Italy)

Mytilus galloprovincialis is one of the most commonly consumed of all bivalve molluscs. The consumption of raw bivalve molluscs has caused outbreaks of food poisoning due to Vibrio parahaemolyticus and Vibrio vulnificus. This paper reports the results of a survey on the presence of V. parahaemolyticus, V. vulnificus fecal coliform bacteria, Escherichia coli and Salmonella spp. in 600 M. galloprovincialis samples collected from retail outlets in the Puglia region. V. parahaemolyticus and V. vulnificus were found in 47 (7.83%) and 17 (2.83%) of the samples, respectively. One sample (0.16%) was contaminated with Salmonella spp. but no relationship was observed between vibrios and fecal coliforms and E. coli. There were no significant differences among vibrios present in bivalve molluscs during the 3-year survey.

Multiplex-touchdown PCR assay for the detection and genotyping of Helicobacter pylori from artificially contaminated sheep milk

Helicobacter pylori (Hp) is an organism commonly present worldwide in the human population, sometimes causing serious illnesses such as duodenal and gastric ulcers, adenocarcinoma of the stomach, and low-grade B-cell mucosa-associated lymphoid tissue lymphoma of the stomach. This article describes a multiplex-touchdown PCR method for the identification and genotyping (vacA-s1/m1, sl/m2, and s2/m2-and cagA genes) of Hp directly from sheep milk artificially contaminated with Hp strains from human gastric biopsies and with Hp ATCC 43504. The strains from humans carried sl/m2 cagA+ and s2/m2 cagA allelic combinations, while the ATCC strains carried an sl/ml cagA+ allelic combination. The technique showed a sensitivity of 15 CFU/ml for species identification and of 1,500 CFU/ml for the detection of genes encoding for VacA and CagA. It has proven to be specific and rapid, and the authors suggest that it be used as a rapid screening method to ensure that sheep milk is uncontaminated with this organism.

Role of exercise stress test in master athletes

BACKGROUND

The effectiveness of cardiovascular screening in minimising the risk of athletic field deaths in master athletes is not known.

OBJECTIVE

To evaluate the prevalence and clinical significance of ST segment depression during a stress test in asymptomatic apparently healthy elderly athletes.

METHODS

A total of 113 male subjects aged over 60 were studied (79 trained and 34 sedentary); 88 of them (62 trained and 26 sedentary) were followed up for four years (mean 2.16 years for athletes, 1.26 years for sedentary subjects), with a resting 12 lead electrocardiogram (ECG), symptom limited exercise ECG on a cycle ergometer, echocardiography, and 24 hour ECG Holter monitoring.

RESULTS

A significant ST segment depression at peak exercise was detected in one athlete at the first evaluation. A further case was seen during the follow up period in a previously "negative" athlete. Both were asymptomatic, and single photon emission tomography and/or stress echocardiography were negative for myocardial ischaemia. The athletes remained symptom-free during the period of the study. One athlete died during the follow up for coronary artery disease: he showed polymorphous ventricular tachycardia during both the exercise test and Holter monitoring, but no significant ST segment depression.

CONCLUSIONS

The finding of false positive ST segment depression in elderly athletes, although still not fully understood, may be related to the physiological cardiac remodelling induced by regular training. Thus athletes with exercise induced ST segment depression, with no associated symptoms and/or complex ventricular arrhythmias, and no adverse findings at second level cardiological testing, should be considered free from coronary disease and safe to continue athletic training.

Coagulase-positive Staphylococci and in food products marketed in Italy

Staphylococcus aureus is a very common organism capable of producing several enterotoxins (SEs) that cause intoxication symptoms of varying intensity in humans when ingested through contaminated food. This paper reports the results of an investigation on the presence of Coagulase-Positive Staphylococci (CPS) and S. aureus in several food products marketed in Italy and on food contact surface swabs sampled from the food industry. A total of 11,384 samples were examined and 1971 of them (17.3%) were found to contain CPS. The assays performed on 541 CPS strains led to the identification of 537 S. aureus strains on which characterization of type A, B, C and D staphylococcal enterotoxins (SEA, SEB, SEC and SED) was performed. A total of 298 S. aureus strains (55.5%) produced one or more SEs: 33.9% of the strains produced SEC, 26.5% SEA, 20.5% SEA+SED, 13.4% SED, 2.7% SEB, 1.7% SEA+SEB, 0.7% SEC+SED and 0.3% produced SEA+SEC and SEB+SEC. The investigation highlighted that these organisms are very common and constitute a potential risk for consumers' health.

The possible role of radiofrequency as complementary treatment of locally advanced gastric cancer

AIM

The prognosis of locally advanced gastric cancer (T3-T4) is bad. The presence of lymph nodes (N3-N4) or haematogenous metastases (liver, lung) gets worse the evolution; principally the hepatic malignancies are cause of scarce survival. The possible use of a palliative treatment as radiofrequency ablation (the good results are note about the treatment of hepatic malignancies by colo-rectal cancer) is reported in recent series. Therefore we decide to use radiofrequency ablation for the treatment of hepatic metastases by gastric cancer, difficulty treated surgically.

MATERIALS AND METHODS

From January 2001 to December 2002, 25 patients affected by hepatic metastases underwent to radiofrequency thermal ablation, 2 of them were affected by gastric adenocarcinoma. Case 1: A.P., 58 year-old man, one year before underwent to subtotal gastric resection according to Billroth II. After repeated postoperative chemotherapy cycles, he presented metastases at IV hepatic segment. The patient underwent to percutaneous radiofrequency ablation. The control CT scan confirmed metastasis disappearance. After three months, a partial recurrence was treated by the alcoholization. Three months after, we observed marked jaundice for multiple diffused metastases, followed by the exitus. Case 2: B.G., 63 year-old man, with advanced gastric adenocarcinoma (T4) at the pylorus and hepatic metastasis at IV segment. The patient underwent to gastrojejunostomy and to intraoperative radiofrequency ablation. Ultrasonography and CT scan controls were performed before discharge. The patient didn't undergo to successive controls. After 7 months, the patient returned with marked jaundice for diffused hepatic metastases; he refused any treatment, and then he died one month after.

CONCLUSIONS

Our preliminary results don't show complications related to the intra and peri-operative radiofrequency, with an important increase of the mean survival. The results, limited by poor experience, may indicate the complementary role of the radiofrequency in the palliative treatment of the hepatic metastases by advanced gastric cancer, difficulty treated surgically.

Routine insertion of permanent peritoneal dialysis catheters in the nephrology ward. The sliding percutaneous technique

AIM

A prerequisite to the technical success of peritoneal dialysis in its different modifications is a safe, reliable, correctly positioned, and functioning peritoneal catheter. The ideal method for insertion of permanent catheters (PC) remains debatable. The most commonly used technique is an open surgical approach, by minilaparatomy. Others have proposed a blind approach, using either a trocar method or a modified Seldinger technique or an insertion by means of peritoneoscopy.

METHODS

We describe our 5-year experience (May 1997 - June 2002) with 68 percutaneous PC insertions in 63 consecutive patients. A modified technique of percutaneous PC insertion was used that here we call sliding percutaneous technique (SPT): 1) a midline incision is made 4 cm below the umbilicus; the peritoneum is punctured using a straight plastic catheter with a stylet. The catheter is pushed caudally towards the left iliac fossa; 2) a straight stiff 90 cm stylet is inserted through the temporary catheter, which is subsequently removed. The stylet has 2 tips, a blunt proximal one, which is pushed through the catheter into the iliac fossa, and the distal one; 3) having the stylet in situ, a double-cuffed curled-end PC is mounted at the distal tip of the stylet starting from the curl; then, the PC is gently slid down along the stylet as a train does along the rail-way. PC failure was defined as mechanical dysfunction, persistent dialysate leak and persistent peritonitis, or exit site/tunnel infection requiring PC removal. Furthermore, PC failure was defined as early, if occurring in the first 30 days after PC placement, or late, if occurring more than 30 days post-operation. Life-table estimates of PC survival were determined by Kaplan-Meier analysis.

RESULTS

Early complications: in the 1st month on dialysis, obstruction to dialysate flow was the commonest cause leading to PC failure. The early actuarial survival (AS) was 90%. Late complications: peritonitis was the commonest cause of PC failure. The late AS, i.e. excluding the catheter failures occurring in the 1st month post-operation, was 82% at 3 years. Global AS, i.e. including both early and late PC failures, was excellent (74% at 3 years).

CONCLUSIONS

Even though this study is retrospective and does not compare percutaneous with surgical PC placement techniques, it allows us to state that percutaneous PC insertion is a well-tolerated, rapidly performed, side-room procedure that gives excellent results, above all when using SPT.

Market survey of Vibrio spp. and other microrganisms in Italian shellfish

A survey was conducted of Vibrio spp., Escherichia coli, fecal coliforms, and Salmonella in 644 molluscan shellfish samples marketed in the Apulia region of southern Italy. Vibrios were found in 278 samples (43%), and levels of E. coli and fecal coliforms were above the Italian legal limit in 27 and 34 samples (4 and 5%), respectively. Salmonella was not detected in any of the samples. Because the majority of the vibrio isolates were found in samples that were compliant with Italian regulations, there appears to be no relationship between the presence of microorganisms of fecal origin and the presence of vibrios potentially harmful to human health.

Isokinetic evaluation of anterior cruciate ligament reconstruction: quadriceps tendon versus patellar tendon

AIM

The goal of this prospective randomized study was to compare the isokinetic recovery of thigh strength after anterior cruciate ligament (ACL) reconstruction by using patellar or quadriceps tendon as graft at the 6th month follow-up.

METHODS

The authors evaluated 48 patients who underwent arthroscopic ACL reconstruction using patellar tendon (PT group) or quadriceps tendon (QT group) as autograft after a 6 months follow-up undergoing the following tests: the Ergojump Bosco System springboard and Universal's FITNET computerized isokinetic system.

RESULTS

The counter movement jump (CMJ) test showed a 24% (p<0.01) strength deficit in patients operated with patellar tendon and 11% in the quadriceps tendon group. Also in the leg press test the greater differences in strength (p<0.05) were verified in the patellar tendon group, above all the peak torque (PT) test carried out at 3 repetitions (15%).

CONCLUSIONS

The strength deficit found in the subjects operated with quadriceps tendon were statistically lower in comparison to that verified in the patellar tendon group. A good recovery in thigh strength after 6 months in patients operated with quadriceps tendon could encourage the use of this kind of graft in order to achieve an easier rehabilitation and a faster release of the patient to daily and sports activity.

[Coxiella burnetii: what is the reality?]

After the Second World War, in Italy Q Fever or Coxiellosis has been shown a significant relevance, a recrudescence with an epidemic state for over ten years. Later, the infectious disease occurred as endemic since the 80s, the outbreaks were just isolated. Workflows analysis of some authors has demonstrated the spread out of the infection throughout Italian herds with a prevalence ranging from 1.2 per cent to 10 per cent. Our survey carried out throughout Campania area in cattle has shown a real positivity over 14 per cent performing the IFAT for the detection of IgG antibodies for Coxiella burnetii. Therefore, it has been so important to stress the influence of cattle farming management in stables as a real risk of Coxiellosis. For example, the Relative Risk (RR) has been registrated about 6.84 (2.18<RR<21.4) in comparison with some herds permanently housed than those kept unhoused and about 8.4 (1.8<RR<38.6) in housed herds and those permanently kept at pasture. Therefore, we have detected a seroprevalence of Q Fever about 11.8 per cent within sheep and about 6.3 per cent within goats. The investigations have focused buffaloes too, tested by several authors, especially from India, but in Italy, only Galiero has recorded significant results: the overall seroprevalence (1.2 per cent) was observed within 1012 buffaloes. Other studies have demonstrated that dogs may transmit Q Fever to humans by infected birth fluids and membranes and by urine. Because of this observation, addressed some of our search projects to assess possible relation among other pathogens, such as Leishmania infantum, Rickettsia conori and Ehrlichia canis. The results have confirmed the presence of C. burnetii (seroprevalence about 7 per cent) within tested dogs in southern Italy. There was no direct estimated relationship between C. burnetii and E. canis and R. conori, instead of significant relation has been shown for L. infantum. The investigation focused on the direct interaction between seropositivity and the age of ruminants. For example, the highest prevalence has been observed in cows and sheep ranging from 3-5 years in which the infection risk was higher than in younger herds. In accordance with the workflows serological analysis, C. burnetii is widespread in Italy among housed ruminants. PCR assay was, therefore performed to test cows with clinical signs of abortion and neonatal mortality. All the survey involved 305 animals (267 foeti and 38 stillborn) with 77 positive herds showing DNA of C. burnetii. To detect C. burnetii pathogen in milk samples, two methods have been combined: the immunomagnetic separation (IMS) and PCR assay, obtaining an increasing of sensitivity (10(-17)) more than only PCR technique (10(-8)). The overall analysis of serological and biomolecular results has demonstrated that C. burnetii is really widespread and may have detrimental effects on farm management system.

Vigorous exercise training is not associated with prevalence of ventricular arrhythmias in elderly athletes

AIM

Physical activity, when vigorous, is not devoided of arrhythmic risk. Since the risk of developing arrhythmias increase as an otherwise healthy person ages, the question arises as to whether high intensity physical activity could be dangerous in the elderly person. The present study addressed the incidence of arrhythmias in elderly athletes in comparison to age-matched control subjects.

METHODS

We studied 49 male athletes engaged in various sport disciplines, mean age 62.3+/-2.3 and 24 sedentary or moderately physically active healthy males, mean age 62.9+/-1.7 years (Controls). All subjects underwent 2-D, M-mode and Doppler echocardiographic examination, resting ECG and exercise stress test followed by 24-hour electrocardiographic monitoring.

RESULTS

No pathological findings were detected in both experimental groups at echocardiographic examination. Exercise performance was greater in athletes than controls (206.9+/-5.2 vs 156.3+/-12 watt, p<0.01). During exercise test, no significant between-groups difference was detected in the incidence of ventricular arrhythmias, that is multiple premature ventricular contractions (MPVC), polymorphous premature ventricular contractions (PPVC) and repetitive premature ventricular contractions (RPVC). No subject featured horizontal or downsloping ST segment depression in both groups. At 24-hour electrocardiographic monitoring the incidence of the overall number of premature ventricular contractions was significantly greater in controls than athletes (87.0% vs 63.3%, p<0.05), whereas no significant difference were detected in the incidence of discrete ventricular arrhythmias between athletes (4.1% MPVC, 14.3% PPVC, 8.2% couplets) and controls (0.5% MPVC, 16.7% PPVC, 12.5% couplets).

CONCLUSION

These finding indicate that in elderly, otherwise healthy, athletes vigorous training even to competition does not result in a greater incidence of ventricular arrhythmias, although caution should be made for a careful preparticipation evaluation.

Nonstoichiometric silica mask for fabricating reverse proton-exchanged waveguides in lithium niobate crystals

Producing channel waveguides requires a photolithographic mask, but the standard technique of using thermally evaporated metal films for proton exchange has proved to be unsuitable for withstanding the rather aggressive process of reverse proton exchange. We report the fabrication of a nonstoichiometric silica mask by ion-plating plasma-assisted deposition. This mask is strong enough to resist both direct and reverse proton exchange and is also compatible with anisotropic dry etching for patterning the mask and with electric field poling. Our technique is a practical alternative to the use of SiO2 sputtered masks.

The stress of competition dissociates neural and cortisol homeostasis in elite athletes

AIM

Stressful situations affect autonomic nervous system activity and hormonal responses. This study aimed to investigate the effects of the stress of sports competition on both endocrine system functioning and neurovegetative control of heart rate (HR) in elite athletes.

METHODS

In 7 top-level pentathletes salivary cortisol levels and autoregressive power spectral analysis of HR variability (HRV) were assessed in the morning and in the afternoon on a regular training day (control) and on the day of a competitive selection trial, held 4 weeks apart.

RESULTS

HR, as well as low (LF) and high (HF) frequency components of HRV did not differ significantly both between and within the control and the trial days. On the selection day, morning cortisol levels were significant and markedly greater than on the control day and increased further in the afternoon in contrast to the control day, when cortisol levels decreased in the afternoon as expected from the normal diurnal variation.

CONCLUSION

These results would indicate a dissociation of the neural and hypothalamic-pituitary-adrenal axis functioning in response to the stress of competition in elite athletes, and the considerable extent to which competition may alter selectively the physiology of stress-related hormones while sparing autonomic cardiac regulation.

Oral theophylline supplementation and high-intensity intermittent exercise

AIM

The present study was carried out to investigate whether oral theophylline supplementation exerts an ergogenic effect during intermittent high-intensity exercise.

METHODS

Ten healthy subjects undertook intermittent exercise (1 min cycling at 120% of VO(2max) with 3 min of recovery until exhaustion). The exercise test was repeated twice, 1 week apart. On each occasion, the subject ingested, in a double blind setting, either theophylline (4.5 mg/kg) or placebo 90 min before commencing the exercise test.

RESULTS

Three subjects could not complete both trials due to nausea and dizziness after theophylline had been administered. Time to exhaustion in the remaining subjects was slightly increased after theophylline administration (55.9+/-6 min vs 59.3+/-5.9 min; p<0.05).

CONCLUSION

Present data indicate that oral theophylline supplementation delays fatigue onset during intermittent high-intensity exercise. The effect, although statistically significant, does not appear to be marked. The possibility of occurrence of negative side effects and the evidence for its ergogenic potential suggests the necessity to include theophylline in the International Olympic Committee (IOC) World Antidoping Agency (WADA) list as a banned or restricted substance.

A case of gastric adenocarcinoma associated with giant-cell phlebitis

A 60-year-old male patient with advanced gastric adenocarcinoma was treated by subtotal gastrectomy with dissection of the regional lymph nodes. Microscopic examination of the tumour revealed tubular adenocarcinoma which invaded the muscularis propria. There was no evidence of metastatic carcinoma in the dissected lymph nodes (pT2N0Mx). Granulomatous reaction comprising epithelioid cells and giant cells involved subserosal muscular veins, adjacent to the carcinoma tissue. Fibrinoid necrosis, with or without infiltration of eosinophils, was noted within the lumen of some veins. The acid-fast and fungal stains were negative. Remnants of parasites were not identified in serial sections of the paraffin blocks. No pulmonary disease was evident on radiographic or pulmonary examination. The presence of granulomatous destruction of muscular veins with sparing of arteries suggested the diagnosis of giant-cell phlebitis. To our knowledge, there have been no previous reports regarding an association between giant-cell phlebitis and advanced gastric adenocarcinoma.

[Conservative surgery for ductal carcinoma in situ of the breast]

BACKGROUND

The conservative surgery is considered currently the treatment of choice for the carcinoma of the breast in the initial stage.

METHODS

From 1993 to the 2000, 46 patients (median age 52 years) affected by intraductal carcinoma of the breast, have been submitted to surgical intervention. In 10 cases (21,7%) a palpable mass was observed (mean dimension of 1.3 cm). In 36 cases (78.3%) non palpable lesions were identified by mammography (26 microcalcifications and 10 non palpable masses). All patients have been treated after stereotactic preoperatory mammographic localization of the lesions. 15 simple mastectomies, 11 mammary resections without radiotherapy and 20 mammary resections followed by radiotherapy have been performed. No patient was submitted to axillary dissection. The radiotherapy has been administered with a boost of 50 Gy on the breast.

RESULTS

At a 36 months median follow-up all the patients are alive and no local recurrence or distant metastases has been observed.

CONCLUSIONS

The treatment of choice is the local resection of neoplasm followed by radiotherapy.

[New trends in the therapy of cryptococcosis in AIDS patients]

The Authors report the clinical and microbiological findings about a 6-months follow up of 9 AIDS-patients with Cryptococcosis. Among these, 7 patients suffered from meningo-encephalitis and 2 from haematogenous infection. The fungicidal treatment during acute illness, included the administration of Amphotericin B (0.6 mg/Kg/die i.v.) plus Flucytosine (100 mg/kg/die i.v.) during the first 15 days followed from itraconazole at doses of 400 mg/die in a single administration, during the following 15 days. The chronic suppressive therapy included itraconazole at doses of 200 mg/die p.o. indefinitely. During the 6-months follow up, one patient died of polymicrobial pneumonia and another of hepatic failure related to a reactivation of a previous HCV hepatitis. In 2 patients the presence of multiple nodular lesions in the cerebral CT scan, related to cryptococcal granulomas, was associated to a persistence of positive liquoral cultures and to a poor prognosis. In 3 patients with meningo-encephalitis, the three drugs regimen was quite effective in eradicating the neurological infection and no relapses were observed during the 6-months follow up. The 2 patients with hematogenous infection alone, didn't relapse during the 6-months follow up.

[Voluntary or accidental ingestion of foreign bodies: clinical considerations in 142 cases]

The authors report on a series of 142 patients who had swallowed foreign bodies over the period 1981-1999. After outlining the various ways in which the foreign bodies were swallowed and the fact that they were eliminated spontaneously by natural routes in 80-90% of cases, the authors deal at some length with the serious complications that occurred in some of these cases, which, as a result of their characteristics and mode of ingestion, may require emergency surgery for their resolution. In particular, the authors describe 6 cases of foreign bodies that were urgently removed by endoscopy and also describe 3 cases in detail (1 perforation and 2 bowel obstructions) in which a laparotomy was required not only to correct the complication but also to definitively clarify the diagnosis.

Complex ventricular arrhythmia induced by overuse of potassium supplementation in a young male football player. Case report

People practising regular physical activity usually drink hydrosaline beverages. In this study is reported the case of a young football player suffering from premature ventricular beats. He used to take regularly an hydrosaline supplementation which gave him a daily intake of potassium of about 5 g. A stress test on a cycle ergometer showed many monomorphus premature ventricular beats which disappeared when the heart rate was higher than 110 beats/min. Moreover, 3629 polimorphus premature ventricular beats were recorded during a 24 hr ECG monitoring. At the time of the first examination, the plasma potassium concentration was 7,8 mEq x l(-1). The football player was then suspended from practicing sport and he was asked to stop his intake of potassium. The clinical examination was repeated after 3 and 6 months and no ventricular arrhythmias were observed during the stress test as well as during the 24 hours ECG monitoring. The plasma potassium concentration was normal again. The present case report is an example of how the misuse of saline supplementations could result in hyperkalemia and how this condition may lead to ventricular arrhythmias.

[Role of ultrasonographic imaging in the surgical management of acute diverticulitis of the colon]

Diverticulosis of the colon is a very frequent pathology in the western word and is characterised by a high percentage of dangerous complications (10-25%). The most accurate method of staging diverticular disease is by CT scan. The aim of our study was to evaluate the sensitivity of ultrasonography in the evaluation and management of diverticular disease of the colon. We studied 51 patients: the parameters used to assess complicated diverticulosis of the colon were: 1) wall thickness; 2) presence of fluid collections and pericolic abscesses; 3) free liquid collections in the peritoneal cavity; 4) subdiaphragmatic free air; 5) presence of fistula tracts. Ultrasonography showed 66% sensitivity in the assessment of wall thickness and in detecting the presence of diverticula. The sensitivity rate was 100% in the detection of abscess complications, pericolic collections, free air and fistula tracts. False-negatives (5 patients) were all recorded in Hinchey stage I. The overall sensitivity amounted to 91%. In our experience the method is a first level examination in the approach to patients suffering from diverticular disease of the colon and presents high sensitivity and diagnostic accuracy. The method, in expert hands, is suggested as a first step in the clinical-diagnostic approach to patients suffering from acute abdomen due to diverticulitis of the colon.

Interleukin-6 involvement in antidepressant action of Hypericum perforatum

Hypericum, a plant widely used as antidepressant has been shown to interact with the immune system. We studied the effects of the administration of the Hypericum perforatum extract Ph-50, a Hypericum extract, standardized to flavonoids (50%) and containing 0.3% of hypericin and 4.5% of hyperforin in a forced swimming test and tryptophan, serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) diencephalic content using a high performance liquid chromatography method in male interleukin-6 (IL-6) knock-out (IL-6(-/-)) and wild type (IL-6(+/+)) mice. Hypericum extract (Ph-50; 500 mg/kg) oral acute administration reduced the immobility time of wild type, but not of knockout mice. Tryptophan content was not modified by Hypericum in all the animal groups. Serotonin and 5-HIAA diencephalic content was increased by Hypericum in both wild type and knockout mice. However, the increase observed in the wild type was greater than in knockout mice. These data indicate that IL-6 could be necessary to the antidepressant action of Hypericum, and that this cytokine (probably) mediates the effects of Hypericum through activation of the serotonin system.

[Surgical treatment of acute colonic diverticulitis. Personal experience]

BACKGROUND

Colonic acute diverticulitis presents in patients that suffered from colonic diverticula in 10-25% of cases higher percentage in the elder patient. Colonic acute diverticulitis mortality leads high rates in over 70 years old patients with a value a upper than 75-80%. Perforation and diffuse peritonitis are the more serious complications. Accurate clinical staging followed by correct surgical option are the base of the therapeutical success.

METHODS

Between january 1995 and june 2000 we studied by a retrospective analysis 56 patients (34M/22F), mean age 67, hospitalized cause acute perforate colonic diverticulitis, all patients were recorded in order their clinical conditions APS score and Hinchey staging of the disease. At the time of the recovery all patients underwent at clinical examination, abdominal ultrasound, plane X-ray, and bloody tests. Surgical operations performed were: PRA; PRA and protective colostomy; Hartmann procedure. In the patients with APS score > 6-10 and aged > 70 Hartmann procedure was performed.

RESULTS

Overall mortality was 9% (5 pazienti), overall morbility was 40%. On the basis of the I and II Hinchey stage mortality rate was 0%. In the III stage was recorded mortality of 4% and 33% in IV stage. Complication were: 6 anastomotic lekage; 7 infections of the laparotomic wound; 1 incisional hernia; 2 lekeages of the stomoa; 3 stomatitis; 5 proctitis.

CONCLUSION

Therapeutical choise treatment has to consider Hinchey stage and APS score. Hartmann procedure is indicated in stage III-IV with score APS > 8-10. For the other patients primary resection anastomosis and if is necessary associated colostomy is the treatment recommended.

Physical activity as a possible aggravating factor for athletes with varicocele: impact on the semen profile

The aim of the present study was to evaluate the influence of physical exercise on seminal parameters of male athletes with varicocele. Sixty healthy male volunteers (athletes and non-athletes, n = 30 + 30) and 60 volunteers affected by varicocele (athletes and non-athletes, n = 30 + 30) were randomly selected for a clinical study. All subjects provided at least two semen samples for routine microscopic analysis. Determinations for basal luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, oestradiol, total and free testosterone under resting conditions were also performed. In both groups with varicocele the percentage of total and progressive forward sperm motility and the percentage of normal spermatozoa were significantly reduced. The percentage of both progressive forward motility and normal spermatozoa were significantly lower in athletes with varicocele compared with non-athletes with varicocele (P < 0.05). Only athletes with varicocele had mean left testis volume significantly lower than the contralateral testis (P < 0.05). No modifications of hormonal parameters at rest were observed in any groups. Physical activity might represent an aggravating factor for spermatogenesis in athletes with varicocele. In countries where sport eligibility is granted by an authoritative body, these results suggest the need to establish general medical criteria to guarantee the continuation of an athlete's training whilst at the same time taking care of his reproductive health.

Photosensitization of the sunscreen octyl p-dimethylaminobenzoate by UVA in human melanocytes but not in keratinocytes

Sunscreens penetrate human epidermis and modify the biology of proliferating cells. This study addressed the question whether the UV response of cultured human cells is affected by direct treatment with nontoxic levels of sunscreens. Cell survival following exposure to UVC or unfiltered UBV was not altered by preincubation with 25 micrograms/mL of octyl p-dimethylaminobenzoate (o-PABA), 2-ethylhexyl p-methoxycinnamate (EHMC) or oxybenzone. However, UVA or UVB filtered to reproduce the solar UV spectrum penetrating to the basal layer of the epidermis, highly sensitized cells to killing by o-PABA but not by its hydrolysis product, 4-dimethylaminobenzoic acid. Sensitization was found in all cell types tested, except normal keratinocytes, and could be prevented by certain antioxidants particularly pyruvate and the hydroxyl radical scavenger mannitol. o-PABA and EHMC applied without UV reduced the adherence of cells. The results indicate that sunscreens may increase cell mobility and the combination of o-PABA with solar UV may selectively damage melanocytes in the skin.

Usage of real-time ultraviolet radiation data to modify the daily erythemal exposure of primary schoolchildren

BACKGROUND/AIMS

Primary schoolchildren in their everyday school life are exposed to solar ultraviolet radiation. This may be through time spent outdoors whilst having meal breaks, physical education classes and other class orientated outdoor activities.

METHODS

This research investigates the UV exposure of primary schoolchildren and the effect real-time UV irradiances data and an associated software package, UVGUIDE, have on UV exposure. This software utilises scientifically collected data, such as facial distribution of UV, as well as accessing real-time on-line UV irradiances data to estimate the UV distribution to the head region. The students can also enter other parameters such as hat usage and hat type to show the effect of using such a UV protective device on their facial UV distribution.

CONCLUSIONS

The results from this study found that the average 3-day erythemal UV exposure in late summer and early autumn to the left shoulder was 33% higher for the students not having access to the on-line UV data and software package.

Identification of Blood Erythroid Markers Useful in Revealing Erythropoietin Abuse in Athletes

Recombinant human erythropoietin (rEpo) is being used with increasing frequency by endurance athletes to improve aerobic potential. Although rEpo administration has been banned by the International Olympic Committee, no methods are available to unequivocally detect its abuse in sports. Prompted by these considerations, we evaluated the main hematological and biochemical modifications measured in the blood of 18 volunteers upon rEpo administration. Different rEpo regimens, iron, folic acid, and vitamin B12 administration did not significantly modify the percentage increase in hematocrit. However, a significant decrease in circulating ferritin (fr) and an increase in the soluble transferrin receptor (sTfr) were not found in athletes receiving low (30 IU/kg) doses of rEpo. Thus, an increase in the sTfr/fr ratio cannot be used as an indicator of rEpo abuse, at least when the hormone is administered at low concentrations. In contrast, the amounts of beta-globin mRNA detected by quantitative competitive (RT)-PCR in whole blood samples significantly increased above the threshold levels in all of the treatments investigated. Taken together, these data suggest that hematocrit value, reticulocyte count, soluble transferrin receptor content, and concentration of beta-globin mRNA, when included in a new multiparametric formula, can detect rEpo abuse in 57.5% of the samples examined with a confidence interval of 99.99%. Thus, the method reported in this paper could significantly improve the tests currently available, which in similar experiments allowed the detection of rEpo abuse in only 7.6% of the samples examined.

Serotonin, norepinephrine and dopamine involvement in the antidepressant action of hypericum perforatum

Hypericum perforatum is considered an effective alternative to the synthetic antidepressants in the treatment of mild-to-moderate depression. Recently, we showed that the effects on neurotransmitter contents in different brain regions of laboratory animals are more evident after administration of hypericum extracts containing a higher concentration of flavonoids, thus suggesting that these compounds are important in the antidepressant action of hypericum perforatum. We studied the effects of Ph-50, a hypericum extract standardized to flavonoids (50%) and containing 0.3% hypericin and 4.5% hyperforin on brain serotonin content, norepinephrine and dopamine by a high-performance liquid chromatography method in discrete brain areas (cortex, diencephalon and brainstem) in male Sprague-Dawley rats. Moreover, we evaluated the effects of Ph-50 alone or in association with sulpiride (a dopamine receptor antagonist), metergoline (a serotonin receptor antagonist) and 6-hydroxydopamine (6-OH-DA, destroying norepinephrine-containing neurons) using a forced-swimming test in the rat. Hypericum extract (Ph-50; 250-500 mg/kg) with acute oral administration enhanced serotonin, norepinephrine and dopamine content in the brain and reduced the immobility time of rats in the forced-swimming test. Sulpiride, metergoline and 6-OH-DA significantly increased the period of immobility in the forced-swimming test for the rats receiving hypericum extract (Ph-50). The results indicate that the neurotransmitters studied could be involved in the anti-immobility effects of hypericum, and suggest that its antidepressant action is probably mediated by serotonergic, noradrenergic and dopaminergic system activation.

Transverse myelitis associated with Mycoplasma pneumoniae pneumonitis: a report of two cases

The authors report two cases of transverse myelitis due to Mycoplasma pneumoniae occurring during a recent acute infection due to Epstein-Barr virus (EBV). The clinical picture included weakness of the legs, bladder dysfunction, fever, headache and in one case, a mild confusional state. Magnetic Resonance Imaging (MRI) revealed a segmental edema of the lumbar tract and cerebro-spinal fluid analysis showed a mild pleocytosis and an increased level of proteins with a blood-brain barrier damage. The diagnosis of acute infection due to Mycoplasma pneumoniae was made on serological criteria. The patients recovered completely after a 14-day course of an associated regimen with Ciprofloxacin (400 mg/day i.v.) plus prednisone (60 mg/day i.v.). The authors emphasise the immunological disorders in the combined infection with Mycoplasma pneumoniae and EBV, supposing that an infective mononucleosis may predispose to mycoplasmic transverse myelitis.

Effects of aerobic exercise training on 24 hr profile of heart rate variability in female athletes

BACKGROUND

The aim of this study was to investigate the effects of exercise training on autonomic regulation of heart rate under daily life conditions.

METHODS

Twenty-six healthy female athletes (age 24.5 +/- 1.9 yrs) involved in regular physical activity were recruited during a period of yearly rest and randomly assigned to a five-week aerobic exercise training program (n = 13) or to a non-exercise control group (n = 13).

MEASURES

Before and after the five-week training, all subjects underwent a bycicle ergometer stress test and a 24-hour dynamic ECG monitoring. Autonomic regulation of heart rate has been investigated by means of both time and frequency domain analyses of heart rate variability (HRV). Spectral analysis of R-R interval variability (autoregressive algorithm) provided markers of sympathetic (low frequency, LF, 0.10 Hz) and parasympathetic (high frequency, HF, 0.25 Hz) modulation of the sinus node.

RESULTS

Trained subjects showed a reduced heart rate response to submaximal workload. Before training there was no significant difference between the two groups. After training resting heart rate did not significantly differ between trained and untrained subjects. No significant differences were observed in the different time domain indexes of heart rate variability. The day-night difference in SD and SDRR were significantly less in the trained as compared to the untrained group. Normalized LF and HF components did not significantly differ between trained and untrained subjects, during the awake period. The decrease in the LF and the increase in the HF component during nighttime were significantly less in the trained group. The LF/HF ratio was significantly decreased during the night in the untrained group whereas it was not significantly different from the awake state in the trained group.

CONCLUSIONS

These findings of the relative night-time increase in LF and the decrease in the day-night difference in time domain indexes of heart rate variability suggest that, in young female athletes, exercise training is able to induce an increase in the sympathetic modulation of the sinus node which may coexist with signs of relatively reduced, or unaffected, vagal modulation.

[Second-line chemotherapy and new drugs for ovarian carcinoma]

Epithelial ovarian carcinoma represents a prototypic example of neoplastic disease sharing at the same time good chemosensitivity as well as marked propensity to relapse. If in one hand the definition of almost clear-cut guidelines has been reached in the setting of first-line therapy (i.e., cytoreductive surgery followed by first-line chemotherapy), more difficult to discern for the oncologist remains the choice of treatment in the occasion(s) of relapse(s). This article focuses on this particular setting of disease, analyzing the specific criteria of choice of drug or their combinations; the definite criteria followed for the use of platinum compounds in the second line of treatment, even if already utilized in the front line therapy, are also analyzed. Specific attention has also been paid in the definition of the role of single parameter as a "prognosticator" and/or as "predictor" of response. The Authors emphasize how clinical definitions remain the more reliable, simple, reproducible tools in therapeutical decision making.