Mesenchymal stem cells are enriched in head neck squamous cell carcinoma, correlates with tumour size and inhibit T-cell proliferation

BACKGROUND

Cancer is a multifactorial disease not only restricted to transformed epithelium, but also involving cells of the immune system and cells of mesenchymal origin, particularly mesenchymal stem cells (MSCs). Mesenchymal stem cells contribute to blood- and lymph- neoangiogenesis, generate myofibroblasts, with pro-invasive activity and may suppress anti-tumour immunity.

METHODS

In this paper, we evaluated the presence and features of MSCs isolated from human head neck squamous cell carcinoma (HNSCC).

RESULTS

Fresh specimens of HNSCC showed higher proportions of CD90+ cells compared with normal tissue; these cells co-expressed CD29, CD105, and CD73, but not CD31, CD45, CD133, and human epithelial antigen similarly to bone marrow-derived MSCs (BM-MSCs). Adherent stromal cells isolated from tumour shared also differentiation potential with BM-MSCs, thus we named them as tumour-MSCs. Interestingly, tumour-MSCs showed a clear immunosuppressive activity on in vitro stimulated T lymphocytes, mainly mediated by indoelamine 2,3 dioxygenase activity, like BM-MSCs. To evaluate their possible role in tumour growth in vivo, we correlated tumour-MSC proportions with neoplasm size. Tumour-MSCs frequency directly correlated with tumour volume and inversely with the frequency of tumour-infiltrating leukocytes.

CONCLUSIONS

These data support the concept that tumour-MSCs may favour tumour growth not only through their effect on stromal development, but also by inhibiting the anti-tumour immune response.

Structure and properties of domperidone and its succinate salt

This paper describes the structure and properties of the drug domperidone and a novel 1:1 domperidone succinate salt. The new salt is characterized by means of thermal, spectroscopic, microscopic and powder diffraction measurements. The crystal structures of the salt and, for the first time, of pure domperidone have been determined by means of single-crystal X-ray diffraction. In both structures, the piperidine ring of domperidone adopts the expected chair conformation, and supramolecular centrosymmetric R2(2)(8) motifs are formed by N-H...O hydrogen bonds between chlorine-substituted oxobenzimidazolyl groups. Further N-H...O hydrogen bonds occur between non-substituted oxobenzimidazolyl groups and the resulting C(4) motifs originates hydrogen-bonded chains, extending along the crystallographic b axis. In the salt, a single N-H...O hydrogen bond forms between the protonated nitrogen of the piperidine ring and the carboxylic O atom of the succinate ion. Two alternative and mutually exclusive positions for the nonsubstituted oxobenzimidazolyl group have also been observed; this disorder makes the hydrogen-bonded chains originating from the bicyclic group polar. The dissolution behaviour of the salt in dosage form is compared with two reference commercial products. The salt shows an increased solubility, a characteristic that could be of great advantage from a pharmaceutical view point.

Congenital myopathies--clinical features and frequency of individual subtypes diagnosed over a 5-year period in the United Kingdom

The congenital myopathies are a group of inherited neuromuscular disorders mainly defined on the basis of characteristic histopathological features. We analysed 66 patients assessed at a single centre over a 5 year period. Of the 54 patients where muscle biopsy was available, 29 (54%) had a core myopathy (central core disease, multi-minicore disease), 9 (17%) had nemaline myopathy, 7 (13%) had myotubular/centronuclear myopathy, 2 (4%) had congenital fibre type disproportion, 6 (11%) had isolated type 1 predominance and 1 (2%) had a mixed core-rod myopathy. Of the 44 patients with a genetic diagnosis, RYR1 was mutated in 26 (59%), ACTA1 in 7 (16%), SEPN1 in 7 (16%), MTM1 in 2 (5%), NEB in 1 (2%) and TPM3 in 1 (2%). Clinically, 77% of patients older than 18 months could walk independently. 35% of all patients required ventilatory support and/or enteral feeding. Clinical course was stable or improved in 57/66 (86%) patients, whilst 4 (6%) got worse and 5 (8%) died. These findings indicate that core myopathies are the most common form of congenital myopathies and that more than half can be attributed to RYR1 mutations. The underlying genetic defect remains to be identified in 1/3 of congenital myopathies cases.

Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial

BACKGROUND

Deep heating therapy (DHT) has shown to improve pain and function in patients with knee osteoarthritis (OA) in the short term. Benefits of superficial heating therapy (SHT) are controversial. Long-term effects of both heating modalities have not yet been investigated.

AIM

To compare the effects of DHT and SHT in patients with symptomatic knee OA, and to determine the long-term effects of heat therapy.

DESIGN

Double-blind randomized clinical trial.

SETTING

Outpatient clinic of Geriatrics and Physiatrics, University Hospital.

POPULATION

Fifty-four patients with radiologically established diagnosis of moderate knee OA (Kellgren-Lawrence grade II or III) and pain lasting for at least three weeks.

METHODS

DHT: local microwave diathermy (three 30-min sessions a week for four weeks); SHT: application of hot packs (three 30-min sessions a week for four weeks).

PRIMARY OUTCOME MEASURE

Western Ontario and McMaster Universities (WOMAC) index for the assessment of joint pain, stiffness and physical function limitations.

SECONDARY OUTCOME MEASURES

British Medical Research Council (BMRC) rating scale for the evaluation of muscle strength, and a visual analogue scale (VAS) for pain assessment. Follow up: 24 weeks for all outcome measures; 12 months for the primary outcome.

RESULTS

Intention-to-treat analyses showed a treatment effect in favor of DHT for all outcome measures. No clinically relevant changes were observed in the SHT group. Benefits of DHT were maintained over 12 months of follow-up.

CONCLUSIONS

DHT via localized microwave diathermy improves pain, muscle strength and physical function in patients affected by knee OA, with benefits maintained over the long term. No clinically relevant improvements were observed in patients who underwent SHT.

CLINICAL REHABILITATION IMPACT

DHT via microwave diathermy delivered three times a week for four weeks significantly improves pain and function in patients affected by moderate knee OA, with benefits retained for at least 12 months. No clinically relevant changes are observed in knee OA patients treated with SHT.

Role of spiritual beliefs on disability and health-related quality of life in acute inpatient rehabilitation unit

BACKGROUND

The influence of spirituality and religious beliefs on health-related quality of life and disability in the rehabilitation field is discussed in literature.

AIM

To describe the role of spiritual belief on functional recovery and health-related quality of life in acute inpatient rehabilitation ward.

DESIGN

Observational cross sectional study.

SETTING

Inpatients clinic of Physical Medicine and Rehabilitation Department, University Hospital.

POPULATION

One hundred and four patients admitted to an inpatient acute rehabilitation ward, after a neurological or orthopedic disease.

METHODS

Anamnestic and demographic data were reported on a standardized form. The Royal Free Interview for Spiritual and Religious Beliefs (RFI) and Cumulative Illness Rating Scale (CIRS) were performed on admission (T0). SF-36 item Short Form Health Survey Questionnaire (SF36) and the Barthel index (BI) were performed on admission (T0) and on discharge (T1).

RESULTS

Statistical analysis was performed on 102 patients with spiritual belief divided in strong (55 cases) and weak (47 cases) spiritual belief. Change from baseline (T1-T0) of SF36 domains between groups showed a significant higher improvement in Physical Role and Physical Composite Score in the weak belief group than in the strong belief group. The latter presented an improvement (without statistical significance) in almost every emotional score. We found no significant difference in change from baseline of Barthel index between the groups.

CONCLUSION

Strength of spiritual belief seems to influence some aspects of quality of life of acute inpatient in the rehabilitation setting. It seems that patients with less spiritual belief showed more improvement in physical role, after acute rehabilitation.

Evaluation of accelerated stability test conditions for medicated chewing gums

The overall stability of medicated chewing gums is investigated under different storage conditions. Active substances with different chemical stabilities in solid state are chosen as model drugs. The dosage form is a three layer tablet obtained by direct compression. The gum core contains the active ingredient while the external layers are formulated to prevent gum adhesion to the punches of the tableting machine. Two accelerated test conditions (40°C/75% RH and 30°C/65% RH) are performed for 6 months. Furthermore, a long-term stability test at room conditions is conducted to verify the predictability of the results obtained from the stress tests. Some drugs are stable in all the conditions tested, but other drugs, generally considered stable in solid dosage forms, have shown relevant stability problems particularly when stress test conditions are applied to this particular semi-solid dosage forms. For less stable drugs, the stress conditions of 40°C/75% RH are not always predictable of chewing gum stability at room temperature and may produce false negative; intermediate conditions, 30°C/65% RH, are more predictive for this purpose, the results of drug content found after 6 months at intermediate stress conditions and 12 months at room conditions are generally comparable. But the results obtained show that only long-term conditions stability tests gave consistent results. During aging, the semi solid nature of the gum base itself, may also influence the drug delivery rate during chewing and great attention should be given also to the dissolution stability.

Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy

BACKGROUND

Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy versus depression-specific psychotherapy.

METHOD

A total of 318 adult out-patients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy (IPT) at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. Our main focus was on predictors and moderators of time to remission on monotherapy at 12 weeks.

RESULTS

Participants with higher scores on the need for medical reassurance factor of the Panic-Agoraphobic Spectrum Self-Report (PAS-SR) had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the Mood Spectrum Self-Report (MOODS-SR) experienced more rapid remission with selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. Non-specific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the Social Phobia Spectrum (SHY) total score. Higher baseline scores on the 17- and 25-item Hamilton Depression Rating Scales (HAMD-17 and HAMD-25) and the Work and Social Adjustment Scale (WSAS) also predicted a longer time to remission, whereas being married predicted a shorter time to remission.

CONCLUSIONS

This exploratory study identified several non-specific predictors but few moderators of psychotherapy versus pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.

[The role of occupational therapy in rehabilitating injured at work]

The evolution of social and health setting in its demographic, productive and welfare elements make work as a finalized activity oriented to different tasks, from individual indepencence to social integration. In this context, the word "re-habilitation" has a double value; on one hand consideration of lifetime acquired abilities; on the other hand recovery of residual activities, consistent with the disablement. In Italy, for years, rehabilitation activities were performed by physiotherapists, who had inadequate occupational knowledge and preferred technical skills of non-finalized function recovery. The acknowledgment of Occupational Therapist took place in the end of the '90s, so that the few organizations sensitive to Occupational Therapy, as "Fondazione Maugeri" and "Fondazione Don Gnocchi", found "prepared ad hoc" personnel only abroad, above all in Spain and Switzerland. Nowadays we have specific first degree courses, but what really obstacles the development of this field is the economic crisis which afflicts healthcare services and avoids the growth of new sectors.

Thermogravimetric investigation of the hydration behaviour of hydrophilic matrices

This article proposes thermogravimetric analysis (TGA) as a useful method to investigate the hydration behaviour of hydrophilic matrix tablets containing hydroxypropylmethylcellulose (HPMC), sodium carboxymethylcellulose (NaCMC) or a mixture of these two polymers and four drugs with different solubility. The hydration behaviour of matrix systems was studied as a function of the formulation composition and of the dissolution medium pH. TGA results suggest that the hydration of matrices containing HPMC is pH-independent and not affected by the characteristics of the loaded drug; this confirms HPMC as a good polymer to formulate controlled drug delivery systems. On the other hand, the performances of NaCMC matrix tablets are significantly affected by the medium pH and the hydration and swelling of this ionic polymer is influenced by the loaded drug. For systems containing the two polymers, HPMC plays a dominant role in the hydration/dissolution process at acidic pH, while at near neutral pH both the cellulose derivatives exert a significant influence on the hydration performance of systems. The results of this work show that TGA is able to give quantitative highlights on the hydration behaviour of polymeric materials; thus this technique could be a helpful tool to support conventional hydration/swelling/dissolution studies.

Postural control in patients with total hip replacement

AIM

The aim of this study was to investigate the balance of the standing position and the motor responses by means of dynamic posturography (DP) in patients affected by hip osteoarthritis and treated by total hip replacement (THR).

METHODS

Data obtained from THR patients were compared with those of control adult groups ofage-matched subjects with normal hearing and no history of audio-vestibular symptoms. The statistical tests used were paired and unpaired Student's t-test. Significance was set for P<0.05. The study was carried out at the Department of Otorhinolaryngology and Department of Physiatrics and Rehabilitation of the A. Gemelli University Hospital of Rome (Italy). Twenty-three consecutive patients, without cochleo-vestibular or neurological pathologies (screened by accurate case-history), affected by hip osteoarthritis and treated by THR were enrolled. The main outcome measure were Sensory Organization Test (SOT), Motor control test (MCT) and Adaptation test (AT) obtained by means of Equi-Test Dynamic Posturography System by NeuroCom (Int. Inc., Clackamas, OR, USA).

RESULTS

When analysing the SOT and MCT, no statistically significant differences were observed between patients and controls. In the AT, the sway energy score decreased in the course of the test in an up and down perturbation both in healthy and in THR patients.

CONCLUSIONS

These data confirm a normal postural control and symmetrical responses in THR patients and confirm the absence of a detectable relationship between balance problems and fall risk. These results could be justified by an irrelevant role of intracapsular proprioceptors in maintaining balance. Moreover DP could be useful in osteo-articular diseases for understanding balance, evaluating surgical outcome and monitoring the rehabilitation program.

The factor structure of lifetime depressive spectrum in patients with unipolar depression

BACKGROUND

While previous attempts to elucidate the factor structure of depression tended to agree on a central focus on depressed mood, other factors were not replicated across studies. By examining data from a large number of items covering the range of depressive symptoms, the aim of the present study is to contribute to the identification of the structure of depression on a lifetime perspective.

METHODS

The study sample consisted of 598 patients with unipolar depression who were administered the Mood Spectrum Self-Report (lifetime version) in Italian (N=415) or English (N=183). In addition to classical exploratory factor analysis using tetrachoric correlation coefficients, an IRT-based factor analysis approach was adopted to analyze the data on 74 items of the instrument that explore cognitive, mood and energy/activity features associated with depression.

RESULTS

Six factors were identified, including 'Depressive Mood', 'Psychomotor Retardation', 'Suicidality', 'Drug/Illness related depression', 'Psychotic Features' and 'Neurovegetative Symptoms', accounting overall for 48.3% of the variance of items.

LIMITATIONS

Clinical information on onset of depression and duration of illness is available only for 350 subjects. Therefore, differences between sites can only be partially accounted using available data.

CONCLUSIONS

Our study confirms the central role of depressed mood, psychomotor retardation and suicidality and identifies the factors 'Drug/Illness related depression', 'Psychotic features' and the neurovegetative dysregulation not captured by the instruments most frequently used in previous studies. The identification of patients with specific profiles on multiple factors may be useful in achieving greater precision in neuroimaging studies and in informing treatment selection.