Effects of a dietary supplement on cholesterol in subjects with moderate hypercholesterolemia

BACKGROUND AND AIMS

Prospective studies have demonstrated that the risk of death due to ischaemic heart disease is strongly correlated with blood cholesterol (TC) levels. Diet is the basic treatment for all dyslipidaemia. If diet alone proves inadequate, supplements can be used to try to reduce cholesterol levels. These substances are indicated in moderate dyslipidaemia, as they are able to induce a moderate reduction in blood cholesterol. The objective of our study was to investigate the effects of a dietary supplement containing Omega-3, Policosanol, Resveratrol, L-carnitine, Monascus purpureus, Coenzyme Q10, Vitamin B6 and Vitamin B12 on TC (primary end point) and LDL, triglycerides and HDL (secondary endpoints).

PATIENTS AND METHODS

The study involved 40 men and 40 women recruited from the outpatient section of our Department randomly assigned to the treatment group (A) or the control group (B).

RESULTS

There was a statistically significant reduction in TC 6 months after the end of treatment in both groups. In Group A, there was also a statistically significant change in HDL, LDL and TG, while in group B, there was no statistically significant change in HDL, LDL or TG.

CONCLUSIONS

The dietary supplement used in our study, in combination with a balanced diet and physical exercise, was found to induce a significant reduction in TC and LDL-C and an improvement in HDL-C. In contrast, while a balanced diet together with physical exercise but without the dietary supplement produced a significant reduction in TC, it had no significant effect on the other lipid parameters tested.

Health-related quality of life and treatment preferences in adolescents with type 1 diabetes. The VIPKIDS study

A multi-centre, observational, cross-sectional study was carried out to determine whether the health-related quality of life (HRQOL) of adolescents with type 1 diabetes is affected by different insulin treatment systems, and which features of HRQOL are impacted by the respective insulin treatment. The study regarded 577 adolescents, aged 10-17 years, with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) (n = 306) or multiple daily injections (MDI) (n = 271). The Insulin Delivery System Rating Questionnaire was validated in Italian and was self-completed by the subjects during a routine visit to the centres. Subjects were compared following the domains of the questionnaire. Good HRQOL was seen in subjects treated with either MDI or CSII. Significant differences were not found in the domains for general diabetes, including diabetes worries, social burden and psychological well-being. Multiple quantile regression analysis showed that CSII confers significant advantages in terms of HRQOL with improvements in treatment satisfaction, perceived clinical efficacy and reduction in treatment interference with daily activities. This favourable impact was more evident in subjects reporting lower HRQOL scores, suggesting that CSII may be especially useful for individuals perceiving a poor HRQOL. Analysis of the domains indicated that CSII was associated with a higher HRQOL than MDI. Life-course HRQOL evaluation using a standardised questionnaire can ensure better chronic disease management. This is particularly important when providing individualised care for adolescents, as they become increasingly responsible for managing their diabetes.

Phenotypical and genotypical expression of Wolfram syndrome in 12 patients from a Sicilian district where this syndrome might not be so infrequent as generally expected

BACKGROUND

Since the original description, there have been only few epidemiological studies of Wolfram syndrome (WS).

AIM

Aims of the present paper are to ascertain WS prevalence and expression in a district of North-eastern Sicily, i.e. a geographic area where consanguineous unions are not very unusual.

MATERIALS AND METHODS

Prevalence rates of WS in the Messina district were calculated by taking into consideration both the total population (653,737) and the populations included within the 0-30 year age range (202,681). We estimated the relative prevalence of WS among patients with youth-onset insulin-dependent diabetes mellitus (DM) who are currently aged under 30 years (256).

RESULTS

Global WS prevalence in our district is 1:54,478, whereas prevalence among individuals under 30 is 1:16,890 and relative prevalence among patients with juvenile-onset insulin-dependent DM is 1:22.3. When compared with the patients with insulin-dependent DM of Messina district, WS patients did not exhibit significant differences in terms of biochemical features at DM onset, whereas age at DM diagnosis was significantly earlier in WS group.

CONCLUSIONS

(a) WS prevalence is not so infrequent as generally expected; (b) in our series, DM presented before 10 years in 11/12 patients and ten cases have already developed all the four peculiar manifestations of WS by 26 years; (c) 9/12 patients exhibited a homozygous frameshift/truncation mutation (Y454_L459del_fsX454), which is the one most frequently found also in patients from other Italian regions; (d) age at DM diagnosis was significantly earlier in WS group than in the patients with insulin-dependent DM of Messina district.

Secondary septal mucocele diagnosed by MRI and CBCT and treated surgically

OBJECTIVE

Here we report a case of a mucocele of the nasal septum diagnosed by MRI and cone beam CT (CBCT) 23 years after Ogston Luc surgery.

METHOD

A 49-year-old man with nasal obstruction was examined by endoscopy, MRI, and CBCT.

RESULTS

Endoscopy showed a smooth and soft septum swelling. MRI revealed an ovalar lesion with high-intensity content on both T1 and T2 images, and a peripheral enhancing rim after i.v. administration of contrast medium. CBCT revealed that the lesion was located in the posterior portion of the septum involving the perpendicular plate of the ethmoid, and destroying the anterior ethmoid cells on the left side but sparing the left lamina papyracea. The patient underwent endoscopic marsupialization of the lesion.

CONCLUSION

A mucocele of the nasal septum is a rare occurrence. MRI and CBCT are effective and affordable diagnostic tools for this condition, enabling differentiation of mucocele from other sinonasal diseases.

Hormone and genetic study in male to female transsexual patients

BACKGROUND

Data of the literature demonstrated controversial results of a correlation between transsexualism and genetic mutations.

AIM

To evaluate the hormone and gene profile of male-female (M-F) transsexual.

SUBJECTS AND METHODS

Thirty M-F transsexuals aged 24-39. Seventeen had already undergone sex reassignment surgery, 13 were awaiting. All subjects had been undergoing estrogen and antiandrogen therapy. We studied hormones of the hypothalamus- pituitary-testicular axis, thyroid and adrenal profile, GH basal and after GHRH stimulation, IGF-I. The gene study analyzed SRY, AR, DAX1, SOX9, AZF region of the Y chromosome.

RESULTS

Pre-surgery subjects had elevated PRL, reduced testosterone and gonadotropins. Post-surgery subjects showed reduced androgens, a marked increase in LH and FSH and normal PRL. Cortisol and ACTH were similar to reference values in pre- and post-surgery patients. There was a marked increase in the baseline and post-stimulation GH values in 6 of the 13 pre-surgery patients, peaking at T15. IGF-I was similar to reference values in both groups except for one post-surgery patient, whose level was below the normal range. There were no polymorphisms in the amplified gene region for SOX9, and a single nucleotide synonimous polymorphism for DAX1. No statistically significant differences were seen in the mean of CAG repeats between controls and transsexual subjects. SRY gene was present in all subjects. Qualitative analysis of the AZFa, AZFb, and AZFc regions did not reveal any microdeletions in any subject.

CONCLUSIONS

This gender disorder does not seem to be associated with any molecular mutations of some of the main genes involved in sexual differentiation.

Protamine-1 and -2 polymorphisms and gene expression in male infertility: an Italian study

BACKGROUND

Correct histone/protamine replacement is an important stage in chromatin condensation during spermiogenesis in humans. There are two types of protamines: protamine 1 (P1) and the protamine 2 family (P2, P3, and P4), coded by the genes PRM1 and PRM2.

AIM

We analyze the sequences and gene expression of PRM1 and PRM2 and their relationship with defective spermatogenesis.

MATERIALS AND METHODS

Sequence analysis was carried out on 163 patients attending our laboratory for analysis of seminal fluid. Patients were divided into three groups: normozoospermic (53), teratozoospermic (60), and azoospermic (50). Gene expression was analyzed in seven patients with azoospermia and one with cryptozoospermia.

RESULTS

Seven single nuclotide polymorphisms (SNP) were identified: G54A, G102T and C230A for PRM1, and C246T, G288C, G298C and C373A for PRM2. For C230A, the CA genotype was present in 38% of teratozoospermic vs 55% of normozoospermic and 64% of azoospermic patients; for C373A, CA was found in 37% of teratozoospermic vs 47% of normozoospermic and 64% of azoospermic patients. In contrast, for G298C, GC was more common in the teratozoospermic (63%) than in the normozoospermic (49%) or azoospermic (48%) groups. These differences could suggest a greater susceptibility of these patients to abnormal sperm morphology. In five patients the levels of transcripts were reduced with respect to the control.

CONCLUSION

These data suggest that premeiotic arrest is associated with extremely reduced protamine expression. New studies of both PRM1 and PRM2 and their mRNA expression could help us better understand the molecular mechanisms underlying the protamine transcription and translation processes.

One stage or two stage treatment of colorectal cancer associated to abdominal aortic aneurysm: morbidity and mortality

The coexistence of colorectal cancer and abdominal aortic aneurysm has been observed with increasing frequency, raising several questions about therapeutic and surgical strategies for management of both diseases. This study has reviewed 440 cases (359 cases analyzed) of colorectal cancer associated with abdominal aortic aneurysm recovered in the literature from year 1987 to 2010. In 120 cases, patients were treated in one stage; in 239 cases, they were treated in two stages. The treatment in two stages was associated with a morbidity of 26.4%, with a mortality of 5% and prosthetic infection of 0.8%. The treatment in one stage had rates of complications and mortality of 13.3% and 4.2% respectively and no cases of prosthetic infection. Analysis of the literature shows that the treatment in two stages exposes patients to a higher risk of complications and prosthetic infection.

Cobalamin status in sickle cell disease

INTRODUCTION

Some studies comparing serum cobalamin in individuals with and without sickle cell disease (SCD) have suggested a higher prevalence of cobalamin deficiency in SCD but others have not. Our aim was to prospectively compare cobalamin status in African-Americans with and without SCD.

METHODS

We analyzed blood samples from 86 subjects in two groups: SCD (n = 29) and non-SCD (n = 57). Serum cobalamin, folate, homocysteine, methylmalonic acid (MMA), anti-intrinsic factor antibody, Helicobacter pylori antibody, and gastrin were measured and compared.

RESULTS

The median cobalamin was 235 pM in the SCD group vs. 292 pM in the non-SCD group (P-value = 0.014). No significant differences in MMA or homocysteine were seen. Using the criteria of a low cobalamin and an elevated MMA or an elevated MMA alone, cobalamin deficiency was suggested in 4 (13.8%) in the SCD group and 6 (10.5%) in the non-SCD group. Two of these SCD patients and four of these control subjects had chronic renal disease, which may lead to elevated MMA in the absence of cobalamin deficiency. The remaining four met criteria for cobalamin deficiency, 2 (6.9%) in the SCD group and 2 (3.5%) in the non-SCD group (P = 0.6).

CONCLUSION

A lower cobalamin was observed in SCD patients without a higher prevalence of cobalamin deficiency. The inclusion of haptocorrin and holotranscobalamin measurement in future studies may provide a better assessment of cobalamin status in this patient group.

Are apolipoprotein E alleles correlated with semen quality?

Apolipoproteins have a unique role in lipoprotein metabolism regulation, aiding lipid transport and acting as a cofactor of the enzymes involved in metabolism. There are three co-dominant alleles, APOE*2, APOE*3 and APOE*4, which encode three protein isoforms, apoE2, apoE3 and apoE4. APOE*3 is the most frequent in all populations thus far investigated, ranging from 50 to 90%. Some studies have tried to resolve a genetic 'dilemma' by evaluating the cause of the frequency and survival of the three alleles. Genetic drift, migration or natural selection could explain the current distribution of APOE gene frequencies worldwide. If APOE*4 is the ancestral allele, APOE*3 must have offered a considerable selective advantage, perhaps consisting of a positive effect during the reproductive period. Given this, there is a need to understand if APOE gene polymorphism might affect reproductive capacity. Few studies have been conducted in this area, and they generally correlate APOE polymorphism with reproductive efficiency in terms of number of children. The aim of our study was to look for correlations between APOE polymorphism in humans and semen quality, to establish if APOE genotypes have any demonstrable effect on spermatogenesis. In conclusion, our data show that APOE polymorphism is not associated with semen quality, as it is present to a similar extent in both normal and impaired or absent spermatogenesis. This demonstrates once again that the use of number of children as an index of fertility is not indicative of real male reproductive capacity.

Prevalence, presentation and clinical evolution of Graves' disease in children and adolescents with type 1 diabetes mellitus

AIMS

To ascertain the prevalence of Graves' disease (GD) in 1,323 Caucasian children with type 1 diabetes mellitus (T1DM), and to compare the course of GD in T1DM patients with the one observed in 109 Caucasian peer patients with GD but without T1DM (group B).

RESULTS

Only 7 patients (0.53%) of the T1DM series also presented with GD (group A)which was diagnosed many years after diabetes presentation. At GD diagnosis, the prevalence of preclinical hyperthyroidism was higher in group A (p = 0.0001), whereas serum TSH receptor antibodies (TRABs) were higher in group B (p = 0.04). The subsequent course with methimazole therapy and after its withdrawal was very similar in both groups.

CONCLUSIONS

GD prevalence in T1DM patients was 0.53%, i.e. almost identical to the one reported in the general population. GD was diagnosed many years after T1DM presentation. At GD diagnosis, the clinical picture was milder and TRAB serum levels were lower in diabetic patients. Preclinical diagnosis and early treatment of GD were not associated with better responsiveness to therapy. Screening programs based on periodical TRAB assessments are not useful in T1DM.

Shape and volume of internal anal sphincter showed by three-dimensional anorectal ultrasonography

PURPOSE

The aim of this work is to characterize the shape and the volume of the internal anal sphincter (IAS) in normal subjects by three-dimensional anorectal ultrasonography.

METHODS

Thirty-nine normal volunteer males (mean age 58.5 ± 18.7) and 25 females (mean age 59.4 ± 14.1) were submitted to anorectal ultrasonography. The tissue is defined by a semiautomatic procedure. Measurements of thickness, length and volume were assessed automatically. The software provides an average number of 57,600 thickness measurements, 360 length measurements for each zone (90 for each quadrant) and seven volume measurements (one for each anatomical area).The mean values of magnitudes were calculated for the entire volume in each quadrant and zone. Age and gender-related variations were analyzed.

RESULTS

In assessments of the whole tissue, only thickness was gender-related, with greater thickness for females (male thickness: 1.81 ± 0.47 mm, female thickness 2.16 ± 0.57 mm, P-value<0.01).In the distal zone: thickness, length and volume were all larger in females (for male and female respectively: 1.83 ± 0.49 mm vs 2.34 ± 0.58 mm, P-value<0.01, for the thickness; 10.87 ± 2.10mm vs 12.18 ± 2.21 mm, P-value<0.02 for the length and 1501 ± 605 mm(3) vs 2169 ± 871 mm(3), P-value<0.01 for the volume). In the medial zone, only thickness was gender-related, with greater thickness in females (male thickness: 2.04 ± 0.60mm, female thickness:2.44 ± 0.74 mm, P-value<0.02).The only variation observed in the proximal zone concerned length, larger in males (respectively: 11.27 ± 2.84 mm vs 9.55 ± 2.43 mm, P-value<0.02). The male population was significantly positively correlated with ageing for volume in the whole tissue (ρ = 0.32, P-value<0.05), and for both thickness and volume in the medial zone (ρ = 0.33, P-value<0.05 for thickness; ρ = 0.39, P-value<0.02 for the volume).

CONCLUSION

This new method is useful to understand both functional anal disorders and local damage which may affect only part of the muscle tissue.

Semen quality in men with Y chromosome aberrations

Infertile males sometimes bear structurally balanced chromosome aberrations, such as translocations and inversions, which involve both autosomes and sex chromosomes. The aim of this study was to evaluate genotype-phenotype correlations in a sample of infertile men with various types of Y chromosome abnormalities. In particular, we examined the effect of (i) balanced structural aberrations such as translocations between sex chromosomes and autosomes; (ii) unbalanced structural aberrations such as deletions or isodicentrics, both [idic(Yp)] and [idic(Yq)]. We studied 13 subjects bearing Y chromosome aberrations. Each patient underwent seminal fluid examination, andrological inspection, hormone study, testicular ultrasound, conventional and molecular cytogenetic analysis and study of Y chromosome microdeletions. Comparison of genotype and sperm phenotype in infertile patients with various Y chromosome aberrations revealed the key role of meiotic pairing defects in arresting spermatogenesis, both in the presence and in the absence of azoospermic factor microdeletions and cell mosaicism. The failure of meiosis and, in consequence, spermatogenesis may be a result of the failure to inactivate the X chromosome in the meiotic prophase, which is necessary for normal male spermatogenesis to take place.

Efficacy of recombinant human follicle stimulating hormone at low doses in inducing spermatogenesis and fertility in hypogonadotropic hypogonadism

BACKGROUND

Recombinant-FSH (rFSH) added to hCG at dose of 450 IU weekly is effective in inducing spermatogenesis in patients with hypogonadotropic hypogonadism (HH), but there are no data on the use of lower doses.

AIM

This observational retrospective study evaluated whether 150-225 IU of rFSH weekly were able to induce spermatogenesis in HH men who failed to start it with hCG alone.

SUBJECTS AND METHODS

Thirty-four patients with pre-pubertal onset HH (20-44 yr old) without adverse fertility factors were considered for this study. After hCG pre-treatment they received also either rFSH (Group 1) or highly purified urinary FSH (hpFSH) (Group 2) 75 IU sc 2 or 3 times weekly. Semen analysis was performed every 3 months during pre-treatment and the 1st yr of combined therapy. Patients were also invited to refer pregnancies in their partners during the subsequent 12 months.

RESULTS

Total sperm count/ejaculate did not show significant difference between 2 groups, while a significantly higher forward motility was observed in Group 1 (p<0.05). The median times to achieve sperm output thresholds (first sperm appearance, sperm concentration >1.5 or >5 mil/ml) were significantly lower in Group 1 (p<0.04, 0.03, and 0.001, respectively). A tendency to a shorter time to pregnancy was shown in partners of Group 1.

CONCLUSIONS

Our data indicate that lower rFSH week dose than that so far used was able to induce potentially fertilizing sperm output in HH men previously treated with hCG. The rFSH effects are comparable to those of hpFSH but with a trend to a faster outcome achievement.

Wolfram syndrome and WFS1 gene

Wolfram syndrome (WS) (MIM 222300) is a rare multisystem neurodegenerative disorder of autosomal recessive inheritance, also known as DIDMOAD (diabetes insipidus, insulin-deficient diabetes mellitus, optic atrophy and deafness). A Wolfram gene (WFS1) has been mapped to chromosome 4p16.1 which encodes an endoplasmic reticulum (ER) membrane-embedded protein. ER localization suggests that WFS1 protein has physiological functions in membrane trafficking, secretion, processing and/or regulation of ER calcium omeostasis. Disturbances or overloading of these functions induce ER stress responses, including apoptosis. Most WS patients carry mutations in this gene, but some studies provided evidence for genetic heterogeneity, and the genotype-phenotype relationships are not clear. Here we review the data regarding the mechanisms and the mutations of WFS1 gene that relate to WS.

Sudden Sensorineural Hearing Loss: MR Imaging

Hearing loss greater than 30 dB over three contiguous pure-tone frequencies occurring within a three day period is defined as sudden hearing loss. It is usually sensorineural (SSNHL), unilateral and appears as an otologic emergency. SSNHL has many possibile etiologies such as: labyrinthine viral infection, ischemic or hemorrhagic illness, trauma, immuno-mediated inner ear disease, tumor, inner ear malformation, and an imbalance between perilymphatic and endolymphatic fluid pressure. Nevertheless in almost 80% of cases SSNHL belongs to the idiopathic category because the etiology is unknown. The aim of this study was to test the diagnostic impact of two MR devices. Fifteen cases of SSNHL studied with a 1.5 T unit in our hospital between January 2006 and December 2008 within two weeks of the onset were retrospectively evaluated. Since January 2009 three more patients affected by SSNHL have been scanned with a 3T MR unit. We discuss the diagnostic sensitivity, clinical usefulness and the cost-benefit ratio of the MR systems.

[Endoscopic diverticulostomy for Zenker's diverticulum. Experience on 123 cases]

AIM

To evaluate the short-term clinical outcome of the patients with Zenker 's diverticulum undergone to endoscopic esophago-diverticulostomy according to Collard.

PATIENTS AND METHODS

A retrospective analysis evaluated 123 patients. The most common symptom was dysphagia, severe in 50 patients (40.6%) and moderate in 73 (59.4%), with a mean dysphagia score of 2.3 (range 0-4). Regurgitation was present in 70 cases (56.9%), with a mean score of 0.8 (range 0-2). The mean diameter of diverticula was 4.1 cm (range 2.5-10). The procedure was undertaken in 87 male and 36 female with a mean follow-up of 69.1 months (range 1-168).

RESULTS

Good results were obtained in 82 patients (66.7%), and the improvement of symptoms in 24 (19.5%), data confirmed by pre versus postoperative dysphagia mean score (2.3 vs 0.4) and by regurgitation score (0.8 vs 0.2). The failures have been seen in 17 patients (13.8%). The mean time of the intervention was 18 minutes (range 15-40), while the mean length of postoperative hospital stay was 2.5 days (range 1-5), with a oral intake in first postoperative day (mean). Major complications were documented in 2 patients (1.6%), minor ones in 10 patients (6.1%), without mortality.

CONCLUSION

Nowadays esophago-diverticulostomy according to Collard, based on our results and on the literature data, represent the most effective and safe technique for the patients with Zenker's diverticulum, with low rate of morbidity and mortality compared to the others surgical on endoscopic procedures.