[Intestinal perforation due to accidental ingestion of foreign bodies]

Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).

Assessing the genotoxicity of urban air pollutants using two in situ plant bioassays

Genotoxicity of urban air has been analysed almost exclusively in airborne particulates. We monitored the genotoxic effects of airborne pollutants in the urban air of Perugia (Central Italy). Two plant bioindicators with different genetic endpoints were used: micronuclei in meiotic pollen mother cells using Tradescantia-micronucleus bioassay (Trad-MCN) and DNA damage in nuclei of Nicotiana tabacum leaves using comet assay (Nicotiana-comet). Buds of Tradescantia clone # 4430 and young N. tabacum cv. Xanthi plants were exposed for 24 h at three sites with different pollution levels. One control site (indoor control) was also used. The two bioassays showed different sensitivities toward urban pollutants: Trad-MCN assay was the most sensitive, but DNA damage in N. tabacum showed a better correlation with the pollutant concentrations. In situ biomonitoring of airborne genotoxins using higher plants combined with chemical analysis is thus recommended for characterizing genotoxicity of urban air.

Lithium attenuates behavioral and biochemical effects of neuropeptide S in mice

Neuropeptide S (NPS) and its receptor NPSR comprise a recently deorphaned G-protein-coupled receptor system. There is a body of evidence suggesting the involvement of NPS in wakefulness, anxiety, locomotor activity and oxidative stress damage. Considering that mood stabilizers block the stimulatory effect of psychostimulants in rodents, the present study aimed to investigate the effects of the pretreatment with lithium and valproate on the hyperlocomotion evoked by NPS. Another relevant action induced by lithium and valproate is the neuroprotection against oxidative stress. Thus, aiming to get further information about the mechanisms of action of NPS, herein we evaluated the effects of NPS, lithium and valproate, and the combination of them on oxidative stress damage. Behavioral studies revealed that the pretreatment with lithium (100 mg/kg, i.p.) and valproate (200 mg/kg, i.p.) prevented hyperlocomotion evoked by NPS 0.1 nmol. Importantly, the dose of valproate used in this study reduced mouse locomotion, although it did not reach the statistical significance. Biochemical analyses showed that lithium attenuated thiobarbituric reactive species (TBARS) formation in the striatum, cerebellum and hippocampus. NPS per se reduced TBARS levels only in the hippocampus. Valproate did not significantly affect TBARS levels in the brain. However, the combination of mood stabilizers and NPS blocked, instead of potentiate, the neuroprotective effects of each one. No relevant alterations were observed in carbonylated proteins after all treatments. Altogether, the present findings suggested that mainly the mood stabilizer lithium evoked antagonistic effects on the mediation of hyperlocomotion and protection against lipid peroxidation induced by NPS.

[Assessment of the genotoxic effects of gaseous emissions and percolates from three municipal landfills using plant bioassays]

The biomonitoring of genotoxic effects in environmental complex mixtures using higher plants is very useful for hazard evaluation. In this study we evaluated the potential application of plant genotoxicity tests in monitoring mutagens in landfill environment. The clastogenic effects of gaseous emissions (biogas)from three municipal landfills were evaluated by in situ monitoring using the Tradescantia micronucleus assay. The cytotoxicity and genotoxicity of leachates were studied using the Allium cepa test. We found no significant differences in micronuclei frequency in pollen cells of Tradescantia. Leachate samples showed elevated toxicity that inhibited root tip development in Allium cepa. Genotoxicity of the leachates was evaluated in diluted samples only. We found a significant increase in chromosomal metaphase aberrations only in one of the samples analyzed. In conclusion, biogas was not shown to be a real hazard, whereas leachates were found to display elevated toxicity. It would be advisable to treat leachates before releasing them into the environment as they can cause ecological damages. Since plant bioassays are very useful for the in situ monitoring of environmental genotoxins they are important for the prevention of environmental pollution resulting from the disposal of solid waste.

Creatine-kinase MB mass: age and sex-associated reference limits in two different platforms that use the same method

BACKGROUND

Recent updated NACB guidelines suggest that troponins are the biomarker of choice for the detection of myocardial necrosis, but the CK-MB mass is still considered an effective and alternative indicator when troponin assays are not available. The aim of the present study was to compare the reliability of two different analytical platforms in establishing the gender-specific 99th percentile for the CK-MB mass.

METHODS

Serum samples collected from healthy subjects were investigated in two different laboratories, LAB 1 (354 subjects: 222 men, 132 women; median age, 40 years, range 19-64 years) and LAB 2 (330 subjects: 224 men, 106 women; median age, 41 years, range 18-71 years), in order to determine the CK-MB mass (microg/L) using the Access((R)) CKMB method (Beckman Coulter), a two-site immunoenzymatic sandwich assay, on UniCel DxI 800 (LAB 1) and Access((R)) 2 (LAB 2) analyzers (Beckman Coulter). The related plasma samples (lithium-heparin) were also evaluated in LAB 2.

RESULTS

Total imprecision (CV%), calculated in control materials, ranged from 6.00 to 9.05 (concentration range, 3.82-36.37) in LAB 1 and from 7.05 to 5.02 in LAB 2 (concentration range, 3.63-34.18). A statistically significant gender-related difference (p<0.05) was found in the whole population studied, values in men being higher than those in women: median=1.86 vs 1.22; 99th percentile=7.64 vs 5.19. The median values in subjects aged 18-28 years (group 1) were lower than those in the other 4 groups (2-5): 1.12 vs 1.59, vs 1.78, vs 1.95 and vs 2.03. The same age-related trend was also observed for CK-MB plasma values, which were comparable to those observed in the matched-serum samples: median 1.12 vs 1.10 (group 1), 1.45 vs 1.50, (group 5).

CONCLUSIONS

The two different analytical platforms provide comparable results. The finding that CK-MB mass values are significantly higher in males than in females represents a relevant information, that will impact on patient classification when a myocardial necrosis has been suspected. Actually, however, numerous assays commercially available, lack of this information.

Central nervous system involvement in Anderson-Fabry disease: a clinical and MRI retrospective study

BACKGROUND

Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by deficiency of alpha-galactosidase A. Central nervous system (CNS) manifestations consist mainly of cerebrovascular events. Brain MRI results are often abnormal.

PURPOSE

The aim of the study was to describe CNS involvement in a group of Italian patients with AFD.

METHODS

Clinical and brain MRI data of 43 patients with AFD (25 men, 41.94+/-10.83 years old and 18 women, 52.48+/-17.50 years old) were analysed retrospectively. 17 male patients and 7 female patients were under treatment with enzyme replacement therapy (ERT).

RESULTS

All 43 patients had signs or symptoms of AFD. 16 men (64%) and 13 women (72%) demonstrated CNS involvement, although with varying severity. Overall, 6 men and 5 women had suffered from cerebrovascular accidents with an age at onset of 33.64+/-13.65 years and 53.68+/-11.71 years, respectively. Brain MR images were abnormal in 16/25 men and in 13/16 women. During CNS monitoring, some patients receiving ERT (5/17 men and 2/6 women) demonstrated neurological deterioration, especially those who had presented with cerebrovascular disease already before starting ERT.

CONCLUSIONS

The study demonstrated a high frequency of CNS involvement in homozygous and heterozygous AFD patients, often characterised by early age at onset and abnormal brain MRIs. At present, ERT is widely used; however, potential beneficent effects may be disguised by the progression of irreversible pathology in short-term follow-up. Therefore, primary and secondary prophylaxes of cerebrovascular disease are extremely important.

Evaluation of chlorite and chlorate genotoxicity using plant bioassays and in vitro DNA damage tests

In the last few years chlorine dioxide has been increasingly used for disinfecting drinking water in many countries. Although it does not react with humic substances, chlorine dioxide added to water is reduced primarily to chlorite and chlorate ions, compounds that are under investigation for their potential adverse effects on human health. The aim of this research was to study the genotoxicity of chlorite and chlorate and their mixtures. The end-points included two plant tests (chromosomal aberration test in Allium cepa and micronucleus assay in Tradescantia, carried out at different times of exposure) and two genotoxicity tests in human HepG2 cells (comet assay and cytokinesis-blocked micronucleus test). Preliminary toxicity tests were carried out for both plant and HepG2 assays. The results showed that chlorite and chlorate are able to induce chromosomal damage to plant systems, particularly chromosomal aberrations in A. cepa root tip cells, even at concentrations lower than the limit established by Italian normative law and WHO guidelines. In HepG2 cells increased DNA damage was only observed for chlorate at the lowest concentration. No increase in micronuclei frequency was detected in any of the samples tested in human HepG2 cells.

A new bioreactor for the controlled application of complex mechanical stimuli for cartilage tissue engineering

Mechanical stimuli have been shown to enhance chondrogenesis on both animal and human chondrocytes cultured in vitro. Different mechanical stimuli act simultaneously in vivo in cartilage tissue and their effects have been extensively studied in vitro, although often in a separated manner. A new bioreactor is described where different mechanical stimuli, i.e. shear stress and hydrostatic pressure, can be combined in different ways to study the mechanobiology of tissue engineered cartilage. Shear stress is imposed on cells by forcing the culture medium through the scaffolds, whereas a high hydrostatic pressure up to 15 MPa is generated by pressurizing the culture medium. Fluid-dynamic experimental tests have been performed and successful validation of the bioreactor has been carried out by dynamic culture of tissue-engineered cartilage constructs. The bioreactor system allows the investigation of the combined effects of different mechanical stimuli on the development of engineered cartilage, as well as other possible three-dimensional tissue-engineered constructs.

Evaluation of primary DNA damage, cytogenetic biomarkers and genetic polymorphisms for CYP1A1 and GSTM1 in road tunnel construction workers

In tunnel construction workers, occupational exposure to dust (alpha-quartz and other particles from blasting), gases (nitrogen dioxide, NO(2)), diesel exhausts, and oil mist has been associated with lung function decline, induction of inflammatory reactions in the lungs with release of mediators that may influence blood coagulation, and increased risk of chronic obstructive pulmonary disease. The present molecular epidemiology study was designed to evaluate whether occupational exposure to indoor pollutants during road tunnel construction might result in genotoxic effects. A study group of 39 underground workers and a reference group of 34 unexposed subjects were examined. Primary and oxidative DNA damage, sister-chromatid exchanges (SCE), and micronuclei (MN) were measured in peripheral blood cells. The possible influences of polymorphisms in gene encoding for CYP1A1 and GSTM1 xenobiotic-metabolizing enzymes were also investigated. Exposure assessment was performed with detailed interviews and questionnaires. There were no significant differences in the level of primary and oxidative DNA damage and frequency of SCE between the tunnel workers and controls, whereas the frequency of MN showed a significant increase in exposed subjects compared to controls. No effects of CYP1A1 or GSTM1 variants were observed for the analyzed biomarkers. Since MN in peripheral blood lymphocytes are recognized as a predictive biomarker of cancer risk within a population of healthy subjects, the genotoxic risk of occupational exposure to various indoor environmental pollutants during road tunnel construction cannot be excluded by this biomonitoring study.

Allium cepa chromosome aberration and micronucleus tests applied to study genotoxicity of extracts from pesticide-treated vegetables and grapes

The Allium cepa assay is an efficient test for chemical screening and in situ monitoring for genotoxicity of environmental contaminants. The test has been used widely to study genotoxicity of many pesticides revealing that these compounds can induce chromosomal aberrations in root meristems of A. cepa. Pesticide residues can be present in fruit and vegetables and represent a risk for human health. The mutagenic and carcinogenic action of herbicides, insecticides and fungicides on experimental animals is well known. Several studies have shown that chronic exposure to low levels of pesticides can cause birth defects and that prenatal exposure is associated with carcinogenicity. This study evaluated the potential application of plant genotoxicity tests for monitoring mutagens in edible vegetables. The presence of pesticides and genotoxic compounds extracted from 21 treated vegetables and eight types of grapes sampled from several markets in Campania, a region in Southern Italy, was monitored concurrently. The extracts were analysed for pesticides by gas chromatography and high-performance liquid chromatography, and for genotoxicity using two plant tests: the micronucleus test and the chromosomal aberration test in A. cepa roots. Thirty-three pesticides were detected, some of which are not approved. Genotoxicity was found in some of the vegetables and grapes tested. Allium cepa tests proved to be sensitive in monitoring genotoxicity in food extracts. The micronucleus test in interphase cells gave a much higher mutagenicity than the chromosomal aberration test in anaphase-telophase cells.

Contrast-enhanced MR imaging in patients with BI-RADS 3-5 microcalcifications

PURPOSE

The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in patients with microcalcifications classed as Breast Imaging Reporting and Data Systems (BI-RADS) 3-5.

MATERIALS AND METHODS

Fifty-five patients with mammographic microcalcifications classified as BI-RADS categories 3, 4 or 5 underwent MRI and biopsy with stereotactic vacuum-assisted biopsy (VAB). Our gold standard was microhistology in all cases and histology with histological grading in patients who underwent surgery. Patients with a microhistological diagnosis of benign lesions underwent mammographic follow-up for at least 12 months. MRI was performed with a 1.5-Tesla (T) unit, and T1 coronal three-dimensional (3D) fast low-angle shot sequences were acquired before and after injection of paramagnetic contrast agent (0.1 mmol/kg). MRI findings, according to the Fisher score, were classified into BI-RADS classes. In patients with cancer who underwent surgery, we retrospectively compared the extension of the mammographic and MRI findings with histological extension.

RESULTS

Histology revealed 26 ductal in situ cancers (DCIS) and ductal microinvasive cancers (DCmic), three atypical ductal hyperplasias (ADH) and 26 benign conditions. Histological grading of the 26 patients with cancer revealed four cases of G1, 11 cases of G2 and 11 cases of G3. If we consider mammographic BI-RADS category 3 as benign and BI-RADS 4 and 5 as malignant, mammography had 77% sensitivity, 59% specificity, 63% positive predictive value (PPV), 74% negative predictive value (NPV) and 67.2% diagnostic accuracy. If we consider MRI BI-RADS categories 1, 2 and 3 as benign and 4 and 5 as malignant, MRI had 73% sensitivity, 76% specificity, 73% PPV, 76% NPV and 74.5% diagnostic accuracy. As regards disease extension, mammography had 45% sensitivity and MRI had 84.6% sensitivity.

CONCLUSION

Mammography and stereotactic biopsy still remain the only techniques for characterising microcalcifications. MRI cannot be considered a diagnostic tool for evaluating microcalcifications. It is, however, useful for identifying DCIS with more aggressive histological grades. An important application of MRI in patients with DCIS associated with suspicious microcalcifications could be to evaluate disease extension after a microhistological diagnosis of malignancy, as it allows a more accurate presurgical planning.

Quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesion

The role of diffusion-weighted magnetic resonance imaging (DWI) to differentiate breast lesions in vivo was evaluated. Sixty women (mean age, 53 years) with 81 breast lesions were enrolled. A coronal echo planar imaging (EPI) sequence sensitised to diffusion (b value=1,000 s/mm(2)) was added to standard MR. The mean diffusivity (MD) was calculated. Differences in MD among cysts, benign lesions and malignant lesions were evaluated, and the sensitivity and specificity of DWI to diagnose malignant and benign lesions were calculated. The diagnosis was 18 cysts, 21 benign and 42 malignant nodules. MD values (mean +/- SD x 10(-3) mm(2)/s) were (1.48 +/- 0.37) for benign lesions, (0.95 +/- 0.18) for malignant lesions and (2.25 +/- 0.26) for cysts. Different MD values characterized different malignant breast lesion types. A MD threshold value of 1.1 x 10(-3) mm(2)/s discriminated malignant breast lesions from benign lesions with a specificity of 81% and sensitivity of 80%. Choosing a cut-off of 1.31 x 10(-3) mm(2)/s (MD of malignant lesions -2 SD), the specificity would be 67% with a sensitivity of 100%. Thus, MD values, related to tumor cellularity, provide reliable information to differentiate malignant breast lesions from benign ones. Quantitative DWI is not time-consuming and can be easily inserted into standard clinical breast MR imaging protocols.

Effect of different organotins on DNA of mollusk (Scapharca inaequivalvis) erythrocytes assessed by the comet assay

The alkaline comet assay, employing a single-cell gel-electrophoresis, is a rapid, simple and sensitive technique for visualizing and measuring DNA damage leading to strand breakage in individual cells. In this study, we report data about the effect of different organotin compounds (MBTC, DBTC and TBTC) on DNA from erythrocytes of the Scapharca inaequivalvis bivalve mollusc. Our results show significant DNA damage after 30 min in vitro incubation with 10microM of organotins. Since TBTC turned out to be the most genotoxic compound, followed by MBTC and DBTC, we exposed the molluscs to 50ppb of TBTC for 11 days. A significant increase of comet parameters was measured in our experimental conditions. The use of the comet test as a high-throughput screening assay to monitor the effect of environmental pollutants on marine organisms has been proposed.