Tumor necrosis factor alpha (TNF-alpha) activates Jak1/Stat3-Stat5B signaling through TNFR-1 in human B cells

The biological actions of tumor necrosis factor alpha (TNF-alpha) are mediated by two cell surface receptors, TNFR-1 and TNFR-2. These receptors do not display protein tyrosine kinase activity. Nevertheless, an early TNF-induced activation of specific tyrosine kinases has been reported as an important cue to the cellular response to this cytokine. Here we present evidence that TNF-alpha induces the activation of the cytoplasmic Janus tyrosine kinases Jak1 and Tyk2 in both human healthy peripheral and lymphoma B cells. This event was accompanied by the recruitment of a specific set of latent cytosolic transcription factors, Stat3 and Stat5b. Furthermore, Jak1 coprecipitated with TNFR-1 after TNF-alpha treatment. These data suggest that at least in human B cells this cytokine can exert its biological effects through the Jak-Stat signaling pathway and that such signals are initiated through an interaction between TNFR-1 and Jak 1.

Involvement of astrocytes in purine‐mediated reparative processes in the brain

Astrocytes are involved in multiple brain functions in physiological conditions, participating in neuronal development, synaptic activity and homeostatic control of the extracellular environment. They also actively participate in the processes triggered by brain injuries, aimed at limiting and repairing brain damages. Purines may play a significant role in the pathophysiology of numerous acute and chronic disorders of the central nervous system (CNS). Astrocytes are the main source of cerebral purines. They release either adenine-based purines, e.g. adenosine and adenosine triphosphate, or guanine-based purines, e.g. guanosine and guanosine triphosphate, in physiological conditions and release even more of these purines in pathological conditions. Astrocytes express several receptor subtypes of P1 and P2 types for adenine-based purines. Receptors for guanine-based purines are being characterised. Specific ecto-enzymes such as nucleotidases, adenosine deaminase and, likely, purine nucleoside phosphorylase, metabolise both adenine- and guanine-based purines after release from astrocytes. This regulates the effects of nucleotides and nucleosides by reducing their interaction with specific membrane binding sites. Adenine-based nucleotides stimulate astrocyte proliferation by a P2-mediated increase in intracellular [Ca2+] and isoprenylated proteins. Adenosine also, via A2 receptors, may stimulate astrocyte proliferation, but mostly, via A1 and/or A3 receptors, inhibits astrocyte proliferation, thus controlling the excessive reactive astrogliosis triggered by P2 receptors. The activation of A1 receptors also stimulates astrocytes to produce trophic factors, such as nerve growth factor, S100beta protein and transforming growth factor beta, which contribute to protect neurons against injuries. Guanosine stimulates the output of adenine-based purines from astrocytes and in addition it directly triggers these cells to proliferate and to produce large amount of neuroprotective factors. These data indicate that adenine- and guanine-based purines released in large amounts from injured or dying cells of CNS may act as signals to initiate brain repair mechanisms widely involving astrocytes.

Down's syndrome is associated with increased 8,12-iso-iPF2alpha-VI levels: evidence for enhanced lipid peroxidation in vivo

Postmortem and in vitro studies have shown that oxidative stress plays a role in the pathogenesis of many of the clinical features of Down's syndrome. The isoprostane 8,12-iso-iPF2alpha-VI is a specific marker of lipid peroxidation. We found elevated levels of this isoprostane in urine samples of subjects with Down's syndrome compared with those of matched controls, which correlated with the duration of the disease. These results suggest that increased in vivo lipid peroxidation is a prominent component early in the course of Down's syndrome.

Childhood epilepsy with occipital paroxysms and benign nocturnal childhood occipital epilepsy

Two types of childhood epilepsy have recently been reported: childhood epilepsy with occipital paroxysms, and benign nocturnal childhood occipital epilepsy. This article reports the clinical evolution, electroencephalographic (EEG) changes, and response to therapy of eight children with childhood epilepsy with occipital paroxysms (five boys and three girls, aged from 1 1/12 to 8 years) and eight children with benign nocturnal childhood occipital epilepsy (six boys and two girls, aged from 1 4/12 to 8 3/12 years). A careful clinical and EEG follow-up of at least 7 years was carried out for all patients. At the end of follow-up, all but one of the patients with childhood epilepsy with occipital paroxysms were seizure-free, and only two were still receiving anticonvulsant drugs. All but three children had a normal EEG, and normal mental development was observed in all but two cases. Patients with benign nocturnal childhood occipital epilepsy had a good long-term prognosis; all but two children with benign nocturnal childhood occipital epilepsy had a normal EEG. These two patients showed learning disabilities and poor school performances, and required remedial education. Therefore, although childhood epilepsy with occipital paroxysms and benign nocturnal childhood occipital epilepsy are two different types of epilepsy, the long-term prognosis seems to be similar.

Lack of mother-to-child HIV-1 transmission is associated with elevated serum levels of 90 K immune modulatory protein

BACKGROUND

90 K is a secreted human serum glycoprotein with immune modulatory activity.

METHODS

Serum 90 K levels were determined by an enzyme-linked immunosorbent assay in 19 HIV-1-infected mothers at the time of delivery, in their new-borns (11 HIV-1 infected and eight uninfected), in 26 HIV-1-uninfected mothers and in 86 new-borns of HIV-1-uninfected mothers.

RESULTS

90 K levels in HIV-1-infected transmissive mothers (22.4 +/- 13.9 microg/ml) were similar to those of HIV-1-uninfected mothers (21.1 +/- 7.6 microg/ml; P = 0.715), but lower than those of HIV-1-infected non-transmissive mothers (45.5 +/- 24.8 microg/ml; P = 0.019). The levels were higher in HIV-1-uninfected (47.6 +/- 22.4 mg/ml) than HIV-1-infected (23.7 +/- 15.6 microg/ml; P = 0.014) new-borns of HIV-1-infected mothers. The new-borns of HIV-1-uninfected mothers had lower levels (11.7 +/- 5.3 microg/ml) than both HIV-1-infected and HIV-1-uninfected new-borns of HIV-1-infected mothers (all differences, P < 0.001).

CONCLUSION

These results suggest that high 90 K protein serum levels in HIV-1-infected mothers and their new-borns are associated with lack of mother-to-child HIV-1 transmission.

Stormy onset of benign childhood epilepsy with occipital paroxysmal discharges

We studied six children with ages ranging from 4 to 10 years who were affected by childhood epilepsy with occipital paroxysms and presented after a stormy onset with prolonged loss of consciousness for 6-14 h. In all these patients, seizures were preceded by visual symptoms in the form of colored circular disks. A CT scan was performed immediately after the onset of symptoms and was normal in all patients. Routine laboratory and cerebrospinal fluid examinations were normal in all patients. The interictal EEG was characterized by continuous or subcontinuous occipital spike wave discharges, which disappeared after the patients' eyes opened. We carried out a 7-year follow-up of all these patients. Only two patients were treated with antiepileptic drugs. The therapy (phenobarbital, clobazam) in the two patients did not induce changes in the EEG pattern. The first did not suffer any further seizures. The second patient had two more seizures (at 8 and 18 months from the onset) with phosphenes, confusional state, and involuntary movements followed by loss of consciousness. Among the other four patients, who did not receive any treatment, only one had any other seizures. The stormy onset of the syndrome described in our six patients emphasizes the extreme variability in the presentation of this type of childhood epilepsy. Our follow-up confirms the good prognosis of this epilepsy even when it has a stormy onset.

Epilepsy with myoclonic absences with early onset: a follow-up study

We studied six children (four girls and two boys) suffering from cryptogenic myoclonic absence seizures with early onset. The age at onset of the seizures ranged between 6 and 27.8 months (mean age +/- SD: 18.5+/-12.4 months). The neurologic evaluation was normal in all patients at the first hospital admission. After the diagnosis, we followed up all children for at least 5 years. At the end of follow-up, two of these patients (a girl and a boy) showed severe mental retardation, a high number (from one to three per day) of seizures, and persistent pathologic electroencephalograms. The other patients showed normal electroencephalograms: all of them were seizure free and without mental retardation. The two patients with mental retardation have been treated with polytherapy. In all other children we used valproate alone successfully. Our data suggest that myoclonic absence seizures with early onset can have a good long-term prognosis. Valproate is a useful anticonvulsant drug in these patients. Mental retardation is present only in patients with poor seizure control.

Inefficient Phospholipase C Activation and Reduced Lck Expression Characterize the Signaling Defect of Umbilical Cord T Lymphocytes

Adult and neonatal immunocompetent cells exhibit important functional distinctions, including differences in cytokine production and susceptibility to tolerance induction. We have investigated the molecular features that characterize the immune response of cord blood-derived T lymphocytes compared with that of adult T lymphocytes. Our findings demonstrate that phospholipase C (PLC) isozymes, which play a pivotal role in the control of protein kinase C activation and Ca2+ mobilization, are differently expressed in cord and adult T lymphocytes. PLCβ1 and δ1 are expressed at higher levels in cord T cells, while PLCβ2 and γ1 expression is higher in adult T lymphocytes. PLCδ2 and γ2 appear to be equally expressed in both cell types. In addition, a functional defect in PLC activation via CD3 ligation or pervanadate treatment, stimuli that activate tyrosine kinases, was observed in cord blood T cells, whereas treatment with aluminum tetrafluoride (AlF4−), a G protein activator, demonstrated a similar degree of PLC activation in cord and adult T cells. The impaired PLC activation of cord blood-derived T cells was associated with a a very low expression of the Src kinase, Lck, along with a reduced level of ZAP70. No mitogenic response to CD3 ligation was observed in cord T cells. However, no signaling defect was apparent downstream of PLC activation, as demonstrated by the mitogenic response of cord T cells to the pharmacologic activation of protein kinase C and Ca2+ by treatment with PMA and ionomycin. Thus, neonatal cord blood-derived T cells show a signaling immaturity associated with inadequate PLCγ activation and decreased Lck expression.

Leukocyte adhesion deficiency disorder in an infant

Leukocyte adhesion defect (LAD) is an inherited disorder of phagocytic function. The three different alpha-chains of the leukocyte integrin family (CD 11a, 11b, 11c) are all dependent on the common beta chain (CD18) for proper insertion into the cell membrane. Deficiency of CD 18 thus causes an inability to express any of these proteins and results in the syndrome of LAD type 1. Clinical features include delayed separation of the umbilical cord, persistent leukocytosis and recurrent infection. A case of severe LAD occurred in a 1 month-old infant. The immunological pattern of the baby showed pathological values of CD11b and CD18 (1.3&#x0025; and 0.2&#x0025; respectively) when compared with normal values (50-70&#x0025;) and lack of random (1.0 nm vs normal of 10&#x00B1;5) and casein-induced (22.0 nm vs normal of 60-120nm) chemotaxis. The baby is now waiting for bone marrow transplantation. Although LAD is a rare form of congenital immune deficiency this disease should be considered when delayed wound healing and recurrent bacterial skin infections are present in a newborn.

Inefficient phospholipase C activation and reduced Lck expression characterize the signaling defect of umbilical cord T lymphocytes

Adult and neonatal immunocompetent cells exhibit important functional distinctions, including differences in cytokine production and susceptibility to tolerance induction. We have investigated the molecular features that characterize the immune response of cord blood-derived T lymphocytes compared with that of adult T lymphocytes. Our findings demonstrate that phospholipase C (PLC) isozymes, which play a pivotal role in the control of protein kinase C activation and Ca2+ mobilization, are differently expressed in cord and adult T lymphocytes. PLCbeta1 and delta1 are expressed at higher levels in cord T cells, while PLCbeta2 and gamma1 expression is higher in adult T lymphocytes. PLCdelta2 and gamma2 appear to be equally expressed in both cell types. In addition, a functional defect in PLC activation via CD3 ligation or pervanadate treatment, stimuli that activate tyrosine kinases, was observed in cord blood T cells, whereas treatment with aluminum tetrafluoride (AlF4-), a G protein activator, demonstrated a similar degree of PLC activation in cord and adult T cells. The impaired PLC activation of cord blood-derived T cells was associated with a a very low expression of the Src kinase, Lck, along with a reduced level of ZAP70. No mitogenic response to CD3 ligation was observed in cord T cells. However, no signaling defect was apparent downstream of PLC activation, as demonstrated by the mitogenic response of cord T cells to the pharmacologic activation of protein kinase C and Ca2+ by treatment with PMA and ionomycin. Thus, neonatal cord blood-derived T cells show a signaling immaturity associated with inadequate PLCgamma activation and decreased Lck expression.

Immunocytochemical localization of phospholipase C isozymes in cord blood and adult T-lymphocytes

The response of T-cells to peptide antigen plus major histocompatibility complex (MHC) consists of a series of cellular events collectively called T-cell activation. An essential component of this pathway is phospholipase C (PLC)gamma1, whose hydrolytic activity increases rapidly after binding of ligands to the T-cell receptor (TCR) and consequent activation of tyrosine kinases. Recent studies also suggest a GTP binding protein-dependent activation of PLCbeta during the early steps of T-cell activation. On the basis of these findings, we first checked the expression of PLC isoforms by Western blotting and by confocal and electron microscopy techniques, and then we looked for the phosphoinositide breakdown induced by CD3 engagement in cord and adult T-lymphocytes. Our results indicated that PLCbeta1 was almost exclusively expressed in cord T-cells, whereas PLCbeta2 was more strongly represented in the adult. The amount of PLCgamma1 was found to be larger in the adult than in cord cells. No significant differences were found in PLCgamma2 and delta2 expression. PLCdelta1 was scarcely detectable. On CD3 stimulation, adult lymphocytes gave rise, as expected, to a dramatic increase in phosphoinositide breakdown, whereas in cord cells this response was scarcely detected. These results indicate that a shift in PLC expression occurs in the postnatal period and that this change is associated with induction of the capability to respond to CD3 engagement with phosphoinositide hydrolysis.

Iron-dependent human platelet activation and hydroxyl radical formation: involvement of protein kinase C

BACKGROUND

Iron is an important modulator of lipid peroxidation, and its levels have been associated with the progression of atherosclerosis. Little is known about the possibility that this metal, when released from tissue stores, may modulate the reactivity of blood cell components, in particular platelets. Therefore, we investigated a possible link between iron, oxygen free radical formation, and platelet function.

METHODS AND RESULTS

Human whole blood was stimulated with collagen 2 micrograms/mL, and an irreversible aggregation with thromboxane (Tx)B2 formation was observed (15+/-4 versus 130+/-10 ng/mL). Deferoxamine (DSF), a specific iron chelator, and catalase, an H2O2 scavenger, inhibited collagen-induced whole-blood aggregation. The aggregation was accompanied by an increase in hydroxyl radical (OH.) levels (30+/-8 versus 205+/-20 nmol/L dihydroxybenzoates), which were reduced by DSF and by 2 specific OH. scavengers, mannitol and deoxyribose. Iron (Fe2+) dose-dependently induced platelet aggregation, TxB2 formation (6+/-2 versus 135+/-8 ng/mL), and protein kinase C (PKC) translocation from the cytosol to the cell membrane when added to platelets that have been primed with a low concentration of collagen (0.2 micrograms/mL). In the same system, an increase in OH. levels was observed (37+/-12 versus 230+/-20 nmol/L dihydroxybenzoates). Mannitol and deoxyribose, but not urea, were able to reduce OH. formation, PKC activation, and platelet aggregation. Selective inhibition of PKC activity by GF 109203X prevented iron-dependent platelet aggregation without influencing OH. production.

CONCLUSIONS

The present study shows that iron can directly interact with human platelets, resulting in their activation. Its action is mediated by OH. formation and involves PKC activity. Our findings provide an additional contribution to the understanding of the mechanism(s) by which iron overload might promote atherosclerosis and coronary artery disease.

Neonatal suppurative parotitis: a study of five cases

Suppurative parotitis is uncommon in newborns. During a 9-year study period, five cases of neonatal suppurative parotitis were detected in 3,624 hospital admissions. The relative risk of developing neonatal suppurative parotitis in admitted infants was 5.52 (0.62-49.35). Staphylococcus aureus was the causative organism most commonly detected in the hospital-acquired cases. Antimicrobial therapy was effective in all cases; surgery was not required.

CONCLUSION

Although neonatal suppurative parotitis is now uncommon in the newborn, it cannot be considered a "vanishing disease".

Zinc sulfate supplementation improves thyroid function in hypozincemic Down children

In subjects affected by trisomy 21 (Down syndrome), hypothyroidism is the most common endocrinological deficit. Plasma zinc levels, which are commonly detected below the normal range in Down patients, are related to some endocrinological and immunological functions; in fact, zinc deficiency has been shown to impair immune response and growth rate. Aims of this study were to evaluate (1) the role of zinc deficiency in subclinical hypothyroidism and (2) thyroid function changes in Down children cyclically supplemented with zinc sulfate. Inverse correlations have been observed between age and triiodotironine (T3) and between zinc and thyroid-stimulating hormone (TSH); higher TSH levels have been found in hypozincemic patients at the beginning of the study. After 6 mo of supplementation, an improvement of thyroid function (TSH levels: 3.96 +/- 1.84 vs 2.64 +/- 1.33 mUI/mL basally and after 6 mo, respectively) was observed in hypozincemic patients. In the second cycle of supplementation, a similar trend of TSH was observed. At the end of the study, TSH significantly decreased in treated hypozincemic subjects (4.48 +/- 1.93 vs 2.96 +/- 1.20 mUI/mL) and it was no longer different in comparison to normozincemic patients. We suggest zinc supplementation to the diet in hypozincemic Down children as a simple and useful therapeutic tool.

Headache in children with centrotemporal spikes

The aim of the study was to evaluate the long-term evolution of headache associated with rolandic centrotemporal spikes (CTS). The patient group consisted of a group of 32 children who suffered from headache and presented CTS at electroencephalogram (EEG). As the control group, we selected 52 sex- and age-matched children with headache without any EEG abnormalities. During a follow-up of 5 years none of them showed epileptic seizures. The number of headache attacks decreased in the majority of patients, as in the controls. A good correlation could be identified between CTS and the number of headaches attacks both at baseline (r = 0.58, P < 0.001) and at follow-up (r = 0.64, P < 0.001). In four children (12.5%), the frequency of headache attacks increased and this increase was associated with a higher frequency of CTS. In two patients, a change in the EEG pattern was observed during follow-up, with a 'migration' of the epileptiform complex from central to parietooccipital leads. In conclusion, these findings confirm that CTS are not pathognomonic of centrotemporal epilepsy and that evolution of CTS and headache in children are statistically related.

Centro-temporal spikes in non-epileptic children: a long-term follow up

OBJECTIVE

This study was undertaken in order to determine the natural evolution of centro-temporal spikes (CTS) in a healthy paediatric population.

METHODOLOGY

Forty children and adolescents (mean age +/- SD: 9.9 +/- 4.1 years) with non-epileptic disturbances (tics, headache, pavor nocturnus, vertigo, etc), who showed CTS during routine EEG recordings were studied. No patient suffered from seizures. A clinical and electroencephalographic follow-up of at least 5.5 years was carried out in all subjects.

RESULTS

At the follow-up examination, 33 of the 40 cases (82.5%) had no CTS or other epileptic discharges in awake and sleep EEGs, while six subjects continued to show CTS discharges in sleep EEG. Among those subjects who showed persistence of CTS in sleep EEG, rolandic epilepsy developed in two cases, while all other subjects continued to be seizure free.

CONCLUSIONS

This study demonstrates that CTS can be present in non-epileptic children and adolescents; in the majority of subjects this EEG abnormality disappears spontaneously and only a small percentage of subjects who have persistence of this pattern develops rolandic epilepsy.

Hypoglycaemia in children with type 1 diabetes mellitus

Hypoglycaemia is a frequent acute complication of IDDM and is usually defined as a blood glucose level below 3.0 mmol/l. Hypoglycaemia stimulates several neuroendocrine responses, such as secretion of glucagon, adrenaline, growth hormone and cortisol, which are generally increased during this phenomenon. The true prevalence of hypoglycaemia is not known. Studies of the epidemiology of severe hypoglycaemia give prevalences ranging from 2.7 to 85.7 episodes per 100 patients per year. The major risk factor for severe hypoglycaemia is hypoglycaemia unawareness, which occurs particularly in patients with type 1 diabetes of long duration and in those with a history of frequent episodes of hypoglycaemia. The first step in the management of hypoglycaemia is to check blood glucose and to treat hypoglycaemia on the basis of symptoms. Hypoglycaemia requires urgent treatment with a fast-acting carbohydrate or, if severe, with parenteral glucagon or intravenous glucose. Prevention measures should be instituted to prevent subsequent episodes, particularly in younger children with hypoglycaemic seizures or when seizures are recurrent.

Human milk 90K (Mac-2 BP): possible protective effects against acute respiratory infections

Eighty-six children fed human milk were followed prospectively from birth to 12 months of age to assess the effect of milk 90K, a secreted glycoprotein with immune-stimulatory properties, on development of acute respiratory infections (ARI). The level of human milk 90K was inversely related to episodes of ARI (r = - 0.34; P = 0.001). The average 90K level in human milk fed to children who did not develop ARI was significantly higher than in milk fed to children in whom infection occurred on multiple occasions (156.6 +/- 144.8 microg/ml versus 70.9 +/- 92.3 microg/ml; P = 0.001). These data suggest that the protective effects of human milk against ARI may be due in part to immune maturation effects by secreted 90K.

Serum lipids and lipoproteins in patients treated with antiepileptic drugs

The concentration levels of serum lipids and lipoproteins were measured in three groups of children and adolescents treated with antiepileptic drugs: carbamazepine (14 patients), phenobarbital (20 patients), and valproic acid (20 patients). Patients treated with these drugs revealed significant changes in lipids and lipoproteins, but when the authors reevaluated the three groups of children 1 year after the end of treatment, a complete return to normal of all parameters was observed. These data demonstrate that the changes induced by these drugs are transient and reversible.

Laser-Doppler-flowmetry in preterm newborns during apneic events

MATERIALS AND METHODS

We have studied with Laser-Doppler-Flowmetry (LDF) Skin Blood Flow Perfusion (SBFP) during apneic events in 15 preterm newborns (mean GA 32.4 w; mean B.W. 1620). Eighty-four apneic episodes were analyzed and the results were gathered into two groups. Group 1 with SBFP belonging to preterms aged up to 5 days and Group 2 with SBFP records of some older newborns (from 5th to 10th day of life). At first a decrease of LDF was often observed during apneic events.

RESULTS

A statistically significant difference between the two groups was noted considering the SBFP percentage reduction, the hematocrit and the time of appearance of the skin blood flow decrease. We also studied the mean of all apneic SBFP reductions in each of those newborns (11/14) who had apneic events in both periods, observing a remarkable increase in mean SBFP reduction when the newborns were older than five days.

CONCLUSIONS

These differences can be caused by rheologic factors such as high hematocrit, less pronounced red cell deformability and a sort of cold vasoparalysis more evident in the first days of life. We think laser-Doppler-flowmetry be suggested when the newborn is able to better contrast the negative effects of apnea, for example centralizing the circle in favour of vital organs.

Modern management of childhood diabetes: a role for computerized devices?

Technology is increasingly relevant in everyday life and it can be very interesting to apply it also in the field of diabetes as it can be one way of ensuring better care. In the Diabetes Control and Complications Trial, the intensively treated patients were seen fortnightly in hospital and contacted even more frequently by telephone during the day as well as at night. For these reasons, health reforms are undergoing a radical change in an attempt to reduce the spiraling costs of health care provision. Therefore, it can be useful to use information technology (IT) in diabetes care. The European Federation for Medical Informatics recently established some Special Issues to advance IT initiatives that may be able to address the problem of adjusting the insulin dose and controlling blood glucose (BG) levels, as well as assisting in the provision of modern-day diabetes care. The Special Issues can be classified under the following headings: databases, algorithms, decision support, models and education. It can be useful to develop a prototype computer system that can be applied to different areas of clinical diabetes care; computerized out-patients' clinical databases that store patients' clinical and biochemical data; statistical and graphical analysis programs that help the clinician; dietary analysis programs which examine food composition and dietary exchanges and help devise meal plans; hand-held insulin dosage adjustment computers that advise patients on a day-by-day or even meal-by-meal basis; expert systems and question and answer programs for patients' education, and finally games for children. These systems have the potential to be useful tools in many aspects of diabetes care but their utilization by the vast majority of the health care community has been extremely limited. Nonetheless, computers cannot substitute for the pediatric diabetes team, which remains the major determinant for better care of diabetes in children and adolescents.

Effect of chronic hyperoxia on young and old rat carotid body ultrastructure

Morphologic, physiological, and biochemical changes occur in the carotid body (CB) during postnatal development in relation to physiological requirements. Chronic normobaric hyperoxia attenuates the carotid chemosensory response to hypoxia. During aging there is less of a CB response to hypoxia, which results in a reduced ventilatory adaptation and chemosensory discharge. To test if the oxygen-sensitive mechanism is affected by chronic hyperoxia in an age-dependent fashion, we have studied structural and ultrastructural aspects of young and old rat CBs. Four groups of six male Wistar rats were used. One group of two-month-old rats and another of 25-month-old rats were kept at room air. The other two groups, age matched, were exposed to 98-100% O2, for 60-65 h, in a large Plexiglas chamber. The rats were anesthetized, CBs were fixed in situ with glutaraldehyde (2.5% in phosphate buffer. pH 7.4, 320 mOsm), and were prepared for electron microscopy. Young hyperoxic rats showed focal necrosis in type I cells, along with an increase of endoplasmic reticulum, Golgi apparatus, and of mitochondria volume, with loss of cristae. These changes were less pronounced in the older rat CBs compared with the young rats. In conclusion, hyperoxia seems to affect the oxygen-sensitive mechanism in the carotid body cells, and the reduced effects shown in the old rat CBs suggest an age-related decreased sensitivity to oxygen.

Focal ischemic injury of middle cerebral artery in newborn infants

Three full term newborns with focal ischemic injury of the middle cerebral artery (MCA) were observed. Diagnosis was suspected by cerebral ultrasonography (US) in the first year of life and then was confirmed by CT-scan and/or MRI. All children had a history of pre-perinatal risk factors of fetal impairment. Neuropsychological outcome, ranging from normal to severe, was evaluated in all three patients; it appears to be related to the type and extension of cerebral injury. In full-term neonates with discrete, moderate or severe neurologic symptoms the possibility of focal ischemic injury in the MCA territory should be considered.

Does chronic hypoxia increase rat carotid body nitric oxide?

The carotid body plays an important role in ventilatory adaptation during chronic hypoxia. Nitric oxide (NO) may act as a regulator in neurotransmission, influencing the carotid body chemosensory discharge. The aim of the study was to understand if NO could contribute to the adaptation process during chronic hypoxia. The rats were kept in chronic hypoxia (10-11% inspired oxygen) for 12 days, while the controls were kept in room air (21% O2). The distribution for diaphorase activity and immunohistochemistry for nitric oxide synthase (NOS) showed that chronic hypoxia induces an increase in NOS activity in the carotid body. It was concluded that NO release increased during chronic hypoxia and causes an inhibitory effect on carotid chemosensory discharge of the rat carotid body.

Novel evidence of expression and activity of ecto-phospholipase C gamma1 in human T lymphocytes

Although much is known about the intracellular phospholipase C (PLC) specific for inositol phospholipids, few data are available about the presence of a less common PLC at the external side of the membrane bilayer of some cell types. This ectoenzyme seems to play particular roles in cellular function by hydrolyzing inositol lipids located on the outer leaflet of the plasma membrane. Here, we provide the first evidence that peripheral T lymphocytes express a discrete level of a PLCgamma1 at the outer leaflet of the plasma membrane. Flow cytometry showed that the PLCgamma1-positive (PLCgamma1(+)) cells (approximately 37%) were CD8(+) and CD45RA+. Biochemical evidence indicated that (1) this ectoenzyme displays a mass similar to the cytoplasmic form, (2) it is phosphorylated on tyrosine residues, and (3) its activity is Ca2+-dependent. In addition, this enzyme appeared to be correlated with the proliferative state of the cell, since stimulation with phytohemagglutinin (PHA) downregulated both its expression and activity, which were restored by treatment with an antiproliferative agent like natural interferon beta. Moreover, the different kinetics of formation of its hydrolytic products, inositol 1 phosphate and inositol 1:2 cyclic phosphate (Ins(1)P and Ins(1:2 cycl)P), formed upon incubation of the lymphocytes with [3H]-lyso-phosphatidylinositol (PI), allow the hypothesis of a selective involvement of the two inositol phosphates in the mechanisms regulating the metabolism of particular T-lymphocyte subsets.

Controversies on the prevention of diabetic nephropathy

Renal function declines progressively in patients with diabetic nephropathy and the decline may be slowed by some preventive interventions. Optimized and intensive insulin therapy delays the onset and slows the progression of diabetic nephropathy. Moreover, dietary restriction, avoiding a high protein intake, could be effective in reducing glomerular hyperfiltration. Finally, there is evidence that angiotensin-converting enzyme inhibitors reduce renal damage by one or more mechanisms independent of their antihypertensive effects. Some controversial aspects of the prevention of diabetic kidney disease are presented and discussed.

Confirmation of the colobomatous macrophthalmia with microcornea syndrome: report of another family

We report on the occurrence of microcornea, coloboma, and macrophthalmia in 4 generations of an Italian family. The patients had no additional physical anomalies, were of normal intelligence, and had a normal karyotype. This condition has been reported in only 1 family [Bateman and Maumenee, 1984: Ophthalmol Pediatr Genet 4:59-66]. The recurrence of this distinctive ocular pattern in our opinion confirms the existence of a new syndrome, with autosomal dominant inheritance.

Persistently low cardiac output predicts high mortality in newborns with cardiogenic shock

BACKGROUND

Cardiogenic shock is an acute "unstable" state of circulatory dysfunction.

OBJECTIVE

To evaluate the haemodynamic aspects of 45 newborn infants affected by cardiogenic shock, in relation to etiologies and the mortality rate.

DESIGN

Retrospective, correlation study of etiologies, mortality rate and haemodynamic measurements by Doppler ultrasound parameters.

PATIENTS

45 newborn infants with cardiogenic shock, Gestational Age (GA) 37 (34-41), Birth Weight (BW) 2750 (1600-3600) g and and a control group of 20 neonates [GA 38 (34-40) wks, BW 2960 (1750-3800) g].

MEASUREMENTS

Left ventricular Cardiac Output (CO) was measured by a duplex scanner with pulsed Doppler and color flow mapping echocardiography in the first 48 hours of life.

RESULTS

In healthy newborns CO was 240 mL/min/kg (210-280), in newborns with cardiogenic shock CO was 170 mL/min/kg (f130-200), p < 0.01. The Stroke Volume was 1.80 mL/kg (1.70-1.90) in the control group and 1.20 (1.15-1.80) in the shocked group (p < 0.05); Heart Rate was 146 beats/min (130-160) and 160 beats/mm (140-194), (p < 0.01) respectively. Twenty-nine infants with cardiogenic shock had CO < or = 150 mL/min/kg and 5 of them (17.2%) died; 16 neonates had CO > 150 mL/min/kg and only one (6.2%) died (p < .01). Twenty-six of 36 newborns with perinatal asphyxia had CO < or = mL/min/kg and 5 of them died, while only one of 10 infants with CO > 150 mL/min/kg died.

CONCLUSIONS

Our results show that persistently low CO (< or = mL/min/kg) during the first 48 hours life, in newborns with cardiogenic shock due to perinatal asphyxia is associated with a significantly higher mortality.

Comparative Study of FISH, PCR and Cytogenetics on 25 Patients Submitted to Bone Marrow Transplantation (BMT) for Chronic Myelogenous Leukemia (CML); Which Tests can we Use in Routine Analysis Post BMT?

Chronic Myeloid Leukaemia (CML) shows an excellent response to allogeneic bone marrow transplantation (BMT) with a 60-80% long term disease free survival in recipients of unmanipulate marrow. The most frequent cause of treatment failure is leukaemic relapse, due to the re-emergence of malignant recipient clones. Clinical and haematological relapse is usually preceded by molecular evidence of relapse. Early detection of molecular relapse may allow intervention with immunotherapy such as donor lymphocyte infusions (DLI). This study was undertaken to compare results from two centres who employ either Fluorescent In Situ Hybridisation (FISH) or polymerase chain reaction (PCR) analysis of DNA polymorphisms as their routine method of detecting residual host cells following BMT for CML in order to establish (1) if these methods are equivalent for routine laboratory use in reporting of chimaerism results to the referring clinician, and (2) if these methods are beneficial for indicating new and early therapeutic strategies. FISH analyses for the X and Y chromosomes (in sex mismatched patients) and/or FISH for BCR and ABL loci were compared with short tandem repeat PCR (STR-PCR) and conventional karyotyping in serial analyses in 25 patients submitted to BMT for Philadelphia positive (Ph) CML. Comparison of all results on samples assessed between 1 and 13 years post BMT indicated that FISH and PCR, performed on the same bone marrow samples displayed similar results in more than 90% of patients in first 3 years after BMT which increased to a concordance rate of 100% in long term survivors. In contrast, comparison of FISH or PCR versus cytogenetic analysis indicated a low concordance rate, with less than 50% of samples showing similar results during all the follow-up period. Eighty percent of recipients (22 patients) had evidence of mixed chimaerism following BMT (initial level of positivity 1-6% recipient cells) during the follow-up period. This low percentage of recipient cells remained stable in 7 patients, while 9 patients reverted to a donor profile. All 16 patients are in haematological remission. In addition the 3 patients with complete donor chimaerism remain in remission. In the remaining 6 patients, a progressive increase in recipient cells occurred (progressive mixed chimaerism, PMC), and was followed by haematological relapse. We conclude that FISH and PCR can be used to monitor CML patients post BMT and transient or stable low level mixed chimaerism is not associated with leukaemia relapse, but PMC is predictive of imminent relapse and its detection may help to illucidate the timing of early intervention with donor lymphocyte infusion.

Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 levels in children with precocious puberty treated with gonadotropin-releasing hormone analog without or in combination with cyproterone acetate

In order to assess the behavior of growth hormone, insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) in girls with central precocious puberty treated with gonadotropin-releasing hormone (GnRH) analog-therapy, we studied 14 girls with this condition, the patients were subdivided into two groups, according to the therapy followed. Group A (n = 7; age 4.2-7.1 years) received GnRH analog in combination with cyproterone acetate, and Group B (n = 7; age 4.4-6.9 years) received long-acting analog alone. Before treatment, IGF-I levels were significantly increased compared to healthy age-matched children in the two groups (447 +/- 33 micrograms/l for Group A and 435 +/- 38 micrograms/l for Group B vs. control 175 +/- 78 micrograms/l; p < 0.01). Moreover, serum IGFBP-3 levels were significantly higher than the age-related reference range for IGFBP-3 (4478.2 +/- 178 micrograms/l for Group A and 4532.3 +/- 167 micrograms/l for Group B vs. control 2905 +/- 641 micrograms/l; p < 0.01). During the two years of gonadal suppression, Group A patients showed a significant decrease in IGF-I and IGFBP-3 levels, while in Group B there was no significant change in IGF-I; moreover, in Group B, IGFBP-3 levels increased significantly compared to baseline values during the first year of treatment (4532.3 +/- 167 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.05) and decreased significantly at the end of the second year of treatment (3816.1 +/- 189 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.01). Our study shows that the two different treatments of precocious puberty (with and without cyproterone acetate) have different effects on IGF-I and IGFBP-3, and suggests that these growth factors are under different metabolic regulation.

Changes in serum lipids and lipoproteins in epileptic children treated with anticonvulsants

OBJECTIVE

To assess the effect of long-term treatment of phenobarbital, carbamazepine and sodium valproate on serum lipids and lipoproteins in epileptic children.

METHODOLOGY

One hundred and fourteen (55 male, 59 female) children and adolescents suffering from various types of epilepsy who received different antiepileptic drugs were studied. The patients were subdivided into three groups according to their therapy: (i) carbamazepine (35 patients); (ii) phenobarbital (34 patients); and (iii) sodium valproate (45 patients). One-hundred healthy sex- and age-matched children served as controls. Lipids and lipoprotein profile were evaluated before the beginning of the anticonvulsant therapy and after at least 2.5 years. In the patients receiving phenobarbital, we re-evaluated 12 children (seven male, five female) at the end of therapy.

RESULTS

The children receiving phenobarbital showed high levels of serum total cholesterol and low-density lipoprotein (LDL) cholesterol and low levels of triglycerides, while children treated with carbamazepine had high levels of total cholesterol, triglycerides, LDL and high-density lipoprotein (HDL) cholesterol. Children treated with valproate had low triglycerides and LDL cholesterol levels with high levels of HDL cholesterol. The patients treated with phenobarbital showed a normalization of all parameters after the end of therapy.

CONCLUSIONS

Anticonvulsant drugs significantly modify serum lipids and lipoproteins in epileptic children. The changes due to phenobarbital seem to be transient.

Prenatal pseudocysts of the germinal matrix in preterm infants

Sonographic characteristics of germinal-matrix (PGM) pseudocysts of prenatal origin detected on cranial ultrasound in preterm newborns were correlated with their outcomes. PGM cysts were classified as typical or atypical, according to their location. Typical PGM cysts were present at the head of the caudate nucleus or slightly medially, adjacent to the foramen of Monro. Cysts were defined as atypical when they were located subependymally elsewhere. Only one infant of 16 with a typical PGM cyst presented with psychomotor retardation. His cerebral scan also showed subependymal calcifications due to cytomegalovirus infection. Three babies had cysts in the frontal periventricular zones (atypical PGM cyst). They had negative cranial MRI (12-15 months of age) and normal neurological follow-up (24 months). In conclusion, isolated prenatal PGM cysts in preterm infants correlate with a normal outcome.

The cardio-facio-cutaneous syndrome: a long-term follow-up of two patients, with special reference to the neurological features

The cardio-facio-cutaneous (CFC) syndrome is a newly recognized syndrome characterized by congenital heart defects, a particular facial appearance and abnormalities of hair and skin; apart from these, the most evident signs are mental retardation and other neurological abnormalities. Some of the phenotypic manifestations resemble those of Noonan syndrome, but this involves different neurological problems. We report on two children affected by cardio-facio-cutaneous syndrome who have been followed up for at least 6 years. The psychomotor retardation was severe. During the follow-up period we made a careful analysis of the neurological aspects of the course in these two patients and wish to stress that some neurological features are peculiar to this syndrome and can be useful in the diagnosis.

Hemodynamic effects of intravenous morphine infusion in ventilated preterm babies

BACKGROUND

the importance of sedation and analgesia of newborn babies in intensive care is only now receiving recognition in many neonatal units.

OBJECTIVE

to evaluate the hemodynamic effects of morphine on Cerebral Blood Flow velocities (CBFv), Cardiac Output (CO), Stroke Volume (SV), Mean Arterial Blood Pressure (MABP) and Heart Rate (HR) in ventilated preterm infants, before and during the infusion of a loading dose.

DESIGN

prospective, open, non-randomized, before-after intervention study with hemodynamic measurements made by Doppler ultrasound.

SETTING

neonatal Intensive Care Unit, Tertiary Care Center.

PATIENTS

sequential sample of 30 ventilated preterm newborns (gestational age (GA) 29 +/- 2 wks, range 27-31, birth weight (BW) 1240 +/- 440 g, range 800-1680).

INTERVENTION

each subject received an intravenous loading dose of morphine (100 mcg/Kg/h) for 2 h, followed by a continuous infusion of 25 mcg/kg/h.

MEASUREMENTS

the following Doppler parameters of the anterior cerebral artery were estimated: Peak systolic flow velocity (Vs), end-diastolic flow velocity (Vd), mean flow velocity (Vm) and Pourcelot' Resistance Index (RI). Measurements of CBFv, CO and SV (by Doppler ultrasound), MABP and HR were made 30 min before (baseline values) and at 15 (M15), 30 (M30), 60 (M60) and 120 min (M120), during the morphine loading infusion. Statistical evaluation analysis of variance, significance was calculated by Student-Newman-Kenfeld test.

RESULTS

there were no statistically significant changes in the cerebral and cardiac Doppler parameters before or during the 120 min of morphine loading infusion. There was a non-significant fall in MABP (MABP: Baseline value = 44 +/- 6 mmHg, M120 = 42 +/- 4 mmHg; reduction = 4%) and HR (HR = Baseline value = 148 +/- 12 beats/min., M120 = 140 +/- 16 beats/min.; reduction = 5%).

CONCLUSIONS

a loading dose of morphine over 2 h did not have any significant effect on MABP or cerebral and cardiac hemodynamics. No adverse effects were noted that could be attributed to morphine therapy.

Molecular studies in three patients with isodicentric Y chromosome

Three patients carrying an isodicentric (idic) Y chromosome associated with a mosaic 45,X cell line were studied using molecular techniques. Genotype-phenotype correlations suggested an effect of the 45,X cell line on sexual differentiation. A relationship was established between instability of the idic(Y) chromosome and localization of the breakpoint on Yq, and between azoospermia and deletion of interval 6 on Yq.

Vertical transmission of hepatitis C virus: an epidemiological study on 2,980 pregnant women in Italy

The risk of mother-to-infant transmission of hepatitis C virus (HCV) varies according to the population studied and the tests used. Aim of the current study was to investigate HCV vertical transmission rate in children born to 30 HCV positive/HIV negative pregnant women in Italy. We investigated the potential vertical transmission of HCV by identifying HCV antibody seropositive pregnant women, by analyzing HCV-RNA in the peripheral blood using PCR and by prospectively following their offspring until 24 months of age. During the third trimester, 2,980 consecutive pregnant women were examined for anti-HCV antibodies by a second generation Enzyme-Linked Immunosorbent Assay (EIA2) and re-assayed by a second generation Recombinant Immunoblot Assay (RIBA2). A total of 32 mothers (1.07%) were positive for EIA2 test; 30 out of 32 had a reactive confirmatory RIBA2 test for HCV. All anti-HCV positive mothers were negative for HIV. These 30 mothers and their 30 babies formed the study cohort. Of the 30 anti-HCV positive mothers, 10 were also positive for serum HCV-RNA by PCR. All the babies born to the 30 anti-HCV positive mothers were initially negative for HCV-RNA (cord blood specimens), but three babies became positive at three months of age and remained positive thereafter. These babies had been born to 3 of the 10 mothers with viremia during the third trimester of pregnancy. These results suggest that HCV vertical transmission is possible in 10% of anti-HCV positives and in about 33% of the HCV-RNA seropositive mothers.

Early infantile epileptic encephalopathy: a long-term follow-up study

The authors describe the electroclinical aspects and long-term evolution of five (in one male and four female patients) cases of early infantile epileptic encephalopathy in the neonatal period, the most common seizures were tonic spasms (either generalized or lateralized) that, very often, occurred in series. All newborns showed the typical suppression-burst pattern. The neurological status (initially normal) progressively deteriorated in the subsequent months, and all infants suffered from severe mental insufficiency and daily intractable seizures. Four out of the five children developed hypsarrythmia and one, Lennox-Gastaut syndrome. The authors discuss the main problems related to the suppression-burst pattern and the long-term prognosis of this abnormality.

90K (Mac-2 BP) in human milk

Human 90K, also known as Mac-2 binding protein (Mac-2 BP), is a secreted glycoprotein which is widely expressed, binds to the human macrophage-associated lectin Mac-2, and may have a role in host defence. We have measured the concentrations of 90K in human breast milk from eight healthy mothers delivering mature healthy infants after full-term pregnancy using a specific immunoenzymatic assay. Maximal 90K concentrations were observed on days 2-3 post-partum, and ranged from 13.4 to 79.2 microg/ml. The concentrations of 90K in the milk had no correlation with those in the maternal blood.

Neonatal diagnosis of tuberous sclerosis

Intracranial tumors are rare in the neonatal period, and generally the most common histological types are astrocytoma, medulloblastoma, choroid plexus papilloma and neuroectodermal tumors. The early diagnosis of these tumors is often very difficult. The authors report a case of a full-term newborn who presented with opisthotonus. A subependymal mass was detected by cerebral ultrasonography, and when the child was 1 month of age depigmentations appeared on the trunk and on the right leg, confirming the suspicion of tuberous sclerosis. At 3 months of age the child suffered infantile spasm with hypsarrhythmia. The developmental delay, the marked progressive neurological deterioration and the daily seizures suggested surgical resection. Histologic studies showed a subependymal giant cell astrocytoma such as typically occurs in tuberous sclerosis.

Newborns with hyperbilirubinemia: usefulness of brain stem auditory response evaluation

We describe brain stem auditory evoked potentials (BAEP) obtained in 48 full-term newborns (20 boys, 28 girls) presenting with high serum total bilirubin concentration (from 238 to 442 mM) without Rhesus of group A, B, O factors incompatibility. Recordings were performed on the 3rd day of life and repeated 5-7 days post-appropriate therapy with photostimulation and exchange transfusion (when bilirubin concentration had decreased below 136 mM). Supplementary recordings were performed 3, 6 and 12 weeks later in order to assess test-retest reliability of components. Mean values of BAEP latencies were compared with those obtained in 40 age-matched control subjects using the same recording procedures. At first recording session (on the 3rd day), latencies of waves III and V obtained in hyperbilirubinemic patients were significantly increased as compared with records in control subjects. Recordings performed 5 to 7 days post-therapy and during subsequent recording sessions showed no significant differences between patients and control groups. Serial neuropsychological evaluations obtained over a 3-year follow-up showed no subsequent neurodevelopmental abnormality for all patients. These findings suggest that hyperbilirubinemia can alter central neurotransmission in auditory brain stem pathways, but this modification is only transient.

Immunological Evaluation of Children Treated with Antiepileptic Drugs

In order to evaluate cellular and humoral immunity in children who were given carbamazepine (CBZ), sodium valproate (VPA) or phenobarbital (PHB) as monotherapy, we studied 137 children and adolescents suffering from various types of epilepsy and 50 healthy control children. The patients were subdivided according to the type of drug received: in particular, Group 1: 50 (26 female, 24 male) children received only CBZ; their age ranged from 2.3 years to 16.0 years (mean ± SD, 8.1 ± 7.9 years); Group 2: 50 (26 female, 24 male) children received only VPA with age from 2.8 to 15.1 (8.9 ± 7.1) years; Group 3: 37 (20 female, 17 male) children who were given only PHB with age from 2.0 to 13.9 (8.4 ± 7.8) years. 50 sex and age- matched healthy children served as controls. All the patients of groups 1, 2 and 3 were studied before the beginning of antiepileptic drug therapy and after 6, 12 and 18 months of therapy. All plasma levels of AEDs were within the therapeutic range. All children of the three groups had a normal number of lymphocytes per millimeter of blood; also the values of CD3, CD4, CD8, CD20 and CD56 and the serum levels of complement (C3 and C4) were similar to those of healthy controls. The natural killer cell activity of children receiving CBZ showed a significant reduction: this reduction was present after 6 months of therapy (baseline: 45.2%; after 6 months: 32.6%; after 12 months 31.3 %; (all determinations vs baseline:p<0.01) and continued to be present until the end of the study (36.9%; p<0.05).

Our data suggest that, in children receiving CBZ, VPA and PHB on monotherapy significant abnormalities of serum immunoglobulin concentrations, serum complement values and lymphocyte subsets are not present. CBZ is shown to have a reducing effect on the natural killer cell activity, but the real role of this abnormality in the immune system of these patients needs more investigation.