Role of cardiac MRI in evaluating patients with Anderson-Fabry disease: assessing cardiac effects of long-term enzyme replacement therapy

PURPOSE

Anderson-Fabry disease is a multisystemic disorder of lipid metabolism secondary to X-chromosome alterations and is frequently associated with cardiac manifestations such as left ventricular (LV) hypertrophy, gradually leading to an alteration in cardiac performance. The purpose of this study was to monitor, using magnetic resonance imaging (MRI), any changes produced by enzyme replacement therapy with agalsidase beta at the cardiac level in patients with Anderson-Fabry disease.

MATERIALS AND METHODS

Sixteen (ten men, six women) patients with genetically confirmed Anderson-Fabry disease underwent cardiac MRI before starting enzyme replacement therapy (baseline study) and after 48 months of treatment with agalsidase beta at the dose of 1 mg/kg (follow-up study).

RESULTS

After 48 months of treatment, a significant reduction in LV mass and wall thickness was observed: 187±59 g vs. 149±44 g, and 16±3 mm vs. 13±3 mm, respectively. A significant reduction in T2 relaxation time was noted at the level of the interventricular septum (81±3 ms vs. 67±7 ms), at the apical level (80±8 ms vs. 63±6 ms) and at the level of the lateral wall (82±8 ms vs. 63±10 ms) (p<0.05). No significant variation was observed in ejection fraction between the two studies (65±3% vs. 64±2%; p>0.05) (mean bias 1.0); however, an improvement was noted in the New York Heart Association (NYHA) class of the majority of patients (12/16) (p<0.05).

CONCLUSIONS

In patients with Anderson-Fabry disease undergoing enzyme replacement therapy with agalsidase beta, MRI documented a significant reduction in myocardial T2 relaxation time, a significant decrease in maximal myocardial thickness and in total LV mass. MRI did not reveal significant improvements in LV global systolic function; however, improvement in NYHA functional class was noted, consistent with improved diastolic function.

Massive rotator cuff tear treated with a synthetic patch: a case report 16 years after surgery

Massive rotator cuff tears usually cannot be repaired due to tendon atrophy and marked retraction, as well as muscles fatty degeneration. There are several options for surgical treatment: open or arthroscopic debridement with or without subacromial decompression, arthroscopic isolated biceps tenotomy, partial tendon repair, use of synthetic or biologic patches, tendon transfers, hemiarthroplasty, reverse arthroplasty, and arthrodesis. In this article, we will discuss a particular case of massive rotator cuff tear treated with Marlex mesh. The patient was clinically, radiologically, and MRI checked 16 years after the surgical implant. The active function of shoulder had preserved very well, the Constant score was 76. The X-rays showed a limited progression of osteoarthritis without further cranial migration of the humeral head. At MR cartilage preservation was appreciated, the patch being in good position and the teres minor being smaller than average but it was nonetheless present. This case report can highlight the usefulness of patches in patients with irreparable rotator cuff lesion both for the immediate benefit in terms of pain, strength, movement, and in perspective allowing for the preservation of anatomical structures that might avoid the need for a prosthetic implant over the years.

Palmitoylethanolamide stimulation induces allopregnanolone synthesis in C6 Cells and primary astrocytes: involvement of peroxisome-proliferator activated receptor-α

Palmitoylethanolamide (PEA) regulates many pathophysiological processes in the central nervous system, including pain perception, convulsions and neurotoxicity, and increasing evidence points to its neuroprotective action. In the present study, we report that PEA, acting as a ligand of peroxisome-proliferator activated receptor (PPAR)-α, might regulate neurosteroidogenesis in astrocytes, which, similar to other glial cells and neurones, have the enzymatic machinery for neurosteroid de novo synthesis. Accordingly, we used the C6 glioma cell line and primary murine astrocytes. In the mitochondrial fraction from cells stimulated with PEA, we demonstrated an increase in steroidogenic acute regulatory protein (StAR) and cytochrome P450 enzyme (P450scc) expression, both comprising proteins considered to be involved in crucial steps of neurosteroid formation. The effects of PEA were completely blunted by GW6471, a selective PPAR-α antagonist, or by PPAR-α silencing by RNA interference. Accordingly, allopregnanolone (ALLO) levels were increased in supernatant of PEA-treated astrocytes, as revealed by gas chromatography-mass spectrometry, and this effect was inhibited by GW6471. Moreover, PEA showed a protective effect, reducing malondialdehyde formation in cells treated with l-buthionine-(S,R)-sulfoximine, a glutathione depletor and, interestingly, the effect of PEA was partially inhibited by finasteride, a 5α-reductase inhibitor. A similar profile of activity was demonstrated by ALLO and the lack of an additive effect with PEA suggests that the reduction of oxidative stress by PEA is mediated through ALLO synthesis. The present study provides evidence indicating the involvement of the saturated acylethanolamide PEA in ALLO synthesis through PPAR-α in astrocytes and explores the antioxidative activity of this molecule, confirming its homeostatic and protective role both under physiological and pathological conditions.

IbpA DR2 subunit immunization protects calves against Histophilus somni pneumonia

Histophilus somni is a prevalent cause of pneumonia and septicemia in cattle. Yet evidence for protection against pneumonia by current vaccines is controversial. We have identified a new H. somni virulence factor, IbpA. Previous studies implicated three likely protective subunits or domains in IbpA (A3, A5, and DR2), which were expressed as recombinant GST fusion proteins and purified for systemic vaccination of calves. After two subcutaneous immunizations, calves were challenged intrabronchially with virulent H. somni strain 2336 and clinical signs were monitored for four days before necropsy. Serum samples were collected throughout. At necropsy, the area of gross pneumonia was estimated, bronchial lavage fluid was collected, lesions were cultured and tissue samples were fixed for histopathology. Results showed that calves immunized with IbpA DR2 had a statistically lower percentage of lung with gross lesions than controls, fewer histologic abnormalities in affected areas and no H. somni isolated from residual pneumonic lesions. Calves immunized with the control GST vaccine, IbpA3 or IbpA5 had larger H. somni positive pneumonic lesions. ELISA results for serum antibodies showed that calves immunized with the IbpA DR2 antigen had high IgG1 and IgG2 and lowest IgE responses to the immunizing antigen. Specific IgG responses were also high in the bronchial lavage fluid. High specific serum IgE responses were previously shown to be associated with more severe pneumonia, but high IgG specific anti-IbpA DR2 responses seem to be critically related to protection. Since the IbpA DR2 Fic motif has been shown to cause bovine alveolar cells to retract, we tested the neutralizing ability of pooled serum from the IbpA DR2 immunized group. This pooled serum reduced cytotoxicity by 75-80%, suggesting that the protection was due to antibody neutralization of IbpA cytotoxicity, at least in part. Therefore, IbpA DR2 appears to be an important protective antigen of H. somni. The study shows, for the first time, that immunization with a purified Fic protein protects against disease in a natural host.

Calpain-mediated cleavage of Beclin-1 and autophagy deregulation following retinal ischemic injury in vivo

Autophagy is the major intracellular degradation pathway that regulates long-lived proteins and organelles turnover. This process occurs at basal levels in all cells but it is rapidly upregulated in response to starvation and cellular stress. Although being recently implicated in neurodegeneration, it remains still unclear whether autophagy has a detrimental or protective role. In this study, we investigated the dynamics of the autophagic process in retinal tissue that has undergone transient ischemia, an experimental model that recapitulates features of ocular pathologies, including glaucoma, anterior ischemic optic neuropathy and retinal vessels occlusion. Retinal ischemia, induced in adult rats by increasing the intraocular pressure, was characterized by a reduction in the phosphatidylethanolamine-modified form of LC3 (LC3II) and by a significant decrease in Beclin-1. The latter event was associated with a proteolytic cleavage of Beclin-1, leading to the accumulation of a 50-kDa fragment. This event was prevented by intravitreal treatment with the non-competitive N-methyl-D-aspartate antagonist MK801 and calpain inhibitors or by calpain knockdown. Blockade of autophagy by pharmacological inhibition or Beclin-1 silencing in RGC-5 increased cell death, suggesting a pro-survival role of the autophagic process in this neuronal cell type. Altogether, our results provide original evidence for calpain-mediated cleavage of Beclin-1 and deregulation of basal autophagy in the rat retina that has undergone ocular ischemia/reperfusion injury.

Thyroid function in Fabry disease before and after enzyme replacement therapy

AM: Patients with Fabry disease (FD), a genetic disorder caused by lysosomal a-galactosidase-A enzyme deficiency and characterized by a systemic accumulation of globotriaosylceramides, present high prevalence of subclinical hypothyroidism. The pathogenic mechanism is thought not to be related to anti-thyroid autoimmunity and may be dependent by intra-thyroid lipid accumulation. In this study, it was investigated whether thyroid function recovers in FD after long-term enzyme replacement therapy (ERT).

METHODS

Study population included 14 FD patients (7 females, 7 males, aged 21-62 years) and 14 sex- and age-matched normal subjects. Thyroid function was evaluated in each patient at baseline and after the beginning of ERT with rh-a-galactosidase-A (1 mg/kg/BW every 2 weeks) for three years.

RESULTS

TSH levels were higher in FD patients than in controls (P<0.05). In FD patients, TSH levels were higher before than after ERT (1.9±0.2 vs 1.2±0.2 mU/L, P<0.01) while fT3 and fT4 levels were normal at baseline and unchanged after ERT. At baseline, TSH levels were >3 mU/L in three patients and normalize after ERT. Anti-Tg and/or anti-TPO titres were positive in 14% of patients and 21% of controls. After ERT, the rate of autoimmunity was unchanged. At the thyroid ultrasonography, a slight hypoechoic pattern was found in 71% of patients at baseline and decreased to 43% after ERT.

CONCLUSION

Primary hypothyroidism in FD patients is reverted after long-term ERT. A screening of thyroid function and periodical re-evaluation during ERT is mandatory in all FD patients.

Trimethoprim-sulfamethoxazole-associated severe hypoglycaemia: a sulfonylurea-like effect

AIM

To report hypoglycaemia, a life-threatening adverse event, associated with trimethoprim-sulfamethoxazole. A sulfonylurea-like effect, leading to insulin raise, was investigated.

METHODS

Two cases of trimethoprim-sulfamethoxazole-associated hypoglycaemia in 2 patients with a diagnosis of new HIV-1-infection presenting with Pneumocystis jiroveci pneumonia are reported. The patients had no predisposing factors, such as renal or liver impairment, interfering with trimethoprim-sulfamethoxazole elimination, thus leading to hypoglycaemia. Insulin plasma levels were measured in both patients.

RESULTS

Severe hypoglycaemia was associated with increased serum levels of insulin up to 84 microU/ml (normal values < 10 microU/ml). Continuous dextrose infusion was necessary, further suggesting the sulfonylurea-like effect of sulfamethoxazole. Interestingly, plasma levels of insulin progressively raised after trimethoprim-sulfamethoxazole administration.

CONCLUSIONS

Only 18 cases of trimethoprim-sulfamethoxazole associated hypoglycaemia are reported in the literature. Hypoglycaemia is a life-threatening condition, likely underreported, to consider when trimethoprim-sulfamethoxazole administration is required, even in the absence of predisposing factors or other hypoglycaemic agents. Physician should bear in mind the potential trimethoprim-sulfamethoxazole-associated adverse event especially when prolonged treatments and elevated dosage are used.

Italian consensus statement on paediatric HIV infection

The objective of this document is to identify and reinforce current recommendations concerning the management of HIV infection in infants and children in the context of good resource availability. All recommendations were graded according to the strength and quality of the evidence and were voted on by the 57 participants attending the first Italian Consensus on Paediatric HIV, held in Siracusa in 2008. Paediatricians and HIV/AIDS care specialists were requested to agree on different statements summarizing key issues in the management of paediatric HIV. The comprehensive approach on preventing mother-to-child transmission (PMTCT) has clearly reduced the number of children acquiring the infection in Italy. Although further reduction of MTCT should be attempted, efforts to personalize intervention to specific cases are now required in order to optimise the treatment and care of HIV-infected children. The prompt initiation of treatment and careful selection of first-line regimen, taking into consideration potency and tolerance, remain central. In addition, opportunistic infection prevention, adherence to treatment, and long-term psychosocial consequences are becoming increasingly relevant in the era of effective antiretroviral combination therapies (ART). The increasing proportion of infected children achieving adulthood highlights the need for multidisciplinary strategies to facilitate transition to adult care and maintain strategies specific to perinatally acquired HIV infection.

Expression profiles of toll-like receptors in anterior kidney of channel catfish, Ictalurus punctatus (Rafinesque), acutely infected by Edwardsiella ictaluri

Using quantitative PCR (QPCR), the relative transcriptional levels of five toll-like receptors (TLR2, TLR3, TLR5, TLR20a and TLR21) were studied in the channel catfish, Ictalurus punctatus (Rafinesque), under uninfected and acutely infected conditions [1-, 2-, 4-, 6-, 12-, 24-, 36- and 48-h post-injection (hpi)]. Under uninfected conditions, the transcriptional levels of the five TLRs were significantly lower than that of 18S rRNA (P < 0.001). QPCR results also revealed that the transcriptional levels of TLR20a and TLR5 were higher than those of TLR2, TLR3 or TLR21. The transcriptional level of TLR3 was significantly lower than that of the other four TLRs (P < 0.001). However, when channel catfish were acutely infected by Edwardsiella ictaluri through intraperitoneal injection, the transcriptional levels of TLRs increased significantly (P < 0.005) at 6 hpi. Among the five TLRs studied, the transcriptional levels of TLR3, TLR5 and TLR21 were never significantly lower than under uninfected conditions (P = 0.16, 0.27 and 0.19, respectively), suggesting these three TLRs might play important roles in host defence against infection by E. ictaluri. The amount of E. ictaluri in the anterior kidney increased at 12 and 24 hpi but decreased at 36 and 48 hpi. Our results suggest that TLRs are important components in the immune system in the channel catfish, and their rapid transcriptional upregulation (within 6 hpi) in response to acute E. ictaluri infection might be important for survival from enteric septicaemia of catfish.

Molecular adaptations in haemoglobins of notothenioid fishes

Since haemoglobins of all animal species have the same haem group, differences in their properties, including oxygen affinity, electrophoretic mobility and pH sensitivity, must result from the interaction of the prosthetic group with specific amino-acid residues in the primary structure. For this reason, fish globins have been the subject of extensive studies in recent years, not only for their structural characteristics, but also because they offer the possibility to investigate the evolutionary history of these ancient molecules in marine and freshwater species living in a great variety of environmental conditions. This review summarizes the current knowledge on the structure, function and phylogeny of haemoglobins of notothenioid fishes. On the basis of crystallographic analysis, the evolution of the Root effect is analysed. Adaptation of the oxygen transport system in notothenioids seems to be based on evolutionary changes, involving levels of biological organization higher than the structure of haemoglobin. These include changes in the rate of haemoglobin synthesis or in regulation by allosteric effectors, which affect the amount of oxygen transported in blood. These factors are thought to be more important for short-term response to environmental challenges than previously believed.

Effect of Helicobacter pylori eradication on platelet count in children with chronic idiopathic thrombocytopenic purpura

Recent reports have suggested, particularly in adults, an association between Helicobacter pylori infection (HPI) and chronic idiopatic thrombocytopenic purpura (cITP) with improvement of platelet count after eradication therapy. We investigated the association of HPI and cITP and the effect of HP eradication therapy on thrombocytopenia in a population of 24 children of both sexes mean age 8.0+/-0.28 years (range 5.4-10.7 years), affected by cITP (PLT <or=50 x 10(9)/l) lasting more than 6 months. HPI was investigated by Helicobacter pylori stool antigens (HpSA). In eight out 24 patients (33.3%) HP infection was identified positive and bacterial eradication was successful following 7 days of triple therapy (amoxicillin, clarithromicin and proton pump inibitors). A follow-up of platelet count was performed for 1 year after HpSA detection. Six out eight patients (75%) had total recovery of platelet count during the first year after bacterial eradication (PLT before therapy 32.5+/-3.5 x 10(9)/l; after 1 year 275+/-106.06 x 10(9)/l) (P<0.05), two patients (25%) had partial recovery (PLT before therapy 30 x 10(9)/l, after 1 year 103.5 x 10(9)/l) although not reaching statistical significance (P>0.05). Non-significant differences were found in platelet count between infected and uninfected patients before eradication treatment (PLT 33.0+/-2.8 x 10(9)/l versus 34.0+/-5.75 x 10(9)/l) (P>0.05), while significant differences were observed after eradication therapy (PLT 315.0+/-7.07 x 10(9)/l versus 43.5+/-2.12 x 10(9)/l) (P<0.05). HP assessment should be performed in all cITP patients and eradication therapy should be attempted in positive cases.

Influence of Helicobacter pylori infection associated with iron deficiency anaemia on growth in pre-adolescent children

In 102 children of both genders aged between 10 and 12 years affected by iron deficiency anaemia (IDA) from various causes, a retrospective study from 1999 to 2007 has been performed to investigate possible relationships between IDA and physical growth. Patients were divided into two groups according to gender. Hb, MCV, ferritin levels, HSDS and body mass index (BMI) were recorded to confirm the diagnosis and the height standard deviation scores were also evaluated. The causes of IDA were investigated. At study entry, both groups of patients, regardless of IDA etiology, had microcytic hypochromic anaemia with low ferritin level. Anthropometric parameters were also reduced. Significant differences of anthropometric parameters were found in both groups in relationship to various causes of IDA (p<0.05) (ANOVA). We conclude that IDA may influence physical growth and etiological factors play an important role on growth delay.

[Cyclers for APD: current potential and possible developments]

The use of automated peritoneal dialysis (APD) is rapidly increasing worldwide. The success of this treatment is closely linked to the development of new mechanical devices (cyclers). At present, the cyclers available in Italy are the Baxter Home Choice Pro, the Fresenius Sleep Safe, and the Gambro Serena. Today's cyclers are characterized by a user-friendly, intuitive interface and sophisticated software. The miniaturization of components has led to a significant reduction of the weight and size of these machines and great flexibility in treatment scheduling. The memory card (patient card) and the possibility of remote control (teledialysis) allow continuous monitoring of the patients and their compliance to treatment. The cyclers of the future could optimize their performance by biosensors able to assess, in real time, the dialysis dose while sensors placed on the drainage line could facilitate the early diagnosis of peritonitis. The peritoneal clearance could be increased with the development of continuous-flow peritoneal dialysis (CFPD). Finally, the introduction of cyclers able to prepare individually tailored solutions different from the standard ones could better meet the clinical needs of the patients and reduce the exposure of the peritoneal membrane to high concentrations of glucose.

Leukocyte interferon alpha early retreatment for Child A HCV genotype 1b-infected cirrhotics intolerant to pegylated interferons

BACKGROUND AND AIM

The pegylated interferon (PEG-IFN)/ribavirin combination has been shown to be effective for hepatitis C virus (HCV)-related compensated cirrhosis, but it frequently causes adverse events, leading to premature termination. In this open study we evaluated the safety and efficacy of early retreatment with leukocyte IFN-alpha in Child A HCV genotype 1b-infected cirrhotics intolerant to PEG-IFNs.

PATIENTS AND METHODS

61 patients were treated with PEG-IFN (either alpha-2b 1.2-1.5 lg/kg weekly or alpha-2a 180 lg/weekly) plus ribavirin (1,000 mg/day) for 48 weeks. During the first 6 months, patients who discontinued treatment because of side effects were retreated with leukocyte IFN-alpha (6 MU/three times weekly) plus ribavirin (1,000 mg/day) for 48 weeks after a 1-month wash-out. The primary end points were safety and efficacy in terms of sustained virological response (SVR).

RESULTS

At intention-to-treat analysis of the 61 patients receiving PEG-IFNs plus ribavirin revealed that 18 (29.5%) obtained a SVR. 16 patients (26.2%) prematurely discontinued treatment and were retreated with leukocyte IFN-alpha plus ribavirin. The switch was well tolerated, and all but one patient completed the treatment period. As a result of the switch, 4 of these 16 (25%) patients also obtained a SVR. Thus, the overall SVR rate of this study was 22/61 (36.1%).

CONCLUSIONS

These results suggest that an early retreatment with leukocyte IFN-alpha may be a safe and valid therapeutic option among difficult-to-treat HCV cirrhotic patients who cannot tolerate PEG-IFNs.

Randomized clinical trial on the effects of full mouth disinfection versus conventional quadrant therapy in the control of chronic periodontitis

AIM

This clinical trial investigates the effectiveness of full-mouth disinfection (FMD) versus conventional etiological therapy in patients with chronic periodontitis (CP).

METHODS

The therapy effectiveness was assessed by a randomized trial, performed over 20 adult periodontitis (AP) patients, divided into two groups. Patients were recruited undergoing strict inclusion/exclusion criteria. The following parameters were considered to evaluate and compare the two procedures: bleeding on probing (BOP), Plaque Index (PLI), probing depth (PD), clinical attachment level (CAL). These clinical data were collected at baseline and at three follow-ups (three months, six months and twelve months from baseline). Each parameter was averaged within each group; then statistic comparisons were performed within groups and between groups.

RESULTS

In the test-group statistically significant improvements (P<0.001) were found for all parameters between baseline and every following review. The same result was reported in the control group (with a further significant difference between first and second review). Finally, the comparison between groups did not show any difference at any time for every parameter considered.

CONCLUSION

FMD outcomes are similar to those of the conventional therapy and improvements can be achieved more quickly. FMD does not cause remarkable side effects and reduces the number of therapy sessions. Some aspects about this treatment need further research: maybe FMD could give an extra reduction of bacterial load, in comparison with traditional therapy, resulting in a longer free-infection period; that could allow a decrease in the frequency of supporting periodontal treatment.

Elevated expression and polymorphisms of SOCS3 influence patient response to antiviral therapy in chronic hepatitis C

BACKGROUND

The response to antiviral therapy of chronic hepatitis C virus (HCV) infection is determined by virological, environmental and genetic factors.

OBJECTIVE

The hypothesis was tested that the expression of specific genes and their haplotype frequencies can differentiate between non-responders (NRs) and sustained virological responders (SVRs) to antiviral treatment.

METHODS

A methodological approach based on molecular marker discovery and validation was used to study the genes influencing the antiviral treatment in lymphoblastoid cell lines from 74 genotype 1b HCV patients (44 from Southern Italy and 30 from Northern Italy) treated with pegylated interferon (IFN) alpha and ribavirin. Furthermore, an association study was performed, testing three single nucleotide polymorphisms (SNPs) of suppressor of cytokine signalling 3 (SOCS3) in 162 NR and 184 SVR subjects (SOCS3 -8464 A/C (rs12952093), -4874 A/G (rs4969170) and 1383 A/G, (rs4969168)).

RESULTS

SOCS3 basal expression levels were significantly increased in two independent sets of NR groups (p<0.05). A highly significant association was found between NRs and both the positively associated haplotype (OR = 2.01, 95% CI 1.45 to 2.79, p = 0.0002) and the negatively associated haplotype (OR = 0.56, 95% CI 0.42 to 0.76, p = 0.0014). In particular, the SOCS3 -4874 AA genotype was strongly associated with failure of antiviral therapy (OR = 4.00, 95% CI 2.09 to 7.66, p = 0.0003) and the AA genotype carriers had significantly higher SOCS3 mRNA and protein levels (p<0.05).

CONCLUSIONS

Basal levels of SOCS3, an inhibitor of the IFN alpha-induced Janus kinase-signal transducer and activator of transcription pathways, and its genetic polymorphisms influence the outcome of antiviral treatment. SOCS3 thus represents a novel blood biomarker for the a priori prediction of treatment response.

AM404, an anandamide transport inhibitor, reduces plasma extravasation in a model of neuropathic pain in rat: role for cannabinoid receptors

Neuropathic pain consequent to peripheral nerve injury has been associated with local inflammation. Following noxious stimulation afferent fibres release substance P (SP) and calcitonin-gene related peptide (CGRP), which are closely related to oedema formation and plasma leakage. The effect of the anandamide transport blocker AM404 has been studied on plasma extravasation after chronic constriction injury (CCI) which consists in a unilateral loose ligation of the rat sciatic nerve (Bennett and Xie, 1988). AM404 (1-3-10 mg kg(-1)) reduced plasma extravasation in the legated paw, measured as mug of Evans Blue per gram of fresh tissue. A strong effect on vascular permeability was also produced by the synthetic cannabinoid agonist WIN 55,212-2 (0.1-0.3-1 mg kg(-1)). Using specific antagonists or enzyme inhibitors, we demonstrate that cannabinoids act at several levels: data on the 3rd day suggest a strong involvement of substance P (SP) and calcitonin gene-related peptide (CGRP) in the control of vascular tone, whereas at the 7th and 14th days the major role seems to be played by prostaglandins (PGs) and nitric oxide (NO). Capsaicin injection in ligated paws of AM404- or WIN 55,212-2-treated rats resulted in an increase of Evans Blue extravasation, suggesting the involvement of the cannabinergic system in the protective effect of C fibres of ligated paws. Taken together, these data demonstrate the efficacy of cannabinoids in controlling pain behaviour through the modulation of several pain mediators and markers of vascular reactivity, such as SP, CGRP, PGs and NO.

[Assessment of APD cyclers]

Automated peritoneal dialysis (APD) is a home treatment that allows exchanges to be performed during the night by means of a mechanical device (cycler). The most important requirements of a cycler are a user-friendly intuitive interface, safety in usage, noiselessness and full portability. These characteristics influence patient satisfaction and consequently patient compliance with dialysis treatment. Other important features of the device are online pressure and flow sensors to avoid damage to the peritoneum, control of inflow and outflow rates, and flexibility in performing different treatment schedules. Today's cyclers allow all these functions and appear to respond well to the current clinical requirements. Another advantage of cyclers is that they can store treatment data on memory cards and send information about home APD treatment to the dialysis center. However, these systems use specific software developed by their manufacturers and do not interact with software of other producers nor with the most common databases; moreover, the data cannot be uploaded to hospital files. The availability of open software for cyclers allowing data to be exported to common database formats would enable us to compare different APD systems. A future goal might therefore be the integration of different APD software systems into a global standard.

Effect of Cross-Linking with Calcium Ions on the Physical Properties of Alginate Films

Three films of sodium alginate, with different amounts of guluronic fraction, were investigated with different techniques. On increasing the fraction of guluronic units the chain-to-chain interaction was promoted. The three samples were ionically cross-linked with calcium ions by soaking the films in a solution of calcium chloride. The introduction of the cross-linking points caused an appreciable change in the physical properties, and the results were discussed in terms of different composition of the materials and in terms of the increased free volume during the cross-linking process.