Theobroma cacao L., the Food of the Gods: a scientific approach beyond myths and claims

Cocoa beans are rich source of polyphenols, contributing about 10% of the dry weight of the whole bean and its derivative chocolate, particularly dark chocolate, is considered one of the major contributors of antioxidants to the American diet after fruits and vegetables. At present the wide variation in cocoa processing and in the content and profile of polyphenols make it difficult to determine to what extent the findings about positive effects expressed in different studies, translate into tangible clinical benefits. Moreover, before claiming any healthy properties to a plant, natural product or food item on human subject, a basic research project approved by scientific and ethical commissions has to be performed. Until now the definition, composition, manufacturing specifications, packaging and labelling of cocoa and chocolate products in Europe, are regulated by "Directive 2000/36/EC of the European parliament and of the council". The definitions take changes in consumer tastes, chocolate composition and labelling into account, but do not consider the real potential of healthy, beneficial and nutraceutical effects. In fact, they fail to establish an official analytical methodology for the quantification of phenolic compounds in cocoa and chocolate. Moreover quantification of these compounds is not used in product classification. This article reviews many qualitative differences of cocoa and chocolate, in particular dark chocolate, aiming to establish the different implications for public health through the use of the analyzed concentration of polyphenols in cocoa products.

The collection and conservation in Italy of stem cells from umbilical cord blood

The blood contained in the umbilical cord offers a precious source of pluripotent stem cells, easily obtainable without invasive procedures, a source that, unlike embryonic stem cells, affords greater respect for ethical concerns. In relation to the therapeutic potential of these stem cells, personalized blood banks for newborns have been created and in various countries systems of research and cryoconservation of umbilical cord blood have been created, especially in private facilities. This facilitates promotion of the culture of donation and development of a network of umbilical cord blood sources, and spurs research to evaluate the real therapeutic potential of these cells. Italy has long prohibited management of umbilical cord blood in private form. Today, with new laws, Italy has achieved the indispensable legislative update in acknowledgment of social needs. Actually, the achieved system is solid autologous conservation. It guarantees to conserve a greater number of umbilical cords in public and private facilities.

Genetic and molecular alterations in rhabdomyosarcoma: mRNA overexpression of MCL1 and MAP2K4 genes

Rhabdomyosarcoma, the most common soft tissue sarcoma in childhood, belongs to the small round cell tumor family and is classified according to its histopathological features as embryonal, alveolar and pleomorphic. In this study we propose to explore genetic alterations involved in rhabdomyosarcoma tumorigenesis and assess the level of mRNA gene expression of controlling survival signalling pathways. For genetic and molecular analysis, array-based comparative genomic hybridization, combined with Real Time PCR using the comparative method, was performed on 14 primary well-characterized human primary rhabdomyosarcomas. Multiple changes affecting chromosome arms were detected in all cases, including gain or loss of specific regions harbouring cancer progression-associated genes. Evaluation of mRNA levels showed in the majority of cases overexpression of MCL1 and MAP2K4 genes, both involved in cell viability regulation. Our findings on rhabdomyosarcoma samples showed multiple copy number alterations in chromosome regions implicated in malignancy progression and indicated a strong expression of MAP2K4 and MCL1 genes, both involved in different biological functions of complicated signalling pathways.

Proteolysis of Milk Fat Globule Membrane Proteins in Preterm Milk: A Transient Phenomenon with a Possible Biological Role?

Milk fat globule membrane (MFGM) proteins constitute a milk fraction currently of great interest, as they appear to significantly contribute to milk protective role. We investigated these proteins in human preterm colostrum and milk. For the former we found a peculiar 2-DE pattern, with a spot concentration at low molecular weight, which mass spectrometry analysis showed to be fragments belonging to some MFGM proteins with a well-known biological and especially immunological role: lactadherin, membrane-associated lactoferrin, butyrophilin, clusterin and heavy-chain immunoglobulin. Since we were able to rule out protease activity after specimen collection, we hypothesize the localization of the proteolytic enzymes in the alveolar cell membranes of the mammary gland. This mechanism is probably under hormonal control and the unexpected advent of preterm delivery would not allow hormonal conditions typical of lactation to occur immediately, causing a delay in enzymatic inhibition. This hypothesis is supported by some of our results, picturing a peculiar transient phenomenon of adaptation of the mammary-gland-membrane proteins after preterm delivery. Further studies will be required to verify whether the presence of protein fragments exerts a specific biological and immuno-defensive role in preterm infants, thus adding evidence to the outstanding biological role and benefits of mother's own milk in feeding preterm infants.

Cardiac and metabolic demands of in place shallow water running in trained and untrained men

AIM

The aim of this study was to assess maximal cardiac and metabolic demand imposed by in place shallow water running (SWR) and to compare such responses with those obtained during treadmill running (TMR).

METHODS

Twelve males, 6 trained (T) pentathletes (age: 19+/-1 years) and 6 untrained (UT) controls (age: 22+/-1 years), performed one maximal TMR test and one SWR maximal test. Heart rate (HR) and oxygen consumption (VO(2)) were continuously measured in both test conditions.

RESULTS

In both groups, resting HR decreased immediately after water immersion (UT group: from 81.8+/-6.2 b x min(-1) to 69.2+/-6 b min(-1); T group: from 71.7+/-2.1 b x min(-1) to 61.7+/-7.7 b x min(-1)). In UT subjects SWR metabolic demand was comparable to that obtained during treadmill (VO(2tmr)=47.9 ml min(-1)+/-3.6; VO(2tmr)=45.2 ml x min(-1) +/- 6.8). In contrast, during shallow SWR, T subjects obtained lower V.O(2max) values with respect to TMR (V.O(2tmr)=68.9 mL x min(-1) +/-5.1; VO(2TMR)=57.2 mL x min(-1)+/-3.9; P<0.05). In the T group maximal HR was lower during SWR (from 191+/-8.1 to 177+/-7.1). At a given stride frequency, SWR was less demanding than treadmill in terms of V.O(2) and HR responses. During SWR the metabolic adjustments were depressed more than the cardiac adjustments.

CONCLUSION

These findings suggest that in place SWR may be a useful exercise to reduce the effects of detraining.

The Italian external quality assessment scheme in classical cytogenetics: four years of activity

BACKGROUND

The Italian external quality assessment scheme in classical cytogenetics was started in 2001 as an activity funded by the National Health System and coordinated by the Italian Public Institute of Health.

OBJECTIVES

The aim of our work is to present data from the first 4 years of activity, 2001-2004.

METHODS

Italian cytogenetics public laboratories were enrolled on a voluntary basis, and this nationwide program covered prenatal, postnatal and oncological diagnosis. The scheme is annual and retrospective; a panel of experts reviewed the quality of images and reports in order to assess technical, analytical and interpretative performance.

RESULTS

Over the 4-year period, the number of participating laboratories increased: from 36 in 2001, 46 in 2002, 49 in 2003 to 51 in 2004. The overall technical performance was satisfactory. Inadequacy or lack of information in reporting was the most frequent analytical inaccuracy identified in all parts of the scheme. However, the percentage of complete reports increased significantly during the period: by 36% in postnatal diagnosis between 2001 and 2004 (p < 0.001) and by 42% in oncological diagnosis between 2002 and 2004 (p = 0.003).

CONCLUSIONS

Our experience reveals that participation in external quality assessment programs has significant advantages, helping to standardize and to assure quality in cytogenetic testing.

Transcranial Doppler and anesthetics

Transcranial Doppler (TCD) is widely used to investigate the effects of anesthetic drugs on cerebral blood flow. Its repeatability and non-invasivity makes it an ideal, first choice method. Anesthesia providers are required to be conscious of the cerebral hemodynamic effects of drugs given in their practice, especially in neurosurgery and in subjects with impaired brain functions. The purpose of this review is to present the basic concepts of the TCD technique and the effects on cerebral hemodynamics of the most popular anesthetic drugs evaluated using TCD ultrasonography.

Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case?control study

BACKGROUND

Psoriasis is a chronic inflammatory disease associated with an increased cardiovascular risk. Metabolic syndrome is a significant predictor of cardiovascular events.

OBJECTIVE

To investigate the prevalence of metabolic syndrome in patients with psoriasis.

METHODS

We performed a hospital-based case-control study on 338 adult patients with chronic plaque psoriasis and 334 patients with skin diseases other than psoriasis.

RESULTS

Metabolic syndrome was significantly more common in psoriatic patients than in controls (30.1% vs. 20.6%, odds ratio 1.65, 95% confidence interval 1.16-2.35; P = 0.005) after the age of 40 years. Psoriatic patients also had a higher prevalence of hypertriglyceridaemia and abdominal obesity, whereas hyperglycaemia, arterial hypertension and high-density lipoprotein cholesterol plasma levels were similar. Although psoriasis patients were more frequently smokers, the association of psoriasis with metabolic syndrome was independent from smoking. There was no correlation between severity of psoriasis and prevalence of metabolic syndrome. Psoriatic patients with metabolic syndrome were older and had a longer disease duration compared with psoriatic patients without metabolic syndrome.

CONCLUSION

Psoriatic patients have a higher prevalence of metabolic syndrome, which can favour cardiovascular events. We suggest psoriatic patients should be encouraged to correct aggressively their modifiable cardiovascular risk factors.

Type 2 diabetes and metabolic syndrome are associated with increased expression of 11beta-hydroxysteroid dehydrogenase 1 in obese subjects

OBJECTIVE

The role of glucocorticoids production in adipose tissue in the development of metabolic disorders in humans has not been fully characterized. We investigated whether in obese subjects, 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) expression in subcutaneous (SAT) and visceral (VAT) adipose tissue is associated with the occurrence of metabolic disorders and the expression of adiponectin and tumor necrosis factor alpha (TNFalpha) and two glucocorticoid-regulated adipokines able to influence the metabolic control.

DESIGN AND SUBJECTS

Sixty-two obese patients were enrolled in the study. SAT and VAT samples were obtained from 13 patients undergoing bariatric surgery (body mass index (BMI) 39.1+/-5.3 kg/m(2)). SAT samples were obtained from 49 patients who underwent periumbilical biopsy (BMI 36.9+/-5.1 kg/m(2)).

MEASUREMENTS

Oral glucose tolerance tests in subjects without known diabetes. Circulating glucose, lipid, insulin, adiponectin, TNFalpha and urinary-free cortisol levels. Real-time PCR to quantify mRNA levels of 11beta-HSD1, hexose-6-phosphate dehydrogenase (H6PDH), adiponectin and TNFalpha. Western blot analysis to evaluate 11beta-HSD1 protein expression.

RESULTS

In the majority of the obese subjects, VAT expresses more 11beta-HSD1 than SAT. VAT 11beta-HSD1 expression was not associated with metabolic disorders. SAT 11beta-HSD1 mRNA levels were higher in subjects with than in those without metabolic syndrome (P<0.05) and in patients with type 2 diabetes compared to patients with impaired or normal glucose tolerance (P<0.0001). SAT 11beta-HSD1 expression was independently related to fasting glucose (P<0.0001) and urinary-free cortisol levels (P<0.01), and increased expression of 11beta-HSD1 was associated with increased adiponectin and TNFalpha expression and decreased serum adiponectin levels (all P's <0.05).

CONCLUSIONS

In obese subjects, increased 11beta-HSD1 expression in SAT, but not in VAT, is associated with the worsening of metabolic conditions. We hypothesize that higher glucocorticoid production in adipose tissue would favor the development of metabolic disorders through a decrease in adiponectin release.

Altered expression of urokinase-type plasminogen activator and plasminogen activator inhibitor in high-risk soft tissue sarcomas

In recent years, classification of soft-tissue sarcomas (STS) has improved with cytogenetic analyses, but their clinical behavior is still not easily predictable. The aim of this study was to detect alterations in the urokinase-type plasminogen system, involved in tumor growth and invasion, by comparing mRNA levels of its components with those of paired normal tissues, and relating them with patient clinical course. Real-time PCR was performed on human STS cell lines and tissues from highly malignant STS, including leiomyosarcomas and malignant fibrous histiocytomas, to evaluate the expression of urokinase-type plasminogen activator (uPA), uPA receptor (uPAR) and plasminogen activator inhibitor-1 (PAI-1). Immunohistochemistry of gene products was also performed. Median mRNA values of all genes studied were higher in tumors than in paired normal tissues. In agreement with data on STS cell lines, significant up-regulation for uPA and PAI-1 genes compared to reference values was seen. Moreover, different levels of expression were related to histotype and metastatic phenotype. There was accordance between uPA mRNA and protein expression, while immunodetection of PAI-1 product was weak and scattered. Clearly, the controversial role of PAI-1 protein requires further biological analyses, but evident involvement of uPA/PAI-1 gene overexpression in STS malignancy may highlight a molecular defect useful in discriminating STS high-risk patients.

Identification of latex UDP glucose pyrophosphorylase (Hev b UDPGP) as a novel cause of latex fruit allergy syndrome

Based on a recently published unusual ase of food allergy in a latex-allergic patients, the present study identifies Hev b UDPGP as a novel allergen in natural rubber latex able to cause latex-fruit allergy syndrome and as a novel, potential pan-allergen in vegetable foods.

Relationship between physical activity and cardiovascular disease. Selected historical highlights

The full awareness that physical exercise represents a form of prevention and therapy for cardiovascular diseases is rather recent, considering that the discovery of blood circulation dates back to the 17th century and that the definition of major cardiovascular risk factors is an acquisition of the 20th century. In this paper a historical review has been undertaken so as to evidence major selected highlights of cardiovascular knowledge applied to physical activity from antiquity to the present day. Despite of the fact that the role of physical activity for the sake of a good body equilibrium is an ancient concept, as documented by the recurrent term ''exercise'' in the works of Hippocrates, only about 70 years have passed from the time when, in the '30s, myocardial infarction patients were strictly advised to observe a period of bed rest of at least 6 weeks; less than a century has passed since the so-called ''chair therapy'' constituted the cornerstone of the therapy of the cardiovascular patient. In the '40s and the '50s a certain amount of attentive mobilization proved to be beneficial, given that it was associated with a remarkable reduction of thromboembolic risk. In the '70s an increasing amount of clinical literature documented that even healthy subjects, remaining in bed for a long period, showed relatively rapidly signs of de-conditioning. In 1973 Kavanagh et al. demonstrated that the patients included in cardiac rehabilitation showed an improvement in their physical work capacity, an increase in their global cardiovascular function and went back more quickly and safely to their work environment, as compared with cardiac patients not performing rehabilitative physical exercise. The studies performed in the '70s provided the bases of modern cardiovascular rehabilitation, a multidimensional and integrated approach, one of whose pillars is structured physical activity.

Value of image fusion in the staging of prostatic carcinoma

PURPOSE

We assessed the value of image fusion in the staging of prostatic cancer in a series of 32 patients who underwent preoperative evaluation with transrectal colour-Doppler ultrasonography (TRUS) and magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Colour-Doppler TRUS exams were performed using a 7.5-MHz biplanar probe. MRI exams were done with a scanner operating at 1.5 Tesla (T) using an endorectal coil. All patients underwent radical prostatectomy within 2 weeks from the imaging assessment. Whole-mount sections were prepared from the surgical specimens and were subsequently digitised by using a high-resolution scanner. The Digital Imaging and Communications in Medicine (DICOM) TRUS and MR images as well as the digitised pathological images were transferred to a graphic workstation to perform image fusion.

RESULTS

Image fusion was technically possible in 25/32 cases in which axial TRUS images were available. The following fusion images were obtained: TRUS + pathological sections; MRI + pathological sections; TRUS + MRI + pathological sections. The final pathological staging concerning the T status was: four pT2b, fourteen pT2c, three pT3a and four pT3b. The three types of image fusion led to the following results: TRUS + pathological sections, correct staging in 20/25 cases (accuracy 80%); MRI + pathological sections, correct staging in 22/25 cases (accuracy 88%); TRUS + MRI + pathological sections, correct staging in 23/25 cases (accuracy 92%).

CONCLUSIONS

Our study suggests that by using image fusion between colour-Doppler TRUS and endorectal MRI, it is possible to improve the accuracy of pathological staging in patients who are candidates for radical prostatectomy.

The concept of normality through history: a didactic review of features related to philosophy, statistics and medicine

Normality characterises in medicine any possible qualitative or quantitative situation whose absence implies an illness or a state of abnormality. The illness concept was first a philosophical one. But the use of mathematics in the study of biological events, which began with Galton (1822-1911) and with Pearson (1857-1936), changed the frame of reference. In the second part of the 19th century mathematics was used to study the distribution of some biological characteristics in the evolution of the species. Around 1900, statistics became the basis for the study of the diffusion of the illnesses. Half a century later statistics made possible the transition from the description of single cases to groups of cases. Even more important is the concept of "normality" in laboratory medicine. In this field the search for the "perfect norm" was, and possibly still is, under way. The widespread use of statistics in the laboratory has allowed the definition, in a certain sense, of a new normality. This is the reason why the term "reference value" has been introduced. However, even the introduction of this new term has merely shifted the problem, and not resolved it.

Cerebral haemodynamic changes during propofol-remifentanil or sevoflurane anaesthesia: transcranial Doppler study under bispectral index monitoring

BACKGROUND

Sevoflurane or propofol-remifentanil-based anaesthetic regimens represent modern techniques for neurosurgical anaesthesia. Nevertheless, there are potential differences related to their activity on the cerebrovascular system. The magnitude of such difference is not completely known.

METHODS

In total 40 patients, treated for spinal or maxillo-facial disorders, were randomly allocated to either i.v. propofol-remifentanil or inhalational sevoflurane anaesthesia. Transcranial Doppler was used to assess changes in cerebral blood flow velocity, carbon dioxide reactivity, cerebral autoregulation and the bispectral index to assess the depth of anaesthesia.

RESULTS

Time-averaged mean flow velocity (MFV) was significantly reduced after induction of anaesthesia in both sevoflurane and propofol-remifentanil groups (P<0.001). At deeper levels of anaesthesia, MFV increased in the sevoflurane group, suggesting an uncoupling flow/metabolism, whereas it was further reduced in the propofol-remifentanil group (P<0.001). Indices of cerebral autoregulation were reduced in patients with high-dose sevoflurane whereas autoregulation was preserved in patients anaesthetized with propofol-remifentanil (P<0.001). Higher CO(2) concentrations impaired cerebral autoregulation in the sevoflurane group but not in patients anaesthetized with propofol-remifentanil.

CONCLUSIONS

Propofol-remifentanil anaesthesia induced a dose-dependent low-flow state with preserved cerebral autoregulation, whereas sevoflurane at high doses provided a certain degree of luxury perfusion.

The concept of "context" in health care: historical perspective and current views

The concept of "Context" presents various aspects ranging from the emotive to the cognitive, from the structural and organisational to the methodological, from the social to the educational, and therefore merits consideration. Furthermore, the influence of the health context on clinical outcomes has recently had a rebound of attention in biomedical literature, given that the ability of clinicians to modify their professional practice is considered to be strongly influenced by the organisational and managerial milieu of their work. In the past attention was largely focussed on the ability of the environment to modify the health status of individuals and so to cause, or con-cause, diseases. There was instead a relative lack of interest in the influence of the health context on health operators, and, more importantly, in its effect on the relationship between patients and health operators and, in turn, of this latter relationship on clinical outcomes. This interest has recently been investigated and research has provided preliminary evidence that physicians adopting a friendly and reassuring approach are more effective than those who keep visits and counselling at a formal level. An awareness that many features of the concept of context in health care have been relatively little studied should address future research to clarifying scientifically the global role of context in health. The promising findings of the studies available, such as those here illustrated, point to the fact that valid research would be both feasible and effective.

The recent Italian Consolidation Act on privacy: new measures for data protection

In the light of the new Consolidation Act on privacy, in effect since January 2004, the author has made some observations in relation to the protection of data concerning health. Special focus has been given to an overall view of the new regulations. "Sensitive data" are seen as differing from health data, while always respecting the rights, the fundamental freedom and the dignity of the person involved. A central role continues to be played by the Controller, who has regulating and control powers.

Past and present of ''what will please the lord'': an updated history of the concept of placebo

In ecclesiastic tradition the term ''Placebo'' indicated the promise to please the Lord in medieval prayer. The expression ''Placebo Domino'' (''I shall please the Lord'') constituted the beginning of a famous passage of a V century A.D. translation of the Bible. It was in the second half of the XVIII century that the word Placebo became an integral part of the medical-pharmacological vocabulary, and in fact Quincy's Lexicon (1787) defined it as a remedy used more to please than to heal people. For centuries placebos have been considered precious deceptive therapies and, until 1945, they were generally considered to be morally useful management tools. At the end of World War II it was clear that a critical evaluation of the function of placebos was needed to shed some light on their real role. Following this methodological call, in the years following different studies on placebos were proposed, and in 1955 HK Beecher published in the JAMA a paper, ''The Powerful Placebo'', in which he concluded that it was evident that placebos had a high degree of therapeutic effectiveness. Recent evidence points to the fact that, on the contrary, placebos do not have major clinical effects and that the limits of their application should be fully acknowledged.

Medically-assisted procreation in Italy

In February 2004, a law was approved in Italy on medically assisted procreation. The authors attempt to discuss the main provisions of the law. In its 18 articles, the law provides access to approved assisted procreation methods for adult couples of different sex, either married or cohabiting, of a potentially fertile age, both living, and establishes that the couple must be offered the chance of reverting to adoption or foster care procedures pursuant to the law in force. The law contains numerous prohibitions and restrictions: heterologous insemination, cloning, the cryo-preservation of embryos and research on human embryos are forbidden; during an assisted reproduction cycle, the methods used must not produce a number of embryos greater than those strictly necessary for a single and simultaneous implant, and in any case never more than three. The law calls for the woman and her husband or partner to be properly informed and for their approval to be given in writing. Fairly severe sanctions have been established for persons who break the law; health workers are however entitled to object on conscientious grounds to performing certain procedures.

Mild Wolf-Hirschhorn phenotype and partial GH deficiency in a patient with a 4p terminal deletion

Wolf-Hirschhorn syndrome (WHS) is caused by a variably-sized deletion of chromosome 4 involving band 4p16 whose typical craniofacial features are "Greek warrior helmet appearance" of the nose, microcephaly, and prominent glabella. Almost all patients show mental retardation and pre- and post-natal growth delay. Patient was born at term, after a pregnancy characterized by intra-uterine growth retardation (IUGR). Delivery was uneventful. Developmental delay was evident since the first months of life. At 2 years, he developed generalized tonic-clonic seizures. Because of short stature, low growth velocity and delayed bone age, at 4 years he underwent growth hormone (GH) evaluation. Peak GH after two provocative tests revealed a partial GH deficiency. Clinical observation at 7 years disclosed a distinctive facial appearance, with microcephaly, prominent eyes, and beaked nose. Brain MRI showed left temporal mesial sclerosis. GTG banded karyotype was normal. Because of mental retardation, subtelomeric fluorescence in situ hybridization (FISH) analysis was performed, disclosing a relatively large deletion involving 4p16.2 --> pter (about 4.5 Mb), in the proband, not present in the parents. The smallest deletion detected in a WHS patient thus far includes two candidate genes, WHSC1 and WHSC2. Interestingly, that patient did not show shortness of stature, and that could be due to the haploinsufficiency of other genes localized in the flanking regions. Contribution of GH alterations and possible GH therapy should be further considered in WHS patients.