Multiple beneficial effects of 1-year nutritional-behavioral intervention on anthropometric and metabolic parameters in overweight and obese boys

PURPOSE

Childhood obesity is on the rise worldwide increasing the risk for metabolic, cardiovascular and liver diseases in children. Eating habits and lifestyle changes are currently the standard of care for treating pediatric obesity. Our study aimed to determine the impact of a dietary intervention based on the Mediterranean Diet (MD) and the Health Eating Plate, on anthropometric and metabolic parameters in obese and overweight boys.

METHODS

We studied 126 overweight/obese boys with anthropometric measurements, blood biochemistry and nutrient intakes evaluation by means of Food Frequency Questionnaire (FFQ) at baseline, at 6 and 12 months after a nutritional-behavioral intervention.

RESULTS

We observed a significant reduction in energy, macronutrients and micronutrients intakes. BMI-SDS significantly decreased after 1 year with the proportion of obese boys decreasing by 33% and of overweight boys by 41%, while also all fat mass measures decreased both in obese and overweight individuals. In obese boys, ALT decreased significantly after 1-year nutritional intervention and these changes correlated with BMI-SDS reduction. Insulin-resistance and secretion indexes correlated with fat mass and BMI-SDS. In obese boys, significant changes were observed at 6 months for insulin concentrations, 1/HOMA-IR and QUICKI. With regard to the lipid profile, significant decreases were observed for total and LDL cholesterol in obese boys.

CONCLUSION

Metabolic and anthropometric risk factors in overweight and obese boys can be improved by a nutritional-behavioral intervention of 1-year duration.

Stroke and the need for immediate assistance at the place of onset: the future of mandatory training for lay people in Italy

Introduction

Lay training is essential to manage emergencies properly, although patients or bystanders need increased recognition of medical urgencies such as strokes. In Italy, as defined by Legislative Decree 81/08, all companies must train employees responsible for correctly recognizing and managing medical emergencies. Our study aims to evaluate the characteristics of medical emergencies concerning patients with a possible stroke in the Lombardy Region.

Methods

A retrospective observational study was conducted. All missions performed by Regional Agency for Emergencies and Urgencies (Agenzia Regionale Emergenza Urgenza - AREU) in which the patient presented a possible stroke, recorded in the SAS-Areu database, were analyzed. The study period was from January 1, 2019, to December 31, 2019.

Results

10,201 patients with possible stroke were rescued, of whom only 540 (5.3%) occurred in workplaces. In workplaces, the percentage of males with a possible stroke was higher (62.2% vs 45.2%; p<0.01) and the mean age of rescued patients was lower (64.7 vs 77.5; p<0.01).

Conclusions

A stroke occurs less frequently in the workplace, while most events occur at home. Man-datory training on early stroke recognition should be extended to schools and conveyed through a media information campaign. Lay training is the first point in the chain of survival; redefining training is critical for the future.

Discoid lupus erythematosus of the vulva

Genital involvement is a rare manifestation in discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE), and there are few reports on vulvar clinical features. We describe a 41-year old Caucasian woman with bilateral vulvar DLE. Although vulvar lesions in lupus are probably more common than is realized, the present report is the first case of genital DLE documented in a female.

Basal cell carcinoma of the vulva

Basal cell carcinoma (BCC), the most common human malignancy, accounting for 75% of all non-melanoma skin cancer, is uncommon on unexposed skin such as the perianal and genital regions. We describe a woman with BCC of the vulva treated with local resection. All margins of excision were free of disease. The patient recovered without complication and there have been no recurrences after 2 years of follow-up. Approximately 200 cases of BCC on perianal and genital skin have been reported in the literature. Although the aetiology of vulvar BCC is not known, early diagnosis is important. Because BCC in these sites sometimes seems innocuous, biopsy of all suspect lesions is advisable.

Malignant hypercalcemia in vulvar cancer

Humoral hypercalcemia of malignancy (HHM) is a common paraneoplastic syndrome, most often associated with squamous cell carcinoma of the lung, esophagus, kidneys and breast, but rarely with vulval cancer. In most patients, HHM is associated with over-production of a peptide analogue of parathormone (parathyroid hormone-related protein, PTHrP). The case of a 70-year-old patient with massive squamous cell epithelioma of the vulva complicated by HHM is reported. To our knowledge, this is the first documented case with high serum concentrations of PTHrP and immunohistochemical confirmation of PTHrP production by neoplastic cells.

Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience

BACKGROUND

Ingrowing toenails are a common problem causing significant morbidity. Many of the procedures used for treating this painful condition cause considerable discomfort and have high failure rates. In recent years, phenol cauterization of the nail bed has been used increasingly.

METHODS

A retrospective study was carried out of all patients treated by this method in the authors' clinic during the period January 1996 to December 2001. In this study, phenol cauterization is the standard form of treatment and 948 phenol cauterizations were carried out in 764 patients.

RESULTS

There was no significant morbidity and the procedure was tolerated well by all patients. Overall recurrence was 4.3% (33 patients) after 18 months. All symptomatic recurrences were successfully treated by repeating phenol cauterization.

CONCLUSIONS

Phenol cauterization compares favourably with other surgical ablation techniques for ingrowing toenails and may be the ablation procedure of choice of an ingrowing toenail.

Evaluation of biocompatibility of metallic dental materials in cell culture model

Biocompatibility of metals for dental use was tested using a three-dimensional model consisting of oral keratinocytes cultured on de-epidermised sub-mucosa. The toxicity of orthodontic metallic wire and soldering material was assessed through parameters such as the morphology and growth rate of the keratinocytes, as well as by classical histology, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The sharp composition of metallic wires and soldering materials was assessed by Auger Electron Spectroscopy (AES). The results of our experiment showed that the new model revealed inhibition of keratinocyte growth and stratification near soldering material, whereas mucosal cells were able to grow and layer out on dental wire. It is concluded that this experimental model, which simulates the oral environment, is useful for studying the effects of materials for dental use for its sensibility and reproducibility. Moreover it can provide morpho-functional information which cannot be achieved by traditional methods.

An evaluation of Hyalofill-F plus compression bandaging in the treatment of chronic venous ulcers

OBJECTIVE

Hyaluronan, a component of the extracellular matrix, plays a significant role in several aspects of tissue repair and the wound healing process.

METHOD

In this Italian study Hyalofill-F, a partial benzyl ester derivative of hyaluronan, used in combination with compression bandaging, was compared with the well-established therapy in Italy of non-adherent gauze plus compression therapy in the treatment of chronic venous leg ulcers.

RESULTS

Hyalofill-F plus compression bandaging performed significantly better than non-adherent gauze plus compression bandage in all of the clinically relevant efficacy parameters. Mean reduction in ulcer area in the hyaluronan-derivative group was 8.1 cm2 after eight weeks of treatment, compared with 0.4 cm2 in the comparator group. The resulting difference of 7.7 cm2 between the two groups was statistically significant (p = 0.0019). Furthermore, statistically significant results in favour of the hyaluronan-derivative group were obtained in the following: speed of epithelialisation; leveling of the margins; degree of maceration; pain intensity and frequency.

CONCLUSION

Hyalofill-F plus compression bandaging resulted in an earlier and greater decrease in ulcer area compared with non-adherent gauze plus compression bandaging, therapy supporting its use in the treatment of chronic venous ulcers.

Stimulatory effect of PG-KII, an NK3 tachykinin receptor agonist, on isolated pancreatic acini: species-related differences

More information is needed on the physiological role of the tachykinins (TKs), especially neurokinin3-receptor (NK3) agonists, in the pancreas. In this paper we investigated and compared the effect of PG-KII (10(-9) to 10(-6) M), a natural NK3-receptor agonist, with that of the known secretagogues substance P (10(-9) to 10(-6)M), caerulein (10(-11) to 10(-8) M) and carbachol (10(-8) to 10(-5) M), on amylase secretion from dispersed pancreatic acini of the guinea pig and rat. PG-KII (10(-7) M) significantly increased basal amylase release from guinea pig pancreatic acini (from 5.4+/-0.9% to 11.3+/-0.5%, P < 0.05) but left basal release in the rat unchanged (6.5+/-0.5%). The stimulant effect of PG-KII on guinea pig acini was significantly reduced by the NK3-receptor antagonist, SR 142801 (5 x 10(-7) M), and left unchanged by the NK1-receptor antagonist, SR 140333 (5 x 10(-7) M). Conversely, substance P (10(-7) M) significantly stimulated amylase secretion from rat and guinea pig acini (12.6+/-0.6% and 12.1+/-0.7%, P < 0.05). This stimulated effect of substance P was antagonized by the NK1--receptor antagonist (5 x 10(-7) M), but not by the NK3-receptor antagonist (5 x 10(-7) M). The PG-KII- and substance P-evoked maximal responses were lower than those evoked by caerulein (10(-9) M) (guinea pig, 19.1+/-1.3%; rat, 1802+/-0.9%, P < 0.01) and carbachol (10(-5) M) (guinea pig, 23.3+/-1.2%; rat, 24.0+/-1.1%, P < 0.01). The inhibitors of phospholipase C U-73122 (10(-5) M), phospholipase A2 quinacrine (10(-5)M), and protein tyrosine kinase genistein (10(-4) M), partly but significantly inhibited PG-KII, as well as carbachol-stimulated amylase release. Coincubation of PG-KII 10(-7) M with submaximal doses of caerulein (10(-11) to 10(-10) M) and carbachol (10(-7) to 10(-6) M) had an additive effect on amylase release. Pre-incubation with PG-KII (10(-7) M) for 30 min significantly reduced the subsequent amylase response to PG-KII, whereas pre-incubation with caerulein 10(-10) M or carbachol 10(-6) M did not. These findings suggest that PG-KII directly contributes to pancreatic exocrine secretion by interacting with acinar NK3 receptors of the guinea pig but not of the rat. PG-KII signal transduction involves the intracellular phospholipase C, phospholipase A2 and protein tyrosine kinase pathways. The NK3 receptor system cooperates with the other known secretagogues in regulating guinea pig exocrine pancreatic secretion and undergoes rapid homologous desensitization.

A new surgical approach for the treatment of severe epithelial skin sun-induced damage

BACKGROUND

Cutaneous photoageing is a complex biological process affecting all layers of the skin. Skin damage resulting from intrinsic ageing and extrinsic photoageing may trigger skin cancer. In patients with advanced photoageing and/or diffuse actinic damage, local therapy is often inadequate and the possibility of combined therapy needs to be assessed.

SUBJECTS

Here we report three cases of patients over 75 years of age with advanced diffuse epithelial skin damage of photoexposed areas consisting of several superficial actinic keratoses, ipermelanotic lesions and multiple skin cancers.

METHODS

Neoplastic lesions and damaged skin were removed by superficial erbium laser ablation and the epidermis reconstructed with autologous epidermal sheets expanded in vitro from healthy cells obtained from unexposed areas of the body.

RESULTS

Our initial studies show that this procedure is very effective in the short term for treating and preventing the UV-induced skin cancer and precancerous lesions, and also suggest good long-term control of the disease with very interesting aesthetic results.

Vulvar Paget disease. Two cases with cytokeratin 7 and 20 expression

Two cases of vulvar Paget's disease are described in two women aged 75 and 60 years, with onset several years earlier as eczema-like manifestations, and evolving into erosive, slightly infiltrative lesions. In both cases immunohistochemical examination revealed positivity for cytokeratins CK7 and CK20. This finding suggested the diagnosis of primitive vulvar Paget's disease, a relatively benign form, unlike the aggressive and rapidly progressive secondary vulvar Paget's disease.

Rothmund-Thomson syndrome (Thomson-type) and myelodysplasia

Rothmund-Thomson syndrome (RTS) is a genetic disease characterized by developmental abnormalities and poikilodermatous skin changes that appear in infancy. An association with myelodysplastic syndromes is rarely reported in RTS, even though impairment of immune function and recurrent infections are described in the literature. A case of Thomson-type RTS in a 14-year-old girl with trilinear myelodysplasia is presented. The patient was kept under hematologic surveillance for myelodysplastic syndrome. Bone marrow transplantation was considered unnecessary at present.

Intraoperative skin expansion in emergency repair of the scalp

We report the case of a road accident victim who sustained fracture of the frontal bone and extensive skin loss. Immediate repair of the skin breach was necessary to protect the set bone fragments. Intraoperative skin expansion provided an immediate gain in tissue and avoided the waiting period required with traditional expansion methods. Besides an excellent immediate functional result, acceptable aesthetic results, confirmed 6 months later, were also obtained.

A new model for studying differentiation and growth of epidermal cultures on hyaluronan-based carrier

Here, a three-dimensional model based on fragments of human de-epidermized dermis (DED) is prepared in order to study the performance of a microperforated, hyaluronan-based membrane as a carrier of cultured epidermal cells. Hyaluronic acid is, in fact, considered to be an optimal biomaterial allowing proliferation of both keratinocytes and melanocytes, and it is already used for clinical aims. The carrier with subconfluent human epidermal cultures is positioned onto the DED and kept in culture until a new epidermis is formed. This model system allowed to study the migration and growth of human epidermal cells from the carrier, resembling 'in vivo' re-epithelization.

A new model of epidermal culture for the surgical treatment of vitiligo

BACKGROUND

Vitiligo can be successfully treated with grafts of autologous cultured epidermal cells.

OBJECTIVE

To evaluate the efficacy of autologous grafting of epidermal cells, cultured by an original method, in the treatment of localized vitiligo refractory to other therapies.

METHODS

Autologous normally pigmented skin was used to culture keratinocytes and melanocytes on a supporting layer of biomaterial (Laserskin), which was grafted directly onto achromatic skin after de-epithelialization with liquid carbon dioxide. The percentage area of repigmentation was calculated by image analysis.

RESULTS

Initial repigmentation of the treated areas was observed 1 month after treatment. Repigmentation continued to increase for 3 months after grafting. Follow-up at 3, 6, 12, and 18 months showed almost complete repigmentation in six out of 11 cases. In four other patients, 40-71% of the grafted achromatic area was repigmented. In one patient, repigmentation was impeded by sepsis.

CONCLUSIONS

The method was found to be effective in the treatment of localized vitiligo refractory to other treatments. The therapeutic procedure was simple, reproducible, and easy to use.

Increased burn patient survival with once-a-day high dose teicoplanin and netilmicin. An Italian multicenter study

This is the final report of a large, controlled, multicenter Italian study on immuno- and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treatment of burn patients consisted of topical silver sulfadiazine, short-term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) for the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles of 5-12 days. At random, half of the patients received thymostimulin, 70 mg i.m. qd for the first month and every other day thereafter. The analysis at completion of 634 valid cases showed that when the results are stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in the first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived. There was no difference in survival of the immunotherapy group in comparison with the parallel group without thymostimulin. The short-term antimicrobial prophylaxis prevented wound infection in only 104 of 634 patients (16%) and they were at low risk (84% Roi index 1). Of the bacterial pathogens involved in septic complications Staphylococcus aureus and Pseudomonas aeruginosa were prevalent (86%): eradication was achieved in 43% of patients and clinical cure or improvement were seen with combination chemotherapy in 64% of all patients, mainly with only one treatment cycle. This value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of complier and non-complier patients was 447 of the 530 valid patients (84%). The overall mortality of the 634 evaluable patients was 13.1%, ranging from less than 2% to 68%. Burn mortality was directly proportional to the percentage of burned body surface area, to increasing age and other variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.

Does immunoglobulin interfere with the immunogenicity to Pasteur Mérieux inactivated hepatitis A vaccine?

BACKGROUND/AIMS

The aim of this study was to compare the immunogenicity of Pasteur Mérieux (P.M. s.v.) inactivated hepatitis A vaccine when given alone with its immunogenicity when given in combination with immunoglobulin.

METHODS

We enrolled 80 healthy volunteers who were seronegative for anti-HAV. Forty subjects (group A) were given two doses of vaccine at 0 and 6 months plus 4 ml of immunoglobulin given simultaneously with the first vaccine injection; and 40 subjects (group B) were given vaccine alone. The population characteristics (age, sex, height and weight) of the two groups were comparable.

RESULTS

Anti-HAV antibody was detectable at week 1 in 100% of group A and in 5.7% of group B, and in 100% of both groups at 4 and 8 weeks. Seroconversion rates (> or = 20 mIU/ml) were 97.4% in group A and 100% in group B at week 24 and were 100% in both groups 4 weeks after a booster injection at 6 months. The antibody response level was lower after concomitant administration of vaccine with immunoglobulin. The antibody geometric mean titer was higher at week 1 in subjects who had been given vaccine and immunoglobulin, but nearly 50% lower at week 4 and thereafter, indicating inhibition of the vaccine-induced immune response by immunoglobulin. At week 28, i.e. 4 weeks after the booster injection, geometric mean titers had increased about 13-15 times in both groups, reaching highly protective antibody levels (3351 mIU/ml in group A and 5843 mIU/ml in group B). No serious adverse effects were observed during the follow-up.

CONCLUSIONS

These data indicate that P.M. s.v. hepatitis A vaccine is highly immunogenic and safe, even when given simultaneously with immunoglobulin. Despite the interference of the immunoglobulin with the active immune response, individuals who were immunized passively plus actively also developed high titers of anti-HAV antibody. It is therefore reasonable to expect that this inhibition will not affect the overall protection conferred by the vaccine.

Immune response to a booster dose of enhanced potency inactivated polio vaccine administered in association with HBV vaccine in adolescents

The immunogenicity and reactogenicity of a booster dose of enhanced potency inactivated polio vaccine (EIPV) were evaluated in 492 healthy 12 year old adolescents. The booster was administered at the same time as the HBV vaccine compulsory in Italy at this age. Blood samples and questionnaires on reactogenicity were collected over 9 months. Analysis of pre-vaccination immunity showed that 97.4% of the subjects were protected against all polio types, 1.9% were negative for two polio types and 0.6% for one. After vaccination 98.4% of the vaccinees showed a significant increase ( > or = 4 times) of antibody titre; the geometric mean titres (GMT) were markedly higher than before vaccination, particularly for poliovirus type 3. The polio booster dose did not affect HBV vaccination. An anti-HBs response > 10 mIU ml-1. (GMT = 2951 mIU ml-1) was observed in 781 (98.6%) of 792 vaccinees (492 given EIPV+HBV and 300 given only HBV) 9 months later. Only mild local and rare general reactions were noted for both the vaccines studied. These data confirm the suitability and efficacy of an EIPV booster dose and HBV vaccination in adolescents.

A seroepidemiologic survey of immunity against poliomyelitis in a group of HIV positive and HIV negative drug addicts

In a seroepidemiological study performed to investigate immunity against poliomyelitis in a population of drug addicts in a rehabilitative residential centre we demonstrated a widespread lack of poliovirus neutralizing antibodies. This was more evident in the HIV positive subjects, 27% of whom were seronegative for poliovirus type 1, 27% for type 2 and 34% for type 3, with 11% seronegative for all three types. These results indicate a gap in immunity to poliomyelitis in the examined population.

Decline in anti-HAV prevalence in the Milan area between 1958 and 1992

We have compared the prevalence of antibody to HAV in sera collected from healthy individuals of Milan in 1958, 1977 and 1992 respectively. The results show a dramatic reduction of HAV circulation likely due to the considerable improvement of socioeconomic and hygienic living conditions which have occurred in Italy during the last decades.

Reproducibility of FCM-DNA ploidy analysis in prostatic cancer: comparison between needle biopsy and surgical specimens

Cytofluorometric analysis of FCM-DNA ploidy also seems to have prognostic value in prostatic carcinoma. Determination of the DNA index preoperatively from needle biopsy samples would be advantageous since it would enable the type of intervention to be established in advance. The finding of intratumoural variability in the DNA index in different solid tumours prompted us to compare the data obtained from needle biopsy and surgical specimens of prostatic cancer. Although the results obtained confirmed the heterogeneity of DNA content in prostatic carcinoma, they nonetheless indicate that preoperative DNA analysis is useful, in particular when aneuploidy is observed, since it provides the clinician with additional information on which to base treatment decisions.