Effects of repeated administration of Levosimendan in advanced heart failure in the elderly patient

Introduction

Advanced heart failure (AHF) is characterized by repeated episodes of hemodynamic instability, frequent hospitalizations with progressive reduction in quality of life. The aim of the study was to verify in a small group of patients, no longer susceptible to heart transplantation (HT) and left ventricular assistance (LVAD), the effectiveness of monthly treatment with Levosimendan for a period of at least 6 months on quality of life and hospitalization.

Materials and methods

29 elderly patients (≥65 years) with AHF, excluded from the waiting list for HT or no longer eligible for inclusion on the waiting list were enrolled. 12 patients practiced at least 1 infusion of Levosimendan and were considered as cases, while 17 patients with maximized treatment were used as controls. All patients underwent a multidimensional evaluation in which Fraity was assessed according to Fried criteria, cognitive function with Mini-Mental State Examination (MMSE), depressive symptoms with Geriatric Depression Scale (GDS).

Results

The 29 patients were followed up monthly and the 12 patients of Levosimendan group practiced an average of 4.6±2.7 infusions in absence of adverse events. The mean age was 73.3±6.2, 87.5% males, with a NYHA class of 3.4±0.4, an ejection fraction of 26.6±4.9 and NT-pro-BNP value of 7016.8±4876.1. Renal function was impaired with eGFR (ml / min) = 36.8±20.1. These patients had been hospitalized 1.8±0.7 times in the previous year. The data are not statistically different compared to the control group although a greater severity of the clinical condition of the case group is evident. The 6 minute walking test (6MWT) was 201.4±118.1 meters. The mean values of Frailty was 4.6±0.5, the GDS 6.4±4.2 and the MMSE 23.8±4.3. Only the MMSE was lower in the case group than in the controls (26.9±1.9, p=0.022). The results in terms of pre-post treatment difference identify an improvement of 35.3±136.3 meters at 6MWT in patients treated with Levosimendan compared to −72.2±94.2 meters in controls (p=0.030), Frailty is reduced by 1.4±1.6 points compared to 0.1±1.1 in controls (p=0.030), the GDS decreases by 0.9±1.5 in cases and increases by 2±2.1 in the control group (p=0.020), the MMSE score increases by 2.12±4.1 in treated patients, while it is reduced by 2.75±2.3 in the control group; p=0.003. The eGFR is reduced in both groups although more in the controls (−1.87±5.8 vs −10.8±11.1; p=0.043). There are no significant differences in mortality while there was less hospitalization during the follow-up period 0.9±0.6 vs 2.4±1.5; p=0.016). Multiple regression analysis shows that hospitalizations reduction is correlated with the recovery of frailty. This association is independent by age and disease severity.

Conclusion

Levosimendan improves physical and cognitive function, at the same time a minor decrease in renal function is observed, with a reduction of unscheduled visits to the hospital.

Funding Acknowledgement

Type of funding sources: None.

Coupled temperature and γ-radiation effect on silica-based optical fiber strain sensors based on Rayleigh and Brillouin scatterings

Coupled temperature and γ-ray influence on Brillouin (PPP-BOTDA) and Rayleigh (TW-COTDR) scatterings are quantified. Aging tests of these distributed strain measuring systems are performed on-line, up to 1 MGy, at room temperature, 80  ^∘C, 100  ^∘C and 120  ^∘C. Brillouin and Rayleigh frequency shifts remain identical regardless of the temperature: 3 MHz (2 MHz) and 7 GHz (3 GHz) for Ge-doped (respectively F-doped) fiber at 1 MGy. Meanwhile, radiation-induced attenuation is diminished because of the higher temperature; hence, the maximal distance range is less deteriorated. These tests help to explain the origin of the Brillouin frequency shift under γ-rays, with an acoustic velocity variation of about 1 m/s in 1 MGy irradiated samples.

Spotlight on brodalumab in the treatment of plaque psoriasis: the evidence to date

The IL-17/IL-23 axis is now understood to influence psoriasis, and the development of novel IL-17 inhibitor medications marks a sea change in the treatment of psoriasis. Brodalumab is a recombinant, fully human immunoglobulin IgG2 monoclonal antibody specifically targeted against IL-17RA. This article discusses the mechanism of action and the efficacy and safety profile of brodalumab presented in the literature. Brodalumab, the latest approved anti-IL-17-class medication, is the only one that exerts its effects on IL-17C as well as on IL-17A and IL-17F, blocking the shared IL-17 receptor A. In this sense, considering the recent evidence, brodalumab could have beneficial effects not only on psoriasis, but also on atopic dermatitis. It could also serve as a therapeutic alternative in patients who develop paradoxical eczematous reactions or atopic-like dermatitis during treatment with other anti-IL-17A (secukinumab, ixekizumab).

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/XdU4cyB54FY

Bioactivity of humic substances and water extracts from compost made by ligno-cellulose wastes from biorefinery

The ligno-cellulose residues from biorefinery production of bio-ethanol were used as woody structuring material within an on-farm composting system, with the aim to obtain bioactive water soluble and humic fractions from composted materials. The molecular characterization of initial biomasses and final products revealed a transformation towards more stable compounds during composting and showed the selective incorporation of specific phenolic derivatives of ligno-cellulose in both bulk samples and corresponding extracts. While the use of the stable bulk composts as organic fertilizer resulted in a decrease of nitrogen and phosphorous assimilation in maize tissues, a bio-stimulation was shown by water soluble organic compounds and humic substances in germination tests and pot experiments, respectively. The differential responses obtained in maize seedlings and plants were related to the molecular composition and concentration of the applied water extracts and humic substances, thus suggesting a role of phenols and lignin derivatives in the stimulation of maize roots and shoots and the enhancement of P uptake. The results confirm that ligno-cellulose residues may be effectively recycled as composting additives in order to enrich mature compost in aromatic and lignin compounds. A preliminary knowledge on the molecular characteristics and biological properties of composted materials is an essential requirement to select the most suitable derivatives from composted ligno-cellulose wastes in sustainable agricultural practices.

Is bupropion useful in the treatment of post-stroke thalamic apathy? A case report and considerations

Post-stroke apathy is considered to be one of the clinical consequences of lesions affecting the structures of the prefrontal cortex, basal ganglia, thalamus and limbic system. However, there is no current consensus on the treatment of post-stroke apathy, which mainly depends on the underlying etiology and comorbidities. A 62-year-old man, affected by hemorrhagic stroke in the left thalamus, presented with mood depression, anhedonia, hyporexia and marked apathy. The patient underwent clinical evaluation before and after receiving two different pharmacological therapies: escitalopram and bupropion. Only after treatment with the latter drug did the patient show changes: high motivation and willingness to pursue activities, greater interest in the external environment and social life activities, and an overall reduction of apathy. On the basis of our observations in this case, we hypothesize that the thalamic lesion resulted in disconnection of the fronto-striatal-thalamic circuits, and that loss of the dopaminergic striatal innervation caused the patient's apathetic state. The resolution of the apathetic disorder may be attributable to the action of the dopaminergic drug bupropion on the mesocortical pathway.

Dog allergy: can a prevalent or exclusive sensitization to Can f 5 be considered a lucky or negative event in real life?

Summary

Recent studies have shown the increasing relevance of allergic sensitization to Can f 5 (a prostatic kallikrein), which is an androgen-regulated protein expressed in the prostate and detectable only in male dogs. Can f 5 can be a prevalent or exclusive sensitizing agent in a considerable percentage of dog-allergic patients. Its specific allergenic characteristics are able to induce possible negative as well as positive clinical effects in individuals sensitized to dogs. In the present article we pointed out the possible pros or cons of sensitization to this allergen in real life. Further studies should be carried out to correctly assess some peculiar characteristics of Can f 5, in order to support the most of positive aspects and remedy at best the negative effects.

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

OBJECTIVES

To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD).

DESIGN

Observational, prospective, cohort study.

SETTING

ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy).

PARTICIPANTS

We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD.

MAIN OUTCOME MEASURE

All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed.

RESULTS

No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage.

CONCLUSIONS

Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.

Plant tolerance to mercury in a contaminated soil is enhanced by the combined effects of humic matter addition and inoculation with arbuscular mycorrhizal fungi

In a greenhouse pot experiment, lettuce plants (Lactuca sativa L.) were grown in a Hg-contaminated sandy soil with and without inoculation with arbuscular mycorrhizal fungi (AMF) (a commercial inoculum containing infective propagules of Rhizophagus irregularis and Funneliformis mosseae) amended with different rates of a humic acid (0, 1, and 2 g kg(-1) of soil), with the objective of verifying the synergistic effects of the two soil treatments on the Hg tolerance of lettuce plants. Our results indicated that the plant biomass was significantly increased by the combined effect of AMF and humic acid treatments. Addition of humic matter to soil boosted the AMF effect on improving the nutritional plant status, enhancing the pigment content in plant leaves, and inhibiting both Hg uptake and Hg translocation from the roots to the shoots. This was attributed not only to the Hg immobilization by stable complexes with HA and with extraradical mycorrhizal mycelium in soil and root surfaces but also to an improved mineral nutrition promoted by AMF. This work indicates that the combined use of AMF and humic acids may become a useful practice in Hg-contaminated soils to reduce Hg toxicity to crops.

Sensitization to Common and Uncommon Pets or Other Furry Animals: Which May Be Common Mechanisms?

Exposure to animal allergens constitutes a relevant risk factor for the development of allergic sensitization. Moreover, an increasing number of people become owners of less common animals. In this article we summarize aspects related to sensitization to cat/dog which may be applied also to uncommon pets or other furry animals. The data discussed here suggest that several different factors may induce allergic sensitization to furry animals with or without previous contact. Allergic sensitization without animal exposure is a relevant risk for patients because they are not aware about the possibility that even severe respiratory symptoms may develop after an occasional animal contact. This aspect should be taken into account by susceptible individuals before acquiring pets or beginning a contact for working/leisure activity with a common as well as uncommon animal. As a consequence, skin prick test and/or evaluation of specific IgE antibodies (by classic ImmunoCAP or micro-array technique ImmunoCAP ISAC) also to less common ("new") mammalian allergens could be recommended in individuals already sensitized to common pets to identify the occurrence of allergic sensitization and consequently to avoid future exposures to uncommon animal allergens.

Can the presence of cat/dog at home be considered the only criterion of exposure to cat/dog allergens? A likely underestimated bias in clinical practice and in large epidemiological studies

An important aspect of allergic sensitization to furry animals is the association of dog and cat exposure in early childhood with the incidence of respective allergies later in life. This topic is very controversial, because some authors have found a "facilitating" effect, while others have noticed a "protective" or even no significant effect in individuals living in urban areas. It is likely that some biases could be responsible of these contradictory findings. Cat/dog ownership or their presence in indoor environments are considered usually the main criteria to assess the exposure to these pets in studies' questionnaires. Even in clinical practice "are there animals at home?" is the common query usually done when collecting anamnestic data. In our opinion, these commonly used questions should not be considered the main index of exposure to pet allergens, because they can lead to erroneous interpretation of the clinical significance of positive skin prick tests for pet allergens as well as of the real risk of exposure to allergens of dog/cat in epidemiological studies. Consequently, we suggest a new, more realistic, classification of modalities of exposure to pet allergens in "real life" based on five possible conditions.

What could be the role of molecular-based allergy diagnostics in detecting the risk of developing allergic sensitization to furry animals?

Although this highly refined diagnostic approach has been used in several fields of allergy diagnosis, we noticed the scarcity of data on the role of CDR in detecting current sensitization to the allergens of common pets (cat / dog) and, especially, its potential usefulness in predicting the risk of sensitization to other furry animals. Reported data suggest that cross-reacting mechanisms might play an important role in a significant proportion of allergic sensitizations to furry animals (common pets and unusual / exotic mammals) especially in the absence of any possible direct / indirect contact. In this context an evaluation of specific IgE by using the micro-array technique ImmunoCAP ISAC (Thermofisher Scientific - Immuno-Diagnostics, Sweden) for lipocalins (Can f 1, Can f 2, Equ c 1, Fel d 4, Mus m 1) and albumins (Bos d 6, Can f 3, Equ c 3, Fel d 2) might be very useful to evaluate the possibility of cross-reactions between the allergens of different animals. In fact, allergic sensitization without animal exposure is a relevant risk for patients, because they are not aware about the possibility that even severe respiratory symptoms may develop after an occasional animal contact. This aspect should be taken into account by susceptible individuals before acquiring new pets, after removal of common pets or beginning a contact for working / leisure activity with a common as well as uncommon animal.

Characterization of typical aquatic humic substances in areas of sugarcane cultivation in Brazil using tetramethylammonium hydroxide thermochemolysis

Aquatic humic substances (AHSs) differ from one environment to another depending on land use and occupation. In addition, the effects of planting sugarcane on AHSs are not well known. Thus, the aim of this study was to characterize AHSs extracted from a river in a typical region of sugarcane cultivation during dry and rainy seasons. The main characteristics of the AHSs were obtained using Fourier transformation infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR) spectroscopy and off-line pyrolysis coupled with gas chromatography and mass spectrometry (off-line tetramethylammonium hydroxide (TMAH)-GC-MS-thermochemolysis). The FTIR and NMR results were used to infer that no distinctions occurred between the sampling periods. The samples were composed of aromatic groups that were potentially associated with the presence of residual vegetable materials (lignin). The results of the off-line TMAH-GC-MS-thermochemolysis indicated that the structures of the AHSs had uniform compositions that were rich in fatty acid methyl esters (FAMEs), polysaccharide derivatives, aliphatic biopolymers derived from plants, long hydrocarbon chains, branched alkyl groups and methylene carbons. Thus, the results showed that the AHSs obtained from the sugarcane cultivation area during the crop period mainly consisted of resistant aliphatic hydrocarbons, which are derivatives of lignin and FAMEs in compounds rich in humic acid. Therefore, we concluded that sugarcane cultivation produces changes in AHSs because greater amounts of lignin derivatives were observed during the dry season, corresponding to sugarcane cultivation.

Molecular characterization of an end-residue of humeomics applied to a soil humic acid

Humeomics encompasses step-wise chemical fractionation and instrumental determination to fully characterize the heterogeneous molecular composition of natural organic matter.

Sensitization to cockroach allergens in the urban atopic populations living in Campania district (southern Italy). A multicenter study

BACKGROUND

Although cockroach (CR) is an important cause of allergic sensitization worldwide, only a few data are available in Italy and in a previous study we have observed, in Naples area, a low prevalence of CR sensitization.

OBJECTIVES

We sought to perform a prospective study for assessing the prevalence of allergic sensitization to CR in a sample of atopic population living in Campania district area (Southern Italy).

METHODS

Ten Allergy Units or Centres of Campania district participated in this cross-sectional study. Each centre was required to collect the results of at least 100 allergy consultations in consecutive outpatients referred for actual or suspected respiratory allergy. We registered demographic data, type and duration of respiratory symptoms, pets ownership, possible exposure to CR allergens, results of the skin prick tests (SPTs).

RESULTS

A total of 1477 patients were examined, 985 (66.68%) had a SPTs positivity to at least one allergen. In this context, ninety were sensitized to CR, thus the overall sensitization prevalence in subjects with respiratory allergy was 6.09% ranging between 0-11% and only five patients were mono-sensitized. Thirteen patients reported rhinitis (R) + bronchial asthma (A), twenty-one R + A + conjunctivitis (C), thirty-seven R + C, five only A and eleven individuals only R. Sixty-seven patients exhibited persistent and twenty-three intermittent symptoms. Dust mite constituted the first cause of associated sensitization to CR.

CONCLUSIONS

The prevalence of allergic sensitization to CR is not negligible in population living in Campania district and shows a higher trend in comparison to that found recently and some years ago in Naples area. Finally, we suggest atopic individuals and especially those highly sensitized to mite allergens or those living in low-income areas to be tested by SPTs / evaluation of serum specific IgE to CR allergens to exclude the occurrence of CR allergic sensitization.

Stabilization by hydrophobic protection as a molecular mechanism for organic carbon sequestration in maize-amended rice paddy soils

The hydrophobic components of soil organic matter (SOM) are reckoned to play an important role in the stabilization of soil organic carbon (SOC). The contribution of hydrophobic substances to SOC sequestration was evaluated in four different paddy soils in the South of China, following a 6-month incubation experiment with maize straw amendments. Soil samples included: a well developed paddy soil (TP) derived from clayey lacustrine deposits in the Tai Lake plain of Jiangsu; an acid clayey paddy soil (RP) derived from red earth in the rolling red soil area of Jiangxi; a weakly developed neutral paddy soil (PP) formed on Jurassic purple shale from Chongq; and a calcic Fluvisol (MS) derived from riverine sediments from a wetland along the Yangtze valley of Anhui, China. The SOC molecular composition after 30 and 180 days of incubation, was determined by off-line thermochemolysis followed by gas chromatography-mass spectrometry analysis. Lignin, lipids and carbohydrates were the predominant thermochemolysis products released from the treated soils. A selective preservation of hydrophobic OM, including lignin and lipids, was shown in maize amended soils with prolonged incubation. The decomposition of lignin and lipids was significantly slower in the TP and RP soils characterized by a larger content of extractable iron oxyhydrates (Fed) and lower pH. The overall increase in hydrophobic substances in maize incubated samples was correlated, positively, with total content of clay and Fed, and, negatively, with soil pH. Moreover, yields of both lignin and lipid components showed a significant relationship with SOC increase after incubation. These findings showed that the larger the lipid and lignin content of SOM, the greater was the stability of SOC, thereby suggesting that OM hydrophobic components may have an essential role in controlling the processes of OC sequestration in paddy soils of South China.

Molecular properties of a fermented manure preparation used as field spray in biodynamic agriculture

Manure products fermented underground in cow horns and commonly used as field spray (preparation 500) in the biodynamic farming system, were characterized for molecular composition by solid-state nuclear magnetic resonance [(13) C cross-polarization magic-angle-spinning NMR ((13) C-CPMAS-NMR)] spectroscopy and offline tetramethylammonium hydroxide thermochemolysis gas chromatography-mass spectrometry. Both thermochemolysis and NMR spectroscopy revealed a complex molecular structure, with lignin aromatic derivatives, polysaccharides, and alkyl compounds as the predominant components. CPMAS-NMR spectra of biodynamic preparations showed a carbon distribution with an overall low hydrophobic character and significant contribution of lignocellulosic derivatives. The results of thermochemolysis confirmed the characteristic highlighted by NMR spectroscopy, revealing a molecular composition based on alkyl components of plant and microbial origin and the stable incorporation of lignin derivatives. The presence of biolabile components and of undecomposed lignin compounds in the preparation 500 should be accounted to its particularly slow maturation process, as compared to common composting procedures. Our results provide, for the first time, a scientific characterization of an essential product in biodynamic agriculture, and show that biodynamic products appear to be enriched of biolabile components and, therefore, potentially conducive to plant growth stimulation.

Sensitization to rodents (mouse/rat) in an urban atopic population without occupational exposure living in Naples, Italy

BACKGROUND

Until now no data on allergic sensitization to rodents allergens in Western Europe and Italy are available. The aim of this report was to investigate clinical significance and characteristics of IgE-mediated sensitization to mouse/rat (M/Rt) allergens in atopic subjects not occupationally exposed to these animals and living in urban area of Naples.

METHODS

In 1765 consecutive outpatients, we selected all subjects with an immediate skin reaction to M/WRt dander clinical history including a carefijul evaluation ofthe modality of exposure, the results of skin-prick tests (SPTs) and specific IgE antibodies were recorded.

RESULTS

Among 1185 SPT-positive patients, 22 were sensitized to M/Rt dander (respectively 1.60% and 0.59%). No patient was mono-sensitized Only three of 22 patients reported indoor conditions suggesting presence of rodents allergens at home. All patients exhibited low degree of SPT positivity and low levels of circulating IgE antibodies to M/WRt. Highfrequency of concomitant allergic sensitization to pet (and other animal) dander has been found.

CONCLUSIONS

Our results suggest that role of allergic sensitization to rodents is negligible in atopic subjects without occupational exposure living in urban area of Naples. However, highly atopic individuals especially those already sensitized to common pet dander should be tested by SPTs/evaluation of serum specific IgE to rodents in the case they could begin an occupational exposure to M/Rt or keeping these animals as pets.

Is there any relationship between allergic sensitization to milk and animal allergens in atopic adults?

No data on the relationship between allergic sensitization to animal dander and milk allergens are available in literature in adults. Considering the high rate of allergic sensitization to mammals in atopic adults living in Naples area, we aimed to evaluate if sensitization to milk allergens could be a risk factor for these subjects. From 755 consecutive outpatients examined between May 1 2009 and December 31 2010, we selected those with an immediate skin reaction to animal dander and milk. A clinical history including evaluation of pet exposure, the results of skin-prick tests (SPTs) and specific IgE antibodies for milk allergens were recorded. Among three hundred sixty SPT-positive patients, 140 were sensitized to animal dander (38.9%) and 9 to milk allergens (6.4%). Among one hundred forty patients sensitized to animals only one was sensitized also to milk allergens; among 9 milk-sensitized individuals 5 were allergic also to animal allergens (only one to cow dander) while 4 were not sensitized to mammals. Our results suggest that relationship between allergic sensitization to milk and animal allergens is negligible in adult atopic individuals living in urban area of Naples and that high rate of sensitization to animals is likely to be due to other mechanisms such as direct/indirect exposure, and allergen cross-reactions.

Is sensitization to furry animals an independent allergic phenotype in nonoccupationally exposed individuals?

BACKGROUND

Patients sensitized to common pets (cat, dog) frequently display an immunoglobulin (Ig) E-mediated response to allergens from other animals.

OBJECTIVE

To evaluate whether individuals sensitized to common pets might be at higher risk of developing allergic sensitization to other mammalian allergens.

METHODS

The study population comprised 900 consecutive patients (300 individuals sensitized to different allergens including those of cat and dog [group AL, 300 sensitized to allergens other than those derived from cat and dog [group B], and 300 nonsensitized individuals [group C, controls]). All patients underwent a physical examination, an interview (clinical history, pet ownership, possible exposure data), and skin prick test (SPT) with a standard panel of allergens including cat, dog, horse, rabbit, rat, mouse, guinea pig, hamster, and cow.

RESULTS

A significant difference in allergic sensitization to mammalian allergens was observed in groupA compared with group B (respectively, 244 vs. 17). No sensitization was found in group C.

CONCLUSION

Since sensitization to pet allergens increases the risk of developing allergy to other furry animals, we suggest performing SPTs with several mammalian allergens to identify allergic sensitization and thus prevent future exposure in individuals who are highly sensitized and environmentally exposed to common pets.

The risk of bronchospasm in asthmatics undergoing general anaesthesia and/or intravascular administration of radiographic contrast media. physiopatology and clinical/functional evaluation

It is well known that patients suffering from bronchial asthma undergoing to surgical procedures requiring general anaesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) experience a risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted on the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. The aim of this review is to underline the need for an accurate clinical and functional evaluation of asthmatics (especially those with a relevant degree of asthma severity) undergoing GA or administration of RCM. Guidelines shared by pulmonologists, allergologists, anesthesiologists and radiologists should be produced in the future for a better evaluation and management of these patients. General practitioner plays an important role in managing asthmatic patients in "Real Life". It is likely that "Real Life"--optimally controlled asthmatics could undergo GA/RCM with lower risks especially in emergency conditions when it is not possible to perform any preoperative evaluation.

Severe respiratory syndrome induced by allergic mono-sensitization to European hamster (Cricetus cricetus) in a older woman

Although the increase in the rate of hamster ownership, no report of allergic sensitization to common hamster (Cricetus cricetus)-derived allergens as a consequence of domestic exposure has been published in Italy. A 64-year-old woman was referred to our Allergy Centre for the recent onset of conjunctival and severe respiratory symptoms (rhinitis, cough, wheezing and dyspnea). About three months ago she had purchased a common hamster as home pet. Another hamster had lived at patient's home for about four months nine years ago. The results of SPT revealed allergic sensitization to Cricetus cricetus dander only (wheal 6x7 mm, positive control 7x7 mm). Total IgE were 59.3 kU/L. Specific IgE only to Cricetus cricetus epithelia (2.10 kUA/L), were also detected. Spirometry revealed a moderate degree of bronchial obstruction. Some important considerations can be drawn from our report: a) few months of hamster ownership are probably sufficient to induce an allergic sensitization and clinical symptoms, b) older age of sensitization in comparison to other studies, c) rapid remission of clinical symptoms after the removal of hamster d) skin prick tests and/or evaluation of specific IgE for hamster allergens should be performed in all potentially susceptible individuals.

Rabbit allergens: a significant risk for allergic sensitization in subjects without occupational exposure

BACKGROUND

Although rabbits are becoming popular as pets, data about the characteristics of allergic sensitization to rabbit allergens in patients without professional exposure are scarce.

AIMS OF THE STUDY

To determine the characteristics of allergic sensitization to pet rabbits, and the role of direct and indirect exposure to rabbits and rabbit allergens in non-professionally exposed patients.

METHODS

From among 1124 consecutive outpatients, we selected all subjects with an immediate skin reaction to rabbit dander. A clinical history including a careful evaluation of the modality of rabbit exposure, the results of skin-prick tests (SPTs) and total/specific IgE antibodies were recorded. The prevalence of rabbit ownership in the Naples area was also calculated.

RESULTS

Among 753 SPT-positive patients, 20 (2.65%) were sensitized to rabbit dander (5 patients were mono-sensitized). Fifteen patients reported direct rabbit contact (7 were rabbit owners and 8 had occasional contact outside the home); 3 patients had indirect exposure through contact with rabbit owners and 2 patients denied any direct or indirect exposure. Rabbit mono-sensitized owners of pet rabbits had persistent (moderate-severe) symptoms. The prevalence of rabbit ownership is 1.56%.

CONCLUSIONS

In susceptible not professionally exposed individuals, direct rabbit contact and, in some cases, indirect or no apparent exposure, may induce allergic sensitization to rabbit allergens. A progressive increase in rabbit sensitization (also by indirect exposure) may be expected as a consequence of the increase in rabbit ownership.

O-Alkylation of a lignite humic acid by phase-transfer catalysis

A mild phase-transfer catalytic reaction has been conducted to O-alkylate the acidic functions of a lignite humic acid (HA), using tetrabutylammonium hydroxide as the phase-transfer catalyst. The HA acidic functional groups were made to react, in tetrahydrofuran, by nucleophilic substitution with several alkyl halides-methyl iodide, and ethyl, propyl, and butyl, and benzyl bromide. The occurrence of the O-alkylation reaction was assessed by elemental analysis and 1H NMR, CPMAS 13C NMR, and FTIR spectroscopy. Bonding of alkyl groups increased the carbon and hydrogen content and the H/C ratios of all the humic reaction products. Increased nitrogen in the reaction products suggested incomplete removal of the phase-transfer catalyst after purification of the alkylated HA. 1H NMR and CPMAS 13C NMR spectra of alkylated products provided evidence of the successful occurrence of the alkylation reactions. Infrared spectra confirmed the NMR results, revealing the characteristic absorption of newly formed alkyl and aryl ethers and esters in the alkylated products and C-H stretching in the aromatic ring of the benzylated derivative. These findings indicate that humic matter can be successfully alkylated with several different alkylating groups by catalysed phase-transfer reaction. This O-alkylation reaction has the advantage of being mild, versatile, and high-yielding compared with traditional methylation reactions applied to HA. The possibility of introducing different alkyl groups into the HA by a mild phase-transfer reaction may become useful by enabling improved fractionation of humic supramolecular associations and further understanding of the molecular nature of humic substances.

Systemic reactions from skin testing: literature review

The skin prick test (SPT) is the most appropriate diagnostic approach to identify IgE sensitization to aeroallergens, foods, hymenoptera venom and some pharmacological compounds. SPT is considered a safe diagnostic approach, but several fatal or near-fatal reactions have been described. Based on the literature, the occurrence of systemic reactions with inhalant allergens has diminished over the last thirty years, whereas fresh food, hymenoptera venom and antibiotic SPT still carry some risk. In general, the risk of systemic reactions is lower with SPT than with intradermal testing. Some patients (history of previous anaphylactic reactions, small children, pregnant women, uncontrolled asthma, high degree of reactivity) should be considered at higher risk of systemic/anaphylactic reactions. Based on the literature, the risk of fatality due to SPT is extremely remote, and severe/anaphylactic reactions are rare. Nevertheless, this risk cannot be completely excluded, especially in highly susceptible subjects. Physicians who perform SPT should be aware of this and apply simple precautional rules.

Direct and prolonged exposure to dogs does not influence the degree of skin prick test positivity to dog allergen

BACKGROUND

The relationship between pet ownership and the risk of developing allergic sensitization to pet allergens is still controversial. We assessed the possible effect of direct exposure to dog allergen on skin reactivity in dog-sensitized patients.

METHODS

We studied, in a case-control trial, 116 adults sensitized to dog allergens (55 with a dog at home for at least 10 years and 61 without it). The degree of response was assessed by skin prick test, performed in quadruplicate with three concentrations of allergenic extract: A (1:20 w/v), B (1:200 w/v) and C (1:2000 w/v). The mean diameter of each wheal was assessed using a visilog image analysis software.

RESULTS

No significant difference between the two groups in the wheal diameters induced by the three concentrations of dog allergen could be demonstrated.

CONCLUSION

The results of this study suggest that direct dog exposure in adults with respiratory allergy is not associated with greater cutaneous response to dog allergens, as compared to non exposed subjects.

Electrospray ionization mass spectrometry of terrestrial humic substances and their size fractions

Electrospray ionization mass spectrometry (ESI-MS) was used to evaluate the average molecular mass of terrestrial humic substances, such as humic (HA) and fulvic (FA) acids from a soil, and humic acid from a lignite (NDL). Their ESI mass spectra, by direct infusion, gave average molecular masses comparable to those previously obtained for aquatic humic materials. The soil HA and FA were further separated in size-fractions by preparative high performance size exclusion chromatography (HPSEC) and analyzed with ESI-MS by both direct infusion and a further on-line analytical HPSEC. Unexpectedly, their average molecular mass was only slightly less than for the bulk sample and, despite different nominal molecular size, did not substantially vary among size-fractions. The values increased significantly (up to around 1200 Da) after on-line analytical HPSEC for the HA bulk sample, at both pH 8 and 4, and for the HA size-fractions when pH was reduced from 8 to 4. It was noticed that HA size-fractions at pH 8 were separated by on-line HPSEC in further peaks showing average masses which progressively increased with elution volume. Furthermore, when the HA and NDL bulk samples were sequentially ultracentrifuged at increasing rotational speed, their supernatants showed mass values which were larger than bulk samples and increased with rotational speed. These variations in mass values indicate that the electrospray ionization is dependent on the composition of the humic molecular mixtures and increases when their heterogeneity is progressively reduced. It is suggested that the dominance of hydrophobic compounds in humic supramolecular associations may inhibit the electrospray ionization of hydrophilic components. Our results show that ESI-MS is reasonably applicable to humic substances only after an extensive reduction of their chemical complexity.

Potential availability of heavy metals to phytoextraction from contaminated soils induced by exogenous humic substances

Effective phytoremediation of soils contaminated by heavy metals depends on their availability to plant uptake that, in turn, may be influenced by either the existing soil humus or an exogenous humic matter. We amended an organic and a mineral soil with an exogenous humic acid (HA) in order to enhance the soil organic carbon (SOC) content by 1% and 2%. The treated soils were further enriched with heavy metals (Cu, Pb, Cd, Zn, Ni) to a concentration of 0, 10, 20, and 40 microg/g for each metal and allowed to age at room temperature for 1 and 2 months. After each period, they were extracted for readily soluble and exchangeable (2.5% acetic acid), plant-available (DTPA, Diethylentriaminepentaacetic acid), and occluded (1 N HNO(3)) metal species. Addition of HA generally reduced the extractability of the soluble and exchangeable forms of metals. This effect was directly related to the amount of added HA and increased with ageing time. Conversely, the potentially plant-available metals extracted with DTPA were generally larger with increasing additions of exogenous HA solutions. This was attributed to the formation of metal-humic complexes, which ensured a temporary bioavailability of metals and prevented their rapid transformation into insoluble species. Extractions with 1 N HNO(3) further indicated that the added metals were present in complexes with HA. The observed effects appeared to also depend on the amount of native SOC and its structural changes with ageing. The results suggest that soil amendments with exogenous humic matter may accelerate the phytoremediation of heavy metals from contaminated soil, while concomitantly prevent their environmental mobility.

Asthma treatment must be always tailored to the individual patient

Several studies have shown that there are notable benefits in adding a long acting beta 2-agonist to an inhaled corticosteroid. Particularly, long acting beta 2-agonists allow to reduce the amount of steroid that is required to induce a specific response and, consequently, its possible side effects. Currently the pharmaceutical market promotes, and physicians tend in any case to privilege, the use of fixed combinations for the treatment of the asthmatic patient and this also in the first phases of the illness. Nevertheless, for the majority of patients with mild to moderate asthma, it seems more reasonable to optimize the dose of the inhaled steroid before considering the addition of a long-acting beta 2-agonist, and use this latter on an 'as needed' basis if its pharmacodynamic characteristics allow it. Use of combinations is the more reasonable therapeutic choice for patients with a more severe pathological picture, who, despite the optimized dosage of the inhaled glucocorticoid, also require a long acting beta 2-agonist. After having verified the stability of the clinical control, it is possible to continue with the combined therapy provided, however, that this allows the treatment of the patient with the lowest dose of corticosteroid able to prevent, as far as is possible, exacerbations. Asthma exacerbations are less frequent with this therapy, but when they appear it is necessary to be immediately able to increase and, sometimes, also maximize the dosage of corticosteroid without being forced to double, or even triple, the dose of the long acting beta 2-agonist unless there is a real need--and which probably, rather, would induce unwanted side effects.

Elemental quantitation of natural organic matter by CPMAS 13C NMR spectroscopy

Cross-polarized magic-angle-spinning NMR (CPMAS-NMR) techniques are assumed to be only semi-quantitative in the assessment of carbon distribution in humic substances or natural organic matter, due to a number of interferences such as spinning side bands (SSB) in spectra, paramagnetic species in samples, and low or remote protonation of aromatic carbons. Fast rotor spin rates or direct polarization NMR techniques are normally applied to improve quantitative signal detectability. Variable contact time pulse sequences were used here to obtain CPMAS-NMR spectra of organic compounds of known structure and different humic substances. Integration of spectral areas, previously subtracted of SSB, and relative stoichiometric factors were used for mathematical elaboration to calculate the elemental content in samples. These values did not significantly differ from those obtained by direct determination of elemental content with quantitative elemental analysis. Our results showed that the carbon observed CPMAS-NMR provides a quantitative representation of the whole carbon content in humic substances.

Deep venous thrombosis in patients undergoing salvage radical cystectomy

OBJECTIVE

The possible occurrence of venous thrombosis in tumor-bearing patients had already been reported by Trousseau in the past century. The blood clotting alterations in cancer-bearing patients can cause Deep Venous Thrombosis (DVT), especially in those patients with disseminated metastases. Anti-tumor chemotherapy can increase the risk of thrombosis. Herein we report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumors.

METHODS

We have retrospectively analyzed the records of patients with infiltrating bladder tumors who underwent salvage radical cystectomy.

RESULTS

We observed the highest incidence of DVT (33.3%; 3 out of 9) in those patients with a higher risk due to anesthesia and an absolute need for extensive surgery. One of our patients died of pulmonary embolism.

CONCLUSION

The diagnosis of DVT and Pulmonary Embolism is not always easy to achieve and all possible tests must be performed whenever possible (e.g. clinical examination, hematological test, etc.).

Increased retention of polycyclic aromatic hydrocarbons in soils induced by soil treatment with humic substances

The analytical recovery of a mixture of polycyclic aromatic hydrocarbons (PAHs) was determined from a soil before and after oxidation with hydrogen peroxide, and subsequently treated with increasing amounts of an exogenous humic acid and subjected to different incubation periods. The release of PAHs from soil depended on the specific structure and physico-chemical properties of each PAH, and increased with additions of exogenous humic materials for both the oxidized and non-oxidized soil as well as with time of PAH permanence in soil. PAH recoveries were lower in the non-oxidized soil, thereby revealing the importance of native organic matter in increasing PAH retention in soils. This study shows that mobility of PAHs in soils can be controlled by soil conditioning with humic substances.

Combined effects of an oxidative enzyme and dissolved humic substances on 13C-labelled 2,4-D herbicide as revealed by high-resolution 13C NMR spectroscopy

Phenoxyalkanoic acids are a widely used class of herbicides. This work employed high-resolution 13C NMR to study the structural changes induced by humic substances and horseradish perodixase on 2,4-dichlorophenoxyacetic acid (2,4-D) 13C-labelled in the side chain. NMR spectra showed that humic substances chemically catalyze abiotic splitting of [13C]2,4-D into 2,4-dichlorophenol and [13C]acetic acid at pH 7 but not at pH 4.7. Peroxidase did not catalyze the oxidative degradation of [13C]2,4-D at any pH tested and inhibited the effect of humic substances. Catalytic degradation by humic substances was attributed to free-radical reactions enhanced by the stereochemical contribution of large conformational structures formed by heterogeneous humic molecules at neutral pH. Inhibition of 2,4-D degradation when humic substances were combined with peroxidase was explained by modification of both chemical and conformational humic structure due to peroxidase-promoted oxidative cross-coupling among humic molecules. Our findings show for the first time that the abiotic degradation of 2,4-D is catalyzed by dissolved humic substances at neutral pH.

Polymerization of humic substances by an enzyme-catalyzed oxidative coupling

A novel understanding of the structural features of humic substances supports the self-assembly supramolecular association of relatively small molecules rather than their polymeric nature. An increase in the conformational stability of humus may thus be achieved through promotion of intermolecular covalent bondings between heterogeneous humic molecules by an enzyme-catalyzed oxidative reaction. We present evidence from high performance size exclusion chromatography (HPSEC) and diffuse reflectance infrared spectrometry (DRIFT) that oxidation of a humic material catalyzed by horseradish peroxidase stabilizes the humic structure by the formation of aryl and alkyl ethers and permanently enhances its molecular size.