Transition from Hashimoto thyroiditis to Graves's Disease: an unpredictable change?

PURPOSE

Hashimoto thyroiditis and Graves's disease are two related autoimmune disorders, representing the leading causes of hypothyroidism and hyperthyroidism. Autoimmune hypothyroidism is generally irreversible but very rarely, some patients would shift to hyperthyroidism. The aim of the study was to seek for possible clinical predictors of the transition from hypo to hyperthyroidism in patients with Hashimoto thyroiditis and to outline their clinical phenotype.

METHODS

Twelve patients with overt autoimmune hypothyroidism who had at least one transition from hypothyroidism to autoimmune hyperthyroidism were compared with 294 consecutive patients with autoimmune hypothyroidism and 69 consecutive patients with autoimmune hyperthyroidism that accessed the outpatient clinic over six months. Demographic, hormonal data and autoantibodies titers were compared.

RESULTS

Prevalence of smoking habit was significantly higher in switchers compared to controls. Switchers showed a significantly higher prevalence of personal and familial history of non-thyroidal autoimmune disorders. TSH levels were significantly lower in the switcher group during the hypothyroid phase and levothyroxine dose required was lower. TSH concentrations were significantly lower while free fT4 and free fT3 values were higher in GD patients compared to switchers during the hyperthyroid phase despite comparable TRAb levels. Prevalence and type of hyperthyroid symptoms and orbitopathy were similar between switchers and GD group. Mean dose of anti-thyroid drugs was significantly higher in GD patients compared to switchers. No differences were observed in the remission rate from hyperthyroidism between the two groups, despite switchers showed a significantly lower time-to-remission.

CONCLUSIONS

Conversion of Hashimoto Thyroiditis towards Graves' disease is a rare phenomenon which can occur almost at any time after the development of autoimmune hypothyroidism. Our findings suggest active surveillance of hypothyroid patients who require frequent reduction of levothyroxine during follow up and testing for TSHR antibodies in these patients.

Hydrocarbon degradation strategy and pyoverdine production using the salt tolerant Antarctic bacterium Marinomonas sp. ef1

One of the most concerning environmental problems is represented by petroleum and its derivatives causing contamination of aquatic and underground environments. In this work, the degradation treatment of diesel using Antarctic bacteria is proposed. Marinomonas sp. ef1 is a bacterial strain isolated from a consortium associated with the Antarctic marine ciliate Euplotes focardii. Its potential in the degradation of hydrocarbons commonly present in diesel oil were studied. The bacterial growth was evaluated in culturing conditions that resembled the marine environment with 1% (v/v) of either diesel or biodiesel added; in both cases, Marinomonas sp. ef1 was able to grow. The chemical oxygen demand measured after the incubation of bacteria with diesel decreased, demonstrating the ability of bacteria to use diesel hydrocarbons as a carbon source and degrade them. The metabolic potential of Marinomonas to degrade aromatic compounds was supported by the identification in the genome of sequences encoding various enzymes involved in benzene and naphthalene degradation. Moreover, in the presence of biodiesel, a fluorescent yellow pigment was produced; this was isolated, purified and characterized by UV-vis and fluorescence spectroscopy, leading to its identification as a pyoverdine. These results suggest that Marinomonas sp. ef1 can be used in hydrocarbon bioremediation and in the transformation of these pollutants in molecules of interest.

Novel Sources of Biodiversity and Biomolecules from Bacteria Isolated from a High Middle Ages Soil Sample in Palermo (Sicily, Italy)

The urban plan of Palermo (Sicily, Italy) has evolved throughout Punic, Roman, Byzantine, Arab, and Norman ages until it stabilized within the borders that correspond to the current historic center. During the 2012 to 2013 excavation campaign, new remains of the Arab settlement, directly implanted above the structures of the Roman age, were found. The materials investigated in this study derived from the so-called Survey No 3, which consists of a rock cavity of subcylindrical shape covered with calcarenite blocks: it was probably used to dispose of garbage during the Arabic age and its content, derived from daily activities, included grape seeds, scales and bones of fish, small animal bones, and charcoals. Radiocarbon dating confirmed the medieval origin of this site. The composition of the bacterial community was characterized through a culture-dependent and a culture-independent approach. Culturable bacteria were isolated under aerobic and anaerobic conditions and the total bacterial community was characterized through metagenomic sequencing. Bacterial isolates were tested for the production of compounds with antibiotic activity: a Streptomyces strain, whose genome was sequenced, was of particular interest because of its inhibitory activity, which was due to the Type I polyketide aureothin. Moreover, all strains were tested for the production of secreted proteases, with those belonging to the genus Nocardioides having the most active enzymes. Finally, protocols commonly used for ancient DNA studies were applied to evaluate the antiquity of isolated bacterial strains. Altogether these results show how paleomicrobiology might represent an innovative and unexplored source of novel biodiversity and new biotechnological tools. IMPORTANCE One of the goals of paleomicrobiology is the characterization of the microbial community present in archaeological sites. These analyses can usually provide valuable information about past events, such as occurrence of human and animal infectious diseases, ancient human activities, and environmental changes. However, in this work, investigations about the composition of the bacterial community of an ancient soil sample (harvested in Palermo, Italy) were carried out aiming to screen ancient culturable strains with biotechnological potential, such as the ability to produce bioactive molecules and secreted hydrolytic enzymes. Besides showing the biotechnological relevance of paleomicrobiology, this work reports a case of germination of putatively ancient bacterial spores recovered from soil rather than extreme environments. Moreover, in the case of spore-forming species, these results raise questions about the accuracy of techniques usually applied to estimate antiquity of DNA, as they could lead to its underestimation.

Mimicking the last step of gene elongation: hints from the bacterial hisF gene

Gene elongation consists in an in-tandem duplication of a gene and divergence and fusion of the two copies, resulting in a gene constituted by two divergent paralogous modules. Many present-day proteins show internal repeats of amino acid sequences, generated by gene elongation events; however, gene elongation is still a poorly studied evolutionary molecular mechanism. The most documented case is that of the histidine biosynthetic genes hisA and hisF, which derive from the gene elongation of an ancestral gene half the size of the extant ones. The aim of this work was to experimentally simulate the possible last step of the gene elongation event occurred during hisF gene evolution under selective pressure conditions. Azospirillum brasilense hisF gene, carrying a single nucleotide mutation that generates a stop codon between the two halves of the gene, was used to transform the histidine-auxotrophic Escherichia coli strain FB182 (hisF892). The transformed strain was subjected to selective pressure (i.e., low concentration/absence of histidine in the growth medium) and the obtained mutants were characterized. The restoration of prototrophy was strongly dependent on the time of incubation and on the strength of the selective pressure. The mutations involved the introduced stop codon with a single base substitution and none of the mutants restored the wild-type codon. Possible correlations between the different mutations and i) E. coli codon usage, ii) three-dimensional structures of the mutated HisF proteins, and iii) growth ability of the mutants were investigated. On the contrary, when the experiment was repeated by mutating a more conserved codon, only a synonymous substitution was obtained. Thus, experiments performed in this study allowed to mimic a possible gene elongation event occurred during the evolution of hisF gene, evidencing the ability of bacterial cells to modify their genome in short times under selective conditions.

Adaptation of Commensal Escherichia coli in Tomato Fruits: Motility, Stress, Virulence

Food contamination can be a serious concern for public health because it can be related to the severe spreading of pathogens. This is a main issue, especially in the case of fresh fruits and vegetables; indeed, they have often been associated with gastrointestinal outbreak events, due to contamination with pathogenic bacteria. However, little is known about the physiological adaptation and bacterial response to stresses encountered in the host plant. Thus, this work aimed to investigate the adaptation of a commensal E. coli strain while growing in tomato pericarp. Pre-adapted and non-adapted cells were compared and used to contaminate tomatoes, demonstrating that pre-adaptation boosted cell proliferation. DNA extracted from pre-adapted and non-adapted cells was sequenced, and their methylation profiles were compared. Hence, genes involved in cell adhesion and resistance against toxic compounds were identified as genes involved in adaptation, and their expression was compared in these two experimental conditions. Finally, pre-adapted and non-adapted E. coli were tested for their ability to resist the presence of toxic compounds, demonstrating that adaptation exerted a protective effect. In conclusion, this work provides new information about the physiological adaptation of bacteria colonizing the tomato fruit pericarp.

Application of Cloning-Free Genome Engineering to Escherichia coli

The propagation of foreign DNA in Escherichia coli is central to molecular biology. Recent advances have dramatically expanded the ability to engineer (bacterial) cells; however, most of these techniques remain time-consuming. The aim of the present work was to explore the possibility to use the cloning-free genome editing (CFGE) approach, proposed by Döhlemann and coworkers (2016), for E. coli genetics, and to deepen the knowledge about the homologous recombination mechanism. The E. coli auxotrophic mutant strains FB182 (hisF892) and FB181 (hisI903) were transformed with the circularized wild-type E. coli (i) hisF gene and hisF gene fragments of decreasing length, and (ii) hisIE gene, respectively. His⁺ clones were selected based on their ability to grow in the absence of histidine, and their hisF/hisIE gene sequences were characterized. CFGE method allowed the recombination of wild-type his genes (or fragments of them) within the mutated chromosomal copy, with a different recombination frequency based on the fragment length, and the generation of clones with a variable number of in tandem his genes copies. Data obtained pave the way to further evolutionary studies concerning the homologous recombination mechanism and the fate of in tandem duplicated genes.

Distinct Clinical Features of Post-COVID-19 Vaccination Early-onset Graves' Disease

CONTEXT

Several case reports of Graves' disease (GD) occurrence after COVID-19 vaccination that are possibly related to the autoimmune syndrome induced by adjuvants (ASIA) were published recently.

OBJECTIVE

The aim of our study was to evaluate possible distinctive features in the presentation and clinical course of patients with GD occurring early (within 4 weeks) after COVID-19 vaccination who attended our Endocrine Unit in 2021.

METHODS

Patients with a first episode of GD attending a tertiary endocrine center between January 1, 2021, and December 31, 2021, were included.

RESULTS

Sixty-four patients with a first episode of GD were seen in 2021: 20 (31.2%) of them had onset within 4 weeks following vaccine administration. Compared with the other 44 patients, the 20 patients with postvaccine early-onset (PoVEO) GD were older (median age 51 years vs 35 years, P = .003) and more likely to be male (40.0% vs 13.6%, P = .018). At diagnosis, the biochemical and immune profiles were similar between the 2 groups. However, at 3 months after starting methimazole, patients with PoVEO GD had significantly lower thyrotropin receptor antibody titer and were taking lower doses of methimazole than the other patients with GD. None in the PoVEO group had sustained free triiodothyronine elevation.

CONCLUSION

This relatively large series suggests that in 2021 PoVEO GD may be a new nosologic entity representing one-third of patients evaluated for new-onset GD in our center. Distinctive features included older age at onset, higher male prevalence, and a better initial biochemical and immunologic response to treatment. Further studies are warranted to clinically and biochemically differentiate these cases from sporadically occurring GD.

Effect of Wastewater on the Composition of Bacterial Microbiota of Phragmites australis Used in Constructed Wetlands for Phytodepuration

Phytodepuration occurs in the plant-mediated remediation processes exploited to remove pollutants from wastewater, and Phragmites australis is one of the most used plants. This goal is achieved using constructed wetlands (CW), which are engineered systems designed to mimic the natural processes of pollutants removal. The aim of this work was to characterize the bacterial communities associated to P. australis, soils, and permeates of the CW of Calice (Prato, Italy), to evaluate the possible effect of wastewaters on the CW bacterial communities, through a next-generation sequencing-based approach. A total of 122 samples were collected from different tissues of P. australis (i.e., roots, aerial parts, and stem), soil (i.e., rhizospheric and bulk soil), and permeates, and analyzed. All samples were collected during five sampling campaigns, with the first one performed before the activation of the plant. Obtained results highlighted a specific microbiota of P. australis, conserved among the different plant tissues and during time, showing a lower alpha diversity than the other samples and not influenced by the more complex and variable environmental (soils and permeates) bacterial communities. These data suggest that P. australis is able to select and maintain a defined microbiota, a capacity that could allow the plant to survive in hostile environments, such as that of CW.

Unravelling the DNA sequences carried by Streptomyces coelicolor membrane vesicles

Membrane vesicles (MVs) are spherical particles with nanoscale dimensions and characterized by the presence of diverse cargos, such as nucleic acids, proteins, lipids, and cellular metabolites. Many examples of (micro)organisms producing MVs are reported in literature. Among them, bacterial MVs are of particular interest because they are now considered as the fourth mechanism of horizontal gene transfer. Streptomyces bacteria are well-known for their ecological roles and ability to synthesize bioactive compounds, with Streptomyces coelicolor being the model organism. It was previously demonstrated that it can produce distinct populations of MVs characterized by different protein and metabolite cargos. In this work we demonstrated for the first time that MVs of S. coelicolor carry both DNA and RNA and that their DNA content represents the entire chromosome of the bacterium. These findings suggest that MV DNA could have a role in the evolution of Streptomyces genomes and that MVs could be exploited in new strain engineering strategies.

Genomic Analysis of Endophytic Bacillus-Related Strains Isolated from the Medicinal Plant Origanum vulgare L. Revealed the Presence of Metabolic Pathways Involved in the Biosynthesis of Bioactive Compounds

Multidrug-resistant pathogens represent a serious threat to human health. The inefficacy of traditional antibiotic drugs could be surmounted through the exploitation of natural bioactive compounds of which medicinal plants are a great reservoir. The finding that bacteria living inside plant tissues, (i.e., the endophytic bacterial microbiome) can influence the synthesis of the aforementioned compounds leads to the necessity of unraveling the mechanisms involved in the determination of this symbiotic relationship. Here, we report the genome sequence of four endophytic bacterial strains isolated from the medicinal plant Origanum vulgare L. and able to antagonize the growth of opportunistic pathogens of cystic fibrosis patients. The in silico analysis revealed the presence of gene clusters involved in the production of antimicrobial compounds, such as paeninodin, paenilarvins, polymyxin, and paenicidin A. Endophytes’ adaptation to the plant microenvironment was evaluated through the analysis of the presence of antibiotic resistance genes in the four genomes. The diesel fuel degrading potential was also tested. Strains grew in minimum media supplemented with diesel fuel, but no n-alkanes degradation genes were found in their genomes, suggesting that diesel fuel degradation might occur through other steps involving enzymes catalyzing the oxidation of aromatic compounds.

In vivo evaluation of the interaction between the Escherichia coli IGP synthase subunits using the Bacterial Two-Hybrid system

Histidine biosynthesis is one of the most characterized metabolic routes for its antiquity and its central role in cellular metabolism; indeed, it represents a cross-road between nitrogen metabolism and de novo synthesis of purines. This interconnection is due to the activity of imidazole glycerol phosphate synthase, a heterodimeric enzyme constituted by the products of two his genes, hisH and hisF, encoding a glutamine amidotransferase and a cyclase, respectively. Despite their interaction was suggested by several in vitro experiments, their in vivo complex formation has not been demonstrated. On the contrary, the analysis of the entire Escherichia coli interactome performed using the yeast two hybrid system did not suggest the in vivo interaction of the two IGP synthase subunits. The aim of this study was to demonstrate the interaction of the two proteins using the Bacterial Adenylate Cyclase Two-Hybrid (BACTH) system. Data obtained demonstrated the in vivo interaction occurring between the proteins encoded by the E. coli hisH and hisF genes; this finding might also open the way to pharmaceutical applications through the design of selective drugs toward this enzyme.

The Histidine Biosynthetic Genes in the Superphylum Bacteroidota-Rhodothermota-Balneolota-Chlorobiota: Insights into the Evolution of Gene Structure and Organization

One of the most studied metabolic routes is the biosynthesis of histidine, especially in enterobacteria where a single compact operon composed of eight adjacent genes encodes the complete set of biosynthetic enzymes. It is still not clear how his genes were organized in the genome of the last universal common ancestor community. The aim of this work was to analyze the structure, organization, phylogenetic distribution, and degree of horizontal gene transfer (HGT) of his genes in the Bacteroidota-Rhodothermota-Balneolota-Chlorobiota superphylum, a group of phylogenetically close bacteria with different surviving strategies. The analysis of the large variety of his gene structures and organizations revealed different scenarios with genes organized in more or less compact—heterogeneous or homogeneous—operons, in suboperons, or in regulons. The organization of his genes in the extant members of the superphylum suggests that in the common ancestor of this group, genes were scattered throughout the chromosome and that different forces have driven the assembly of his genes in compact operons. Gene fusion events and/or paralog formation, HGT of single genes or entire operons between strains of the same or different taxonomic groups, and other molecular rearrangements shaped the his gene structure in this superphylum.

Antibacterial activity of bacteria isolated from Phragmites australis against multidrug-resistant human pathogens

Background: Rising number of multidrug-resistant human pathogens demands novel antibiotics: to this aim, unexplored natural sources are investigated to find new compounds. In this context, bacteria associated to medicinal plants, including Phragmites australis, might represent an important source of antimicrobial compounds. Materials & methods: In the present work, 21 bacterial endophytes isolated from P. australis roots were tested, by cross-streaking, for their inhibitory activity against 36 multidrug-resistant pathogens isolated from food, clinical patients and hospitals. Results & conclusion: Seven endophytes, belonging to Pseudomonas and Stenotrophomonas, were able to inhibit the growth of most of the target strains. In conclusion, this preliminary work could pave the way for the discovery of new antibiotics against superbugs.

Medicinal Plants and Their Bacterial Microbiota: A Review on Antimicrobial Compounds Production for Plant and Human Health

Medicinal plants (MPs) have been used since antiquity in traditional and popular medicine, and they represent a very important source of bioactive molecules, including antibiotic, antiviral, and antifungal molecules. Such compounds are often of plant origin, but in some cases, an origin or a modification from plant microbiota has been shown. Actually, the research continues to report the production of bioactive molecules by plants, but the role of plant–endophytic interaction is emerging. Classic examples are mainly concerned with fungal endophytes; however, it has been recently shown that bacterial endophytes can also play an important role in influencing the plant metabolism related to the synthesis of bioactive compounds. In spite of this, a deep investigation on the power of MP bacterial endophytes is lacking. Here, an overview of the studies on MP bacterial microbiota and its role in the production of plant antimicrobial compounds contributing to prime host defense system and representing a huge resource for biotech and therapeutic applications is provided.

Temporal Evolution of Bacterial Endophytes Associated to the Roots of Phragmites australis Exploited in Phytodepuration of Wastewater

Improvement of industrial productions through more environment-friendly processes is a hot topic. In particular, land and marine environment pollution is a main concern, considering that recalcitrant compounds can be spread and persist for a long time. In this context, an efficient and cost-effective treatment of wastewater derived from industrial applications is crucial. Phytodepuration has been considered as a possible solution and it is based on the use of plants and their associated microorganisms to remove and/or transform pollutants. In this work we investigated the culturable microbiota of Phragmites australis roots, sampled from the constructed wetlands (CWs) pilot plant in the G.I.D.A. SpA wastewater treatment plant (WWTP) of Calice (Prato, Tuscany, Italy) before and after the CW activation in order to check how the influx of wastewater might affect the resident bacterial community. P. australis specimens were sampled and a panel of 294 culturable bacteria were isolated and characterized. This allowed to identify the dynamics of the microbiota composition triggered by the presence of wastewater. 27 out of 37 bacterial genera detected were exclusively associated to wastewater, and Pseudomonas was constantly the most represented genus. Moreover, isolates were assayed for their resistance against eight different antibiotics and synthetic wastewater (SWW). Data obtained revealed the presence of resistant phenotypes, including multi-drug resistant bacteria, and a general trend regarding the temporal evolution of resistance patterns: indeed, a direct correlation linking the appearance of antibiotic- and SWW-resistance with the time of exposure to wastewater was observed. In particular, nine isolates showed an interesting behavior since their growth was positively affected by the highest concentrations of SWW. Noteworthy, this study is among the few investigating the P. australis microbiota prior to the plant activation.

Exploring the role of the histidine biosynthetic hisF gene in cellular metabolism and in the evolution of (ancestral) genes: from LUCA to the extant (micro)organisms

Histidine biosynthesis is an ancestral pathway that was assembled before the appearance of the Last Universal Common Ancestor; afterwards, it remained unaltered in all the extant histidine-synthesizing (micro)organisms. It is a metabolic cross-road interconnecting histidine biosynthesis to nitrogen metabolism and the de novo synthesis of purines. This interconnection is due to the reaction catalyzed by the products of hisH and hisF genes. The latter gene is an excellent model to study which trajectories have been followed by primordial cells to build the first metabolic routes, since its evolution is the result of different molecular rearrangement events, i.e. gene duplication, gene fusion, gene elongation, and domain shuffling. Additionally, this review summarizes data concerning the involvement of hisF and its product in other different cellular processes, revealing that HisF very likely plays a role also in cell division control and involvement in virulence and nodule development in different bacteria. From the metabolic viewpoint, these results suggest that HisF plays a central role in cellular metabolism, highlighting the interconnections of different metabolic pathways.

The Cultivable Bacterial Microbiota Associated to the Medicinal Plant Origanum vulgare L.: From Antibiotic Resistance to Growth-Inhibitory Properties

The insurgence of antibiotic resistance and emergence of multidrug-resistant (MDR) pathogens prioritize research to discover new antimicrobials. In this context, medicinal plants produce bioactive compounds of pharmacological interest: some extracts have antimicrobial properties that can contrast different pathogens. For such a purpose, Origanum vulgare L. (Lamiaceae family) is a medicinal aromatic plant, whose essential oil (EO) is recognized for its antiseptic, antimicrobial and antiviral activities. The cultivable bacteria from different compartments (i.e., flower, leaf, stem and soil) were isolated in order to: (i) characterize the bacterial microbiota associated to the plant, determining the forces responsible for the structuring of its composition (by evaluation of cross inhibition); (ii) investigate if bacterial endophytes demonstrate antimicrobial activities against human pathogens. A pool of plants belonging to O. vulgare species was collected and the specimen chemotype was defined by hydrodistillation of its essential oil. The isolation of plant associated bacteria was performed from the four compartments. Microbiota was further characterized through a culture-independent approach and next-generation sequencing analysis, as well. Isolates were molecularly typed by Random Amplified Polymorphic DNA (RAPD) profiling and taxonomically assigned by 16S rRNA gene sequencing. Antibiotic resistance profiles of isolates and pairwise cross-inhibition of isolates on agar plates (i.e., antagonistic interactions) were also assessed. High level of diversity of bacterial isolates was detected at both genus and strain level in all different compartments. Most strains were tolerant against common antibiotics; moreover, they produced antagonistic patterns of interactions mainly with strains from different compartments with respect to that of original isolation. Strains that exhibited high inhibitory properties were further tested against human pathogens, revealing a strong capacity to inhibit the growth of strains resistant to several antibiotics. In conclusion, this study regarded the characterization of O. vulgare L. chemotype and of the bacterial communities associated to this medicinal plant, also allowing the evaluation of antibiotic resistance and antagonistic interactions. This study provided the bases for further analyses on the possible involvement of endophytic bacteria in the production of antimicrobial molecules that could have an important role in clinical and therapeutic applications.

The Streptomyces coelicolor Small ORF trpM Stimulates Growth and Morphological Development and Exerts Opposite Effects on Actinorhodin and Calcium-Dependent Antibiotic Production

In actinomycetes, antibiotic production is often associated with a morpho-physiological differentiation program that is regulated by complex molecular and metabolic networks. Many aspects of these regulatory circuits have been already elucidated and many others still deserve further investigations. In this regard, the possible role of many small open reading frames (smORFs) in actinomycete morpho-physiological differentiation is still elusive. In Streptomyces coelicolor, inactivation of the smORF trpM (SCO2038) – whose product modulates L-tryptophan biosynthesis – impairs production of antibiotics and morphological differentiation. Indeed, it was demonstrated that TrpM is able to interact with PepA (SCO2179), a putative cytosol aminopeptidase playing a key role in antibiotic production and sporulation. In this work, a S. coelicolor trpM knock-in (Sco-trpMKI) mutant strain was generated by cloning trpM into overexpressing vector to further investigate the role of trpM in actinomycete growth and morpho-physiological differentiation. Results highlighted that trpM: (i) stimulates growth and actinorhodin (ACT) production; (ii) decreases calcium-dependent antibiotic (CDA) production; (iii) has no effect on undecylprodigiosin production. Metabolic pathways influenced by trpM knock-in were investigated by combining two-difference in gel electrophoresis/nanoliquid chromatography coupled to electrospray linear ion trap tandem mass spectrometry (2D-DIGE/nanoLC-ESI-LIT-MS/MS) and by LC-ESI-MS/MS procedures, respectively. These analyses demonstrated that over-expression of trpM causes an over-representation of factors involved in protein synthesis and nucleotide metabolism as well as a down-representation of proteins involved in central carbon and amino acid metabolism. At the metabolic level, this corresponded to a differential accumulation pattern of different amino acids – including aromatic ones but tryptophan – and central carbon intermediates. PepA was also down-represented in Sco-trpMKI. The latter was produced as recombinant His-tagged protein and was originally proven having the predicted aminopeptidase activity. Altogether, these results highlight the stimulatory effect of trpM in S. coelicolor growth and ACT biosynthesis, which are elicited through the modulation of various metabolic pathways and PepA representation, further confirming the complexity of regulatory networks that control antibiotic production in actinomycetes.

Cancer costs and gender: a snapshot of issues, trends, and opportunities to reduce inequities using Australia as an example

As the cancer burden increases, so too does the cost, to health systems, economies, and individuals. There is increasing interest in productivity and out-of-pocket costs for individuals and their carers, but these remain poorly understood. The costs of cancer in women, often carers themselves, are less understood. This summary analysis explored data on the cancer burden in Australia (and health costs in comparable countries), including expenditure reports and literature on macroeconomic outcomes and out-of-pocket costs, to highlight the cost impacts of a cancer diagnosis in women, at a societal and an individual level. Data on productivity costs were skewed toward men, as men are over-represented in paid work compared with women. Data on societal and individual costs of cancer in women were scant, yet the predominance of women in unpaid work suggests the cost is significant. Evidence for the benefits of cancer prevention and early detection suggests that improved targeting of interventions to women would reduce costs at a societal and an individual level. More research is needed on the specific impacts of cancer on women and those they care for, to better target public health and support services to need.

Diffusion approximations for some simple chemical reaction schemes

We shall establish functional limit laws for the concentration of the various species in simple chemical reactions. These results allow us to conclude that, under quite general conditions, the concentration has an approximate normal distribution. We provide estimates for the mean and the variance which are valid at all stages of the reaction, in particular, the non-equilibrium phase. We also provide a detailed comparison of our results with the earlier work of Dunstan and Reynolds ([7], [8]).

Correction: Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors

Correction for ‘Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors’ by S. Teracciano et al., Chem. Commun., 2016, 52, 12857–12860.

Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors

Dramatic improvement in the biological activity of DHPM derivatives as a new class of Hsp90 C-terminal inhibitors for cancer therapy.

"Secondary signs of lateralization" in apogeotropic lateral canalolithiasis

The diagnosis of lateral canalolithiasis is based on the typical finding of the horizontal paroxysmal positional nystagmus induced by the Pagnini-Mc Clure manoeuvre. This technique usually identifies also the affected side, namely, the side where the paroxysmal nystagmus is more intense in geotropic forms and the side where the paroxysmal nystagmus is less intense in apogeotropic forms. However, this method is not always applicable since, especially in apogeotropic forms, the intensity of the nystagmus is not so distinctly different between the two sides. Further useful signs to identify the affected side have been described in the Literature: Pseudo-spontaneous nystagmus in the sitting position; Leaning and Bowing nystagmus; Null-point in the vertical plane; Sitting to supine positioning nystagmus; Null-point in the horizontal plane. They are fully explained at pathophysiological level by the mechanism of canalolithiasis, as they are caused by otoliths moving in the ampullopetal direction in the non-ampullary segment (geotropic canalolithiasis) of the lateral canal or in ampullofugal direction in the ampullary segment (apogeotropic canalolithiasis) of the lateral canal. In other words, the movement of otoliths determines excitatory or inhibitory endolymphatic flow that generates specific nystagmic eye-movements. Authors analyse the characteristics of these signs, that they define as "Secondary signs of lateralization", in 64 cases of apogeotropic lateral canalolithiasis. A decisive contribution of the "Secondary signs of lateralization" to diagnose the pathological side has been verified in 13 out of 64 cases, whereas, in all other cases, Pagnini-Mc Clure diagnostic manoeuvre proved successful in correctly identifying the affected side by itself. Among the "Secondary signs of lateralization", the Pseudo-spontaneous nystagmus in the sitting position and the Sitting to the supine positioning nystagmus were particularly useful, due to both their frequency and their easy detection, as they do not require additional manoeuvres besides those usually performed during health examination of a patient affected by lateral canalolithiasis. In conclusion, the Authors propose a decision-making algorithm to diagnose and treat lateral canalolithiasis based on the attempt to obtain as much information as possible for a correct diagnosis, with the least trouble and inconvenience for patients.

[Clinical study on 40 cases of inflammatory pathologies of upper respiratory and digestive tract treated by inhalatory crenotherapy]

OBJECTIVES

Authors present beneficial effects of crenotherapy on 40 patients suffering from inflammatory mucosal conditions of upper respiratory-digestive tract (URDT).

MATERIALS AND METHODS

Our study was realized at the hydrothermal premises in Telese Terme (BN, Italy). Subjects selected for this study are 40 patients (22 males and 18 females) aged 20-68 years (mean 38.6 years) who suffered from catarrhal and inflammatory mucosal diseases of URDT. The patients, who are informed about the modalities of the study, undergo E.N.T. examination and nasal mucosal brushing for cytologic analysis before and after crenotherapy.

RESULTS

At the end of the therapeutic course we observed a relevant improvement of clinical indicators and of mucociliary transport time in URDT. Moreover, a satisfactory control of local inflammation is highlighted by a rhinocytogram, performed after crenotherapy and showing an increase in plasma cells, a decrease in granulocytes and a normalization of mucous secretion (nasal mucosal histology).

CONCLUSIONS

Our study shows that sulphurous waters are particularly effective in anti-catarrhal and anti-inflammatory therapy of URDT.

Converting apogeotropic into geotropic lateral canalolithiasis by head-pitching manoeuvre in the sitting position

Liberatory treatment of lateral canalolithiasis is more effective for the geotropic, than for the apogeotropic forms and, therefore, it is worthwhile attempting to convert the apogeotropic forms into the geotropic forms. In 36 cases of apogeotropic lateral canalolithiasis, one to five Head-Pitch Manoeuvres were performed in the sitting position (Head-Pitch Test) in the attempt to transform apogeotropic into geotropic lateral canalolithiasis. The Head Pitch Test was performed by a quick 60 degrees forward-flexion and a slow maximal backward-extension of the head. The Head-Pitch Test was effective in 36.1% of cases, less than the repeated Head-Rolling in the supine position, but it was always well tolerated by patients. The quick 60 degrees forward-flexion of the head can evoke a horizontal nystagmus beating towards the healthy side in apogeotropic lateral canalolithiasis and towards the affected side in geotropic lateral canalolithiasis (Bow Nystagmus). Slow backward-extension of the head can evoke a horizontal nystagmus beating towards the affected side in apogeotropic lateral canalolithiasis and toward the healthy side in geotropic lateral canalolithiasis (Lean Nystagmus). Conversion from apogeotropic to geotropic lateral canalolithiasis by the Head-Pitch Test was effective when Bow and Lean Nystagmus changed directions or when the Head-Pitch Test evoked Bow Nystagmus toward the affected side and Lean Nystagmus toward the healthy side. Conversion occurred in 10 patients during the 60 degrees forward-flexion of the head. In contrast, in 3 patients, it occurred during extension of the head, when a "Lean Nystagmus" toward the healthy side appeared. In addition, Pseudospontaneous Nystagmus and Positioning Nystagmus that arose when the patient moved from the sitting to the supine position changed direction or were evoked ex-novo, both directed toward the healthy side. In all cases, Pagnini-McClure diagnostic manoeuvre confirmed the transformation with a Positional Paroxysmal Horizontal Geotropic Nystagmus, which was more intense when the affected ear was brought down. The Head-Pitch Test can be used as the method of choice to transform apogeotropic into geotropic lateral canalolithiasis. However, anterior flexion of the head in the geotropic forms must be avoided since involuntary and harmful transformations from the geotropic into the apogeotropic form can occur, moving otoliths towards the anterior arm and cupula.

Submandibular gland myoepithelioma

Benign myoepithelioma is a very rare form of salivary gland tumor, composed entirely of myoepithelial cells. It accounts for approximately 1% of all salivary gland tumors and is most frequently located in the parotid gland and in the minor salivary glands of the hard palate. We describe herein the ninth reported case of myoepithelioma of the submandibular gland. Benign myoepithelioma must be differentiated from several benign and malignant epithelial and mesenchymal tumors. Immunohistochemical staining can help differentiate between these conditions, but histopathology remains the gold standard for diagnosing this neoplastic process.

Quantitative analysis of fetal DNA in maternal plasma in pathological conditions associated with placental abnormalities

An increased fetal DNA concentration in maternal plasma has been observed in placental pathological conditions associated with hypertension and preeclampsia. To confirm these data, we performed real-time quantitative PCR on the SRY gene in a group of physiological and pathological male-bearing pregnancies. In 78 physiological pregnancies, fetal DNA concentration in maternal plasma was 20.7, 13.4, 23.6, and 74.8 genome-equivalents (g.e.)/mL during the first, second, and third trimesters and at term, respectively. In 10 preeclamptic women, fetal DNA concentration ranged from 59.3 to 615.2 g.e./mL (median: 332.9). In 7 women with preeclampsia and IUGR (intrauterine growth retardation), fetal DNA ranged from 96.5 to 859 g.e./mL (median: 146.8). In 4 women with IUGR and hypertension, fetal DNA ranged from 34 to 473.5 g.e./mL (median: 142.4). In 3 patients with IUGR, fetal DNA ranged from 168.6 to 519.7 g.e./mL (median: 308.1). In 2 patients with IUGR and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, fetal DNA concentration ranged from 105 to 394.1 g.e./mL (median: 249.7). Four women who developed preeclampsia some weeks later showed fetal DNA levels within the physiological range. These data suggest that increased fetal DNA concentrations might represent a valuable marker of placental abnormalities and suggest that this rise may precede clinical manifestation of preeclampsia by only a few weeks.

Selecting a clinical system

For more than three decades, health care information systems have built upon the administrative and financial information needs of the health care delivery organization. Industry analysts project that administrative and financial information systems will continue to be important to health care, but post-Y2K resources increasingly will fall on the purchase, installation and support of clinical documentation and reporting tools. This manuscript provides a brief overview of the electronic medical record (EMR), and identifies and explains the need for EMRs in health care. This article also provides strategies for medical group managers and information systems managers to successfully select and negotiate a contract for an electronic medical record.

Stereotactic aspiration and drainage of brain abscesses. Experience with 9 cases

The first-line treatment for brain abscesses is still a much-debated argument. Recently, stereotactic aspiration of these lesions has gained ground as a valid alternative to the traditional medical and/or surgical therapeutical treatments. From 1991 to 1995, 9 patients affected by intracranial abscesses were surgically treated by stereotactic puncture of the lesion and drainage of pus, using the Kelly-Goerss stereotactic system. Multiple abscesses were present in one case. Specific antibiotic therapy was used in the post-operative stage, when possible. One death occurred four weeks after surgery for acute ischemia of the brain stem. Follow-up CT demonstrated gradual resolution of the abscesses in all the cases and a successful return to normal daily life in all the surviving patients. In one case, recurrence of the abscess occurred two months after resolution: a successful result was obtained by steroids and broad-spectrum antibiotic therapy alone. Possible advantages of this technique are discussed and compared with the traditional routes. The literature concerning this argument is reviewed.

Circadian gastric acidity in Helicobacter pylori positive ulcer patients with and without gastric metaplasia in the duodenum

BACKGROUND

The presence of gastric metaplasia allows helicobacter pylori to colonise the duodenum and this condition is thought to be acquired as a response to acid hypersecretion. This functional disorder, however, is present only in a subgroup of duodenal ulcer patients and, in addition, surface gastric metaplasia has been frequently found in the proximal duodenum of normal subjects and patients with non-ulcer dyspepsia, who cannot be certainly considered as acid hypersecretors.

AIMS

To clarify the role of acid in inducing gastric type epithelium in the duodenum. This study aimed at assessing whether the pattern of circadian gastric acidity differs between H pylori positive duodenal ulcer patients with and without duodenal gastric metaplasia.

PATIENTS

Seventy one patients with duodenal ulcer confirmed by endoscopy and who were found to be positive for H pylori infection by histology on antrum biopsy specimens were enrolled into this study.

METHODS

Gastric type epithelium in the duodenum was found in 49 of 71 ulcer patients (69%). Continuous 24 hour gastric pH metry was performed in 50 healthy subjects and in the two subgroups of duodenal ulcer patients with and without gastric metaplasia in the duodenum. Gastric acidity was calculated for 24 hours (1700-1659), night (2000-0759) and day-time (0800-1959).

RESULTS

Ulcer patients without gastric metaplasia showed a significantly higher gastric acidity (p < 0.001) than controls for every time interval considered, while the ulcer subgroup with gastric metaplasia was more acid than healthy subjects (p < 0.001) during the whole 24 hour period and the daytime. There was no difference between the two subgroups of duodenal ulcer patients with and without gastric metaplasia during the various time segments analysed.

CONCLUSION

The findings confirm that the circadian gastric acidity of duodenal ulcer patients is higher than that of controls. As there is no difference in gastric pH between duodenal ulcer patients with and without gastric metaplasia, gastric hyperacidity is not specific to patients with duodenal gastric metaplasia. It is probable that this histological change is a non-specific response to mucosal injury resulting from various factors and not exclusively to acid.

Evaluation of 24-hour gastric acidity in patients with hepatic cirrhosis

BACKGROUND/AIMS

Data from previous studies on gastric acid secretion in patients with hepatic cirrhosis are controversial, due, at least in part, to the possible interference of liver failure and altered gastric mucosal microcirculation on the pharmacological action of the substances used to stimulate the parietal cell. For this reason, we wished to investigate the circadian pattern of gastric acidity by means of continuous 24-hour pH monitoring, which permits measurement of pH fluctuations in a nearly physiological manner and does not require any pharmacological stimulus.

METHODS

Forty-nine patients with liver cirrhosis of different aetiology were recruited for this study. They underwent 24-hour gastric pH-metry with an electrode positioned in the gastric corpus, and their pattern of gastric acidity was compared with that of 49 healthy subjects, matched for age and sex. In a subgroup of 31 patients with cirrhosis, antral pH was recorded in addition to body pH in order to assess whether there are regional differences in gastric acidity.

RESULTS

The circadian, daytime and nocturnal gastric acidity in patients with cirrhosis was significantly lower (p < 0.05-0.001) than that of controls. In the 31 patients studied with two electrodes, antral pH was higher (p < 0.05) than body pH only during the night. The prevalence of Helicobacter pylori infection was rather low (42%) in our patients.

CONCLUSIONS

There is a marked hypoacidity over the circadian cycle in patients with cirrhosis compared to controls, and the greatest difference between them is visible during the nocturnal hours. Also, in patients with liver cirrhosis the pH in the antrum is higher than that in the body of the stomach during the night for reasons that need to be elucidated.

Are duodenal ulcer seasonal fluctuations paralleled by seasonal changes in 24-hour gastric acidity and Helicobacter pylori infection?

The occurrence of duodenal ulcer is characterized by seasonal variation, for poorly understood reasons. No previous study has assessed whether 24-h intragastric acidity and Helicobacter pylori infection have similar seasonal fluctuations in patients with this disorder. For this reason, we evaluated retrospectively the circadian gastric pH in 319 new patients (226 men and 93 women, mean age 45.2 years) with endoscopically proven duodenal ulcer, who agreed to undergo this examination during the years 1987-1992 in our center. The month-by-month occurrence of the disease over the global 6-year period was assessed, and the mean pH values were calculated for each patient during three time intervals of interest: 24 h, daytime (08:00-19:59 h), and nighttime (20:00-07:59 h). The mean pH values of these three time periods were then calculated month by month throughout the annual cycle. H. pylori infection was sought by histology in 171 patients examined in the period from 1990 to 1992. The percentage of H. pylori-positive duodenal ulcer patients was then calculated for each season. The calendar fluctuation of duodenal ulcer occurrence showed an evident increase (p < 0.001) in fall (October-December) and in winter (January-March) compared with spring (April-June) and summer (July-September). Both 24-h and nighttime gastric acidity showed no significant variation by month, whereas daytime gastric pH varied significantly (p < 0.05) with two evident decreases, meaning higher acidity, in April and August. H. pylori infection was detected in 152 of 171 patients (89%), and the percentage of H. pylori-positive duodenal ulcers did not differ from season to season. We conclude that there was no parallel circannual fluctuation of duodenal ulcer, gastric acidity, and H. pylori infection in the restricted sample of patients we studied. This reduces the apparent relevance of acid in inducing ulcer seasonal fluctuation. Also, the responsibility of H. pylori in this phenomenon can be excluded until a reliable diagnostic method capable of distinguishing recent from old infection is found.

Volumetric reconstruction and stereotactic computer assisted resection in intracerebral lesions

Since 1990 112 patients have undergone stereotactic resection of intra-axial tumoural lesions with volumetric reconstruction, using the Kelly-Goerss system. Stereotactic integration of CT, angiographic and particularly MRI information, together with three-dimensional information of the lesion, provide an innovative evaluation of the most appropriate surgical approach, even for each single patient. The main limitation of this surgical method is in cases where the infiltrating part of the tumour is pre-eminent, while it can allow "macroscopically complete resection" of well circumscribed lesions, almost independently of their location and volume. Some technical aspects of stereotactic resection of brain tumours are discussed in the light of our experience.

Urbanization gradients and cancer mortality in Uruguay, 1988-1992

Cancer deaths occurring in Uruguay in the period 1988-1992 were classified by site, sex and residence according to the ninth version of the International Classification of Diseases (ICD-9), in order to analyze gradients of urbanization. For this purpose, Uruguayan counties were classified as rural, suburban and urban, using population density as an ordinal indicator of the degree of urbanization. Significant increasing trends with urban excess were observed for cancers of the colon, rectum, lung and female breast. In addition, this study showed significant urban deficits for esophageal, gastric and uterine cancers, contrasting with previous studies. These differences seem to be real rather than artifactual due to misclassification. The study thus provides interesting new findings concerning urban differences between developed communities and a partially developing country.

Antisecretory effects of three omeprazole regimens for maintenance treatment in duodenal ulcer

This study was carried out to assess the antisecretory effects and their possible changes over time of three different dose regimens of omeprazole that could be proposed for maintenance treatment in duodenal ulcer. Forty-five patients with endoscopically proven duodenal ulcer were studied by means of 24-hr gastric pH-metry both in basal conditions and on the fifth day of acute treatment with omeprazole 20 mg in the morning. Ulcers healed after four weeks (in three cases after eight weeks) and afterwards, 15 patients were randomized to receive orally at 0800 hr in single-blind fashion omeprazole 10 mg daily (group A), 15 to receive omeprazole 40 mg on Saturday and Sunday followed by a five-day period without medication (group B), and 15 to receive omeprazole 20 mg every other day (group C) for up to three months. On the 20th and 80th days of these maintenance treatments 24-hr gastric pH-metry was repeated to assess the antisecretory effectiveness of each regimen over a two-month period. In patients of group B these tests began at 1700 hr on Friday, the last of five days off treatment, and in those of group C at 1700 hr of the day off medication. All three dose regimens of omeprazole were able to raise pH values significantly (P < 0.01-0.001) compared to basal levels. Omeprazole 20 mg every other day was more effective (P < 0.01) than omeprazole 40 mg weekend, but did not differ significantly from omeprazole 10 mg daily. The durations of acid inhibition (pH > 3.0 units/24 hr) were 12.44, 10.00, and 17.38 hr with groups A, B, and C, respectively. There was no significant difference between the pH profiles of the 20th and 80th days with every dose regimen. It is concluded that all three dose regimens of omeprazole are effective in reducing gastric acidity and their pharmacodynamic action does not change with time. Therefore they are suitable to be assessed in large clinical trials aimed at verifying the prevention of duodenal ulcer recurrence for longer periods.

Bolus infusion of famotidine: effects on gastric pH by repeated 12-hour doses of 20 mg in postoperative patients

This study was carried out to assess the efficacy of intravenous (IV) famotidine in suppressing gastric secretion over a 48-hour period. Twenty postoperative patients requiring a nasogastric tube received famotidine 20 mg IV every 12 hours and gastric pH was measured continuously by means of an indwelling probe. A baseline recording was performed over the first 4 hours and then the drug was infused every 12 hours (q12h) over a 15-minute period for the subsequent 48 hours. The mean pH value achieved during each time segment under active treatment was significantly higher (P < .001) than the mean basal value. Also the density distributions of minutes spent at the various pH units confirm that famotidine is highly effective (P < .001) in raising and maintaining gastric pH above 4.0 units during most of the drug-related period (44 hours). It can be concluded that repeated intravenous boli of famotidine 20 mg every 12 hours allow us to obtain an effective control of intragastric acidity. The antisecretory action is consistent over the total 48-hour period examined and therefore the use of intermittent infusion of famotidine seems to be advisable, as opposed to the recommended continuous IV administration of cimetidine and ranitidine. There is, however, a considerable intersubject variability in the antisecretory response to the drug.

Antisecretory effect of three premeal doses of cimetidine 400 mg versus a single morning dose of omeprazole 20 mg: pathophysiological implications for duodenal ulcer treatment

The success of omeprazole in the healing of duodenal ulcer has been attributed to its profound and almost around-the-clock inhibition of acid, but the relevance of reducing meal-stimulated acid secretion exclusively has recently been emphasized in several clinical trials. For this reason, we used 24-h continuous intragastric pH monitoring to compare the pharmacodynamic effects of placebo, three fractioned premeal doses of cimetidine 400 mg and omeprazole 20 mg mane. Fifteen patients with duodenal ulcer in clinical remission were randomized to receive the above medications in single-blind fashion on three separate occasions, at least 2 wk apart. Both active regimens produced higher pH values (p < 0.05-0.001) than placebo, but omeprazole was much more effective than cimetidine (p < 0.01-0.001) during the various time intervals analyzed (24 h, evening, nighttime, daytime). The greater effectiveness of omeprazole was confirmed by its longer-lasting antisecretory action, insofar as the drug increased gastric pH above 3.0 units for about 21 h, whereas the daytime cimetidine regimen maintained this threshold for 7.30 h (p < 0.001) over the circadian cycle. As these markedly different pharmacodynamic effects have been proven to produce similar fast rates of duodenal ulcer healing in clinical trials, it is reasonable to assume that a small but well addressed reduction of gastric acidity can ensure the same therapeutic benefit as a strong and continuous acid inhibition. In this light, the acid peaks in response to meals seem to be important pathophysiological events, whose control is sufficient to permit quick ulcer healing.

Low physical activity and worsening of glucose tolerance: results from a 2-year follow-up of a population sample in Malta

The relationship between the level of habitual physical activity and glucose intolerance was examined cross-sectionally and during a 2-year follow-up among a sample of 388 subjects in Malta. At baseline, the subjects were classified into three categories of physical activity, which was inversely related to the 2-h post challenge blood glucose (P = 0.02). In a multivariate analysis, age (standardized regression coefficient 0.23; P less than 0.001), family history of diabetes (0.20; P less than 0.001), and physical activity (-0.18; P = 0.002) were the strongest predictors of the 2-h blood glucose at baseline. The age standardized 2-year risk of glucose intolerance, i.e. impaired glucose tolerance or diabetes was consistently and inversely related to the level of physical activity. Among subjects with normal glucose tolerance at baseline (n = 127) those with low physical activity had a 2.7 times higher risk of glucose intolerance during follow-up than those with high physical activity (P = 0.1), and even a 3.7-fold risk of glucose intolerance at baseline (n = 196) when both the subjects with normal and impaired glucose tolerance at baseline were considered together (P = 0.005). Similar trends were observed for the risk of diabetes. The suggested protective effect of physical activity was independent of body mass, a family history of diabetes and gender. Within the limits of this small study we conclude that physical activity may have some importance in the primary prevention of impaired glucose tolerance and, possibly, non-insulin-dependent diabetes mellitus.

Cancer in migrants to Uruguay

Mortality rates from different cancers in the principal groups of migrants to Uruguay are compared with those in their countries of origin (Argentina, Brazil, Italy and Spain) and in the Uruguay-born population. Oesophageal cancer is very common in Uruguay and European-born populations, initially at low risk, appear to acquire rather higher rates after migration. For most migrants, the mortality from cancers of the breast, colon-rectum, corpus uteri and prostate is closer to the moderately elevated rates of Uruguay than those in their countries of origin. The results suggest that migrants to Uruguay undergo changes in some important environmental exposures, probably dietary, which give rise to substantial alterations in cancer risk within their lifespan.

Esophageal cancer in Uruguay: a case-control study

Esophageal cancer has constituted a major public health problem in Uruguay, with age-adjusted death rates of 14.5 X 10(5) for males and of 3.8 X 10(5) for females. A case-control study was undertaken to ascertain the possible association of the local custom of drinking infusions of Ilex paraguariensis ("maté") with cancer of the esophagus, after controlling for well-known risk factors, such as alcohol and tobacco consumption. Two hundred twenty-six patients with esophageal cancer and 469 controls (control:case = 2.1) were interviewed at the time of admission or consultation at the Oncology Institute of Montevideo from 1979 through 1984. Males showed elevated risks of esophageal cancer associated with heavy tobacco [relative risk (RR) = 10.8] and alcohol (RR = 10.3) exposures. Among females, the independent effects of tobacco and alcohol were nonsignificant. Maté consumption had an independent effect in both males and females, with odds ratios of 6.5 and 34.6, respectively, for heavy users. Moreover, a well-defined dose response was evident in both sexes.

Exposure to lead and cadmium of the general population of Malta

The blood levels of lead (PbB), cadmium (CdB), and zinc protoporphyrin (ZPP) were determined in 538 Maltese adult subjects. A relatively high level exposure to both metals was discovered. For lead, the median value is 274 micrograms/l with percentile 90 and 98 respectively 564 and 863 micrograms/l. These values are to be compared with the reference values proposed by a directive of the European Community, respectively 200, 300 and 350 micrograms/l. For cadmium, the median value is 2.2 micrograms/l with percentile 90 and 98 respectively 3.8 and 5.7 micrograms/l. These values are compared with those of a Belgian population which are respectively 1.7, 2.6 and 4.3 micrograms/l. The causes of this relatively high exposure are not known. A few tentative hypotheses, which are to be investigated, are made.

[Association breast cancer-meningioma. Report of two cases (author's transl)]

The theoretic and clinical interest of the association between breast cancer and meningioma is underlined. In both reported cases two women, which respectively two and three years ago, had undergone mastectomy operation due to breast cancer, showed symptoms and signs of cranial tumor. The operation revealed the diagnosis of meningioma in both instances permitting effective treatment of the lesion.