Risk of CFTR-related disorders and cystic fibrosis in an Italian cohort of CRMS/CFSPID subjects in preschool and school age

The identification of cystic fibrosis screening-positive, inconclusive diagnosis (CFSPID) in infants is a controversial outcome of newborn screening for cystic fibrosis (CF). Today, despite improvements in the knowledge of CFSPID and the description of several cohorts, little data are available on cohorts with a follow-up period of more than 6 years. In this study, we report the outcomes of an Italian cohort of CFSPID individuals with CFSPID or formerly CFTR-related disorders (CFTR-RD) (CFSPID > CFTR-RD) or diagnosed with CF (CFSPID > CF). This was an observational and multicentre Italian study collecting clinical data on CFSPID born between the period January 1, 2011, and December 13, 2019. A total of 268 participants were included: 243 with persistent CFSPID, 7 with CFSPID > CFTR-RD, and 18 with CFSPID > CF. The trend of sweat chloride (SC) values, percentage of definitive diagnoses, lung function in school-aged children, and development of CF-related complications were evaluated. At the end of the observation period, almost 80% of the individuals with CFSPID did not have a conclusive diagnosis. A total of 29 children (10.8%) transitioned to a diagnosis of CF for pathological SC values (≥ 60 mmol/L) or multi-organ involvement, and 18 (6.7%) to CFTR-RD. Children who were followed up for > 6 years (median age, 7.5 years; range, 6.04-10.5) had normal lung function and were pancreatic sufficient, and the evolution in CF was only present in two cases.

CONCLUSION

Most Italian preschool and school-aged children with CFSPID did not have a conclusive diagnosis, and progression to CF was unlikely in children > 6 years of age. An annual follow-up could be indicated to identify early evolution in clinical features consistent with a CFTR-RD.

WHAT IS KNOWN

• Cystic Fibrosis newborn screening identifies also subjects with an inconclusive diagnosis (CFSPID). • Over time a variable percentage of CFSPIDs will be diagnosed as CF. • Little data is available on CFSPIDs with a follow-up period of more than six years.

WHAT IS NEW

• 80% of Italian preschool and school-age CFSPIDs not have a conclusive diagnosis. • Italian preschool and school-age CFSPIDs have normal lung function and are pancreatic sufficient. • Annual follow-up after 6 years is recommended in CFSPID with abnormal LCI2.5 or with a CF-causing variant in trans with a VVCC.

Similarities and differences in the functional architecture of mother- infant communication in rhesus macaque and British mother-infant dyads

Similarly to humans, rhesus macaques engage in mother-infant face-to-face interactions. However, no previous studies have described the naturally occurring structure and development of mother-infant interactions in this population and used a comparative-developmental perspective to directly compare them to the ones reported in humans. Here, we investigate the development of infant communication, and maternal responsiveness in the two groups. We video-recorded mother-infant interactions in both groups in naturalistic settings and analysed them with the same micro-analytic coding scheme. Results show that infant social expressiveness and maternal responsiveness are similarly structured in humans and macaques. Both human and macaque mothers use specific mirroring responses to specific infant social behaviours (modified mirroring to communicative signals, enriched mirroring to affiliative gestures). However, important differences were identified in the development of infant social expressiveness, and in forms of maternal responsiveness, with vocal responses and marking behaviours being predominantly human. Results indicate a common functional architecture of mother-infant communication in humans and monkeys, and contribute to theories concerning the evolution of specific traits of human behaviour.

Elevated sweat chloride test: is it always cystic fibrosis?

BACKGROUND

The sweat chloride test (ST) is the gold standard for cystic fibrosis (CF) diagnosis in symptomatic patients, within the newborn screening and in the follow-up of CF patients during molecular therapies. However, false positives have been reported in patients with different diseases. We describe and discuss 4 cases due to different clinical conditions in which we recorded false positive ST, and the test remained altered for a period of varying length.

CASES PRESENTATION

Case 1: Eight months old female child suffering from constipation, recurrent vomiting and failure to thrive, family history of recurrent pancreatitis without mutations in the PRSS1 and SPINK1 genes. Both ST and fecal elastase were altered although no CFTR gene mutations were found. Due to rapid clinical deterioration, celiac disease was suspected and diagnosed by laboratory tests and intestinal biopsy. After 2 weeks of gluten-free diet ST and fecal elastase normalized. Case 2: 14 months old male suffering from bilateral renal dysplasia, episodes of metabolic alkalosis, recurrent respiratory infections and recurrent vomiting. The child had more ST positives, but no CFTR mutations were found. During follow-up, he developed sensorineural hearing loss and an atrial septic defect was found. Finally, a diagnosis of Klinefelter was made, but the ST normalized several years later. Case 3 and 4: Two boys with stubborn constipation and fecal occlusion treated with Poly Ethylene Glycol (PEG) with salts showed pathological ST. The test returned normal a few days after stopping treatment.

CONCLUSIONS

We hypotesized the possible causes of ST alteration in these conditions: in celiac disease it could be due to a transient dysregulation of the aquaporins, rapidly reversed by the diet; in Klinefelter, it may be due to stable pubertal hypoandrogenism; while, the PEG formulation itself contains salts that can temporarily alter ST.

Schistosomiasis, strongyloidiasis and Chagas disease: the leading imported neglected tropical diseases in Italy

BACKGROUND

In recent years, an increasing number of individuals affected by neglected tropical diseases (NTDs) have been observed in Italy, due to migration, international travels and climate changes. Reliable data on the current NTD epidemiology in Italy and the health system preparedness on this issue are not available.

METHODS

We report the results of a survey on selected NTDs (schistosomiasis, strongyloidiasis, echinococcosis, Chagas disease, leishmaniasis, cysticercosis, filariasis and scabies) in nine Italian sentinel centres, in order to investigate their occurrence throughout the country and identify which ones are a priority for public health interventions, development of protocols for case management, and training activities. To explore the preparedness of the centres, we investigate the availability of specific diagnostic tools and drugs, needed for the management of the most common NTDs. We also reviewed and summarized the available national policies, recommendations and guidelines on NTDs in Italy.

RESULTS

Overall, 4123 NTDs cases were diagnosed in nine Italian centres within a 7-year period (2011-2017). Schistosomiasis and strongyloidiasis were the most common NTDs, accounting for about one-third each of all the diagnosed cases, followed by Chagas disease. The number of cases showed a significant trend to increase over time, mainly due to foreign-born subjects. Serology for Schistosoma spp. and Strongyloides stercoralis was available in seven and five centres, respectively. Agar plate stool culture for S. stercoralis was available in three sites. Ivermectin and praziquantel were always available in six centres. Six national policies, recommendations and guidelines documents were available, but for the most part, they are not fully implemented yet.

CONCLUSIONS

This survey showed how some NTDs, such as schistosomiasis and strongyloidiasis, are becoming more common in Italy, due to multiple components. A list of seven key actions was proposed, in order to improve diagnosis, management and control of NTDs in Italy.

Hybrid FePt/SiO2/Au nanoparticles as a theranostic tool: in vitro photo-thermal treatment and MRI imaging

We have produced an innovative, theranostic material based on FePt/SiO₂/Au hybrid nanoparticles (NPs) for both, photo-thermal therapy and magnetic resonance imaging (MRI). Furthermore, a new synthesis approach, i.e., Au double seeding, for the preparation of Au nanoshells around the FePt/SiO₂ cores, is proposed. The photo-thermal and the MRI response were first demonstrated on an aqueous suspension of hybrid FePt/SiO₂/Au NPs. The cytotoxicity together with the internalization mechanism and the intracellular fate of the hybrid NPs were evaluated in vitro on a normal (NPU) and a half-differentiated cancerous cell line (RT4). The control samples as well as the normal cell line incubated with the NPs showed no significant temperature increase during the in vitro photo-thermal treatment (ΔT < 0.8 °C) and thus the cell viability remained high (∼90%). In contrast, due to the high NP uptake by the cancerous RT4 cell line, significant heating of the sample was observed (ΔT = 4 °C) and, consequently, after laser irradiation the cell viability dropped significantly to ∼60%. These results further confirm that the hybrid FePt/SiO₂/Au NPs developed in the scope of this work were not only efficient but also highly selective photo-thermal agents. Furthermore, the improvement in the contrast and the easier distinction between the healthy and the cancerous tissues were clearly demonstrated with in vitro MRI experiments, proving that hybrid NPs have an excellent potential to be used as contrast agents.

Magnetic interactions and in vitro study of biocompatible hydrocaffeic acid-stabilized Fe–Pt clusters as MRI contrast agents

A detailed magnetic study of separated Fe–Pt NPs and Fe–Pt clusters was performed to predict their optimal size and morphology for the maximum saturation magnetization, a factor that is known to influence the performance of a magnetic-resonance-imaging (MRI) contrast agent. Excellent stability and biocompatibility of the nanoparticle suspension was achieved using a novel coating based on hydrocaffeic acid (HCA), which was confirmed with a detailed Fourier-transform infrared spectroscopy (FTIR) study. An in vitro study on a human-bladder papillary urothelial neoplasm RT4 cell line confirmed that HCA-Fe–Pt nanoparticles showed no cytotoxicity, even at a very high concentration (550 μg Fe–Pt per mL), with no delayed cytotoxic effect being detected. This indicates that the HCA coating provides excellent biocompatibility of the nanoparticles, which is a prerequisite for the material to be used as a safe contrast agent for MRI. The cellular uptake and internalization mechanism were studied using ICP-MS and TEM analyses. Furthermore, it was shown that even a very low concentration of Fe–Pt nanoparticles (<10 μg mL⁻¹) in the cells is enough to decrease the T₂ relaxation times by 70%. In terms of the MRI imaging, this means a large improvement in the contrast, even at a low nanoparticle concentration and an easier visualization of the tissues containing nanoparticles, proving that HCA-coated Fe–Pt nanoparticles have the potential to be used as an efficient and safe MRI contrast agent.

Study of magnetic interactions revealed optimal size and morphology of Fe–Pt nanoparticles. Novel biocompatible hydrocaffeic acid coating was used to prepare highly efficient and safe MRI contrast agent, which was proven by in vitro study.

A novel treatment of cystic fibrosis acting on-target: cysteamine plus epigallocatechin gallate for the autophagy-dependent rescue of class II-mutated CFTR

This corrects the article DOI: 10.1038/cdd.2016.22.

A novel treatment of cystic fibrosis acting on-target: cysteamine plus epigallocatechin gallate for the autophagy-dependent rescue of class II-mutated CFTR

We previously reported that the combination of two safe proteostasis regulators, cysteamine and epigallocatechin gallate (EGCG), can be used to improve deficient expression of the cystic fibrosis transmembrane conductance regulator (CFTR) in patients homozygous for the CFTR Phe508del mutation. Here we provide the proof-of-concept that this combination treatment restored CFTR function and reduced lung inflammation (P<0.001) in Phe508del/Phe508del or Phe508del/null-Cftr (but not in Cftr-null mice), provided that such mice were autophagy-competent. Primary nasal cells from patients bearing different class II CFTR mutations, either in homozygous or compound heterozygous form, responded to the treatment in vitro. We assessed individual responses to cysteamine plus EGCG in a single-centre, open-label phase-2 trial. The combination treatment decreased sweat chloride from baseline, increased both CFTR protein and function in nasal cells, restored autophagy in such cells, decreased CXCL8 and TNF-α in the sputum, and tended to improve respiratory function. These positive effects were particularly strong in patients carrying Phe508del CFTR mutations in homozygosity or heterozygosity. However, a fraction of patients bearing other CFTR mutations failed to respond to therapy. Importantly, the same patients whose primary nasal brushed cells did not respond to cysteamine plus EGCG in vitro also exhibited deficient therapeutic responses in vivo. Altogether, these results suggest that the combination treatment of cysteamine plus EGCG acts 'on-target' because it can only rescue CFTR function when autophagy is functional (in mice) and improves CFTR function when a rescuable protein is expressed (in mice and men). These results should spur the further clinical development of the combination treatment.

Prediction of acute pancreatitis risk based on PIP score in children with cystic fibrosis

BACKGROUND

Currently no tools to predict risk of acute (AP) and recurrent pancreatitis (ARP) in children with cystic fibrosis (CF) are available. We assessed the prevalence of AP/ARP and tested the potential role of Pancreatic Insufficiency Prevalence (PIP) score in a cohort of children with CF.

METHODS

We identified two groups of children, on the basis of presence/absence of AP/ARP, who were compared for age at diagnosis, clinical features, genotypes and sweat chloride level. PIP score was calculated for each patient.

RESULTS

10/167 (5.9%) experienced at least one episode of AP during follow up; 10/10 were pancreatic sufficient (PS). Patients with AP/ARP showed a PIP score ≤0.25 more frequently (6/10) than patients without AP/ARP. The odds ratio (95% CI) of developing pancreatitis was 4.54 (1.22-16.92) for patients with PIP <0.25 when compared with those who have a PIP score >0.25 (p 0.0151). PIP score was correlated with sweat chloride test (p < 0.01).

CONCLUSION

PIP score, PS status and normal/borderline sweat chloride levels could be applied to predict pancreatitis development in children with CF. ARP could lead to pancreatic insufficiency.

Brand new SPINK1 and CFTR mutations in a child with acute recurrent pancreatitis: a case report

We report a case of a 2,5 years old female, referred to our center for pancreatitis. Medical investigation revealed history of acute recurrent pancreatitis (ARP) since 1 year of age. Family history was negative for pancreatitis. Abdominal ultrasonography and magnetic resonance excluded both biliary tract stenosis and anatomic abnormalities. Calcium metabolic disorders, viral and bacterial infections were ruled out. Molecular sequencing of CFTR revealed heterozygosis for the mutation S1235R, a CFTR-related disorders associated mutation. Fecal elastase-1 (E1) was 529 μg/gr feces (normal value 200-500 μg/gr feces). No mutation of PRSS1 gene was detected but heterozygosity for p.Lys41Asn (c.123G>C), a new mutation of SPINK1 gene, was revealed. We speculate that the association of both SPINK1 and CFTR gene mutations may be responsible of ARP in our patient. Further studies need to better elucidate the role of genetic factors in ARP, as well as the influence of environmental factors.

The use of a combination of different MR methods to study swelling of hydrophilic xanthan matrix tablets at different pHs

Modified-release matrix tablets have been extensively used by the pharmaceutical industry as one of the most successful oral drug-delivery systems. The key element in drug release from hydrophilic matrix tablets is the gel layer that regulates the penetration of water and controls drug dissolution and diffusion. Magnetic resonance imaging (MRI) is a powerful, non-invasive technique that can help improve our understanding of the gel layer formed on swellable, polymer-matrix tablets, as well as the layer's properties and its influence on the drug release. The aim was to investigate the effects of pH and ionic strength on swelling and to study the influence of structural changes in xanthan gel on drug release. For this purpose a combination of different MRI methods for accurate determination of penetration, swelling and erosion fronts was used. The position of the penetration and swelling fronts were the same, independently of the different xanthan gel structures formed under different conditions of pH and ionic strength. The position of the erosion front, on the other hand, is strongly dependent on pH and ionic strength, as reflected in different thicknesses of the gel layers.

Acute strongyloidiasis in Italian tourists returning from Southeast Asia

Strongyloidiasis is a soil-transmitted helmithiasis with worldwide distribution. Contrary to chronic form, hyperinfestation and life-threatening dissemination, first (invasive) stages of the disease are not well characterized. This paper describes two cases of acute strongyloidiasis in travelers returning from Southeast Asia and highlights the need to take strongyloidiasis into account also among acute travel-related illnesses.

Impact of hepatitis B vaccination in a highly endemic area of south Italy and long-term duration of anti-HBs antibody in two cohorts of vaccinated individuals

The aims of this study were to evaluate the impact of hepatitis B vaccination on the changing pattern of HBV infection in a former hyperendemic area (Afragola, South Italy), and to assess the long-term persistence of anti-HBs in two cohorts of individuals vaccinated as infants 18 and 23 years ago. Our data shows a significant decline in the prevalence of hepatitis B virus (HBV) markers in the general population from 1978 to 2006 (HBsAg: 13.4% versus 0.91%; anti-HBc: 66.9% versus 7.6%; p<0.001). Data from two cohorts of vaccinees provides further evidence regarding the long-term persistence of vaccine-induced anti-HBs. Data here reported indicates that the implementation of vaccination had a great impact in the control and prevention of hepatitis B in Italy.

Three-dimensional in vivo magnetic resonance microscopy of beech (Fagus sylvatica L.) wood

Spatial structure and water distribution in branch tissues after mechanical injury were investigated in vivo by three-dimensional (3D) magnetic resonance (MR) microscopy. On a beech tree (Fagus sylvatica L.), transplanted in a portable pot, a branch was topped and then MR imaged. High-resolution 3D MR images revealed structures which could not be identified by conventional MR images or by light microscopy. MR measurements confirmed our assumption that moisture content is decreasing towards the wounded part of the branch. This indicates that quick moisture loss from mechanically wounded tissues represents the initial passive response of compromised tissue.

Determination of cadmium, chromium, lead and vanadium in six fish species from the Adriatic Sea

Concentrations of cadmium, chromium, lead and vanadium were determined in samples of six fish species collected along the coast of the Adriatic Sea. The concentrations of the elements studied were generally low, often below the detection limits of the analytical methods. The highest values (microg x kg(-1) fresh weight) were observed, mainly in the central area of the Adriatic Sea, for anchovy (Cd 20.2, Cr 82.9, Pb 45.9, V 89.9), red mullet (Cd 3.1, Cr 31.0, Pb 36.0, V 79.1) and mackerel (Cd 7.7, Cr 28.0, Pb 11.4, V 43.5). The concentrations of cadmium and lead in all the species examined were below the maximum levels indicated by the European Community for these two elements in seafood, and also would lead to exposure levels lower than the provisional tolerable daily intakes suggested by the FAO/WHO for Cd (420 microg x week(-1) for a 60-kg person) and Pb (1500 microg x week(-1) for a 60-kg person). The concentration of chromium was lower than the recommended daily amount (50-200 microg x day(-1) for a 60-kg person) indicated by the US National Research Council. An 11-34% contribution to the daily vanadium ingestion with fish was calculated for the population of the Adriatic coast.

Evaluation of aluminium concentrations in samples of chocolate and beverages by electrothermal atomic absorption spectrometry

Samples of chocolate, cocoa, tea infusions, soft drinks and fruit juice have been examined by, electrothermal atomic absorption spectrometry (ETA-AAS) for the presence of aluminium (Al). Fruit juices and chocolate were analysed after an adequate sample preparation; the other products were evaluated directly. Sampling was performed in duplicate for 248 independent samples. The mean Al concentration in chocolate was 9.2 +/- 7.5 mg kg(-1), and individual values were correlated with the per cent of cocoa in samples (Y = 0.63 + 0.27X, r = 0.78, p < 0.0001). Al concentration in commercial tea infusions ranged from 0.9 to 3.3 mg l(-1) (mean = 1.80 +/- 65 mg l(-1), whereas in laboratory-prepared samples it was 2.7 +/- 0.93 mg l(-1). In soft drinks, the concentrations of Al were lower, ranging from 9.1 to 179 microg l(-1); the highest values were observed in samples of orange squash (mean = 114 +/- 56 microg l(-1)). Apricot juice showed the highest Al level (mean = 602 +/- 190 microg l(-1)), being statistically, different from that of pear (mean = 259 +/- 102 microg l(-1)), but not different from that of peach juice (mean = 486 +/- 269 microg kg(-1)). Toxicologically, the amount of Al deriving from the consumption of these products is far below the acceptable daily intake of 1 mg kg(-1) body weight indicated by the FAO/WHO, and it is a verv low percentage of the normal Al dietary intake.

Element concentrations and cataract: an experimental animal model

The determination of inorganic ions in cataractous human lenses has been the subject of several investigations; nevertheless, few studies have been concerned with trace element contents in lenses, and data are sometimes contradictory. An animal experimental model of induced cataract is here proposed with the aim of evaluating the changes of Ca, Na, K, Cu and Zn concentrations. The cataract was produced by an Nd:YAG Laser treatment of the right eye of sexteen male rabbits. The determination of the elements was performed by atomic absorption spectrometry (both flame and flameless methods) after an acid digestion of samples. Compared with the results obtained in left lenses used as a control (Ca 14.4+/-5.7 mg/kg d.w.; Na 1.3+/-0.5 g/kg d.w.; K 9.9+/-1.1 g/kg d.w.; Cu 0.24+/-0.09 mg/kg d.w.; Zn 24.8+/-2.3 mg/kg d.w.), the mean concentration values of opaque lenses showed some significant changes for Ca, Na, and Cu (Ca 123.7+/-106.6 mg/kg d.w.; Na 4.5+/-4.3 g/kg d.w; Cu 0.43+/-0.21 mg/kg d.w.). Potassium showed a tendency to decrease, and zinc to increase. Positive correlations were found between calcium and sodium both in controls (r=0.73, p<0.001) and in treated lenses (r= 0.87, p<0.0001). An inverse correlation between Ca and K confirmed the tendency of potassium to decrease.

Effect of surface coating on water migration into resin-modified glass ionomer cements: a magnetic resonance micro-imaging study

Magnetic resonance micro-imaging was applied to study water diffusion into resin-modified glass ionomer cement restoration and to evaluate the effect of surface coating over restoration. Two cavities were prepared on the labial surface of extracted teeth and restored with resin-modified glass ionomer cement; one was protected with surface coating and the other was not. Immediately after restoration, the teeth were immersed in water. Progress of water diffusion into restorations was monitored by T(1) weighted spin-echo MRI at one-day intervals after the start of immersion. To quantify the water diffusion, a model was developed and compared with imaging data. Best fit yielded an effective water diffusion coefficient D = (2.3 +/- 0.4) 10(-12) m(2)/sec. Experimental results demonstrated that surface coating protects the dental cement against water intrusion from the surface of the restoration which faces the oral cavity. Such coating, however, does not prevent water penetration from the dentine side.

Long-term epidemiological survey of hepatitis B virus infection in a hyperendemic area (Afragola, southern Italy): results of a pilot vaccination project

In 1983, a pilot project of universal hepatitis B vaccination was introduced in a hyperendemic area in southern Italy (Afragola) and is ongoing to date. In this area before the start of vaccination, we found significant evidence of HBV endemicity: the acute viral hepatitis B incidence in the general population averaged 63/100,000; the HBsAg and anti-HBc prevalence rates were 13.4% and 66.9%, respectively; there was involvement of hepatitis B virus (HBV) in 48.1% of chronic liver pathologies (46.3%) in chronic viral hepatitis, 49.5% in cirrhosis and 71.7% in hepatocellular carcinoma cases). We studied the acute viral hepatitis incidence during the vaccination period from 1983 to 1997 and compared the HBsAg and anti-HBc prevalences in 1978 to those in 1997, after 15 years of vaccination. The HBV-related chronic pathology prevalence was also studied. We found a remarkable drop in the acute viral hepatitis incidence, from an average annually of 63/100,000 in the five years before vaccination to 3/100,000 in the last five years of vaccination. In addition, the HBsAg carrier prevalence in the general population decreased from 13.4% in 1978 to 3.7% in 1997. The percentage dropped in children and adolescents from 6.8% to 0.7%, in young people from 10.2% to 1.1% and in adults from 15.8% to 4.0%. The anti-HBc carrier prevalence, found to be 66.9% in 1978, was 34.2% in 1997. Finally, we found a much less significant involvement of HBV in chronic liver pathologies; in fact, it was present in only 18.2% of cases in 1997 and in 48.2% in 1982. In the light of the data, we can assert that universal hepatitis B vaccination has had a substantial effect on HBV endemicity in the Afragola area. We believe that the reduction found in the incidence of acute viral hepatitis B and HBV-related chronic liver pathologies is connected to the decrease in HBV carriers in the area, which therefore reduces the risk of contagion for the unvaccinated.

Chronic cryptogenic hepatitis in childhood is unrelated to hepatitis G virus

OBJECTIVES

The aim of this study was to define the features of chronic cryptogenic hepatitis (CCH) in childhood and to investigate whether it is related to hepatitis G virus infection.

METHODS

Forty-six children (24 males; age range, 1.5 to 17 years) with CCH were studied. CCH was diagnosed when serum alanine aminotransferase concentrations were more than 1.5 times normal for longer than 6 months without any apparent cause of liver disease.

RESULTS

No patient had acute symptomatic onset or had received a blood transfusion. Three had undergone minor surgical procedures. All appeared to be healthy during follow-up (median, 4.2 years; range, 1 to 10 years). Hypertransaminasemia was the only aberrant liver function test. Elevated serum alanine aminotransferase values alternated with normal values in 40 children (86.9%). Five children (10.8%) had a spontaneous sustained (>12 months) remission of hypertransaminasemia. Twelve (26%) had laboratory signs of autoimmunity, but none fulfilled the criteria for autoimmune hepatitis. Of 20 children who underwent liver biopsy, 13 (65%) had minimal chronic hepatitis, 4 (20%) had mild chronic hepatitis and 3 (15%) had moderate chronic hepatitis. Serum hepatitis G virus RNA was detected in 2 girls (4%) whose risk factor was a hepatitis G virus-infected mother and a minor surgical procedure, respectively. In 12 families at least 1 other member had chronic liver disease.

CONCLUSIONS

Childhood CCH seems to be a symptomless disease characterized by isolated hypertransaminasemia with onset during the first 4 years of life and mild to moderate histologic liver lesions. Although the frequency of spontaneous remissions is low, childhood CCH seems, in the short run, to be a nonprogressive disease. Hepatitis G virus does not play a major role in CCH.

Immunization programme against hepatitis B virus infection in Italy: cost-effectiveness

In Italy in the 1980s the extent of viral hepatitis B infection was on average about 11,000 symptomatic cases of acute viral hepatitis (AVH) per year (19/100,000 inhabitants). The prevalence of HBsAg carriers in the general population was about 3% and in pregnant women 2.4%. 64,000 people were affected by chronic viral hepatitis (CVH) or cirrhosis (prevalence rate 112/100,000) and 3400 by hepatocellular carcinoma (HCC) (prevalence rate 5.9/100,000). To reduce these HBV related pathologies in the Italian population, universal vaccination of newborn babies, 12-year old adolescents and high risk groups was implemented in 1991. The annual cost of this immunization is about 57 million 544 thousand USD: direct costs: 41 million 34 thousand USD; indirect costs: 16 million 510 thousand USD. Concerning the vaccination impact on HBV endemicity in Italy, we found a significant reduction of acute viral hepatitis incidence (4.2/100,000 in 1996 versus 19/100,000 in the '80s) and HBsAg carrier prevalence (0.9% in 1997 versus 3% in the '80s). As for the assistance and social cost of acute viral hepatitis occurring from 1991 to 1996 (17,608 cases) it was 238 million 908 thousand USD, while the cost for the same pathology in the years from 1985 to 1990 (35,614 cases) was 483 million 216 thousand USD. Thus, the saving during the years of the vaccination was evaluated in 244 million 308 thousand USD. At the moment, we have no information about the reduction in chronic sequelae of HBV pathology as an effect of the vaccination, because the incidence of this pathology generally starts to appear after 15 years (in our case in 2006).

Long-term epidemiological survey of hepatitis B virus infection in a hyperendemic area (Afragola, southern Italy): results of a pilot vaccination project

In 1983, a pilot project of universal hepatitis B vaccination was introduced in a hyperendemic area in southern Italy (Afragola) and is ongoing to date. In this area before the start of vaccination, we found significant evidence of HBV endemicity: the acute viral hepatitis B incidence in the general population averaged 63/100,000; the HBsAg and anti-HBc prevalence rates were 13.4% and 66.9%, respectively; there was involvement of hepatitis B virus (HBV) in 48.1% of chronic liver pathologies (46.3%) in chronic viral hepatitis, 49.5% in cirrhosis and 71.7% in hepatocellular carcinoma cases). We studied the acute viral hepatitis incidence during the vaccination period from 1983 to 1997 and compared the HBsAg and anti-HBc prevalences in 1978 to those in 1997, after 15 years of vaccination. The HBV-related chronic pathology prevalence was also studied. We found a remarkable drop in the acute viral hepatitis incidence, from an average annually of 63/100,000 in the five years before vaccination to 3/100,000 in the last five years of vaccination. In addition, the HBsAg carrier prevalence in the general population decreased from 13.4% in 1978 to 3.7% in 1997. The percentage dropped in children and adolescents from 6.8% to 0.7%, in young people from 10.2% to 1.1% and in adults from 15.8% to 4.0%. The anti-HBc carrier prevalence, found to be 66.9% in 1978, was 34.2% in 1997. Finally, we found a much less significant involvement of HBV in chronic liver pathologies; in fact, it was present in only 18.2% of cases in 1997 and in 48.2% in 1982. In the light of the data, we can assert that universal hepatitis B vaccination has had a substantial effect on HBV endemicity in the Afragola area. We believe that the reduction found in the incidence of acute viral hepatitis B and HBV-related chronic liver pathologies is connected to the decrease in HBV carriers in the area, which therefore reduces the risk of contagion for the unvaccinated.

Anti-HBs responses in children vaccinated with different schedules of either plasma-derived or HBV DNA recombinant vaccine

This study evaluated the immunogenic and protective effects of plasma-derived and DNA recombinant anti-hepatitis B virus vaccines administered to infants at various ages and with different vaccination schedules: 3 monthly doses in the first 3 months of life, 3 doses (at 3, 5 and 11 months) or 2 doses (at 1 and 3 months) or 2 doses (at 3 and 5 months). Anti-HBs (hepatitis B surface) and anti-HBc (hepatitis B core) markers were investigated twice: one month and ten years after vaccination in 261 children immunized with plasma-derived vaccine, and one month and five years after vaccination in 449 children immunized with DNA recombinant vaccine. In all groups, the appearance of anti-HBs protective levels one month after vaccination and their persistence in the following years were found in a larger number of subjects when the vaccine doses had been administered after the third month of life rather than in the first three months. Moreover, our results show that the reappearance of surface antibodies a week after the booster, in vaccinated children who became anti-HBs- in the years following vaccination, occurred in a larger number of subjects when the primary vaccination with 3 doses had been performed in the first quarter or with 2 or 3 doses in the second quarter. In contrast, protective levels of anti-HBs were found in a small number of children belonging to the group vaccinated with 2 doses in the first three months, and among them the majority seroconverted only one month after the booster. Anti-HBc was found 10 years after vaccination in only one child immunized with 2 doses of plasma-derived vaccine, and 5 years after vaccination in two children immunized with 2 doses of DNA recombinant vaccine. All these children were found to lose anti-HBs, and none of them had signs of disease or became a carrier. Based on these results, the disappearance, in some children, of protective levels of anti-HBs in the years following vaccination does not mean the loss of anti-HBV protection. In fact, the trial showed that they reacted immediately to booster stimulation, demonstrating a solid immunologic memory. Therefore, there may be no reason for giving booster injections when the vaccination of infants is carried out correctly.

Viral hepatitis in the Bhutanese population: preliminary results of a seroepidemiological investigation

A seroepidemiological study of the prevalence of markers related to the most common forms of viral hepatitis was carried out in Bhutan on 1,666 healthy people of both sexes, from the general population. A group of 440 pregnant women were screened separately. Our results suggest that in Bhutan, hepatitis A and hepatitis B are widespread, while there is a low prevalence of hepatitis C and E. Anti-HAV (anti-hepatitis A virus) was found in all 171 tested subjects over 12 years of age, and anti-HBc (anti-hepatitis B core antigen) in 63.1% of 1,666 tested people. On the other hand, anti-HEV proved positive in 2.0% of 257 tested subjects, and anti-HCV in only 1.3% of 611 tested subjects. Hepatitis B surface antigen (HBsAg) was found in 5.9% of the sample from the general population (5.2% in children, 5.6% in young people and 6.3% in adults) and in 5.4% of the pregnant women. Furthermore, 29.1% of HBsAg-positive pregnant women were HBeAg- and HBV DNA-positive, too. Comparing the pregnant women's prevalence data to those found in children, we suggest that the main route of HBV transmission in the Bhutanese population is vertical, from mother to child; this finding is important for the implementation of a correct anti-HBV vaccination strategy in Bhutan.

Micro magnetic resonance imaging of water uptake by glass ionomer cements

OBJECTIVES

The purpose of the present study was: 1) to visualize the water penetration into glass ionomer cement samples prepared in two different setting modes as a function of time, and 2) to assess the potential use of micro magnetic resonance imaging by studying penetration processes.

METHODS

An encapsulated form of resin-modified glass ionomer cement (Fuji II LC, GC) was used in this study. The mixed cement was syringed into quartz tubes (4 mm ID x 10 mm long). Half of the samples were radially exposed to a light source for 120 s; the other half were allowed to set chemically in a photographic darkroom. One hour after the start of mixing, samples were extruded from the quartz tubes, immediately immersed in distilled water, and stored at 37 degrees C. Eight specimens were prepared with each setting mode and imaged at different times. Micro magnetic resonance imaging was performed on a Bruker Biospec System equipped with micro-imaging utilities. A spin echo technique was used. A small tube containing a mixture of normal and deuterated water was added as a standard to which the signals from the samples were normalized. The average signal, as calculated by the image processing software from each region, was divided by the signal from the standard sample to obtain the normalized intensity. The results were analyzed by a Student's t-test.

RESULTS

After 24 h of immersion, water diffused 1 mm into the chemical-cured material and approximately 0.5 mm in the light-cured samples. After 96 h, the water had reached the center of all chemical-cured samples but not of the light-cured samples. After 192 h, water had reached the center of the cylinders of both groups of samples.

SIGNIFICANCE

MRI microscopy is a good method for monitoring the water permeability of glass ionomer cements. The technique is nondestructive thus, the process can be followed on the same sample without destroying it. By using some special imaging techniques, refinement of the method will be possible.

Prognostic value of contrast enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis

Conventional radiograms have been used to quantitate the progression of rheumatoid arthritis, mainly through the assessment of bone erosions, but this approach has many limitations. It has been suggested that an advantage of contrast-enhanced Gd-DTPA MRI over radiography may be its prognostic value due to its ability to show the natural history of active destructive to inactive fibrous pannus. The aim of this study was to evaluate the possible prognostic value of MRI for future development of bone erosive changes in small hand joints in patients with RA. The results of the study confirm that in joints in which inflammatory active pannus is shown by contrast-enhanced MRI, progression of bone-destructive changes can be expected.

Determination of chromium and nickel in commercial foam bath products by ETA-AAS

The presence of some inorganic elements, such as Ni and Cr in cosmetic products could be responsible for some skin diseases, such as allergic dermatitis. This paper deals with the determination of these two elements in commercial samples of foam bath products by means of the ETA-AAS technique. Four different analytical procedures for sample digestion are evaluated and discussed. Results indicated that the high-pressure microwave digestion is the best procedure for treatment of the complex matrices considered in the study. Chromium values were in the range of 22-199 micrograms/kg, whereas those of nickel fell within the range 26-287 micrograms/kg. The detection limit (3 sigma) of the whole procedure was 3 micrograms/kg for Cr and 15 micrograms/kg for Ni. The analytical data demonstrated that both Ni and Cr were present in all the samples at very low concentrations, and that foam bath products are a relatively minor source of exposure to these elements.

Discrimination between neuropathy and myopathy by use of magnetic resonance imaging

Since discrimination between myopathy and neuropathy may be difficult it seemed reasonable to investigate the possibility of assessment of these disorders by means of magnetic resonance imaging. Children with Duchenne muscular dystrophy and children with the juvenile type of spinal muscular atrophy were selected for the study and compared to healthy volunteers. Measurements were performed on a small Bruker imaging system operating at 2.35 T, and T1 weighed images on the lower extremities were recorded. Images obtained on the diseased extremities could be clearly distinguished from the images from healthy children. Furthermore, preferential involvement of fast muscles in patients with muscular dystrophy, and differences in distribution of fatty degeneration of muscles enable reliable discrimination between muscular dystrophy and spinal muscular atrophy.

Force, fatigue, and the cross-sectional area of wrist extensor muscles after radial nerve grafting

The force and fatigue of the wrist extensor muscles during maximal voluntary and tetanic contractions were measured and compared in the injured and noninjured extremities of 11 patients with radial nerve gap injury and in 9 normal volunteers. The cross-sectional area (CSA) of the wrist extensor muscles was determined by magnetic resonance imaging and was correlated with force. In the patient group, an average of three (range, 2-4) sural nerve cable grafts, measuring 11.5 +/- 5 cm (range, 5-20 cm) in length, were sutured to the nerve stumps at least 9 years before this study. Differences in the CSA values of the injured and noninjured arms were compared, and a ratio was established (CSAR). The mean CSAR was 82.9% +/- 14.3. These differences were not statistically significant (P > 0.10, paired t-test). Despite very well-recovered muscular mass, the maximal voluntary contraction force was found to be incompletely recovered by up to 62.7% +/- 23, when compared with the noninjured side (P < 0.05, paired t-test). The fraction maximal voluntary contraction force/CSA had decreased by up to 76.4% +/- 25.5 (P < 0.05, paired t-test). An increased fatigability of the affected muscles persisted in all patients. The patients' noninjured extremity behaved in the same way as that of the dominant extremity of normal volunteers with regard to force, lever, and CSA values.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged T1 values of the crushed nerve are not exclusively attributable to Wallerian degeneration or endoneurial edema

Axonotmesis of the left sciatic nerve was performed on adult male Wistar rats. T1 values of the crushed nerve samples were determined with proton magnetic resonance spectroscopy. Denervation changes of the dependent hind plantar flexor muscles were assessed with proton magnetic resonance imaging of their cross-sectional area and muscle force measurements. However, Tl relaxation time of the crushed nerve samples remained prolonged implying the absence of nerve regeneration. This would be in contradiction with what is known about regeneration after simple crash and the muscle force and magnetic resonance imaging measurements of the dependent plantar flexor muscles. These studies indicated that sufficient nerve regeneration had taken place to restore their muscle force and volume. A model is suggested to explain the persistence of prolonged Tl values in the presence of muscle force recovery.

Proton NMR study of the state of water in fibrin gels, plasma, and blood clots

A proton NMR relaxation and pulsed field gradient self-diffusion study of water in fibrin gels, plasma, and blood clots has been performed with special emphasis on the effect of the sol-gel and shrinkage transitions. Deuteron NMR in fibrin gels was also studied to supplement the proton data. It is shown that a measurement of the water proton or deuteron T1/T2 ratio allows for a determination of the bound water fraction in all these systems. The change in the T1/T2 ratio at the shrinkage transition further allows for a determination of the surface fractal dimension of the gel if the change in the volume of the gel is known. The self-diffusion coefficient of water in these systems, which determines the transport properties of the gel, is found to be proportional to the free water fraction in both the nonshrunken and shrunken state.

[The effect of althesin anesthesia on atrioventricular conduction]

A study of one of the several factors influencing operative risk was made by studying the effects of Althesin on the conduction system by recording the His potentials in 8 patients.