Multivariate analysis of mean Raman spectra of erythrocytes for a fast analysis of the biochemical signature of ageing

Ageing of red blood cells (RBC) is a physiological process, fundamental to ensure a proper blood homeostasis that, in vivo, balances the production of new cells and the removal of senescent erythrocytes. A detailed characterization at the cellular level of the progression of the ageing phenomenon can reveal biological, biophysical and biochemical fingerprints for diseases related to misbalances of the cell turnover and for blood pathologies. We applied Principal Components Analysis (PCA) to mean Raman spectra of single cells at different ageing times to rapidly highlight subtle spectral differences associated with conformational and biochemical modifications. Our results demonstrate a two-step ageing process characterized by a first phase in which proteins plays a relevant role, followed by a further cellular evolution driven by alterations in the membrane lipid contribution. Moreover, we used the same approach to directly analyse relevant spectral effects associated to reduction in Haemoglobin oxygenation level and membrane fluidity induced by the ageing. The method is robust and effective, allowing to classify easily the studied cells based on their age and morphology, and consequently to evaluate the biological quality of a blood sample.

Enhanced recovery after surgery efficacy in an older patients and high-risk population affected by colorectal cancer: a more than 1000 patients experience

AIM

Enhanced recovery after surgery programs aims to standardize care, improving colorectal surgery outcomes. Older patients are a challenge population for these programs. The aim of this manuscript is to explore the effect of application Enhanced recovery after surgery protocol among older patients and high-risk patients undergone colorectal surgery for cancer.

METHOD

Since January 2005, until September 2016, 1189 consecutive patients underwent elective Colorectal Surgery and treated according to our Enhanced recovery after surgery protocol. Patients are divided in three groups according to age: Group1 under 69 y-o (control group), Group2 70 to 79 y-o and Group3 over 80 y-o. Primary end point was Time to Readiness to Discharge.

RESULTS

Median Time to Readiness to Discharge was 4 days (3-30) in Group 1, 5 (3-47) in Group 2 and 5 (3-19) in Group 3. Length of stay in Group 1 had a median length of 6 days (3-58), in Group 2 of 8 days (3-70) and in Group 3 of 8 days (3-53).

CONCLUSIONS

Once more Enhanced recovery after surgery program has showed its efficacy in colorectal surgery field. Moreover, our experience has underlined the need to concentrate efforts mainly on older and high-risk patients.

Insights into the morphological pattern of erythrocytes' aging: Coupling quantitative AFM data to microcalorimetry and Raman spectroscopy

Erythrocytes (RBCs) constitute a very interesting class of cells both for their physiological function and for a variety of peculiarities. Due to their exceptionally strong relationship with the environment, the morphology and nanoscale characteristics of these cells can reveal their biochemical status and structural integrity. Among the possible subjects of investigations, the RBCs' ageing is of the utmost importance. This is a fundamental phenomenon that, in physiological conditions, triggers the cell turnover and ensures the blood homeostasis. With these premises, in recent years, we have presented an atomic force microscopy-based methodology to characterize the patterns of RBC ageing from the morphological point of view. In the present work, we used an ageing protocol more similar to the physiological conditions and we used differential scanning calorimetry and atomic force microscopy to probe the cross correlation between important structural and functional proteins. We also assessed the role played by fundamental structural and membrane proteins in the development of the most relevant morphological intermediates observed along the ageing. Furthermore, we coupled the morphological ageing patterns to the (bio)chemical alterations detected by Raman spectroscopy. This allowed identifying the chronology of the ageing morphologies and the metabolic pathways most involved in their development. As a whole, the present study provides the base to correlate specific molecular alterations to the development of structural anomalies, and these latter to the functional status of blood cells.

[Feasibility and effectiveness of laparoscopic right colectomy with extracorporeal anastomosis]

AIM

Despite the laparoscopic right hemicolectomy has been validated by many randomized prospective trials, clear evidences on the validity of the totally mini-invasive technique, namely, through intracorporeal anastomosis, are still lacking. The aim of this study was the assessment of short-term outcome within three months from laparoscopic right colectomy with intra- or extra-corporeal anastomosis.

METHODS

With no exclusion, all patients undergoing laparoscopic right hemicolectomy at our institution have been enrolled in this study. Group A included patients undergoing laparoscopic right hemicolectomy with extracorporeal anastomosis (LAC) and Group B, included patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (TLC). Patients' data, surgery details, results of postoperative period and histological tests have been prospectively recorded in a database and analysed.

RESULTS

Between December 2006 and December 2008, 45 patients underwent right hemicolectomy, 21 with extracorporeal anastomosis and 24 had intracorporeal ones. As to patients' characteristics and histopathological results there are no difference between the groups. Anastomotic dehiscence occurred one in group A and one in group B (P>0.05). Both patients underwent reoperation. We recorded 6 postoperative ileus with vomiting in the LAC group and only 1 in the TLC group (P<0.05). The incidence of Non-Surgical Site Complications (NSSC) was of 4.54% in LAC group and 8.33% in TLC group (P>0.05). Hospitalization was of 5 days for both groups.

CONCLUSION

In conclusion, we believe that this technique is feasible in terms of safety; it doesn't significatively affect the length of surgical procedure and guarantees maintenance of oncological radicality standards of reference. Besides it significatively improves quality of the post-operative period.

[The development of a fast track surgery program after laparoscopic colonic surgery in a General Surgery Unit]

AIM

The aim of the "Fast-Track Surgery" program is to decrease the perioperative stress response to surgical trauma and thus to decrease the complication rates after elective surgery. Critics of the "Fast-Track"(FT) rehabilitation may argue that all reports of successful programs came from major specialised hospital units and that implementation in smaller or less specialised units may be difficult, if not impossible.

METHODS

We retrospectively studied 101 patients that, from November 2004 to October 2007, underwent laparoscopic colorectal surgery in our institute. A detailed "Fast-Track Surgery" protocol was prepared and given to patients, physicians and nurses, with the aim to create a standard treatment. Data about demographics, ASA score, preoperative complicating diseases, diagnosis, type of surgery and postoperative clinical data were analyzed. Univariate analysis of the relationship among all factors (patient characteristics, intervention characteristics, protocol compliance and presence of complications) described here and length of hospital stay was performed.

RESULTS

We compared our results to those of major trials previously published and observed no substantial differences in morbidity, mortality and length of postoperative hospital stay between the two. Univariate analysis showed that compliance to the elements of the FT protocol influences the length of postoperative period more significantly than the patient characteristics or surgical procedure.

CONCLUSION

Based on six comparative single-centre studies, the FT program was found to reduce length of hospital stay and was deemed safe for major abdominal surgeries. The present study shows that enhanced recovery or FT program can also be implemented safely in a General Surgery Unit.

Heterogeneous expression of cyclooxygenase-2 and inducible nitric oxide synthase within colorectal tumors: correlation with tumor angiogenesis

BACKGROUND

Recent studies have shown that the cyclooxygenase (COX) and the inducible nitric oxide synthase (iNOS) pathways are involved in the development of tumor angiogenesis in human cancers.

AIMS

To investigate whether a different pattern of COX-2 and iNOS expression/activity exists within different areas of colorectal tumors and to analyze the relationship between these two enzymes and tumor angiogenesis.

METHODS

Microvessel density (MVD) and COX-2, iNOS, vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR-2) protein expression were evaluated at both the invasive front (IF) and the tumor center (TC) in 46 human colorectal cancer specimens. We also investigated the concentration of PGE2 and NO at the same sites.

RESULTS

COX-2 and iNOS protein expression and activity were significantly higher within the IF than the TC of the tumor specimens. Similarly, MVD and VEGF/VEGFR-2 expression significantly increased from the TC to the IF. Only COX-2 expression was significantly correlated with MVD and VEGF/VEGFR-2 expression at both the TC and the IF.

CONCLUSION

Our study shows a heterogeneous expression of COX-2 and iNOS in colorectal cancer. The up-regulation of COX-2 at the IF parallels an increase in vessel density and VEGF/VEGFR-2 expression, thus supporting the hypothesis that the tumor periphery is the most aggressive portion of a colorectal tumor.

Central modifications of allopregnanolone and beta-endorphin following subcutaneous administration of Nestorone

The aim of the present study was to evaluate the potential action of Nestorone (alone or in combination with estradiol valerate) on the level of allopregnanolone and of the opioid beta-endorphin in selected brain areas. Wistar ovariectomized rats were given 0.05 mg/(kg day) of estradiol valerate (E2V) or subcutaneous Nestorone at three dose levels: low dose (10 microg/(kg day)), antiovulatory dose (50 micro/(kg day)) and high dose (250 microg/(kg day)) with and without E2V. E2V therapy reversed the reduction of allopregnanolone and beta-endorphin induced by ovariectomy anywhere was analyzed except for the adrenal gland. Nestorone showed no effect on allopregnanolone concentration in serum or any part of the brain tissue when given alone while it had a synergistic increasing effect in allopregnanolone concentration in some parts of the brain (hippocampus, hypothalamus, anterior pituitary and serum) when given at high dose of 250 microg/(kg day) in combination with E2V. At lower doses it possesses a synergistic effect with E2V only in the hippocampus (at 50 microg/(kg day)) and in the anterior pituitary (at 10 and 50 microg/(kg day)). Nestorone administered alone at any dose led to significant increase in beta-endorphin levels in the hippocampus only while, in the high dose group, there was a significant increase in endorphin levels in anterior pituitary and hypothalamus in addition to hippocampus as compared to ovariectomized control rats. In addition, only the highest dose of Nestorone added to estrogen increased beta-endorphin levels of hippocampus and plasma. Thus the lower doses of Nestorone alone or in combination with estrogen do not seem to exert any great effect on both allopregnanolone and beta-endorphin. It is only the highest dose of Nestorone that increases allopregnanolone and beta-endorphin levels in selected brain areas, which are the hippocampus, the hypothalamus, the anterior pituitary and serum/plasma. This suggests that Nestorone at the antiovulatory dose levels may not alter the positive effects of estrogen treatment on mood and behaviour.

Influence of endogenous and exogenous sex hormones on plasma brain-derived neurotrophic factor

BACKGROUND

Brain-derived neurotrophic factor (BDNF) is a mediator of neuronal plasticity and influences learning, memory and cognitive behaviour. The aim of this study is to assess plasma BDNF variations according to hormonal status.

METHODS

A total of 60 subjects were included: 20 fertile ovulatory women, 15 amenorrhoeic women and 25 postmenopausal women. Blood samples were collected after overnight fasting. For 5 out of the 20 fertile women, samples were collected every 2 days throughout the whole menstrual cycle. Following basal evaluation, 10 out of 25 postmenopausal women were administered a hormone replacement therapy (HRT) and reevaluated after 6 months of treatment. Plasma BDNF concentrations were measured by enzyme-linked immunosorbent assay. In fertile women, estradiol (E(2)), progesterone and gonadotrophins were also assessed.

RESULTS

In fertile women, luteal phase levels of plasma BDNF were significantly higher than follicular phase levels (P < 0.001). BDNF increased from early follicular phase up to Day 14 of the cycle, reaching a pre-ovulatory peak, similar to E(2). A second rise took place during mid-luteal phase, with a peak on Day 24. Amenorrhoeic subjects, as well as postmenopausal women, showed significantly lower plasma BDNF levels compared with fertile females (P < 0.001). BDNF was positively correlated with E(2) and progesterone and negatively correlated with menopausal age. HRT restored BDNF levels to those present in fertile women during the follicular phase.

CONCLUSIONS

Plasma BDNF levels are influenced by hormonal status. Modifications in BDNF circulating levels during the menstrual cycle suggest a potential role for gonadal sex hormones (E(2) and progesterone) in regulating neurotrophin expression.

Progesterone and progestins: effects on brain, allopregnanolone and beta-endorphin

The increased use of hormonal therapies over the last years has led to improve the knowledge of pharmacological, biochemical and metabolic properties of several progestins and their effects in target tissues, such as the central nervous system. Progesterone and synthetic progestational agents are able to modulate the synthesis and release of several neurotransmitters and neuropeptides in response to specific physiological and pathological stimuli. While these actions may relay on differential activation of progesterone receptor or recruitment of intracellular pathways, some of the differences found between synthetic progestins may depend on the specific conversion to neuroactive steroids, such as the 3-alpha, 5-alpha reduced metabolite, allopregnanolone. This is a potent endogenous steroid that rapidly affects the excitability of neurons and glia cells through direct modulation of the GABA-A receptors activity exerting hypnotic/sedative, anxiolytic, anaesthetic and anticonvulsive properties. Estrogens increase the CNS and serum levels of allopregnanolone and the addition of certain but not all synthetic progestins determines a further increase in allopregnanolone levels, suggesting that the metabolism into this reduced product is related to the chemical structure of progestin molecule used. In addition, depending on specific progestin molecule used, different interaction are found with the estradiol-induced beta-endorphin synthesis and release, showing that diverse progestins have specific and divergent actions on the opiatergic system. These results highlight the concept that natural and synthetic progesterone receptor agonists may systematically induce different biological actions in CNS. This may have far-reaching implications for the clinical effects and related indications of each compound.

Disadaptive disorders in women: allopregnanolone, a sensitive steroid

Allopregnanolone, a neurosteroid acting as a potent anxiolytic agonist of the gamma-aminobutyric acid A receptor, has been shown in animal models to modify its concentrations at central and peripheral levels according to the estrous cycle. Moreover, it modulates behavioral and biochemical responses to acute and chronic stress, anxiety, depression, aggressiveness, convulsions, anesthesia, sleep, memory, pain and feeding. These observations suggest that fluctuations of allopregnanolone might be involved in the development, course and prognosis of some mental disorders in humans. This has been hypothesized for depressive disorders, premenstrual dysphoria, anorexia and bulimia nervosa and Alzheimer's disease, where increased, decreased or dysregulated secretion of the main neurosteroids and their metabolites has been observed. Women show a marked gender-related sensitivity to disadaptive disorders. In addition to the well-studied role of sex steroids in modulating mood and behavior, a putative involvement of neurosteroid fluctuations, and in particular of allopregnanolone, has recently been hypothesized. In fact, several paraphysiological events and various disadaptive disorders in women are associated with modifications of circulating levels of this neurosteroid that might associated with a certain vulnerability to an altered adaptation to stressful life events.

Effects of dietary cadmium and its bioconcentration in tilapia Oreochromis niloticus

The administration of cadmium, as food supplement, its bioaccumulation, and the effects on the development of tilapia Oreochromis niloticus were investigated. The average size and weight and its behavior compared with controls were investigated during the period January 31, 1997, until March 31, 1999. At intervals of 60 days the measurements of size and weight were performed, and the concentration of cadmium in feces, water, muscular tissue, and viscera were determined by atomic absorption spectroscopy. The initial average cadmium concentration in food was 5 mg small middle dotkg(-1) and only after 6 months a small effect on size and weight could be observed. With increases in cadmium concentration to 50 mg small middle dotkg(-1), beginning after the 7th month, and 100 mg small middle dotkg(-1) after the 16th month, a clear difference in size and weight and also in behavior could be observed. An LC(50) value of 40 mg small middle dotkg(-1) was observed after the 23rd month.

Mercury in two fish species from the Paraná river floodplain, Paraná, Brazil

Total mercury concentrations were measured in dorsal muscle tissue of two edible fish species, Prochilodus scrofa 'curimba' and Pseudoplatystoma corruscans 'pintado', respectively detritivorous and carnivorous. Fish species were sampled monthly between February 1993 and January 1994 and bimonthly between April 1994 and February 1995 in three subsystems of Paraná river' system (Ivinhema River/Lake Patos; Baía River/Lake Guaraná and Paraná River/Cortado Channel), between Paraná and Mato Grosso do Sul. Total mercury was determined by HNO3/H2SO4/V2O5 digestion, SnCl2 reduction, and vapour generation method analysis (CGCH 900), adapted to Atomic Absorption Spectrometer (CGAA 7000 ABC). The mean mercury concentrations varied from 82.0 to 310.5 ng g(-1) and from 68 to 294.4 ng g(-1) in 'curimbas' and 'pintados', respectively. Mercury level increases in sexually mature 'curimbas'. Mercury values detected do not exceed the prevailing criteria for issuance of fish consumption advisories (< 500 ng g(-1)).

[Aneurysm of the hepatic artery. A case report]

The authors describe the case of the sixty-one-year-old man admitted to hospital because of a growing jaundice that after the surgical operation proved to be caused by a compression of the PBV determined by a voluminous aneurysm of the hepatic artery. The integrity of the gastroduodenal artery made it possible to make a simple aneurysmectomy with clinic. The patient was discharged from hospital after fifteen days from the surgical operation; he was surgically healed and with normal enzymatic values. The follow-up two years after discharge confirmed a hematochemical state within normal limits.