Embodiment of action-related language in the native and a late foreign language - An fMRI-study

Theories of embodied cognition postulate that language processing activates similar sensory-motor structures as when interacting with the environment. Only little is known about the neural substrate of embodiment in a foreign language (L2) as compared to the mother tongue (L1). In this fMRI study, we investigated embodiment of motor and non-motor action verbs in L1 and L2 including 31 late bilinguals. Half had German as L1 and French as L2, and the other half vice-versa. We collapsed across languages to avoid the confound between language and order of language acquisition. Region of interest analyses showed stronger activation in motor regions during L2 than during L1 processing, independently of the motor-relatedness of the verbs. Moreover, a stronger involvement of motor regions for motor-related as compared to non-motor-related verbs, similarly for L1 and L2, was found. Overall, the similarity between L1 and L2 embodiment seems to depend on individual and contextual factors.

Communication on analgesia and sedation: parents’ opinions in six pediatric ICU in northern Italy

Introduction

Communication between healthcare professionals and parents regarding analgesic and sedative treatments for seriously ill children is challenging. Although appropriate information may help parents during admission to the pediatric intensive care unit (PICU), some areas of communication may be missed.

Objectives

To explore and describe the opinions of parents of children admitted to PICU about analgosedation, information received about it and its potential adverse effects, and suggestions for improving the comfort of hospitalized children.

Methods

Parents’ opinions were collected in six PICUs in northern Italy. Parents of children who were hospitalized for more than 48 hours and required analgesia and sedation were asked to provide opinions on the quality of information with respect to the treatments used, possible short- and long-term sequelae, satisfaction with efficacy, environmental factors perceived as disturbing, and suggestions for improving children’s comfort.

Results

Forty-eight parents participated. Information about analgosedation was rated, as was its effectiveness. Parents pointed out some interesting suggestions to improve their children’s comfort during their hospitalization in PICU. On the other hand, it was found that information about possible complications, withdrawal syndrome, delirium, or difficulties in obtaining the desired level of sedation was often provided poorly or inadequately. In addition, wide differences were found between centres, particularly with regard to analgosedation side effects and withdrawal syndrome.

Conclusions

Parents should receive early explanations of these potential complications. Even considering the limited number of participating PICUs, distributed exclusively in northern Italy, and the small number of participants, this is the first data collection focused on communication between health professionals and parents of children undergoing analgosedation treatment in pediatric intensive care units.

Key messages

• This is the first data collection focused on communication between health professionals and parents of children undergoing analgosedation treatment in pediatric intensive care units.

• Information about possible complications, withdrawal syndrome, delirium, or difficulties in obtaining the desired level of sedation was often provided poorly or inadequately.

Parents’ knowledge about their children’s congenital heart disease: an observational study

Introduction

Congenital heart diseases (CHD) represent abnormalities of cardiovascular structure or function present at birth. The degree of knowledge of parents of children with CHD determines the quality of care and the quality of life of their children. Several studies have shown that parents’ knowledge is still lacking.

Objectives

This study aims to translate and validate in Italian the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD) and to assess the knowledge of parents of children with CHD about heart defect, treatments, preventive measures, opportunities for physical activity and reproductive problems of their children.

Methods

Translation and validation of the questionnaire were performed using a multistep method: forward translation, backward translation, and pilot testing. Five experts in CHD were included for the validation of the questionnaire. The sample consisted of fifty-four pairs of parents of children with CHD. Parents were contacted by telephone; knowledge was assessed using an electronic questionnaire.

Results

Five items were found to have an Item Content Validity Index (I-CVI) of 0.6, 2 of 0.5, and 2 of 0.2. The Scale ContentValidity Index (S-CVI) was found to be 0.80. Regarding parental knowledge, the results show that almost all parents are able to correctly state the name of the diagnosis and the description and location of the heart defect. However, parental knowledge has important gaps; in particular, parents are less informed about the most characteristic sign of endocarditis, the possibility of contracting endocarditis more than once in a lifetime, and risk factors. Parental knowledge also seems to be lacking regarding symptoms suggesting worsening health status in their children.

Conclusions

The Italian version of the LKQCHD has proved to be a valid tool to measure the level of knowledge of parents of children with CHD, allowing to identify in which areas it is necessary to improve the education addressed to parents.

Key messages

• Assessing the knowledge of parents of children with CHD allows to improve their education.

• The Italian version of the LKQCHD is a valid tool to measure the level of knowledge of parents of children with CHD.

Management of Hypothyroidism in Internal Medicine: Patient Profile and Effects of an Educational Programme in the Cluster-Randomized FADOI TIAMO Study

BACKGROUND AND AIMS

There is still limited knowledge regarding the clinical profile and appropriateness of treatment in patients with hypothyroidism hospitalized in Internal Medicine (IM) Departments in Italy. The aim of this study is to evaluate: 1) the characteristics of patients and possible deviations from national and international clinical practice recommendations (CPRs) in evidence-based guidelines (EBGs); 2) the improvement of patient management by means of a standardized educational programme (EP).

METHODS

A nationwide multicentre study, comprising two replications of a retrospective survey (phases 1 and 3) with an intervening EP (phase 2) in half of the centres and no EP in the other half, was conducted. The EP was based on outreach visits. Centres were assigned to the two arms of the study, labelled the training group (TG) and control group (CG) respectively, by cluster randomization. Four EBGs and 39 CPRs provided the basis on which 22 treatment management indicators were identified (7 referring to the time of hospital admission, 15 to post-admission).

RESULTS

The 21 participating centres recruited 587 hospitalized patients with hypothyroidism, 421 of which were females (71.7%, mean age 74.1 + 14.4 yrs): 318 in phase 1 and 269 in phase 3. The cause of hypothyroidism was unknown in 282 patients (48%). Evaluation at the time of admission identified satisfactory adherence to CPRs (>50%) for 63.6% of the indicators. In the phase 3, TG centres showed significant improvement vs CG in 4 of the 15 post-admission indicators, while 1 out of 15 was significantly worse.

CONCLUSIONS

The EP based on outreach visits significantly improved some indicators in the management of patients with hypothyroidism, with specific reference to appropriateness of TSH dosage and levothyroxine (LT4) treatment modality.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT05314790.

Nursing care in early extubation of cardiosurgical patient: a literature review

Introduction

Recent studies show that mechanical ventilation (MV) is necessary in only 5-10% of cardiosurgical patients. Thus, this finding denies the theory arguing that a prolonged period of MV (24 hours to 7 days) reduces the risk of complications. Based on these considerations, strategies have developed, i.e. the Fast Track (FT), with the aim of encouraging early extubation (1 to 8 hours after surgery). The objectives of this review are: to verify the effectiveness of FT in terms of reducing post-operative complications, mortality and costs, to analyse the operating procedures and inclusion criteria of each protocol and to outline nursing care in the whole process.

Methods

Literature search was performed in Cochrane, PubMed, and CINAHL databases. No limits have been applied on study design and publication timespan. Population included adult patients who underwent cardiac surgery with admission to an intensive care unit and were mechanically ventilated.

Results

16 articles (including 8 RCT) have been selected. The protocols require that nurses, based on specific parameters, assess the possibility of weaning from sedation and early extubation according to standardised practices. Early extubation decreases the risk of MV-related complications by decreasing hospitalization lenght and thus total costs by at least 3%. No significant differences have been found between FT and standard of care regarding postoperative complications and mortality.

Conclusions

Taking into account both the proven applicability, safety and efficacy of FT protocols and their high heterogeneity in published studies, that prevent their comparison, further research is needed to identify a reliable algorithm for early extubation based on pre-operative, intraoperative and postoperative data.

Key messages

Early extubation decreases the risk of MV-related complications by decreasing hospitalization lenght and thus total costs by at least 3%. Recent studies show that mechanical ventilation (MV) is necessary in only 5-10% of cardiosurgical patients.

End-of-life decisions and appropriateness of care in intensive care: a cross-sectional, pilot study

In Intensive Care Units (ICUs) patients can experience severe organ failures. In several cases, failures can be incurable, making many of the treatments inappropriate, according to ethical principles. Based on the current legislation, in ICUs, clinicians proceed to limit life support care in most of the cases described. Despite this, some studies report that in many cases the care provided is inappropriate for the prognosis. The study aims at investigating the type and frequency of healthcare personnel's End of Life Decisions (DEL) and the point of view of patients' family, contributing to the debate.

A non-interventional cross-sectional pilot study was conducted in 3 ICUs in North-Eastern Italy. Two questionnaires were administered: the first investigates DEL and the perception of nurses and physicians regarding the inadequacy of care provided to patients (from the ELDY study), the second focuses on the family's opinions. Data are expressed by frequencies, percentages, means and standard deviations.

In line with most of previous studies, cases identified as DEL are all related to non-treatment decisions (n = 20, 74%), 44% of these are related to having stopped or not started treatments already knowing the possibility of anticipating the end of life of the patient, while 27% had the precise intention of shortening life. The situation has been discussed with patient's relatives only in two cases. The cause of increased inappropriateness (87%) was the perception that other patients would benefit more from intensive care than the patient in charge, and 40% of the healthcare personnel reported that similar situations occur very frequently.

The restriction of treatment has been confirmed as the most frequent DEL, and interruption being more frequent than non-implementation. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients' family.

Key messages

When severe organ failures are incurable, in ICUs clinicians proceed to limit life support to the patient in charge. Despite this, in many cases the care provided is inappropriate for the prognosis. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients’ family.

Caregivers' and relatives' grief in intensive care unit: a literature review on nursing practices

Introduction

The sudden and unexpected nature, which often characterizes death in intensive care, complicates the processing of the loss by relatives and caregivers increasing the risk of complicated grief (CG). Due to the high social impact and long-term consequences on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. This review aims to identify nursing interventions for the management of the bereavement of relatives and caregivers and to assess their effectiveness, relatives' and caregivers' satisfaction and prevention of CG.

Methods

Research was performed in CINAHL, PubMed, Psycinfo and Scopus databases with no limits on study design and publication timespan. The population included relatives or caregivers of patients died in intensive care unit.

Results

14 studies met inclusion criteria. Two studies show that the communication of the bad news through dialogue between the team and relatives/caregivers can reduce, in the latter, the levels of anxiety and depression and the incidence of post-traumatic stress disorder. The quality study by Kentish-Barnes et al. (2017) shows that subjects perceived support in receiving a letter of condolence, but the RCT of the same author concludes that those who received the letter were more exposed to the risk of CG. Four studies claim that follow-up meetings facilitate the process of adaptation to loss by providing relatives/caregivers the opportunity to clarify the circumstances of death. Finally, two studies report that the events of commemoration arouse positive emotions in family members.

Conclusions

The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines. Further research is needed and it should consist of RCTs of high methodological quality.

Key messages

Due to the long-term consequences of the sudden death on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines.

A dynamic viticultural zoning to explore the resilience of terroir concept under climate change

Climate change (CC) directly influences agricultural sectors, presenting the need to identify both adaptation and mitigation actions that can make local farming communities and crop production more resilient. In this context, the viticultural sector is one of those most challenged by CC due to the need to combine grape quality, grapevine cultivar adaptation and therefore farmers' future incomes. Thus, understanding how suitability for viticulture is changing under CC is of primary interest in the development of adaptation strategies in traditional wine-growing regions. Considering that climate is an essential part of the terroir system, the expected variability in climate change could have a marked influence on terroir resilience with important effects on local farming communities in viticultural regions. From this perspective, the aim of this paper is to define a new dynamic viticultural zoning procedure that is able to integrate the effects of CC on grape quality responses and evaluate terroir resilience, providing a support tool for stakeholders involved in viticultural planning (winegrowers, winegrower consortiums, policy makers etc.). To achieve these aims, a Hybrid Land Evaluation System, combining qualitative (standard Land Evaluation) and quantitative (simulation model) approaches, was applied within a traditional region devoted to high quality wine production in Southern Italy (Valle Telesina, BN), for a specific grapevine cultivar (Aglianico). The work employed high resolution climate projections that were derived under two different IPCC scenarios, namely RCP 4.5 and RCP 8.5. The results obtained indicate that: (i) only 2% of the suitable area of Valle Telesina expresses the concept of terroir resilience orientated towards Aglianico ultra quality grape production; (ii) within 2010-2040, it is expected that 41% of the area suitable for Aglianico cultivation will need irrigation to achieve quality grape production; (iii) by 2100, climate change benefits for the cultivation of Aglianico will decrease, as well as the suitable areas.

Anterolateral ligament reconstruction with autologous grafting: A biomechanical study

BACKGROUND

To evaluate the reliability of the Iliotibial band compared to gracilis tendon as a graft to be used in anterolateral ligament reconstruction.

METHODS

Gracilis tendon and a strip of Iliotibial band compared were harvested from 8 fresh human cadaveric knees. The gracilis tendon was prepared to obtain a graft of 10cm in length (Group 1). Iliotibial band compared was prepared to obtain a graft of 10cm in length and 0.5cm in width from the middle portion (Group 2). All the specimens were fixed on a servo hydraulic tensile machine with dedicated cryo-clamp. The loading protocol, used to compare the previously published results of ultimate failure load and Stiffness of the anterolateral ligament (Group 3), included a cyclic preconditioning between 10 and 25N at 0.1Hz for 10cycles and then a load to failure test at 20mm/min.

FINDINGS

Gracilis tendon showed higher Ultimante Failure Load and stiffness when compared to a strip of Iliotibial band. Gracilis tendon and a strip of Iliotibial band compared showed higher Ultimante Failure Load and stiffness when compared with native anterolateral ligament as reported by Kennedy.

INTERPRETATION

Both grafts tested in the present studies are suitable for an anatomical anterolateral ligament reconstruction.

Can an adjustable-loop length suspensory fixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study

BACKGROUND

The aim of this study was to compare bone femoral tunnel enlargement in patients who underwent anterior cruciate ligament (ACL) transtibial reconstruction using an adjustable-loop length suspensory fixation device and a fixed-loop length suspensory fixation device.

METHODS

All patients treated for ACL reconstruction with an ipsilateral hamstring between March 2013 and March 2014 were evaluated. Subjects were assigned to Group A (TightRope™ (TR) femoral fixation) or Group B (EndoButton® (EB) femoral fixation). All patients were evaluated with the Lachman test, pivot-shift test, 2000 International Knee Documentation Committee (IKDC) knee examination and KT1000 arthrometer. The subjective evaluation was performed using the 2000 IKDC Subjective Knee score, the Lysholm knee score, and the Tegner activity scale. CT examination was performed to evaluate femoral tunnel enlargement at four different levels. All patients were assessed at a 12month follow-up visit. Power analysis was performed a priori in accordance with the femoral tunnel enlargement values from the CT scans. Differences with P-values of ≤0.05 were considered to be statistically significant.

RESULTS

The groups were homogenous at baseline with regard to age, gender, BMI, dominance and disease duration. At the final follow-up, no statistically significant differences (P>0.05) were found according to subjective and objective clinical outcome measures. According to the femoral tunnel enlargement, no statistically significant difference was found between the two groups (P>0.05).

CONCLUSION

In transtibial ACL reconstruction, the use of a fixed or adjustable-loop length device products, on the femoral side, led to similar clinical and radiological results.

291 THE USE OF THE DYNAMIC IMPACT APPROACH AND DESORPTION ELECTROSPRAY IONIZATION - MASS SPECTROSCOPY TO ANALYZE ADIPOGENESIS IN PORCINE ADIPOSE-DERIVED STEM CELLS

The measurement of end products of metabolism in combination with the dynamic measurement of the transcriptome can be a valuable approach to study complex processes, such as adipogenesis. For this purpose, we have combined the analysis of metabolic pathways using transcriptomics data with in situ lipid imaging obtained by desorption electrospray ionization–mass spectroscopy (DESI-MS). The transcriptome data was obtained from a previous experiment where adipose-derived stem cells (ASC) from 3 individual pigs were induced to differentiate into adipocytes for 21 days. The metabolic pathway analysis of transcriptomics data was performed using the dynamic impact approach (DIA) to determine the directional impact of pathways and gene categories. For the DESI-MS, porcine ASC were induced towards adipogenic differentiation (Monaco et al. 2009 Open Tissue Eng. Regen. Med. J. 2, 20–33) for 2 weeks in 24-well plates over round coverslips. Direct lipid profile of fatty acids and phospholipids in 3 different locations in undifferentiated and differentiated ASC was performed. Relative values of ion counts in each location were used for statistical analysis by means of a two-tailed t-test with unequal variance and false discovery rate (FDR) correction. The DIA uncovered amino acid and lipid metabolism as being the most affected pathways during adipogenesis. Among lipid-related pathways, the DIA indicated a strong induction during differentiation of unsaturation of fatty acids (FA) and metabolism of lipids, particularly triacylglycerol formation (TAG). The metabolism of tryptophan, phenylalanine, and histidine was strongly induced among amino acid-related metabolism. Among the lipid molecules identified in the mass-to-charge ratio (m/z) range of 250–1000 by the DESI-MS, >200 had significantly (FDR <0.01) lower abundance and ~30 lipids had higher abundance in differentiated compared with undifferentiated ASC. The lipid profile of undifferentiated cells was featured by a large amount of lipid molecules in the lower (m/z 780) mass range but with almost no signal in the intermediate range. The differentiated cells had a consistent large increase in amount of molecules in the range from m/z 500 to 650 and a decreased amount in the lower and upper ranges. Among the lipid molecules that decreased during differentiation, we identified several phospholipids, particularly phosphoserine and phosphoinositol species, but also linoleic, linolenic, arachidic, and eicosapentaenoic acids. The unsaturated FA oleate and docosahexaenate increased >10-fold and 2.2-fold, respectively, due to adipogenic differentiation. High-resolution experiments are being performed in order to annotate more, if not all, lipid species identified in the samples by DESI-MS. The DIA indicated greater unsaturation of FA during adipogenesis, confirmed by DESI-MS, which corresponds to the characteristic increase in lipid fractions with intermediate molecular mass. This can be considered a signature of adipogenesis in porcine ASC and essential for TAG formation. The DESI-MS appears to be a valuable tool for rapid lipid profile of cells and with the potential to be used to identify cell differentiation.

213 TRANSCRIPTOMIC COMPARISON BETWEEN PORCINE ADIPOSE AND BONE MARROW MESENCHYMAL STEM CELLS DURING IN VITRO OSTEOGENIC AND ADIPOGENIC DIFFERENTIATION

Previous data support the use of adipose-derived stem cells (ASC) as an alternative to bone marrow as a source of adult stem cells for therapeutic purposes. The aims of the present study were to directly compare the transcriptome of ASC and bone marrow-derived mesenchymal stem cells (BMSC) in order to uncover potential functional differences between the two mesenchymal stem cells (MSC), to identify differentially expressed genes (DEG) and related functions that may drive MSC to become bone or adipose and to identify potential markers for adipogenic and osteogenic differentiation. ASC and BMSC, isolated from subcutaneous adipose tissue and femurs of 3 adult pigs were differentiated in vitro along the osteogenic and adipogenic lineage for up to 4 wk. At 0, 2, 7 and 21 days of differentiation, RNA was extracted for microarray analysis. Data were normalized by Lowess and statistical analysis run using ANOVA with Benjamini-Hochberg false discovery rate (FDR) correction. Data mining was carried out using Ingenuity Pathway Analysis and DAVID. Analysis of undifferentiated MSC for genes with the highest expression and DEG between MSC and fully differentiated tissues uncovered MSC being featured by low immunity and high angiogenic capacity. The direct comparison between differentiation lineages indicated that the expression of a limited number of genes has to change in order to determine cell fate. Functional analysis of the DEG between differentiation lineages indicated that osteogenesis is characterised by larger cell proliferation and cytoskeleton organisation with a crucial role of G-proteins compared to adipogenesis. On the other hand, adipogenesis is driven by PPAR signalling, has greater angiogenesis, lipid metabolism, migration and tumorigenesis capacity compared to osteogenesis. The direct comparison between ASC and BMSC during the same differentiation uncovered that ASC is featured by a greater lipid metabolism compared to BMSC, while BMSC has a more pronounced cell growth and proliferation than ASC. In addition, we uncovered 39 specific gene markers for adipogenesis and 65 for osteogenesis. NAD(P)H dehydrogenase quinone 1 (NQO1), aquaporin 3 (AQP3), stearoyl-CoA desaturase (SCD), fatty acid binding protein 3 and 5 (FABP3 and FABP5) and ferritin light polypeptide (FTL) were among the best adipogenic markers. Hemopexin (HPX), collagenase type 3α (COL3A1), annexin A8-like 1 (ANXA8L1), flotillin 2 (FLOT2) and periostin or osteoblast specific factor (POSTN) were among the best osteogenic markers. Overall, the data indicated that the transcriptome of the two MSC are similar across the conditions studied. In addition, despite the limited DEG between the two MSC, the enrichment of several functions/pathways might indicate differences in therapeutic application. This work was support by the Illinois Regenerative Medicine Institute (IDPH # 63080017).

314 ADIPOSE- AND BONE MARROW-DERIVED MESENCHYMAL STEM CELLS PRESENT LARGE SIMILARITIES IN TRANSCRIPTOME PRIOR TO AND DURING ADIPOGENIC AND OSTEOGENIC DIFFERENTIATION

Previous data support adipose-derived stem cells as an alternative to bone marrow as a source of adult stem cells for therapeutic purposes. The aim of the present study was to directly compare the transcriptome of adipose-derived (ADSC) and bone marrow-derived (BMSC) mesenchymal stem cells prior to differentiation and during in vitro osteogenic and adipogenic differentiation. The ADSC and BMSC were harvested from 3 adult pigs and differentiated in vitro into adipocytes and osteocytes for up to 4 weeks. Prior to differentiation and at differentiation day 2, 7, and 21, cells were harvested and RNA extracted for transcriptomics analysis by a 13 263 oligo 70-mers array (Sus scrofa AROS V1.0 with extension; Operon). Data were normalized by Lowess and statistical analysis was run using ANOVA with Benjamini-Hochberg false discovery rate (FDR) correction. Data mining was carried out using Ingenuity Pathway Analysis and David. Using an FDR of <0.05 for overall tissue effect and a post-hoc correction of P < 0.001, we observed 65 differentially expressed genes (DEG) between ADSC and BMSC before starting differentiation (0.66% of unique genes in the array). Functional analysis uncovered significant enrichment of extracellular matrix genes with direct roles in cell adhesion, migration, movement, and morphology. When the interaction cell type × differentiation × time was assessed, we observed >2 000 DEG with an FDR <0.05. This large number was mostly due to time effects. When pair-wise comparisons between cell types for each time point during the same differentiation were performed (post-hoc P < 0.001), we observed a strikingly low number of DEG. The number of DEG was lower between cell types in osteogenic (<100 DEG) compared with adipogenic (<200 DEG) differentiation. We observed significant enrichment (FDR-corrected P-value cut-off <0.05) of functions related to metabolism, antigen presentation, angiogenesis, and cell cycle in both differentiation conditions. We also observed an overall greater induction of the enriched functions in ADSC and a decrease in BMSC during adipogenic differentiation and the opposite during osteogenic differentiation except for metabolism, which appeared to be larger in ADSC in all cases. Among the significant enriched functions of DEG between the 2 differentiations, we observed enrichment of genes involved in metabolism, cell death, cell-to-cell signalling, and antigen presentation in ADSC during adipogenic compared with osteogenic differentiation. In BMSC we observed enrichment of functions related to cell death, antigen presentation, and lipid metabolism in osteogenic v. adipogenic differentiation. Overall data uncovered a high similarity at the transcriptional level between ADSC and BMSC both prior to differentiation and during differentiation. Those data support ADSC being particularly similar to BMSC. This work was support by the Illinois Regenerative Medicine Institute (IDPH # 63080017).

313 UNSORTED, FRESHLY ISOLATED PORCINE ADIPOSE-DERIVED STEM CELLS ARE MORE EFFICACIOUS IN BONE HEALING COMPARED WITH PURIFIED CD34+ ADIPOSE-DERIVED STEM CELLS

We have previously shown that heterologous transplantation of porcine adipose-derived stem cells (ADSC) enhances bone healing. Freshly harvested ADSC are a heterogeneous population that contains several types of cells other than stem cells. The isolation of highly purified ADSC could be of clinical importance. In this study, we compared the in vitro growth characteristics and in vivo healing potential of ADSC unsorted or separated using CD34 as a marker. The ADSC were extracted from the back fat of 4 male pigs at 6 months of age. For the in vitro experiment, aliquots of the ADSC were sorted by magnetic beads (Miltenyi Biotec, Gladbach, Germany) into CD34-positive (CD34+) and CD34-negative (CD34–) cell populations. The unsorted ADSC (uADSC), plus the CD34+, CD34–, and a 50:50 mixture of CD34+ and CD34– (MIX) were plated in 24-well plates and differentiated into osteocytes. A robotic stage inverted microscope was used to photograph the entire culture well, and then number, dimension, and density of bone nodules were assessed. Alizarin red (AR) staining was performed and quantified. Cells were harvested before cell plating and then on several time points during expansion, at confluence, and at 3, 6, or 18 days [d] of differentiation for cell counting and RNA extraction. Real-time RT-PCR was performed for CD34, COL1A1, and SPARC genes. For the in vivo experiment, freshly isolated ADSC were sorted by flow cytometry into CD34+ and CD34– cell populations. Unsorted and sorted cells were transplanted, in duplicate, into 10- or 25-mm mandible osteoctomies. Mandibles were harvested after 8 weeks for evaluation of healing by DEXA scanning. In vitro data were statistically analysed using a mixed model (SAS) with time and cell type as fixed effect and pig as the random effect. The in vivo data were assessed by ANOVA with cell types as the fixed effect and pig as the random effect. Freshly harvested ADSC contained 42.3 ± 11.0% CD34+ cells. The uADSC reached confluence at 6 days after plating, whereas other cell types reached confluence at 16 days. Expression of CD34 decreased after plating but was similar between cell types. Among osteogenic genes, only expression of SPARC increased during differentiation. The number of osteogenic nodules was higher (P < 0.05) in uADSC than the in other cell types, but the area and nodule density were similar to CD34– and greater (P < 0.05) than CD34+ and MIX. The amount of AR was higher (P < 0.05) in uADSC compared with CD34– and MIX but similar to CD34+. In the in vivo trial, uADSC had a greater (P < 0.05) healing compared with sorted cells. Among those, CD34– cells appeared to increase healing compared with CD34+ cells. Results indicate that CD34+ cells do not differ significantly from CD34– in the in vitro osteogenic differentiation but have lower in vivo healing capacity; however, in vitro data were confused by a lack of pure CD34– cells. The freshly isolated ADSC have a greater healing capacity than sorted cells, as indicated by in vitro and in vivo experiments. Overall our data indicate that the sorting of ADSC CD34+ cells is not of clinical relevance.

381 LABELING AND ANALYSIS OF SWINE ADIPOSE-DERIVED STEM CELLS WITH CARBOXYFLUORESCEIN DIACETATE AND QUANTUM DOTS

The quantity, accessibility, and abundance of subcutaneous adipose tissue in humans make it an attractive alternative to bone marrow as a source of adult stem cells for therapeutic purposes. Adult adipose-derived mesenchymal stem cells can differentiate into a variety of lineages including adipose, bone, cartilage, and muscle. In addition, the use of adult stem cells for regenerative medicine rather than those from embryos avoids concerns with ethics, safety, and immunology. One important issue is the ability to track the transplanted stem cells during the regeneration process to evaluate the stem cell-mediated healing. The objective of this study was to compare the efficiency, longevity, and intensity of carboxyfluorescein diacetate, succinimidyl ester (CFDA SE) and quantum dot nanocrystal (Qtracker™, Invitrogen, Carlsbad, CA, USA) labeled adipose-derived stem cells (ADSC) over an in vitro culture period of 4 weeks. Adipose-derived stem cells (6 x 106) previously isolated and frozen at -196°C were thawed and cultured in 75-cm3 flasks with 14 mL of DMEM. Cells were grown to 80% confluence and trypsinized. After trypsinization, the cells were divided into 4 treatments (3 x 106 cells per treatment). The treatments were (1) unlabeled control, (2) labeled with 30 μM CFDA SE, (3) labeled with 15 nM Qtracker™, and (4) labeled with 15 nM Qtracker™, following the Invitrogen Qtracker™ protocol. Cells (1 x 106) were removed from each treatment every week for 4 weeks and fixed in formalin for later analysis. When all the samples were collected, they were analyzed using flow cytometry. Data were analyzed via chi-square test. The percentage of cells labeled with CFDA SE and Qtracker™ was 99.35 and 98.46%, respectively, immediately after labeling. By 1 wk, the percentage of cells labeled with CFDA SE and Qtracker™ had deceased (P < 0.01) to 0.11 and 1.48%, respectively. The CFDA SE-labeled cell percentages had decreased (P < 0.01) to 0% at 2, 3, and 4 wk, respectively. The Qtracker™-labeled cells also decreased (P < 0.01) to 0.745, 1.69 and 0.45% at 2, 3, and 4 wk, respectively. The high rate of cell division of these cells in vitro might be responsible for the rapid loss of both labels during the first week of culture. Previous results from our lab have shown that the CFDA SE is retained in the cells for up to 6 wk in vivo (Lima AS et al. 2006 Reprod. Fertil. Dev. 18, 208). Similar studies need to be done with the quantum dot-labeled cells to determine the Qtracker™ label’s longevity in vivo. In conclusion, quantum dots can be used to label ADSC, in vitro, for at least 4 wk, albeit at much lower levels than those observed during the week following labeling. Determination of a suitable label for high-percentage porcine ADSC labeling during long-term in vitro culture remains to be completed. This research was supported by the Intel Scholar’s Program and the Illinois Regenerative Medicine Institute.

72 PREGNANCY OUTCOME AFTER OVIDUCTAL TRANSFER OF ZONA-FREE 1-CELL-STAGE PORCINE EMBRYOS PRODUCED BY HANDMADE CLONING

The pig is an important animal model for the study of human diseases. An important step for better use of this species in biomedical research is to obtain genetically identical individuals by procedures such as somatic cell nuclear transfer (SCNT). As the in vitro culture environment is usually sub-optimal for embryo development, the oviductal transfer of cloned embryos at the 1-cell stage may be more efficient for the establishment of pregnancies. However, the transfer at such an early stage usually requires the presence of zona pellucida or agar embedding to protect embryos from the recipient’s immune system (Loi et al. 1999 Livest. Prod. Sci. 60, 281-294). This study aimed to evaluate the developmental viability of 1-cell-stage porcine handmade cloned embryos directly transferred to the oviduct of female recipients without the zona pellucida or agar embedding. After 40 h of IVM in TCM-199 +10% follicular fluid, COCs obtained from sows were denuded, selected for the presence of a polar body (459/689), and submitted to a 0.2% pronase solution in 25% fetal bovine serum (FBS) for partial zona removal, followed by rinses in manipulation medium and pure FBS. Subsequent to oocyte splitting by manual bisection in a 5 μg mL-1 cytochalasin B solution (CCB), hemi-oocytes (87.1%) were screened under fluorescent microscopy using Hoechst 33 342 stain, resulting in 57.6% enucleated halves (461/800). A somatic cell culture established from a fetal clone pig biopsy (Adam et al. 2007 Oncogene 26, 1038-1045) at passage 4 was used for embryo reconstruction, which was done in a 0.05% phytohemagglutinin (PHA) solution, by sticking 2 cytoplasts and a somatic cell in a linear orientation. Reconstructed couplets, rinsed in calcium- and magnesium-free fusion medium, were electrofused in a fusion chamber after exposure to a 30-V AC pulse for 20 s for alignment, followed by two 24-μs-long DC fusion pulses of 1.3 kV cm-1. Fused couplets (154/214) were exposed for 10 min to a solution containing 5 μg mL-1 CCB and 10 μg mL-1 cycloheximide, followed by electrical activation (two 24-μs-long DC pulses of 0.9 kV cm-1) in fusion medium containing calcium and magnesium. Activated embryos were cultured in vitro for 12 h in 500 μL of PZM-3 medium in the well of the well (WOW) system, in a plastic bag filled with gas mixture (90% N2, 5% O2, 5% CO2), at 38.5°C. Then, a total of 70 and 80 non-agar-embedded, zona-free 1-cell-stage cloned porcine embryos were transferred directly to the oviducts of a sow and a gilt, respectively, both synchronous at approximately 12 h before ovulation. The recipient sow was diagnosed pregnant by ultrasonography on Day 66 of gestation. Although the sow was diagnosed open on Day 72, this study demonstrates that the transfer of 1-cell-stage zona-free embryos directly to the oviduct of a synchronous sow can result in pregnancy.

401 MIGRATION AND THERAPEUTIC POTENTIAL OF PORCINE ADULT ADIPOSE-DERIVED MESENCHYMAL STEM CELLS

Bone marrow is one current source of adult stem cells for therapeutic purposes; however, the magnitude and accessibility of subcutaneous adipose tissue in humans make it an attractive alternative. Numerous in vitro studies have been conducted to determine how these cells act in vitro, but it is imperative to determine the vast abilities of these cells in vivo. The objective of this study was to evaluate in vivo migration and bone healing ability after transplanting adipose-derived stem cells (ADSC) in a swine model. Adipose-derived stem cells were isolated from subcutaneous adipose tissue of adult Yorkshire pigs and cultured in vitro. At 80 to 90% confluence/passage 3, the cells were trypsinized and labeled in suspension with carboxyfluorescein succinimidyl ester (CFDA-SE). This project included 20 pigs weighing between 63.5 and 81.7 kg. Bilateral mandibular osteoectomies with 10-mm defects were performed on each pig. Of the 20 pigs, half received a treatment of 2.5 million CFDA-SE labeled stem cells administered directly into each defect (DI), and the remaining half received a treatment of approximately 5 million CFDA-SE labeled stem cells through an ear vein injection via catheter (EVI). The time points were 1 h and 2 and 4 wk, with 2 pigs per time with the DI and EVI treatments. Pigs were slaughtered at each time, and spleen, liver, lung, kidney, ear vein, blood, and mandible tissues were collected. Blood samples were collected from the jugular vein with EDTA and processed via flow cytometry after collection. Tissues were fixed in 10% buffered formalin for histology. Fluorescent microscopy (CFDA-SE excitation/emission is 492/517 nm) has confirmed that transplanted ADSC do indeed migrate to a site of injury or trauma. Labeled cells were also present in blood collected from the 1-h time point group. Currently, we have not seen the presence of labeled ADSC in the other tissues (spleen, liver, lung, and kidney) after the 1-h time point. We did observe that ADSC administered by DI and EVI were able to significantly heal and regenerate bone defects within 4 wk post-surgery (P < 0.05, ANOVA with F-test), in contrast to bone defects in pigs that did not receive cell injections (control). Evidence of ADSC-related healing and bone regeneration was evident by gross visualization, dual-energy x-ray absorptiometry (DXA) and micro computer tomography (microCT) analysis. The clinical implications of these results are significant for treating many diseases in which inflammation or defects exist, such as cardiac disease, neurological disease, or traumatic injuries to both soft and hard tissue. If the adult stem cells can be harvested from fat, encouraged to produce bone or cartilage, and then reinserted into defects, treatment protocols for trauma victims could be developed that would reduce the need for alternate harvesting techniques for bone. This work was support by a grant from the Illinois Regenerative Medicine Institute (IDPH # 63080017).

436 RISK ANALYSIS OF α-LACTALBUMIN TRANSGENE TRANSFER TO NONTRANSGENIC CONTROL ANIMALS DURING REARING, BREEDING, PARTURITION AND LACTATION

Assessment of general risk posed from transgenic (T) animals is important to their future contributions to society. Identification of potentially harmful properties of transgenic livestock is the initial step in a risk assessment. We previously developed and characterized transgenic swine containing a mammary-specific transgene (bovine a-lactalbumin, bALAC) that results in increased milk production in sows. We are currently determining whether bALAC is expressed in tissues of T swine other than the lactating mammary gland and whether the transgene DNA (Tg) crosses into nontransgenic control (C) swine under various physiological and physical conditions. The specific aims addressed in the present study were to determine (1) whether the Tg can be transferred directly by physical association or contact; (2) whether the Tg can be transferred directly via mating; (3) whether the Tg can be transferred directly during gestation and parturition; and (4) whether the Tg can be transferred directly during lactation. The T animals utilized in these studies are in at least generation 10 and have stable incorporation of the Tg. Comparable age- and weight-matched animals, T and C, were housed together allowing general contact that is normal in swine production, for either 180, 220, or 250 days of age after weaning. Swine typically ingest saliva, regurgitated food, and stool or urinary products, as well as other bodily fluids and cells during normal housing. In the second study, vaginal, cervical, uterine, oviductal, and ovarian tissues from C females on 2, 7, or 90 days after mating to T males, and penis, bulbourethral gland, urethra, testis, and epididymis tissues from C males on 2 or 7 days after mating to Tg females were collected. The presence of Tg in tissues from all C animals was tested by using PCR. We have analyzed for the presence of the Tg in various tissues [including mammary gland, salivary gland, skin (sebaceous gland), muscle, lung, liver, kidney, brain, ovary, oviduct, uterus, cervix, vagina, penis, bulbourethral gland, urethra, testis, epididymis, blood, inner and outer placental membranes and intestine]. Results indicate no presence of the Tg in tissues of C animals (n = 28) after co-habitation for 180, 220, or 250 days (n = 305 samples analyzed) or at 2 (n = 7), 7 (n = 16), or 90 (n = 6) days post-mating (n = 72, 192, or 71 samples analyzed, respectively). At Day 112 of gestation, all the samples (n = 78 samples analyzed) from nontransgenic piglets (n = 13) whose dam was aTg female were negative except for the outer placental membrane (n = 13), which screened positive for the transgene. This is not surprising because the outer placental membrane is in close contact with the uterus of the Tg dam. Finally, control piglets (n = 4) that were cross-fostered (3 days after birth) and suckled Tg dams showed no evidence of the transgene in their tissues (n = 20 samples analyzed) at weaning. The present results suggest that there is no horizontal Tg transmission between T and C pigs caused by rearing, mating, gestation, or lactation. This project was supported by USDA BRAG Project #2005-03799.

390 ISOLATION AND ADIPOGENESIS OF GRIZZLY BEAR MESENCHYMAL STEM CELLS

During winter hibernation, grizzly bears (Ursus arctos horribilis) do not eat but instead rely on internal fat stores as a primary source of metabolic energy. The resulting seasonal fluctuations in appetite and body mass make the grizzly bear a naturally occurring animal model for human conditions such as obesity and anorexia. An in vitro model of hibernating bear stem cells might enhance our understanding of processes such as stem cell proliferation and differentiation. Mesenchymal stem cells, derived from bone marrow and adipose tissue among others, differentiate into adipocytes and might play important roles in energy metabolism. In the current study, we examined the in vitro viability and morphology of mesenchymal stem cells isolated from grizzly bear adipose tissue (ADSC) and bone marrow (BMSC); these ADSC and BMSCs underwent adipogenic differentiation for 0, 7, 14, 21, and 28 days. Bone marrow stem cells and ADSC were isolated using mechanical disaggregation, collagenase digestion, centrifugation, and plating onto tissue culture polystyrene. Cell viability and proliferation was quantified using the colony forming unit assay and a hemocytometer. Both stem cell types were differentiated into adipocytes using 10 μM insulin, 1 μM dexamethasone, and 0.5 mM isobutylmethylxanthine (all Sigma- Aldrich, St. Louis, MO, USA) with the addition of 10% fetal bovine (FBS) or bear serum from the active feeding period. Adipogenic differentiation was confirmed using Oil Red O and quantified using ImageJ. Statistical analysis was performed using an unpaired t-test between treatments of the same time point. All cells were isolated within 28 h of tissue harvest. Adipose-derived stem cells formed an average of 11 colonies (0.011%), whereas BMSC formed 1.5 colonies (0.0015%) per 100 000 cells. Doubling time forADSC was approximately 54 h in 10% FBS. BothADSC and BMSC had an initial spindle-shaped morphology, which gradually became more rounded during adipogenic differentiation. For bear serum at Day 28, ADSC had a significantly (P < 0.01) greater stained area per cell than did BMSC. In summary, both types of mesenchymal stem cells successfully differentiated into adipocytes and maintained viability. In conclusion, grizzly bear mesenchymal stem cells canbesuccessfully isolated, expanded, and differentiated in culture. These results allow for future studies using the bear as an in vitro model for fat metabolism during hibernation and active periods. This work was partially supported by the Carle Foundation Hospital, the Intel Scholar’s Research Program, USDA Multi-State Research Project W1171, and the Illinois Regenerative Medicine Institute (IDPH # 63080017). In addition, the authors would like to thank Agatha Luszpak for support with the analysis.

69 EFFECTS OF CELL TYPE, PRE-ACTIVATION PROTOCOL, AND CULTURE CONDITIONS ON DEVELOPMENT OF PORCINE HANDMADE CLONED EMBRYOS

Despite the rather successful and widespread use of cloning in various species, distinct cell types from the same species and even the same genotype display differences in blastocyst yield. Moreover, variations in the protocol for embryo production can influence development to the blastocyst stage and subsequent fetal development. The aim of this study was to evaluate the effect of 2 cell types and 2 embryo pre-activation protocols with or without the presence of FCS in the in vitro culture medium on development of handmade pig cloned embryos to the blastocyst stage. Cumulus-oocyte complexes recovered from sow ovaries were in vitro-matured for 38 to 40 h. Denuded matured oocytes selected by the presence of a polar body had the zona pellucida removed in a 0.2% protease HEPES-buffered solution +25% FCS, followed by manual bisection and UV screening of enucleated halves using Hoechst stain. Clone embryo reconstruction was performed using a phytohemoagglutinin solution to adhere 2 cytoplasts and a somatic cell. Adipocyte-derived mesenchymal stem cells (ADMSC) from a Yorkshire pig or granulosa cells (GC) from an Ossabaw pig were used as nuclear donors. Following electrical fusion, couplets were pretreated with a brief exposure to cytochalasin B (CB) or cytochalasin B + cycloheximide (CB+CX) in the presence of serum before the electrical activation (Naruse et al. 2007 Theriogenology 68, 709-716; Du et al. 2009 Reprod. Fertil. Dev. 21, 114). Activated embryos were in vitro-cultured in the well of the well (WOW) system, with 2 embryos per microwell, for 7 days in PZM-3 medium +0.3% BSA in the presence (FBS+) or absence (FBS-) of 10% FCS. Cleavage (Day 2, chi-square test) and blastocyst (Day 7, Fisher test) rates, on a per WOW basis, were compared for a level of significance of 5%. Our preliminary data indicate that the presence of serum in the IVC affected cleavage and blastocyst yield in a cell-type-dependent manner. The presence of serum enhanced the blastocyst yield for ADMSC, whereas for GC, only the absence of serum allowed any blastocyst development. The cell type and the pre-activation protocol did not appear to affect cleavage and embryo development to the blastocyst stage. Despite the low number of replications, our results reinforce the importance of optimizing the embryo production system taking into consideration the individual requirements for distinct cell types, procedures, and culture conditions. Table 1.Effects of cell type, pre-activation process and in vitro culture (IVC) medium on development of handmade pig cloned embryos

179 INTERNAL CONTROL GENES FOR QUANTITATIVE PCR OF PORCINE MESENCHYMAL STEM CELLS DURING ADIPOGENIC AND OSTEOGENIC DIFFERENTIATION IN VITRO

Uncovering transcriptomic adaptation of porcine adult stem cells during differentiation in vitro towards a target tissue can provide important information for human adult stem cell therapeutic applications. High-throughput microarrays allow the parallel analysis of thousands of genes simultaneously. However, quantitative RT-PCR (qPCR) remains the chosen method for high-precision mRNA abundance analysis and microarray data verification. Essential for qPCR reliability is data normalization using appropriate internal control genes (ICG). The objective of this study was to find reliable ICG for normalization of qPCR data for porcine adult mesenchymal stem cells induced to differentiate toward adipogenic and osteogenic lineages. Mesenchymal stem cells were harvested from porcine adipose tissue and bone marrow and cultured in vitro with specific differentiation media for up to 3 weeks. The experiment was analyzed by a porcine 13 000-oligo microarray, and data were mined to uncover highly stable genes. Statistical analysis was performed using PROC MIXED of SAS (SAS Institute Inc., Cary, NC, USA). The model included fixed effect of time, cell type, differentiation, and all interaction between them. Pig (n = 3) was considered a random variable. Initial microarray analysis revealed 27 genes with high stability across all samples (sample/reference = 1 ± 0.2). Gene network analysis identified 20 genes without known co-regulation (i.e. common up-stream regulators). Among those genes, we could design high-quality primers (i.e. absence of primer-dimer, single amplicon) only for 10 of them (BANF1, DAK, DPH3, GTF2H3, PRR3, NSUN5, NUBP, SSU72, TIMM17B, and VPS4A), and qPCR using a standard curve was run. Stability of those genes was assessed using pairwise comparison of expression ratios. All genes examined were highly stable with TIMM17B, NSUN5, and VPS4A as the most stable. All the potential ICG tested had significant time, tissue × differentiation, and tissue × time effects. For the 3 most stable genes, we did not observe additional effects, while other ICG were significantly affected by differentiation. The analysis also indicated calculation of the normalization factor using the 3 most stable genes (NF3) as highly reliable; however, the use of 7 genes (NF7) would provide the best reliability. To assess the effect of normalization, we ran qPCR for DBI and COL1A1, genes specific of adipogenic and osteogenic differentiation, respectively. The effect on qPCR data normalization was highly apparent for the adipogenic differentiation and less apparent for the osteogenic differentiation. No differences were observed when qPCR data were normalized by NF3 or NF7. The combination of microarray data and pairwise analysis uncovered novel and high reliable ICG for qPCR normalization in adult porcine stem cells induced into adipogenic and osteogenic lineages. This work was supported by the Illinois Regenerative Medicine Institute.

311 RISK ANALYSIS OF ALPHA-LACTALBUMIN TRANSGENE TRANSFER TO NON-TRANSGENIC CONTROL ANIMALS DURING REARING AND BREEDING

Assessment of general risk posed from transgenic (T) animals is important to their future contributions to society. Identification of potentially harmful properties of transgenic livestock is the initial step in a risk assessment. Direct and indirect impacts of potential harmful properties of T livestock need to be evaluated at 3 levels, namely (1) characterization of how the transgene, its product, and the T livestock behave in their immediate environment, that is, in their barn or pen; (2) determination of possible impacts of large-scale release of T livestock, that is, if they were to be integrated into the larger population of food animal livestock; and (3) determination of the more complex environmental and safety consequences of their release into livestock populations. We previously developed and characterized transgenic swine containing a mammary-specific transgene (bovine α-lactalbumin, bALAC) that results in increased milk production in sows. We currently are determining whether bALAC is expressed in tissues of T swine other than the lactating mammary gland and whether the transgene DNA (Tg) crosses into non-transgenic control (C) swine under various physiological and physical conditions. The specific aims addressed in the present study were to determine: (1) whether the Tg can be transferred directly from T animals to C animals by physical association or contact and (2) whether the Tg can be transferred directly from an adult T animal to an adult C animal via mating. The T animals utilized in these studies are in at least generation 10 and have stable incorporation of the Tg. Comparable age- and weight-matched animals, T and C, were housed together allowing for general contact that is normal within swine production, for either 180, 220, or 250 d of age after weaning. Swine due to their behavior ingest saliva, regurgitated food, and stool or urinary products, as well as other bodily fluids and cells during normal housing. In a second study, vaginal, cervical, uterine, oviductal, and ovarian tissues from C females on 2, 7, or 90 d after mating to T males and penis, bulbourethral gland, urethra, testis, and epididymis tissues from C males on 2 or 7 days after mating to Tg females were collected. The presence of Tg in tissues from all C animals was tested via PCR. We have analyzed for the presence of the Tg in various tissues [including mammary gland, salivary gland, skin (sebaceous gland), muscle, lung, liver, kidney, brain, ovary, oviduct, uterus, cervix, vagina, penis, bulbourethral gland, urethra, testis, epididymis, and intestine]. Results indicate no presence of the Tg in tissues of C animals (n = 28) after co-habitation for 180, 220, or 250 d (n = 305 samples analyzed) or at 2 (n = 5), 7(n = 14), or 90 (n = 2) d post-mating (n = 60, 174, or 24 samples analyzed, respectively). The present results suggest that there is no horizontal Tg transmission between T and C pigs due to rearing or mating. This work provides a critical step toward providing rigorous scientific data for risk assessment of transgenic livestock. This project supported by the USDA BRAG Project #2005-03799.

282 ADIPOGENIC DIFFERENTIATION IN VITRO OF PORCINE ADULT MESENCHYMAL STEM CELLS

The quantity and accessibility of subcutaneous adipose tissue in humans make it an attractive alternative to bone marrow as a source of adult stem cells for therapeutic purposes. However, before such a cell source substitution can be proposed, the properties of stem cells derived from adipose tissue (ADSC) and bone marrow (BMSC), and their differentiated progeny must be compared in an animal model, such as swine, that adequately simulates the structure and physiology of humans. The objective of this work was to induce adult porcine stem cells isolated from subcutaneous adipose tissue and bone marrow to differentiate in vitro along the adipogenic lineage and to compare their transcript profile properties. ADSC and BMSC were isolated from subcutaneous adipose tissue and femurs of adult pigs, respectively, and differentiated along the adipogenic lineage using specific inducing medium. Cells were incubated up to 4 weeks with medium replaced every 3 days. Histological staining with Oil Red O was performed at 0, 2, 4, 7, 14, 21, 28 days of differentiation (dd) to confirm the adipogenic differentiation. RNA was also extracted at these time points. qPCR was performed on PPARG, DBI, ACSL1, CD36, CEBPA, DGAT2, ADFP, ADIPOQ, SCD. The geometrical mean of GTF2H3, NUBP, and PPP2CB was used as an internal control. Gene expression was analyzed using a mixed model of SAS with repeated time. The adipogenic differentiation of both ADSC and BMSC was confirmed by the Oil Red O positive staining. The relative mRNA abundance of all the genes at dd0 was similar between the ADSC and BMSC. The relative mRNA abundance of most of the genes was also similar between ADSC and BMSC throughout the adipogenic differentiation. ACSL1 and ADIPOQ had analogous expression patterns among the cell types. ACSL1 had relatively large mRNA abundance before differentiation, but ADIPOQ was barely detectable. As a consequence of differentiation, ACSL1 increased in relative mRNA abundance about 10-fold, whereas ADIPOQ mRNA increased about 1000-fold. Temporal expression patterns of SCD, DGAT2, and ADFP were similar. The increase in gene expression was >800% for SCD, >500% for ADFP, and >50 000% for DGAT2 after 7dd. ADSC had significantly higher expression of those genes compared to BMSC at 14 and 28dd. Both ADIPOQ and DGAT2 were almost undetectable prior to differentiation. mRNA expression of CD36 and DBI was similar with a significantly larger increase in expression of ADSC compared with BMSC. Relative mRNA abundance of CEBPA and PPARG was also larger in ADSC compared with BMSC; however, BMSC had a remarkable increase in temporal expression of those genes throughout adipogenic differentiation. These results suggest both cell types can differentiate towards the adipogenic lineage but with quantitatively different gene expression patterns. More investigation is needed before the ADSC can be considered a practical alternative source for stem cells in future human clinical applications. This research was supported by the Illinois Regenerative Medicine Institute.

280 MULTILINEAGE POTENTIAL OF PORCINE BONE MARROW AND ADIPOSE-DERIVED MESENCHYMAL STEM CELLS IN 3-D ALGINATE HYDROGELS

Adipose tissue presents an appealing alternative to bone marrow as a source of mesenchymal stem cells (MSC). However, in order to enhance cell proliferation and differentiation, 3-dimensional (3-D) culture may be required. A 3-D culture has benefits due to its more in vivo-like environment. Further, to form a functional tissue, a scaffold material is required to ensure proper shape and allow for efficient delivery of nutrients and growth factors. Alginate, a resorbable hydrogel, is a potential injectable scaffold for fat and bone tissue engineering due to its high biocompatibility, gelation with calcium and slow dissolution in a physiologic environment. In the present study, we examined the viability, gene expression and morphology of MSC, isolated from porcine adipose (ADSC) and bone marrow (BMSC), during osteogenic and adipogenic differentiation in a 3D alginate hydrogel environment for 0, 7 and 14 days (d). ADSC and BMSC were infused into alginate hydrogels, which polymerized upon the addition of Ca+2 ions. Both stem cell types were differentiated into osteoblasts using 0.1 μm dexamethasone, 10 mm beta glycerophosphate and 50 μm ascorbic acid, whereas adipocytes were differentiated using 10 μm insulin, 1 μm dexamethasone, and 0.5 mm IBMX. Osteogenic differentiation was confirmed using alkaline phosphatase, Von Kossa, and alizarin red S staining and adipogenic differentiation was confirmed using Oil Red O. Cell viability and proliferation was quantified using the MTT assay. Gene expression was measured using qPCR. The morphology of ADSC and BMSC differentiated toward osteogenic lineages changed with both cell types forming osteogenic nodules over time. The nodules formed by ADSC were larger in diameter than those formed by BMSC. Unlike the osteogenic cells that formed nodules, the ADSC and BMSC differentiated into adipogenic cells showed no significant changes in cell size or aggregation. Gene expression results indicated increased PPARG expression in BMSC with time whereas ADSC showed a peak of expression on day 7 and then decreased. ADSC showed increased (14-fold) PPRG expression when compared with BMSC. ADSC had 160-fold less expression of ALP than BMSC. BMSC showed a 16-fold higher expression level of BGLAP than ADSC. ADSC showed a 15.8% higher expression than BMSC for COL1a1. Both ADSC and BMSC showed similar trends SPARC expression, but BMSC had a 12-fold higher expression of SPP1 than ADSC. In summary, both types of mesenchymal stem cells successfully differentiated into both lineages and maintained viability in the hydrogel over time. In conclusion, alginate is a viable scaffold material for the differentiation of mesenchymal stem cells for tissue engineering applications. These results allow for future studies using the pig as an in vivo fat and bone tissue engineering model. This research was supported by the Illinois Regenerative Medicine Institute.

182 OSTEOPONTIN GENE EXPRESSION IN IMMATURE AND MATURE SWINE CUMULUS CELLS AND OOCYTES

Osteopontin (OPN) is an acidic single-chain phosphorylated glycoprotein found in both the female and the male reproductive tract that is believed to facilitate reproduction. It was recently reported in swine that OPN improves in vitro fertilization (Hao et al. 2006 Biol. Reprod. 75, 726–733). In bovine, OPN improves the efficiency of in vitro embryo production, and it has been detected on the zona pellucida (ZP) of immature and mature oocytes (Monaco et al. 2007 J. Anim. Sci. 85, 529 abst). This study was designed to evaluate the gene expression of OPN (SPP1) in immature and mature swine cumulus cells and oocytes. Ovaries from a local slaughterhouse were collected on three different days. Half of the immature cumulus–oocyte complexes (COCs) from each day were vortexed in 1 mL TCM-199 HEPES containing 10 mg mL–1 hyaluronidase to separate immature cumulus cells, while the other half of the COCs were maturated for 40-42 h and then the cumulus cells were separated. RNA from cumulus cells and oocytes was extracted and genomic DNA was removed by DNase treatment. cDNA was synthesized using 100 ng of RNA and diluted 50% with DNase–RNase-free water. The RT-PCR product from cumulus cells and oocytes was run in a 2% agarose gel stained with ethidium bromide to verify the presence of SPP1. Relative mRNA abundance between immature and mature cumulus cells was assessed by SYBR green real-time RT–PCR run in triplicate using a 6-point twofold dilution standard curve. GAPDH was used as internal control. Primers for SPP1 and GAPDH were designed spanning an exon/exon junction. The presence of a single and specific PCR product was assessed by gel electrophoresis (a single band was expected at 100 and 90 bp, respectively, for SPP1 and GAPDH), dissociation curve, and sequencing. A t-test was used to assess differences between immature (n = 3) and mature (n = 3) cumulus cells. SPP1 was detected in agarose gel in both immature and mature oocytes and cumulus cells. Cumulus cells presented a Ct for SPP1 ranging from 20 (immature) to 29 (mature). Immature cumulus cells showed a 32-fold larger mRNA abundance compared to the mature cumulus cells (P < 0.05) when data were transformed using a standard curve. Results showed expression of SPP1 in porcine oocytes and cumulus cells. However, maturation significantly decreased the expression of SPP1 in cumulus cells. The presence of SPP1 mRNA in oocytes and cumulus cells and the larger mRNA abundance before maturation may suggest a role of this protein prior to maturation of oocytes. Additional studies will be required to determine the specific role of SPP1 in oocyte maturation in the pig.

311 RISK ASSESSMENT OF α-LACTALBUMIN TRANSGENIC PIGS

Assessment of the general risk posed by transgenic animals is important to their future contributions to society. Identification of potentially harmful properties of transgenic livestock is the initial step in a risk assessment. Direct and indirect impacts of potential harmful properties of transgenic livestock need to be evaluated at 3 levels: (1) characterization of how the transgene, the transgene product, and the transgenic livestock behave in their immediate environment; that is, in their barn or pen; (2) determination of possible impacts of large-scale release of transgenic livestock; that is, if they were to be integrated into the larger population of food animal livestock; and (3) determination of the more complex environmental and safety consequences of their release into the livestock population. We previously developed and characterized transgenic swine containing a mammary-specific transgene (bovine α-lactalbumin, bALAC) that results in increased milk production in sows (Bleck et al. 1998). We are currently determining whether bALAC is expressed in tissues of transgenic (T) swine other than the lactating mammary gland, and whether the transgene (DNA; Tg) crosses into non-transgenic control (C) swine under various physiological and physical conditions. The specific aims addressed in the present study were to determine (1) whether the Tg can be transferred directly from T animals to C animals by physical association or contact, and (2) whether the Tg can be transferred directly from an adult T animal to an adult C animal via mating. The T animals utilized in these studies were in generation 10 at least and have stable incorporation of the Tg. Comparable age- and weight-matched animals, T and C, were housed together allowing for general contact that is normal within swine production, for 180, 220, or 250 days after weaning. Due to the nature of swine behavior, these animals may ingest saliva, regurgitated food, and stool and urinary products as well as other bodily fluids and cells during normal housing and establishment of dominance hierarchy. In a second study, vaginal, cervical, uterine, oviductal, and ovarian tissues were collected from C females on 2 or 7 days after mating to T males. The presence of Tg in tissues from all C animals was tested via PCR. We have analyzed for the presence of the Tg in various tissues, including mammary gland, salivary gland, skin (sebaceous gland), muscle, lung, liver, kidney, brain, ovary, oviduct, uterus, cervix, vagina, and intestine. Preliminary results indicate no presence of the Tg in tissues of C animals (n = 20) after cohabitation for 180, 220, or 250 days (n = 201 samples analyzed) or at 2 (n = 3) or 7 (n = 5) days post-mating (n = 38 and 59 samples analyzed, respectively). This work provides a critical first step toward providing rigorous scientific data for risk assessment of transgenic livestock. The USDA BRAG Program, Project No. 2005–03799, supported this work.

284 HIGH-THROUGHPUT MICROFLUIDIC TECHNOLOGIES FOR STEM CELL RESEARCH

One of the major issues in stem cell biology is to determine the conditions that enable stem cell culture, which has been slow and laborious due to the present nature of culture systems. Our current research is designed to leverage existing robotic and fluid handling technologies with the unique fluid control and microenvironment properties of the microscale, along with the extensive expertise in stem cell research. One key advantage of microfluidic systems for stem cell research is the ability to ultra-miniaturize the cell-based assays. Swine adipose-derived stem cells (ADSCs) were cultured and differentiated into adipogenic and osteogenic cells. A fluid handling robot was used to implement the passive pumping in the microdevices, which did not require any fluid connectors. A 192-channel micro-conduit polydimethylsiloxane (PDMS) array was made using soft lithography and bonded onto a standard microplate. The fluid handling robot was programmed to load cells and change medium. The total time to change medium for 192 channels was 30 min. Swine adipose-derived stem cells were cultured using DMEM + 10% fetal bovine serum (FBS) for six days in a 100% humidified 5% CO2 atmosphere. Two different cell concentrations were compared (1 � 106 cells and 2 � 106). The ADSCs were differentiated into adipogenic and osteogenic cells using specific differentiation media for the following ten days. The medium was changed every 24 h by the fluid handling robot. To assess for the differentiation, the adipogenic and osteogenic cells were stained using oil red O and alizarin red S to verify fat and calcium formation, respectively. Fatty acid accumulation was confirmed by red-stained lipid vesicles inside the adipogenic cells, and calcium formation was observed as red-stained calcium deposits around the osteogenic cells. We also determined that the concentration of 1 � 106 cells (equivalent to 1500 cells per channel) gave better results than the concentration of 2 � 106 cells (equivalent to 3000 cells per channel) in terms of cell morphology and differentiation parameters. The use of multifactorial directed differentiation using high-speed robotic systems, as employed in our research, will enable the examination of large matrices of culture and differentiation conditions for stem cells. Furthermore, our approach enables the use of gene expression analysis and other analytical methodologies to study the differentiation and cell function of cells cultured under essentially unlimited conditions. Using the automated microscale system in large factorial experiments allows analysis of the basic mechanisms underlying stem cell development in vitro, and ultimately in vivo. This research was supported by the Illinois Regenerative Medicine Institute (IRMI).

202 EFFECT OF OSTEOPONTIN ON IN VITRO EMBRYO DEVELOPMENT IN CATTLE

Osteopontin (OPN) is an acidic single-chain phosphorylated glycoprotein found both in the oviduct fluid (ODF) and oviductal epithelium in cattle, which is believed to facilitate fertilization. It was recently reported that addition of a rabbit polyclonal immunoglobulin G antibody against purified bovine milk OPN with sperm oocytes, bovine oocytes, or both decreased (P < 0.05) fertilization compared with the in vitro-fertilized control (Goncalves et al. 2007 Theriogenology 67, 468–74). The aim of the present work was to determine the effect of in vitro addition of OPN to the fertilization medium on both cleavage and postfertilization embryo development in cattle. In the first experiment, in vitro-matured oocytes were fertilized in modified TALP medium in the presence of 0.0, 0.1, 1.0, or 10 µg mL–1 of OPN. In a second experiment, matured oocytes were in vitro-fertilized in modified TALP medium in the presence of 0.0, 10, 20, or 40 µg mL–1 of OPN. In vitro fertilization was carried out with frozen–thawed spermatozoa from a bull previously tested for IVF. After 20 to 22 h of coincubation at 39�C, 5% in CO2 in air, presumptive zygotes were vortexed to remove cumulus cells, washed, and transferred, 30 to 50 per well, into 400 µL of SOF modified medium. Zygotes were incubated in a humidified mixture of 5% CO2, 7% O2, and 88% N2 in air at a temperature of 39�C. On Day 7 of development (Day 0 = day of insemination), cleavage and development rates into transferable embryos (TE)–tight morulae (TM) and blastocysts (Bl) of superior quality were recorded. Differences in the percentages of both cleavage and blastocyst rates among groups were analyzed by a chi-square test. In experiment 1, numerically higher percentages of TM–Bl (29.5, 29.5, 30.5, and 37.5%, respectively, in the control group and in the groups with 0.1, 1, and 10 µg mL–1 of OPN; P = 0.25) and Bl (28.6, 27.5, 29.1, and 36.7, respectively, in the control group and in the groups with 0.1, 1, and 10 µg mL–1 of OPN; P = 0.24) were observed with 10 µg mL–1 of OPN. In experiment 2, significantly more cleavage (80.0 v. 71.3%; P < 0.05) and higher percentages of TM–Bl (44.6 v. 34.5%; P < 0.05) and Bl (39.2 v. 30.6%; P = 0.06) were observed with 10 µg mL–1 of OPN v. the control. Combined analysis from both experiments showed an overall effect of 10 µg mL–1 of OPN v. the control in the percentages of TM–Bl and Bl (respectively, 41.1 v. 33.3% and 37.7 v. 30.5%; P < 0.05). These results indicate that it is possible to improve the efficiency of bovine in vitro embryo production by adding the oviductal protein OPN.

286 OSTEOGENIC DIFFERENTIATION IN VITRO OF PORCINE ADULT MESENCHYMAL STEM CELLS

The quantity and accessibility of subcutaneous adipose tissue in humans make it an attractive alternative to bone marrow as a source of adult stem cells for therapeutic purposes. However, before such a cell source substitution can be proposed, the properties of stem cells derived from adipose (ADSCs) and bone marrow (MSCs) and their differentiated progeny must be compared in an animal model that adequately simulates the structure and physiology of humans. The objective of this work was to induce adult porcine stem cells isolated from subcutaneous adipose tissue and bone marrow to differentiate in vitro along the osteoblastic lineage and to compare their morphological, phenotypic, and genotypic properties. MSCs and ADSCs were isolated respectively from femurs and subcutaneous adipose tissue of adult pigs and cultured in vitro using DMEM supplemented with 10% fetal bovine serum (FBS), 1% penicillin G-streptomycin, and 5.6 mg L–1 amphotericin B. After 3 passages, cells were differentiated along the osteogenic lineage using lineage-specific inducing medium. Osteogenic medium contained 100 nm dexamethasone, 10 mm β-glycerophosphate, and 0.005 mm ascorbic acid-2-phosphate. Osteogenic cultures were incubated for 4 weeks in 95% air and 5% CO2 at 39�C. Spent medium was replaced with fresh medium every 3 days. Histological staining with alkaline phosphatase, Von Kossa, and alizarin red S were performed at 0, 2, 4, 7, 14, 21, and 28 days of differentiation (dd). At the same time points, RNA was extracted. qPCR was performed on COL1A1, BGLAP, SPARC, and SPP1. As internal control, the geometrical mean of GTF2H, NUBP, and PPP2C was used. Relative mRNA abundance between cell types was calculated using 1/efficiencydCT. The osteogenic differentiation of both MSCs and ADScs was confirmed by the organization of the cells in nodules and by alkaline phosphatase-, Von Kossa-, and alizarin red S-positive staining. The percent relative abundance of the 4 genes in both cell types was COL1A1 (ca. 50) > SPARC (ca. 45) > SPP1 (ca. 5) > BGLAP ( < 0.1). Cell types showed similar mRNA abundance for COL1A1 and SPARC while SPP1 and BGLAP were, respectively, 10- and 19-fold higher in MSCs than in ADSCs. All of the genes had the same pattern among tissues during differentiation except for SPP1, which showed a >10-fold increase at 14 v. 0 dd only for MSCs. Adipose-derived stem cells demonstrated a clear osteogenic differentiation and similar expression and pattern of the two osteogenic genes most abundant in MSCs (COL1A1 and SPARC). However, the higher abundance of SPP1 and BGLAP and the different behavior of SPP1 in MSCs suggest a different transcription profile between the two cell types. From these preliminary results, adipose tissue can be a practical alternative source for stem cells in future human clinical applications.

Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study

Anatomic reconstructions of anterior cruciate ligament (ACL) with double bundle gracilis and semitendonosus tendons graft, reproducing AM and PL bundles, have been introduced to offer a better biomechanical outcome, especially during rotatory loads. On the other hand, many methods of tenodesing the lateral aspect of the tibia to the femur to reduce internal rotation (IR) of the tibia and minimize anterior translation of the tibia relative to the femur as a backup for intra-articular reconstruction, have been also suggested. The goal of this study is to evaluate the effect, on the IR of the tibia, of a lateral reconstruction in addition to a standard single bundle ACL reconstruction as compared with an anatomic double bundle ACL reconstruction. Computer assisted ACL reconstruction has been used because it could be very effective in evaluating the global kinematic performance of the reconstructed knee. We selected 20 consecutive ACL reconstruction procedures to be performed in males in our hospital. Patients were alternately assigned to one of the two groups--group A: standard single bundle ACL reconstruction with doubled gracilis and semitendinosus tendons graft with an arthroscopically assisted two incisions technique and a lateral extraarticular reconstruction; group B: double bundle ACL reconstruction with doubled gracilis and semitendinosus tendons graft with an arthroscopically assisted two incisions technique. In all ACL reconstruction procedures navigation process was performed. Both surgical techniques reduced significantly AP displacement, IR and external rotation (ER) of the tibia respect to pre-operative ACL deficient condition (p<0.05). Comparing the group A after the single bundle reconstruction and the group B after the AM bundle fixation, non differences were found in AP displacement, IR and ER of the tibia (p=0.75, p=0.07 and p=0.07 respectively; power: 0.94). Comparing the group A after the addition of the lateral tenodesis and group B after the PL bundle fixation (AM+PL) no differences in AP tibial displacement and in ER of tibia were found (p=0.9 and 0.15, respectively; power: 0.99); however a significant reduction in IR of the tibia was found in group A after the addition of the lateral tenodesis respect to the group B after the addition of the PL bundle (p=0.0001; power: 0.26). On the basis of our study, the addition of a lateral extraarticular reconstruction to a standard single bundle ACL reconstruction with hamstrings tendons graft in an "in vivo" reconstruction, is more effective in reducing the IR of the tibia at 30 degrees of knee flexion, as compared with a standard single bundle ACL reconstruction and with an anatomic double bundle reconstruction is confirmed.

89 OPEN PULLED STRAW VITRIFICATION FOR IN VITRO-PRODUCED BUFFALO (BUBALUS BUBALIS) EMBRYOS

The aim of this study was to compare the efficiency of different combinations of cryoprotectants for vitrification of IVP buffalo (Bubalus bubalis) embryos at different developmental stages by the open pulled straw (OPS) method. In method A, we evaluated the vitrification and warming solutions previously used to vitrify buffalo embryos in French straws (Gasparrini et al. 2001 Theriogenology 55, 307). Embryos were equilibrated in 1.4 M glycerol for 5 min before being placed into 1.4 M glycerol + 3.6 M ethylene glycol (EG) for 5 min. Then, embryos were transferred into 3.4 M glycerol + 4.6 M EG for 25 s and loaded into the OPSs. For warming, OPSs were briefly immersed in a 0.5 M sucrose solution; the embryos were exposed to 0.25 M sucrose for 5 min before transfer to SOF medium for culture. In Method B, we examined the vitrification and warming solutions previously used for OPS vitrification of cattle embryos (Vajta et al. 1998 Mol. Reprod. Dev. 51, 53-58). Buffalo embryos were equilibrated in 7.5% EG + 7.5% dimethyl sulfoxide (DMSO) for 3 min before transfer into 16.5% EG + 16.5% DMSO and 0.5 M sucrose. After 25 s, they were loaded into the OPSs. For warming, embryos were recovered in a 0.25 M sucrose solution and transferred into a 0.15 M sucrose solution for 5 min before being placed in SOF medium. A total of 293 IVP buffalo embryos (eight replicates) were vitrified at Day 7 of culture (Day 0 = in vitro fertilization). Embryos were vitrified at the following developmental stages: early blastocyst (eBL, n = 26 and 34 with methods A and B, respectively), blastocyst (Bl, n = 31 and 35 for Methods A and B, respectively), expanded blastocyst (XBl, n = 29 and 38 for Methods A and B, respectively), and hatched blastocyst (HBl, n = 46 and 54 for Methods A and B, respectively). Embryo survival rate was determined as the percentage of vitrified-warmed embryos undergoing further development during a 24-h in vitro culture period. Differences between methods were analyzed by ANOVA following arcsine transformation of data. The overall embryo survival rate recorded at 24 h was not significantly different between Methods A and B (70% vs. 62%, respectively). Specifically, no differences were observed in embryos vitrified at the eBL (70% vs. 73%, A and B, respectively), Bl (69% vs. 70%, A and B, respectively), and HBl (46% vs. 36%, A and B, respectively) stages. In contrast, a significantly higher survival rate was recorded for XBl-stage embryos vitrified-warmed by Method A as compared to Method B (90% vs. 53%, respectively; P < 0.01). In Method A, survival rate of XBl was significantly higher than that of HBl (P < 0.05), but it was not different from that of eBl and Bl. Within Method B, the survival efficiency was similar for eBL, BL, and XBl, whereas survival rate of HBl was significantly lower (P < 0.05). In conclusion, although overall embryo survival in vitro was similar between methods, the combination of cryoprotectants used in Method A seemed more suitable for vitrification of IVP buffalo embryos at the XBl stage.

[Emergent pathology in occupational medicine: the mobbing]

Mobbing constitutes a phenomenon not yet clearly defined. The activity, located in the II Faculty of Medicine and Surgery, is specifically dedicated to such phenomenon, which is the outcome of cooperation. The examined population is composed by a light prevalence of men (51.3%) respect to women (48.6%), aged around 42 years and employees (71.6%), workers (28.4%). All patients have been submitted to working anamnesis before being subjected to a psychiatric examination and psycodiagnostic tests. The emerged data underline a trouble of adaptation 55.4% of the cases, 40.5% is affected by psychiatric pathologies, 4.1% of the patients do not show mental disorders. A certification of compatibility with mobbing has been possible to be verified in 49% of the cases. Nevertheless, it is necessary a connection between a physician and business medical service. We hope a necessary enactment of a specific regulation.

[Moral and psychological violence at work: assessment and certification]

Mobbing constitutes a phenomenon not yet clearly defined. The activity, located in the H Faculty of Medicine and Surgery, is specifically dedicated to such phenomenon, which is the outcome of cooperation. The examined population is composed by a light prevalence of women (54%) respect to men (46%), aged around 44 years and employees (73%), workers (27%). All patients have been submitted to working anamnesis before being subjected to a psychiatric examination and psycodiagnostic tests. The emerged data underline a trouble of adaptation 63% of the cases (to which we have released a certification of compatibility with mobbing), 28% is affected by psychiatric pathologies, 9% of the patients do not show mental disorders. Nevertheless, it is necessary a connection between a physician and business medical service.

[Preventive and therapeutic approach to tuberculosis in the general, and high-risk populations]

Authors in the present contribute illustrate the tuberculosis disease in all aspects, the infection, the disease in active phase and in the resistant phase, the law, the prevention and the professional risk in exposed subject, and to consider the epidemiological aspect. Authors hope a coordinate approach between the different figure involved in the therapy and prevention of tuberculosis disease.

[The flu syndrome: update and therapeutic and prophylactic approach]

Authors in the present work analyse the history of the flu from V century A.C. until our days. We can know the different flu epidemic the structure of the virus and to take note of the different preventing device; of these the core is the vaccine. Thanks the vaccine is possible to weaken the big epidemics. Authors attract the importance on the mass vaccine and conclude to mention the new antivirus drugs per os.