Performance of Two Different Flight Configurations for Drone-Borne Magnetic Data

The compensation of magnetic and electromagnetic interference generated by drones is one of the main problems related to drone-borne magnetometry. The simplest solution is to suspend the magnetometer at a certain distance from the drone. However, this choice may compromise the flight stability or introduce periodic data variations generated by the oscillations of the magnetometer. We studied this problem by conducting two drone-borne magnetic surveys using a prototype system based on a cesium-vapor magnetometer with a 1000 Hz sampling frequency. First, the magnetometer was fixed to the drone landing-sled (at 0.5 m from the rotors), and then it was suspended 3 m below the drone. These two configurations illustrate endmembers of the possible solutions, favoring the stability of the system during flight or the minimization of the mobile platform noise. Drone-generated noise was filtered according to a CWT analysis, and both the spectral characteristics and the modelled source parameters resulted analogously to that of a ground magnetic dataset in the same area, which were here taken as a control dataset. This study demonstrates that careful processing can return high quality drone-borne data using both flight configurations. The optimal flight solution can be chosen depending on the survey target and flight conditions.

A Survey Among Italian Physicians During COVID-19 Outbreak. Could Bacillus Calmette-Guérin Vaccine Be Effective Against SARS-CoV2?

Background: Epidemiological studies show that BCG-vaccinated population seems to be more likely protected from COVID-19 infection, but WHO gave a stark warning on use of BCG vaccine without confirmed COVID-19 trials. The aim of the study is to evaluate whether TB vaccination, performed several years earlier, could confer protection against COVID-19.

Methods: After the Ethical Committee authorization, professional orders were used to contact physicians with an online survey. Specialty, COVID-19 infection and previous BCG vaccination were recorded. Statistical data analysis was performed.

Results: 1906 physicians answered the questionnaire, (M = 1068; F = 838; mean age 50.7 ± 13.3 years; range 24–87), more than half (1062; 55.7%) experienced BCG vaccination. Professional activity was recorded, and only 49 subjects (2.6%) of them were infected by SARS-CoV2. Among the group of infected people, asymptomatic form occurred in 12 subjects (24.5%); a pauci-symptomatic form in 24 subjects (49.0%); and a severe form (pneumonia and/or respiratory distress) in 13 (26.5%). Considering only the clinically relevant form of COVID-19, period prevalence was 2.2% (23/1062) in the vaccinated group and 1.7% (14/844) in the unvaccinated group (OR: 1.31, 95% C.I.: 0.68–2.63, p = 0.427).

Conclusion: Our experience does not confirm the possible protective role of BCG vaccination, performed years earlier, against COVID-19. Although recent epidemiological studies point out in BCG-vaccinated population a lower prevalence of SARS-CoV2 infection, in our cohort of physicians no significant difference was found in terms of prevalence of COVID-19 infection. Our data underline the necessity to follow the WHO warning about the indiscriminate use of BCG vaccine, until clear evidence of protection by BCG vaccination against COVID-19 is fully demonstrated.

Atopic dermatitis severity during exposure to air pollutants and weather changes with an Artificial Neural Network (ANN) analysis

BACKGROUND

Epidemiological studies have shown an association between global warming, air pollution, and allergic diseases. Several air pollutants, including volatile organic compounds, formaldehyde, toluene, nitrogen dioxide (NO₂ ), and particulate matter, act as risk factors for the development or aggravation of atopic dermatitis (AD). We evaluated the impact of air pollutants and weather changes on AD patients.

MATERIALS AND METHODS

Sixty AD patients ≥5 years of age (mean age: 23.5 ± 12.5 years), living in the Campania Region (Southern Italy), were followed for 18 months. The primary outcome was the effect of atmospheric and climatic factors on signs and symptoms of AD, assessed using the SCORAD (SCORing Atopic Dermatitis) index. We measured mean daily temperature (TOD), outdoor relative humidity (RH), diurnal temperature range (DTR), precipitation, particulate with aerodynamic diameter ≤ 10 μm (PM₁₀ ), NO₂ , tropospheric ozone (O₃ ), and total pollen count (TPC). A multivariate logistic regression analysis was used to examine the associations of AD signs and symptoms with these factors. An artificial neural network (ANN) analysis investigated the relationships between weather changes, environmental pollutants, and AD severity.

RESULTS

The severity of AD symptoms was positively correlated with outdoor temperatures (TOD, DTR), RH, precipitation, PM₁₀ , NO₂ , O₃ , and TPC. The ANN analysis also showed a good discrimination performance (75.46%) in predicting disease severity based on environmental pollution data, but weather-related factors were less predictive.

CONCLUSION

The results of the present study provide evidence that weather changes and air pollutions have a significant impact on skin reactivity and symptoms in AD patients, increasing the severity of the dermatitis. The knowledge of the single variables proportion on AD severity symptoms is important to propose alerts for exacerbations in patients with AD of each age. This finding represents a good starting point for further future research in an area of increasingly growing interest.

Management of the patient with allergic and immunological disorders in the pandemic COVID-19 era

The pandemic COVID-19 abruptly exploded, taking most health professionals around the world unprepared. Italy, the first European country to be hit violently, was forced to activate the lockdown in mid-February 2020. At the time of the spread, a high number of victims were quickly registered, especially in the regions of Northern Italy which have a high rate of highly-polluting production activities. The need to hospitalize the large number of patients with severe forms of COVID-19 led the National Health System to move a large number of specialists from their disciplines to the emergency hospital departments for the treatment of COVID-19. Furthermore, the lockdown itself has limited the possibility for general practitioners and pediatricians to be able to make outpatient visits and/or home care for patients with chronic diseases. Among them, the patient with atopic diseases, such as asthma, rhinitis and atopic dermatitis, is worthy of particular attention as she/he is immersed in a studded negative scenario with the onset of spring, a factor that should not be underestimated for those who suffer from pollen allergy. The Italian Society of Asthma Allergology and Clinical Immunology, to quickly deal with the lack of references and specialist medical procedures, has produced a series of indications for immunologic patient care that are reported in this paper, and can be used as guidelines by specialists of our discipline.

Amyand's hernia with acute phlegmonous appendicitis: case report

Any inguinal hernia containing the vermiform appendix is called Amyand's hernia. Amyand hernias are very rare and even rarer is the association of Amyand hernia with acute appendicitis. Due to the rarity of this entity, it constitutes a challenging case in terms of diagnosis and treatment. The surgical management is not yet standardized and there are no clear guidelines. There are some controversies regarding whether to perform an appendectomy if appendix appears normal or whether mesh can be used for the hernia repair if appendectomy is performed. We describe a case of Amyand hernia in a 90-year old man with acute appendicitis and we review current literature regarding surgical strategy.

Can Longo stapled haemorrhoidopexy for haemorroids be a day-case procedure?

We retrospectively collected data of 100 consecutives elective Longo's procedures for third- and fourth-degree simptomatic haemorroids, classified ASA grade I and II. All patients stayed overnight, because discharge was scheduled the day after the operation. 98 were discharged the day after the operation. Two patients were not discharged the day after because mild and severe bleeding respectively occurred during the first night after the operation which settled conservatively. All the patients were discharged on oral NSAID and stool softeners. None required rehospitalisation. Our retrospective study, pointing out that, in general patients did not require active intervention on the first postoperative night, represents an encouragement to introduce day-case stapled procedure for haemorroids.

Thermal ablation combined with high ligation of sapheno-femoral junction for lower limb primary varicosity

AIM

For long time the traditional surgical treatment for lower limb varicose veins has been high ligation of sapheno-femoral junction and stripping of great saphenous vein. Surgery, however, has been frustrated by postoperative pains, discomfort and recurrences so that it has been challenged by minimally invasive endovenous techniques such as laser treatment and radiofrequency ablation. The aim of the article is to assess the feasibility of a combined approach to greater saphenous vein reflux: high ligation of sapheno-femoral junction and thermal treatment of the great saphenous vein.

METHODS

A retrospective analysis on 95 patients treated with high ligation and thermal ablation at our institution was performed, assessing duration of surgery, post-operative pain and analgesics requirements, early complications and resumption of activities.

RESULTS

Two patients (5,4%), in the laser group experienced skin burns in the course of the GSV. Moderate ecchymosis, by laser fibre-Romainduced perforation of the vein wall, were observed in another two patients (5.4%). Four limbs (10.8%) in the EVLT group developed transient paraesthesias. Analgesic requirement on POD 3 was nil for RFA group; conversely half of the EVLT patients did take analgesics, either 2 or 3 tabs were required. On POD 7, the patients of RFA group continued to not ask for any analgesics, but the same half of the patients in EVLT group still needed 1-2 tabs to carry out their normal activities smoothly. On POD 15, no patient did require analgesics. Resumption of routine activities was earlier for RFA group patients than for those in the EVLT group. The RFA group resumed their activities within 3 days, whereas EVLT group in 8-9 days. High ligation of the SFJ didn't add too much time or morbidities.

CONCLUSION

High ligation of saphenous femoral arc combined with catheter delivered thermal energies for saphenous ablation, even when combined with high ligation of saphenous femoral arc, demonstrated to be minimally invasive, easy to learn and easy to perform, with early resumption and return to normal activity. EVLT achieved similar results to RFA and both techniques were considered equally effective and safe; the results we obtained were not statistically significant but RFA showed less pain, ecchymosis and haematomas, as well as provided better short-term quality of life.

Utility of continuous intraoperative neural monitoring in thyroid surgery in a low volume centre

This retrospective study, of a single surgeon's experience, evaluates the role of intraoperative neuromonitoring (IONM) for total thyroidectomy, in a low-volume district general hospital. 128 patients with normal preoperative vocal fold function underwent thyroid surgery with routine use of nerve monitoring. Patients were followed for 6 months after surgery, and postoperative Romanerve function was determined by fiberoptic laryngoscopy. One (0,8%) patient was found to have a unilateral vocal fold paralysis, but after 6 months this patient had regained vocal fold motion. The technique of intraoperative neuromonitoring in thyroid surgery is safe and reliable in excluding postoperative recurrent laryngeal nerve palsy; it has high accuracy, specificity, sensitivity and negative predictive value. Neuromonitoring is useful to identify the recurrent laryngeal nerve and it can be a useful adjunctive technique for reassuring surgeons of the functional integrity of the nerve. Its application can be particularly recommended for low-volume thyroid operation centres.

Public Prevention Plans to Manage Climate Change and Respiratory Allergic Diseases. Innovative Models Used in Campania Region (Italy): The Twinning Aria Implementation and the Allergy Safe Tree Decalogue

In recent years, climate change has been influenced by air pollution, and this destructive combination has justifiably sounded an alarm for nations and many institutional bodies worldwide. Official reports state that the emission of greenhouse gases produced by human activity are growing, and consequently also the average temperature. The World Health Organization (WHO) believes that health effects expected in the future due to climate change will be dramatic, and has invited international groups to investigate potential remedies. A task force has been established by the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC), with the aim to actively work on correlation between pollution and climate change. The Task Force provided prevention tools to suggest city leaders how to improve the health conditions of allergic people in public urban parks. The "Allergy Safe Tree Decalogue" suggests the preparation and maintenance of public low allergy-impact greenery. Through the Twinning ARIA project, the Division for the Promotion and Enhancement of Health Innovation Programs of Campania Region (Italy), sought to promote the implementation of the project in the regional Health System. The main objective will be to investigate the current use and usefulness of mobile phone Apps in the management of allergic respiratory disease, through Mobile Airways Sentinel networK (MASK), the Phase 3 of the ARIA initiative, based on the freely available MASK App (the Allergy Diary, Android and iOS platforms). The effects of these prevention activities will be registered and compared with monitoring efforts thanks to the Aerobiology Units, located throughout the Campania area. A joint effort between researchers and public administrations for the implementation of prevention plans coherently with the two models proposed in a specific area, i.e. the Decalogue for public administrations and the MASK Allergy Diary app for individual patients suffering from allergy, will be implemented as a pilot.

Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases

Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. Several trials have investigated the role of self-adhesive mesh repair for inguinal hernia, with special attention to the incidence of chronic postoperative inguinal pain and recurrence. The purpose of our study was to retrospectively evaluate the early and long-term results using a self-gripping mesh (Parietex Progrip® , Covidien) in our institution. A total of 204 patients, mean age 50.3 standard deviation (SD) 15.3, was included in the study. The repair was performed under local anaesthesia in 159 (78%) cases and locoregional anaesthesia in remaining 45 (22%). Mean operative time was 39 ± 20 minutes. The time for self-gripping mesh placement ranged from 5 to 9 minutes (mean 7 ± 2 minutes). There were no intraoperative complications. Clinical follow-up was performed at 1 month, 1 year and 2 years and consisted in the evaluation of complications, discomfort/pain and recurrence. One case of cutaneous infection and three cases of seroma were observed at one-month follow-up and were all treated conservatively. 8 patients were lost at one year follow-up, and another 4 were lost at 2 years. 3 patients died for other causes during follow-up. At 1 year and 2 years follow-up no cases of seroma, testicular complications or mesh infection were observed. Two cases of recurrence were recorded at 2 years follow up. No patient reported VAS score > 2 at one month, 1 year and 2 years follow-up. There were no readmissions, systemic complications or death during 2 years follow-up. Lichtenstein open repair using Parietex Progrip® mesh is a simple, rapid, effective and safe method for inguinal hernia repair. The main advantage of self-fixing mesh is the reduced operative time. A suturless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rate in the majority of the trials.

Urban air pollution and climate change: "The Decalogue: Allergy Safe Tree" for allergic and respiratory diseases care

BACKGROUND

According to the World Health Organization, air pollution is closely associated with climate change and, in particular, with global warming. In addition to melting of ice and snow, rising sea level, and flooding of coastal areas, global warming is leading to a tropicalization of temperate marine ecosystems. Moreover, the effects of air pollution on airway and lung diseases are well documented as reported by the World Allergy Organization.

METHODS

Scientific literature was searched for studies investigating the effect of the interaction between air pollution and climate change on allergic and respiratory diseases.

RESULTS

Since 1990s, a multitude of articles and reviews have been published on this topic, with many studies confirming that the warming of our planet is caused by the "greenhouse effect" as a result of increased emission of "greenhouse" gases. Air pollution is also closely linked to global warming: the emission of hydrocarbon combustion products leads to increased concentrations of biological allergens such as pollens, generating a mixture of these particles called particulate matter (PM). The concept is that global warming is linked to the emission of hydrocarbon combustion products, since both carbon dioxide and heat increase pollen emission into the atmosphere, and all these particles make up PM10. However, the understanding of the mechanisms by which PM affects human health is still limited. Therefore, several studies are trying to determine the causes of global warming. There is also evidence that increased concentrations of air pollutants and pollens can activate inflammatory mediators in the airways. Our Task Force has prepared a Decalogue of rules addressing public administrators, which aims to limit the amount of allergenic pollen in the air without sacrificing public green areas.

CONCLUSIONS

Several studies underscore the significant risks of global warming on human health due to increasing levels of air pollution. The impact of climate change on respiratory diseases appears well documented. The last decades have seen a rise in the concentrations of pollens and pollutants in the air. This rise parallels the increase in the number of people presenting with allergic symptoms (e.g., allergic rhinitis, conjunctivitis, and asthma), who often require emergency medical care. Our hope is that scientists from different disciplines will work together with institutions, pharmaceutical companies and lay organizations to limit the adverse health effects of air pollution and global warming.

Gravity modeling finds a large magma body in the deep crust below the Gulf of Naples, Italy

We analyze a wide gravity low in the Campania Active Volcanic Area and interpret it by a large and deep source distribution of partially molten, low-density material from about 8 to 30 km depth. Given the complex spatial-temporal distribution of explosive volcanism in the area, we model the gravity data consistently with several volcanological and petrological constraints. We propose two possible models: one accounts for the coexistence, within the lower/intermediate crust, of large amounts of melts and cumulates besides country rocks. It implies a layered distribution of densities and, thus, a variation with depth of percentages of silicate liquids, cumulates and country rocks. The other reflects a fractal density distribution, based on the scaling exponent estimated from the gravity data. According to this model, the gravity low would be related to a distribution of melt pockets within solid rocks. Both density distributions account for the available volcanological and seismic constraints and can be considered as end-members of possible models compatible with gravity data. Such results agree with the general views about the roots of large areas of ignimbritic volcanism worldwide. Given the prolonged history of magmatism in the Campania area since Pliocene times, we interpret the detected low-density body as a developing batholith.

Donors Thrombocytapheresis with Last Generation Cell Separators

An exciting, fast moving and promising field remains the use of plasma-free synthetic medium for platelet storage (10, 11), that along with the potential for getting more plasma for therapeutic needs, might also improve the quality of stored platelets. Addition of acetate to solution, may be the way to obtain these results. An astonishing fact is that citrate remains the only anticoagulant for platelet collection, and remains as well the only real cause of donor disconfort during thrombocytapheresis.

Plasma Exchange: The Cost/benefit Ratio and the Critical Revision of Indications

The number of conditions that can benefit from Plasma-Exchange (PE) continues to grow. We have recently added to the list the Cyclosporin-A induced hypertrygliceridemia and myoglobinuric acute renal insufficiency.

Such as any therapeutic measure for PE, four evolutive phases can be recognized: the discovery and research, the confirmation of indications, the routine applications and the decline, when new more powerful tools are offered by culture or technology. We have participated in the first three phases during the last 20 years.

Not necessarily all experiences were favourable. Nonetheless, we feel that, for the time being, a hemapheresis unit is an absolute necessity for a medium - sized hospital even if only therapeutic procedures are carried out. The phase four, decline of interest and applications, cannot be foreseen. Finally the ability of PE to shorten substantially the length of hospital stays along with the ease with which procedure can be performed on ambulatory patients, substantiate a favourable cost/benefit ratio for this therapeutic modality.

A Method for the Study of Cryoglobulin Solubilization Curves at 37°C. Preliminary Studies and Application to Plasma Exchange in Cryoglobulinemic Syndromes

A simple method for the study of kinetic solubility curves of cryoglobulins is presented. In its first application to the study of 21 patients with cryoglobulinemia, it was possible to ascertain that clinical condition roughly correlates with decreased solubility whereas no correlation is found with per cent cryocrit.

In the group of patients we studied, 6 underwent plasma exchange treatment when glomerulonephritis, acute renal insufficiency, cerebritis and polyneuropathy appeared: in these patients, following 2 to 5 apheretic sessions, solubility increased showing a sort of correlation with clinical benefits determined by treatment. The preliminarity of this study is underlined.

Cascade filtration: Clinical Application in 26 Patients with Immune Complex and Igm Mediated Diseases

A new technique which allows lymphocytapheresis to be combined with cascade filtration (CF) is described in this paper. This therapeutical approach was applied for the treatment of patients affected by necrotizing vasculitis (1), inflammatory myopathies (5), Cryoglobulinemia (5), immune complex polyneuropathies (7), rheumatoid arthritis (3) and psoriasis (3 patients). Two cases of Waldenstrom's macroglobulinemia were also treated after the onset of the hyperviscosity syndrome. 78 procedures have been performed without any untoward effect. From a clinical point of view all patients had some improvement following treatment, thereby confirming not only the clinical safety of this therapeutical approach but also its effectiveness at least in the management of diseases which usually respond to plasma exchange treatment. Laboratory investigations showed that with CF it is possible to selectively remove IgM, immune complexes, fibrinogen, lipoproteins and high molecular weight plasma components, sparing most albumin and IgG globulins (85 and 71%, respectively).

Acute Intravascular Hemolysis in Two Patients Transfused with Dry-Platelet Units Obtained from the Same ABO Incompatible Donor

Since 1989 we have been collecting dry-platelets on a routine basis. Dry-platelets are those collected along with 25–30 ml of contaminating plasma cell with separators such as the Amicus, AS 104 and the Excel Pro. Platelets are resuspended in non plasma media for storage and for at least 60 hours their viability and functionality are not impaired. In this article we report on two hemolytic crises determined by two O Rh D + units of single donor platelets (SPD) taken from the same donor in a double-apheresis session. The two split units were admistered to two A Rh D + patients suffering from metastatic breast cancer and severe aplastic anemia (SAA) respectively. In both cases the hemolytic reaction was of the intravascular type, with a drop in hemoglobin (Hgb) level from 8.6 to 5.4 and from 8.8 down to 5.3 g/dl respectively. From the patients’ RBC only α - agglutinins were eluted and donor's indirect antiglobulin test (IAT) was negative with extended panel RBCs. In the first case the clinical course after erythroexchange (Erex) was uneventful whereas in the second one, that suffering from SAA, after Erex, acute renal failure and shock did complicate the clinical course and the patient died seven days after the incriminated platelet transfusion.

Intraoperative Blood Salvage: A New Artificial Organ?

Optimal blood supply is critical to modern medical practice. Among the different possibilities of improving the quality and safety of blood, it is generally felt that autologous donation has played an important role and has contributed to changing transfusional practices, mainly since the appearance of HIV and HCV on the blood transfusion scene. At the San Martino Hospital Immunohematology Service, the autotransfusion era began in 1985. Autologous predeposit donation was the first to be introduced, followed by intentional perioperative hemodilution, intraoperative blood salvage with DFC apparatuses and lastly post-operative blood salvage. From about 200 autologous donations in 1985 we reached 5,372 in 1993 and more than 6,000 autologus donations are expected for 1994. Only 189 intraoperative blood salvages, were carried out in 1986, 593 in 1989, 1,207 in 1993 and more than 1,500 blood salvage sessions are anticipated for 1994. In the meantime, the total number of homologous RBC units employed in the Hospital dropped from 45,000 in 1985 to 18,000 in 1994, with the Onco-hematological Divisions using approximately 10,000 units of packed RBC.

Intraoperative Blood Salvage (IOBS) in Cardiac and Vascular Surgery

The extensive application of IOBS has permitted a great reduction in the use of homoglous transfusion which presently represents the largest field of application of autologous systems. In cardiac and vascular surgery, IOBS is particularly useful to the goal of preventing the transmission of viral disorders and other adverse effects related to homologous transfusions. The apparatuses for IOBS may also be used to perform hemodilution and sequestration of a desired amount of platelet rich plasma. The appropriate usage of drugs in perioperative period and the promotion of hemostasis with IOBS are important costituents for the correct transfusional management of the patient. The feasibility and safety of IOBS is known and in expert hands it is an optimal method for the transfusional treatment of surgical patients

Asthma management in a specialist setting: Results of an Italian Respiratory Society survey

BACKGROUND

Asthma considerably impairs patients' quality of life and increases healthcare costs. Severity, morbidity, and degree of disease control are the major drivers of its clinical and economic impact. National scientific societies are required to monitor the application of international guidelines and to adopt strategies to improve disease control and better allocate resources.

AIM

to provide a detailed picture of the characteristics of asthma patients and modalities of asthma management by specialists in Italy and to develop recommendations for the daily management of asthma in a specialist setting.

METHOD

A quantitative research program was implemented. Data were collected using an ad hoc questionnaire developed by a group of specialists selected by the Italian Pneumology Society/Italian Respiratory Society.

RESULTS

The records of 557 patients were analyzed. In the next few years, specialists are expected to focus their activity patients with more severe disease and will be responsible for selection of patients for personalized biological therapy; however, only 20% of patients attending Italian specialist surgery can be considered severe. In 84.4% of cases, the visit was a follow-up visit requested in 82.2% of cases by the specialist him/herself. The Asthma Control Test is used only in 65% of patients. When available, a significant association has been observed between the test score and asthma control as judged by the physician, although concordance was only moderate (κ = 0.68). Asthma was considered uncontrolled by the specialist managing the case in 29.1% of patients; nevertheless, treatment was not stepped up in uncontrolled or partly controlled patients (modified in only 37.2% of patients).

CONCLUSIONS

The results of this survey support re-evaluation of asthma management by Italian specialists. More resources should be made available for the initial visit and for more severely ill patients. In addition, more extensive use should be made of validated tools, and available drugs should be used more appropriately.

Oxidative stress markers in patients with hymenoptera venom allergy

Oxidative stress occurs in many allergic and immunologic disorders as a result of the imbalance between the endogenous production of free reactive oxygen species (ROS) and/or the reduction of antioxidant defense mechanisms. Advanced glycation end products (AGEs), advanced oxidation protein products (AOPPs), and nitrosylated proteins (NPs) can be used as markers of oxidative stress and inflammation. Our objective was to examine the serum levels of AGEs, AOPPs, and NPs in patients with allergic reactions to hymenoptera venom before and after ultrarush venom immunotherapy (VIT). The study included two groups of patients: 30 patients allergic to yellow jacket or honey bee venom and treated by aqueous preparation of Vespula spp (26 patients) or Apis mellifera (four patients) VIT, and 30 healthy donors as controls. Blood samples were collected to measure serum levels of AGEs, AOPPs, and NPs at baseline (T1), at the end of the incremental phase of the VIT protocol (T2), and after 15 days (T3). Serum AOPP levels at T1 were significantly higher in comparison with controls (p = 0.001), whereas serum levels of NPs at T1 were significantly lower than those in controls (p < 0.0001). No significant difference in circulating levels of AOPPs, AGEs, and NPs was found during immunotherapy. These findings suggest that, although hymenoptera venom allergy (HVA) is characterized by isolated episodes of reactions to stinging insect venom and is not included among chronic inflammatory diseases, an oxidative stress status occurs in patients suffering from this kind of allergy. Furthermore, VIT does not modify serum levels of these oxidative stress biomarkers.

The adhesion molecule ICAM-1 is overexpressed in patients with Hymenoptera venom allergy and decreases after ultrarush venom immunotherapy

Adhesion molecules, including ICAM-1, are an important factor in allergic inflammation caused by inhalant allergens, but there are no studies investigating their possible role in Hymenoptera venom allergy (HVA). We measured the level of ICAM-1 in 13 venom-allergic patients before and after ultra-rush venom immunotherapy (VIT). Eight patients were treated by yellow jacket venom and 5 were treated by honeybee venom. Serum ICAM-1 levels were assayed by an immunoenzymatic method, with a detection limit of 0.35 ng/ml. The mean level of ICAM-1 changed from 316.4±78.2 ng/ml before VIT to 294.7±77.9 after VIT. This difference was statistically significant (p = 0.019). These findings show that in patients with HVA there is an over-expression of ICAM-1, and that ultra-rush VIT significantly decreases ICAM-1 levels. It is likely that the known ability of VIT to correct the imbalance in T lymphocytes subpopulations and in the associated production of cytokines may account for this observation. In fact, such cytokines include IL-4 and TNF-alpha, that up-regulate adhesion molecules.

Characterization of a novel PMA-inducible pathway of interleukin-13 gene expression in T cells

Although interleukin 13 (IL-13) is an important mediator of asthma and allergic diseases, the molecular mechanisms regulating IL-13 gene expression are not well understood. This study was designed to define the molecular mechanisms governing IL-13 gene expression in T cells. IL-13 expression was examined in human peripheral blood T cells and in the EL-4 T-cell line by enzyme-linked immunosorbent assay and reverse-transcription polymerase chain reaction. An IL-13 promoter deletion analysis was performed using luciferase-based reporter plasmids transiently transfected into EL-4 cells by electroporation. DNA binding factors were investigated using electrophoretic mobility shift assays. In contrast to IL-4 expression, which required concomitant activation of calcium- and protein kinase C- (PKC-) dependent signalling pathways, PKC activation alone was sufficient for IL-13 protein secretion in mitogen-primed (but not resting) peripheral blood T cells, and for IL-13 mRNA expression and promoter activity in EL-4 T cells. Promoter deletion analysis localized a phorbol 12-myristate 13-acetate (PMA)-sensitive element to a proximal promoter region between -109 and -79 base pairs upstream from the IL-13 transcription start site. This promoter region supported the binding of both constitutive and PMA-inducible nuclear factors in gel shift assays.

HIV-1 envelope gp41 peptides promote migration of human Fc epsilon RI+ cells and inhibit IL-13 synthesis through interaction with formyl peptide receptors

We evaluated the effects of synthetic peptides (2017, 2019, 2020, 2021, 2023, 2027, 2029, 2030, 2031, and 2035) encompassing the structure of HIV-1(MN) envelope gp41 on both chemotaxis of human basophils and the release of preformed mediators (histamine) and of cytokines (IL-13). Peptides 2019 and 2021 were potent basophil chemoattractants, whereas the other peptides examined were ineffective. Preincubation of basophils with FMLP or gp41 2019 resulted in complete desensitization to a subsequent challenge with homologous stimulus. Incubation of basophils with low concentration (5 x 10(-7) M) of FMLP, which binds with high affinity to N-formyl peptide receptor (FPR), but not to FPR-like 1, did not affect the chemotactic response to a heterologous stimulus (gp41 2019). In contrast, a high concentration (10(-4) M) of FMLP, which binds also to FPR-like 1, significantly reduced the chemotactic response to gp41 2019. The FPR antagonist cyclosporin H inhibited chemotaxis induced by FMLP, but not by gp41 2019. None of these peptides singly induced the release of histamine or cytokines (IL-4 and IL-13) from basophils. However, low concentrations of peptides 2019 and 2021 (10(-8)-10(-6) M) inhibited histamine release from basophils challenged with FMLP but not the secretion caused by anti-IgE and gp120. Preincubation of basophils with peptides 2019 and 2021 inhibited the expression of both IL-13 mRNA, and the FMLP-induced release of IL-13 from basophils. These data highlight the complexity of the interactions between viral and bacterial peptides with FPR subtypes on human basophils.

[Laparoscopic appendectomy as first choice intervention in the treatment of inflammatory diseases of the appendix. Analysis of 397 laparoscopic interventions]

Despite the increasingly widespread use of laparoscopy, especially for gallbladder diseases, laparoscopic appendectomy has not yet met with universal acceptance. The aim of the present retrospective study was to illustrate the technical aspects and the results of 397 laparoscopic appendectomies carried out at the Surgical Department of the San Giovanni Battista Hospital in Zagarolo, Rome, from January 1993 to December 2000. The patients included 260 females with a mean age of 35.5 years and 137 males with a mean age of 38.5 years. All the appendectomies were carried out laparoscopically, with a conversion index of 0%, by two surgeons, utilising only three trocars and the Veress needle technique. Mean operating time was 22.5 min (range: 15-30 min). The mean postoperative hospital stay was 1.5 days. Morbidity was 1.76% (7 cases) and mortality nil. The authors emphasise the numerous advantages of laparoscopic techniques in their experience, including the excellent cosmetic results, reduced postoperative pain, rapid functional recovery, and lower incidences of adhesions, wound infections and laparocele, and believe that laparoscopic appendectomy is a reliable operation for treating all inflammatory diseases of the appendix.

[Videolaparoscopic treatment of varicocele: retrospective study of 165 cases]

Idiopathic varicocele is a common condition that is present in approximately 15% of the general male population. The mechanism by which varicocele exerts a deleterious effect on testicular function and semen quality remains unknown. Nevertheless, it is generally regarded as a significant factor in male infertility. Varicocelectomy is accomplished with a variety of approaches: the inguinal and high retroperitoneal procedures are still commonly accepted methods, but laparoscopic varicocelectomy is currently proving an increasingly popular procedure. The authors report the results of a retrospective study of 165 laparoscopic varicocelectomies performed from 1993 to 2000 and conclude that this approach is simple, safe and effective and should be recommended as the treatment of choice.

Mechanisms of IgE elevation in HIV-1 infection

Serum IgE levels are high in adults and children with HIV-1 infection and could be a marker of poor prognosis. Allergic reactions and adverse reactions to drugs also tend to increase in HIV-1-infected individuals. An imbalance between a "T(H)1-like" and a "T(H)2-like" cytokine profile has been documented in HIV-1 infection. We have demonstrated that HIV-1 gp 120 from different clades is a stimulus for histamine and cytokine (IL-4 and IL-13) release from basophils. Gp 120 acts as a viral superantigen, interacting with the V(H)3 region of IgE to induce mediator release from human Fc epsilonRI+ cells. Human basophils and mast cells express the chemokine receptor CCR3, which binds the chemokines eotaxin and RANTES. By interacting with the CCR3 receptor on Fc epsilonRI+ cells, HIV-I Tat protein is a potent chemoattractant for human basophils and lung mast cells. Preincubation of basophils with Tat protein upregulates mRNA CCR3 and the surface expression of this chemokine receptor. Tat also induces IL-4 and IL-13 release from basophils. Extracellular Tat can influence the directional migration of human Fc epsilonRI+ cells, the expression of chemokine receptor CCR3, and the release of T(H)2 cytokines. Our results indicate two novel mechanisms by which two HIV-1 proteins, gp120 and Tat, trigger the release of cytokines critical for T(H)2 polarization from human Fc epsilonRI+ cells.

Lepromatous vasculitis successfully treated by plasma exchange (PE)

Vascular involvement is presently considered a "common pathway" in a number of diseases that is mediated by circulating immune complexes (CIC). CIC are found in the circulation when the disease is active and in single patients their level may parallel disease activity. Lepromatous leprosis is characterized by the presence of CIC and deposits of immunoglobulins and complement in vascular lesions of the different organs and an Arthus-like mechanism is considered as the basis for the clinical picture. The same mechanism is considered to play an essential pathophysiologic role in Lucio's phenomenon, which is characterized by lymphohistiocytic vascular infiltrates with or without thrombosis and secondary cutaneous infarction. Lepromatous vascular involvement is mediated by CIC whose antigen composition is known, the same as it is with HCV mediated cryoglobulinemia, HBV positive panarteritis nodosa, rheumatoid vasculitis, or Wagner's granulomatosis, which are usually treated by PE [1-3]. PE has been employed for lepromatous vasculitis since 1979 [4] and other cases have been successfully treated afterwards [5,6]. We report on another patient successfully treated by plasma exchange.

[Biological-clinical significance of angiogenesis and mast cell infiltration in squamous cell carcinoma of the oral cavity]

There are little data on the biological and prognostic role of neoangiogenesis in squamous cell carcinoma of the oral cavity (SCCOC). In particular, the role mast cells--reservoirs of angiogenetic peptides--play in neovascularization is not clear. In this work 50 cases of SCCOC T1-3 N0-1 M0 were studied, examining the microvasal density (MVD), mast cell density (MCD), relationship between these two parameters and their relationship with the pathological clinical features. Microvessels were identified with an immunohistochemical method using pan-endothelial anti-CD34 antibody while a histochemical method was used to label the mast cells with toluidine blue on adjacent sections for each tumor sample. MVD and MCD were characterized using an image analyzer. The mean MVD was 30 +/- 17 s.d. per sample while the average MCD was 8 +/- 6 s.d. per sample. Statistical analysis comparing MVD and MCD using the Pearson method showed a direct, significant correlation between the two variables (correlation coefficient = 0.496; p = 0.000). When the carcinomas were divided into subgroups with high and low MVD and MCD--using the median counts (27 and 7 respectively) as cutoff point--no association was found with the main clinical pathological features (age, sex, tumor diameter, lymph node status, cytopathological grading). As regards the correlation with prognosis, after an median 020 months of follow-up, the subgroup of patients with tumors with high MVD presented a better overall survival at 18 months from diagnosis than did the subgroup with tumors with a lower degree of vascularization (70% vs. 45%; p = 0.049 log rank test). The data obtained suggest that mast cells play an active role in angiogenetic processes in SCCOC and indicate that MVD is a favorable prognostic factor for SCCOC patients.

Are mast cells MASTers in HIV-1 infection?

HIV-1 gp120 interacts with IgE V(H)3(+) on the surface of human basophils and mast cells (Fc epsilon RI(+) cells), acting as a viral immunoglobulin superantigen. gp120 from different clades induces mediator release from Fc epsilon RI(+) cells. gp120 also induces IL-4 and IL-13 synthesis in human basophils. The chemokine receptors CCR3 and CXCR4, which are coreceptors of HIV-1 infection, are expressed by human Fc epsilon RI(+) cells. HIV-1 Tat protein is a potent chemoattractant for basophils and lung mast cells, interacting with CCR3. Incubation of basophils with Tat protein upregulates the surface expression of the CCR3 receptor. There is evidence that human Fc epsilon RI(+) cells could be infected in vitro by M-tropic HIV-1 strains.

Human mast cells and basophils in HIV-1 infection

Mast cells and basophils (FcvarepsilonRI(+) cells) are classically involved in allergic disorders. HIV-1 glycoprotein gp120 acts as a viral superantigen by interacting with the heavy chain, variable 3 (V(H)3) region of IgE to induce cytokine release from FcvarepsilonRI(+) cells. The chemokine receptors CCR3 and CXCR4, co-receptors for HIV-1, are expressed by FcvarepsilonRI(+) cells. Via its interaction with CCR3, HIV-1 transactivation (Tat) protein is a potent chemoattractant for FcvarepsilonRI(+) cells. Incubation of basophils with Tat protein upregulates the surface expression of the CCR3 receptor. There is some evidence that human FcvarepsilonRI(+) cells could be infected in vitro by M-tropic HIV-1 strains.

Gemcitabine as single agent therapy in advanced non small cell lung cancer and quality of life in the elderly

BACKGROUND

The aim of this study is to test the efficacy of gemcitabine as single agent therapy in advanced non-small cell lung cancer in the elderly by the evaluation of the clinical response, the survival increase and the quality of life.

METHODS

Nineteen patients (age >65 years) with a PS >2, bearing an advanced non-small cell lung cancer (IIIb-IV) not treated with chemotherapy before, were charged between December 1996 and December 1998. Sixteen patients were treated with gemcitabine at the dose of 1000 mg/mq 1-8-15 every 28 days. CT scan, X-rays and skeletal scintigraphy were used in the evaluation of the therapeutic response. The toxicity was estimated by following WHO indexes. The quality of life and the modification of the specific symptoms were estimated by particular tests (Spitzer Index, IADL, EORTC-LC13).

RESULTS

One complete response (6%), 4 partial responses (25%), 7 cases of illness stabilization (43%), 4 cases of illness progression, were shown. One year of survival was found in 43% of cases with a 14 week of therapeutic response and a global survival ratio of 12.4 weeks. Only 2 cases (12.5) of medium grade G3-leucopenia were found. All patients improved their quality of life (IADL and Spitzer indexes) with reduction of symptoms, (EORTC-LC13) and increase of self-agin and relationships.

CONCLUSIONS

The effectiveness of gemcitabine as single agent therapy as not yet been tested due to the scanty number of patients, nevertheless it must be considered in relation to the improvement of the patient s quality of life.