Role of triglyceride-glucose index in metabolic assessment of sarcoidosis patients

Sarcoidosis is a rare granulomatous disease that can affect any organ. It leads to an increased risk of metabolic syndrome and insulin resistance, due to biochemical pathways involved in low-grade inflammation in both diseases. The aim of our retrospective case-control study was to evaluate the utility of triglyceride-glucose (TyG) index, a surrogate of insulin resistance, for metabolic assessment of sarcoidosis patients. A cohort of 90 sarcoidosis patients and a cohort of 90 control subjects were enrolled. Clinical, anamnestic, and biochemical data were collected. Results showed that TyG index values were higher in the sarcoidosis cohort than in the control group (p < 0.001), even after excluding the influence of diabetes and metabolic syndrome (p = 0.018). In the sarcoidosis cohort, TyG index was not correlated with clinical phenotyping (p = 0.358), gender (p = 0.139), radiological stage (p = 0.656), glucocorticoids cumulative dose (p = 0.682) or treatment regimen (p = 0.093), while significant positive correlations with waist circumference (p < 0.001), systolic and diastolic pressure (p = 0.041 and p = 0.029, respectively), Framingham score (p = 0.007) were found. Receiving operating characteristics curve analysis identified a TyG index optimal cut-off value of 8.64 (66.7% sensitivity, 77.8% specificity, area under the curve -AUC- 75%, 95% confidence interval -CI- 65-85, p < 0.001) to detect metabolic syndrome and a cut-off value of 8.69 (64.1% sensitivity, 70.6% specificity; AUC 67%, 95% CI 55-78, p = 0.007) to detect an intermediate cardiovascular risk according to Framingham risk score. Concluding, TyG index can be considered a useful tool for the metabolic assessment of sarcoidosis patients, given its capacity to predict metabolic syndrome and cardiovascular risk.

Cardiovascular risk in rare diseases: a prognostic stratification model in a cohort of sarcoidosis patients

Sarcoidosis is a rare granulomatous disease that can affect any organ; as other chronic diseases, it leads to increased risk of atherosclerosis and cardiovascular (CV) disease. The aim of our observational study was to define a prognostic stratification model of sarcoidosis patients based on the evaluation of CV risk through common carotid Doppler ultrasound and cardiovascular risk scores assessment; for this reason, a clinical phenotyping of sarcoidosis patients in four subgroups was done, based on the different organ involvement. A cohort of 53 sarcoidosis patients and a cohort of 48 healthy volunteers were enrolled. Results showed that CV risk was higher in sarcoidosis cohort than in the control group when evaluated through CV risk scores and Doppler parameters: peak-systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly lower in sarcoidosis cohort (p = 0.045 and p = 0.017, respectively), whereas intima media thickness (IMT) showed higher values in sarcoidosis group than in controls (p = 0.016). The analysis of sarcoidosis phenotypes showed no significative differences of CV risk among them when CV risk scores were considered, while partial differences emerged by evaluating subclinical atherosclerosis. Results also highlighted a relationship between CV risk score and carotid Doppler ultrasound parameters: EDV showed an inverse correlation with Framingham score (R = - 0.275, p = 0.004), whereas IMT showed a direct one (R = 0.429; p = 0.001); furthermore, an inverse correlation between PSV and EDV and illness duration (R = - 0.298, p = 0.030 and R = - 0.406, p = 0.002, respectively) was found, so suggesting a higher CV risk in patients with a longer story of disease.

Sarcoidosis and autoimmunity: In the depth of a complex relationship

Sarcoidosis is a chronic granulomatous disease that can virtually affect any organ. Its etiology is unknown, although it has been proposed that environmental or biological agents can act as triggers, ultimately leading to chronic inflammation in genetically predisposed individuals. The main component of sarcoid inflammation is represented by an exaggerated T- lymphocytic cellular response to a putative antigen that could not be efficiently cleared in the patient. However, several clinical and immunological observations, such as the association of sarcoidosis to autoimmune diseases or the presence of autoantibodies in the serum of patients with sarcoidosis, suggest that humoral-mediated immune response might also play a role in the pathogenesis of sarcoidosis. The aim of this review is to deepen the relationship between sarcoidosis and autoimmunity, by analyzing the most recent advances and proposing new fields of research.

Do infants have abstract grammatical knowledge of word order at 17 months? Evidence from Mandarin Chinese

We test the comprehension of transitive sentences in very young learners of Mandarin Chinese using a combination of the weird word order paradigm with the use of pseudo-verbs and the preferential looking paradigm, replicating the experiment of Franck et al. (2013) on French. Seventeen typically-developing Mandarin infants (mean age: 17.4 months) participated and the same experiment was conducted with eighteen adults. The results show that hearing well-formed NP-V-NP sentences triggered infants to fixate more on a transitive scene than on a reflexive scene. In contrast, when they heard deviant NP-NP-V sequences, no such preference pattern was found, a performance pattern that is adult-like. This is at variance with some of the results from Candan et al. (2012), who only found evidence for canonical word order comprehension at almost age 3 when considering fixation time. Furthermore, within the age range tested, performance showed no effect of age or vocabulary size.

Clinical phenotyping in sarcoidosis management

Sarcoidosis is a heterogeneous granulomatous disease. Biological markers and clinical features could allow specific phenotypes to be associated with different prognosis, severity and treatment responses. This retrospective multicentre study aims to analyse the clinical and immunological features of sarcoidosis and to identify a routine non-invasive biomarker useful in clinical practice.

The Layered Syntactic Structure of the Complementizer System: Functional Heads and Multiple Movements in the Early Left-Periphery. A Corpus Study on Italian

In this paper we document the developmental trajectory of the complementizer system (CP-system) in Italian by looking at the earliest spontaneous production of eleven young children, whose transcriptions are available on CHILDES. We conducted a novel corpus analysis, tracking down a number of constructions in which the clausal left-periphery is activated. First, we considered the appearance of the different complementizer particles in the CP-system, which overtly realize the three distinct functional projections ForceP, IntP, and FinP. The analysis revealed that children acquiring Italian correctly use these complementizer particles already in the third year of life. Second, we looked for the simultaneous activation of different functional projections within the CP-system. We went through our corpus searching for complex sentences in which more than one constituent was moved to the left periphery. This option is allowed by the adult grammar of Italian and, as our search revealed, it is also attested in the grammar of young children. Soon after their second birthday, sequences in which a left-dislocated Topic and a Wh- element co-occur are attested, directly supporting the existence of a (high) Topic position above FocusP. Moreover, movement in general conforms to the constraints of the adult grammar, with no attested violation of obligatory inversion (a consequence of the Q-Criterion). Importantly, “why-questions” did not require inversion, much as in the adult grammar of Italian. Taken together, children's use of complementizer particles and their activation of multiple landing sites for movement show that 2-year-olds already possess a richly articulated functional structure of the CP-system, aligned to the layered adult structure. In concluding the paper, we also discuss some temporal differences between constructions activating high and low portions of the CP-system. In particular, we detect a temporal precedence for wh-questions over why-questions. Since the former activate a lower projection, this is consistent with the recently proposed Growing Trees hypothesis, according to which the development of the CP-system proceeds stepwise.

Morphosyntactic weaknesses in Developmental Language Disorder: the role of structure and agreement configurations

Agreement is a morphosyntactic dependency which is sensitive to the hierarchical structure of the clause and is constrained by the structural distance that separates the elements involved in this relation. In this paper we present two experiments, providing new evidence that Italian-speaking children with Developmental Language Disorder (DLD), as well as Typically Developing (TD) children, are sensitive to the same hierarchical and locality factors that characterise agreement in adult grammars. This sensitivity holds even though DLD children show accrued difficulties in more complex agreement configurations. In the first experiment, a forced-choice task was used to establish whether children are more affected in the computation of S-V agreement when an element intervenes hierarchically or linearly in the agreement relation: DLD children are more subject to attraction errors when the attractor intervenes hierarchically, indicating that DLD children discriminate between hierarchical and linear configurations. The second experiment, also conducted through a forced-choice task, shows that the computation of agreement in DLD children is more 'fragile' than in TD children (and also in children with a primary impairment in the phonological domain), in that it is more sensitive to the factors of complexity identified in Moscati and Rizzi's (2014) typology of agreement configurations. To capture the agreement pattern found in DLD children, we put forth a novel hypothesis: the Fragile Computation of Agreement Hypothesis. Its main tenet is that DLD children make use of the same grammatical operations employed by their peers, as demonstrated in Experiment 1, but difficulties increase as a function of the complexity of the agreement configuration.

Treatment of Pyonephritis Complicated by Septic Shock Using Extracorporeal Device Polymyxin B-Hemoperfusion

Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) is an established treatment method for septic shock caused by Gram-negative infections. We report one instance in which PMX-DHP therapy has been used successfully in a 33-year-old woman with septic shock from urosepsis. Although there is lack of recommendations in latest Surviving Sepsis Campaign Guidelines, evidence of PMX-DHP efficacy in this subset of patients is growing.

Chitotriosidase: a biomarker of activity and severity in patients with sarcoidosis

Background

Serum chitotriosidase is a promising biomarker that has shown high specificity and sensitivity in patients with sarcoidosis. The aim of this study was to investigate correlations between serum chitotriosidase, clinical phenotypes, disease localizations and different radiological lung involvement and to identify clinical features associated with over-expression of chitotriosidase in a large cohort of sarcoidosis patients.

Methods

Chitotriosidase activity was evaluated in a population of 694 consecutive patients (males 39%, age 55.8 ± 12.8 years). Clinical and respiratory functional characteristics, Clinical Outcome Scale (COS) classification, clinical phenotypes proposed by the GenPhenResA project, and radiological assessment, including CT scan, were collected. Serum sampling and clinical and functional assessments at follow-up were also included.

Results

Significantly higher chitotriosidase activity was observed in sarcoidosis patients than in healthy controls (p < 0.0001). Evidence of lung fibrosis with reticular abnormalities and traction bronchiectasis at High resolution CT, presence of multiple extrapulmonary sarcoid localizations and increased 24-h urinary excretion of calcium were associated with significantly higher chitotriosidase activity (p < 0.005). Patients with remitted or minimal disease had lower values of chitotriosidase than patients with persistent disease. At follow-up, patients who required an increase in steroid dose showed an increase in its activity.

Conclusions

Chitotriosidase is a reliable biomarker of sarcoidosis. It is increased in patients with sarcoidosis correlating with disease activity, severity and multiorgan dissemination. Steroid therapy tended to reduce chitotriosidase expression, however it responded in cases of disease relapse.

Ocular Hypertension and Corneal Thickness: A Long-Term Prospective Study. Results after Two Years

Purpose

To study the importance of the central corneal thickness (CCT) in patients with ocular hypertension in a 2-year follow-up.

Methods

A total of 110 subjects with ocular hypertension (intraocular pressure [IOP] >21 mmHg and normal automated visual field test) were admitted to the study. All patients periodically underwent the following tests: 1) circadian IOP curve; 2) standard automated perimetry (SAP, Humphrey 30–2 SITA test); 3) short wavelength automated perimetry (SWAP); 4) frequency doubling technology perimetry (FDT, N-30 threshold test); 5) nerve fiber layer analysis with GDx; 6) ibopamine test; 7) ultrasonic pachymetry. Patients were divided into three groups, based on corneal thickness. The frequency of abnormal tests within these groups was evaluated with the Pearson's χ2 test. Baseline IOP was corrected using the Doughty and Zaman formula. CCT was also considered as a continuous variable. A control group of 48 normal subjects was also considered.

Results

The mean CCT was 562.8 um ± 37.7. The difference with respect to normal subjects was statistically significant (p<0.01). Using the correction formula, 43 eyes (39.1%) had an IOP <21 mmHg. Abnormal test results were more frequently found with FDT. The percentage of abnormal results was found to be inversely proportional to CCT. The other tests gave inconsistent or conflicting results. Using the values of CCT as a continuous variable, no significant association was found with the GDx number and the visual field indices.

Conclusions

The results of our 2-year study confirm the importance of CCT measurement in the evaluation of the risk of developing glaucomatous damage.

Open pelvic fracture associated with lumbosacral dislocation and extensive perineal injury

Open pelvic fractures are caused by high-energy trauma. Injuries to other organs are common and the mortality rate can be as high as 50%. Perineal injury is reported in 5% of open pelvic fractures. We report a case of a 31-year-old man that had an open pelvic injury with Denis zone III fracture of the sacrum, lumbosacral dislocation, symphysis dislocation, bilateral pubic rami fractures and an extensile perineal wound. He underwent an early diverting colostomy in order to prevent pelvic sepsis and subsequent stage reconstruction of the pelvic ring. At a 4-year follow-up a full recovery was present. The aim of this paper is to underline the importance of a safe, approach to manage open pelvic fractures.

Task-dependency and structure-dependency in number interference effects in sentence comprehension

We report three experiments on French that explore number mismatch effects in intervention configurations in the comprehension of object A'-dependencies, relative clauses and questions. The study capitalizes on the finding of object attraction in sentence production, in which speakers sometimes erroneously produce a verb that agrees in number with a plural object in object relative clauses. Evidence points to the role of three critical constructs from formal syntax: intervention, intermediate traces and c-command (Franck et al., 2010). Experiment 1, using a self-paced reading procedure on these grammatical structures with an agreement error on the verb, shows an enhancing effect of number mismatch in intervention configurations, with faster reading times with plural (mismatching) objects. Experiment 2, using an on-line grammaticality judgment task on the ungrammatical versions of these structures, shows an interference effect in the form of attraction, with slower response times with plural objects. Experiment 3 with a similar grammaticality judgment task shows stronger attraction from c-commanding than from preceding interveners. Overall, the data suggest that syntactic computations in performance refer to the same syntactic representations in production and comprehension, but that different tasks tap into different processes involved in parsing: whereas performance in self-paced reading reflects the intervention of the subject in the process of building an object A'-dependency, performance in grammaticality judgment reflects intervention of the object on the computation of the subject-verb agreement dependency. The latter shows the hallmarks of structure-dependent attraction effects in sentence production, in particular, a sensitivity to specific characteristics of hierarchical representations.

Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)

Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients.

Hemodynamically Unstable Pelvic Trauma is a frequent death cause among people who sustain blunt trauma. We present the results of the First Italian Consensus Conference.

Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7-year experience

BACKGROUND AND PURPOSE

Levodopa/carbidopa intestinal gel (LCIG) infusion is nowadays becoming an established therapeutic option for advanced Parkinson's disease (PD) patients with fluctuating symptoms unresponsive to conventional oral treatment. As the implementation of LCIG therapy is increasing, there is a need for safety and efficacy data from current clinical practice.

METHODS

All PD patients treated with LCIG at our centre over a 7-year period were analysed to determine the duration of treatment, retention rate, reasons for discontinuation, LCIG efficacy in motor complications, modifications of concomitant therapy and adverse events.

RESULTS

Of the 59 patients, seven subjects (12%) died of causes unrelated to LCIG infusion and 11 patients (19%) discontinued therapy prior to the cut-off date. Duodopa improved motor complications and over 90% of patients reported an improvement in their quality of life, autonomy and clinical global status. The most common adverse events were dislocation and kinking of the intestinal tube.

CONCLUSIONS

LCIG infusion is effective for the long-term treatment of advanced PD patients and exerts a positive and clinically significant effect on motor complications with a relatively low dropout rate.

Sleep improvement with levodopa/carbidopa intestinal gel infusion in Parkinson disease

BACKGROUND

Sleep disorders are common in patients with advanced Parkinson's disease (PD). Nocturnal akinesia and sleep fragmentation frequently coexist with daytime sleepiness, influencing daytime functioning. Levodopa/carbidopa intestinal gel (LCIG) infusion has been shown to improve motor complications in advanced PD, and preliminary findings suggest that sleep might improve following LCIG infusion.

OBJECTIVE

To analyze the impact of LCIG infusion on sleep symptoms and daytime sleepiness in patients with PD.

METHODS

Twelve consecutive patients with PD completed the PD-Sleep-Scale-version-2 (PDSS-2) and the Epworth-Sleepiness-Scale (ESS) at baseline and after 2-4 months of LCIG treatment. Activities of daily living, motor symptoms and complications were assessed with the Unified-PD-rating-Scale section II, III, and IV.

RESULTS

Nocturnal sleep improved substantially in all patients switched to LCIG infusion. PDSS-2 total score and subscores for 'Disturbed sleep', 'Motor symptoms at night', and 'PD symptoms at night' were significantly reduced. ESS measures of daytime sleepiness also improved. Motor complications and activities of daily living improved significantly with LCIG.

CONCLUSION

Subjective measures of sleep quality and daytime sleepiness improve in patients with advanced PD undergoing LCIG infusion. Further studies with a larger number of patients and polysomnographic recordings are needed to confirm the beneficial effect on sleep and clarify the underlying mechanisms.

Hawking radiation from ultrashort laser pulse filaments

Event horizons of astrophysical black holes and gravitational analogues have been predicted to excite the quantum vacuum and give rise to the emission of quanta, known as Hawking radiation. We experimentally create such a gravitational analogue using ultrashort laser pulse filaments and our measurements demonstrate a spontaneous emission of photons that confirms theoretical predictions.

Sentence syntax and content in the human temporal lobe: an fMRI adaptation study in auditory and visual modalities

Priming effects have been well documented in behavioral psycholinguistics experiments: The processing of a word or a sentence is typically facilitated when it shares lexico-semantic or syntactic features with a previously encountered stimulus. Here, we used fMRI priming to investigate which brain areas show adaptation to the repetition of a sentence's content or syntax. Participants read or listened to sentences organized in series which could or not share similar syntactic constructions and/or lexico-semantic content. The repetition of lexico-semantic content yielded adaptation in most of the temporal and frontal sentence processing network, both in the visual and the auditory modalities, even when the same lexico-semantic content was expressed using variable syntactic constructions. No fMRI adaptation effect was observed when the same syntactic construction was repeated. Yet behavioral priming was observed at both syntactic and semantic levels in a separate experiment where participants detected sentence endings. We discuss a number of possible explanations for the absence of syntactic priming in the fMRI experiments, including the possibility that the conglomerate of syntactic properties defining "a construction" is not an actual object assembled during parsing.

Apathy and verbal fluency in STN-stimulated PD patients

OBJECTIVE

To evaluate apathy and its relation to verbal fluency tasks in a consecutive series of 19 patients with Parkinson's disease (PD) submitted to deep brain stimulation of the subthalamic nucleus (DBS of STN).

METHODS

19 consecutive PD patients submitted to bilateral DBS of STN were studied for apathy pre-operatively and 17 months after surgery. The PD patients underwent a battery of cognitive tests assessing reasoning, memory and frontal executive functions, including phonemic and categorial fluency tasks. The Beck Depression Inventory (BDI) was used for depression. Apathy was assessed by means of the Apathy Scale (AS). In order to quantify changes among individual patients, the clinical criterion of more or less than 1 SD (standard z-score) was used to register a patient as improved or worsened, respectively.

RESULTS

After surgery, apathy scores did not change and mood improved (p < 0.02), while a significant worsening was found in the phonemic fluency (p < 0.001). The percentage of patients with an apathy score above the recommended cut-off value (14) was 42% both before and after DBS of STN. Individual outcomes on the apathy scale (1 SD criterion) evidenced that 53% of the patients remained stable, 16% improved, while 31% worsened. This last percentage reduced to 21% (4/19) when considering only the PD patients with an apathy score > or =14 after surgery. No significant correlation was found between the apathy scores variation and any of the neurological variables considered, and, in particular, no correlation was found between apathy and verbal fluency.

CONCLUSIONS

The results of the present study suggest that DBS of STN does not necessarily induce apathy even if individual patients show a moderate post-operative worsening of apathetic symptoms.

Agreement and movement: a syntactic analysis of attraction

This paper links experimental psycholinguistics and theoretical syntax in the study of subject-verb agreement. Three experiments of elicited spoken production making use of specific characteristics of Italian and French are presented. They manipulate and examine its impact on the occurrence of 'attraction' errors (i.e. incorrect agreement with a word that is not the subject of the sentence). Experiment 1 (in Italian) shows that subject modifiers do not trigger attraction errors in free inverted VS (Verb Subject) structures, although attraction was found in VS interrogatives in English (Vigliocco, G., & Nicol, J. (1998). Separating hierarchical relations and word order in language production. Is proximity concord syntactic or linear? Cognition, 13-29) In Experiment 2 (in French), we report stronger attraction with preverbal clitic object pronouns than with subject modifiers. Experiment 3 (in French) shows that displaced direct objects in the cleft construction trigger attraction effects, in spite of the fact that the object does not intervene between the subject and the verb in the surface word order (OSV). Moreover, attraction is stronger in structures with subject-verb inversion (...). These observations are shown to be naturally interpretable through the tools of formal syntax, as elaborated within the Principles and Parameters/Minimalist tradition. Three important constructs are discussed: (1) the hierarchical representation of the sentence during syntactic construction, and the role of intermediate positions by which words transit when they move; (2) the role of specific hierarchical (c-command) but also linear (precedence) relations; and (3) the possibility that agreement involves two functionally distinct components. A gradient of computational complexity in agreement is presented which relates empirical evidence to these theoretical constructs.

A structure-activity study for the inhibition of metalloproteinase-9 activity and gene expression by analogues of gallocatechin-3-gallate

Catechins are able to modulate the gelatinolytic activity of matrix metalloproteinase-9 (MMP-9) by reducing its release from macrophages. Gallocatechins decrease MMP-9 secretion by lowering MMP-9 promoter activity and mRNA levels. The effect appears to be dependent on some structural and stereochemical requirements. In this study, the relationship between chemical structure and activity was studied by testing the effect of analogues of (+/-)-gallocatechin-3-gallate (+/-)-GCG, selectively deprived of hydroxyl groups, on MMP-9 activity, transcription, and secretion. Our results indicate that (+/-)-GCG and (+/-)-catechin-3-gallate are characterized by a substitution pattern compatible with direct inhibition of MMP-9 activity. Conversely, when transcription was the target, (+/-)-trans-3-flavanol-3-benzoate, lacking all the hydroxyl groups, was the most effective both in lowering MMP-9 promoter activity and consequently protein secretion, and in inhibiting nuclear-factor-kappaB-driven transcription. Our results suggest that the structural requirements for enzyme inhibition are different from those necessary for targeting gene expression.

Mannanoligosaccharides and aflatoxin B1 in feed for laying hens: effects on egg quality, aflatoxins B1 and M1 residues in eggs, and aflatoxin B1 levels in liver

Ninety-six laying hens were allocated to 4 groups and fed diets (control diet (0-0), diet supplemented with 2.5 ppm aflatoxin B1 (0-AF); diet supplemented with 0.11% mannanoligosaccharide (MOS-0); diet supplemented with 0.11% MOS and 2.5 ppm aflatoxin B1 (MOS-AF) for 4 wk to evaluate the effect of aflatoxin B1 (AFB1), mannanoligosaccharide (MOS), or both on egg quality and the in vivo efficacy of MOS to interact with an oral administration of AFB1. After 2 and 3 wk, egg weight decreased (P < 0.05) in the group fed MOS-0 versus groups on 0-0 and 0-AF. Egg shell weight was lower (P < 0.05) in the group fed 0-AF. Aflatoxin influenced color parameters, which were probably related to interference of AFB1 with lipid metabolism and pigmentary substances deposition in yolk. MOS appeared to increase protein percentage in albumen. No AFB1 or aflatoxin M1 (AFM1; a polar metabolite of AFB1) residues were found in eggs of the experimental groups. Livers from groups 0-0 and MOS-0 always tested negative for AFB1 and AFM1. Differences (P < 0.01) were found between AFB1 hepatic levels of group 0-AF (mean +/- SD: 4.13 +/- 1.95 ppb) and group MOS-AF (mean +/- SD: 2.21 +/- 1.37 ppb). The data demonstrated the ability of MOS to adsorb and degrade AFB1, reducing gastrointestinal absorption of AFB1 and its levels in tissues.

Soil physical changes and plant availability of Zn and Pb in a treatability test of phytostabilization

A treatability test of phytostabilization was carried out on two soils sampled downstream a mining Italian area with Lolium italicum and Festuca arundinacea. Beside chemical content of Pb and Zn in aerial parts and in roots, also some physical parameters were determined at the end of the growth cycle of plants. Particle size distribution was analysed with a laser granulometer while cracking patterns and porosity were determined by means of image analysis. Compost, used at two rates (10%, and 30% v/v) in order to improve soil physical characteristics, always raised biomass with similar effects for both doses. The concentration of Pb and Zn in aerial parts and in roots of L. italicum and F. arundinacea decreased more than five times in presence of compost. A general lack of clear effects of both plants on soil physical parameters was noticed. Formation of more water stable aggregates, a rise of the area occupied by cracks, and new porosity formed by elongated and irregular pores were found in soil samples treated with compost.

[Bacterial pneumonia in HIV-infected patients]

Patients and methods: This is a retrospective study performed on HIV-positive patients discharged from our Institution from January 1993 through December 1998 with a diagnosis of bacterial pneumonia. Cases of TB or atypical micobacterial infection were excluded from this analysis. Causative organisms were identified, when possible, by taking into account positive cultures from diverse sources (blood, sputum, pleural fluid and others). Results: In the 6-yr period we considered, 120 patients were identified. Among them, we were able to obtain clinical and imaging data on 98 cases. Focal infiltrates on chest X-ray studies were present in 87.7% of cases, 24.5% had a pleural effusion, 9.2% nodular lesions, 4.1% cavitary images and in 2 patients only hilar lymphadenopaties were noted. Causative agents resulted to be S. aureus (14 cases); P. aeruginosa (11); S. pneumoniae (6); R. equi (4); Enterobacter spp. and K. pneumoniae (3 cases each); E. coli, Peptostreptococcus spp and Enterococcus spp. (1 case each). No causative organism was isolated in 54 patients (55.1%) and the diagnosis was based on clinical and therapeutical grounds. Around half of cases (46.9%) responded well to therapy, while 11 (11.2%) died because of the lung infection. In 3 cases other opportunistic infections were the cause of death and 22 cases of relapse were recorded as well. Five patients resulted lost to follow-up. Conclusions: This retrospective study demonstrated a high prevalence of S. aureus lung infections along with the presence of otherwise rare causative organisms such as R. equi. Radiologic appearance of lung lesions did not differ substantially from the one of HIV negative patients. A relatively good response to antibiotic therapy was also noted.

Aflatoxin B1 and clinoptilolite in feed for laying hens: effects on egg quality, mycotoxin residues in livers, and hepatic mixed-function oxygenase activities

Ninety-six laying hens were allocated to four groups administered different diets (group 0-0 received a complete diet, group 0-AF received a diet supplemented with 2.5 ppm of aflatoxin B1 [AFB1], group 2-0 received a diet supplemented with 2% clinoptilolite [CPL], and group 2-AF received a diet supplemented with 2% CPL and 2.5 ppm of AFB1) for 4 weeks to evaluate the effect of AFBI and/or CPL on egg quality and the ability of CPL to interact with the oral administration of AFB1. The possible effects of AFB1 on cytochrome P450-dependent hepatic mixed-function oxygenase (MFO) activities were also evaluated. Mycotoxin reduced yolk weight, while CPL influenced albumen percentage relative to that of eggs laid by chickens in group 0-AF Eggs laid by chickens in groups 0-AF and 2-AF had stronger shells and weighed less than the eggs of other groups. The eggs of treated groups were lighter in color than those of the control group (P < 0.01), and the tendency to yellowness in eggs was increased by CPL, probably through the affinity of red pigments for adsorbents and a consequent prevalence of yellow tonality. Color parameters might be connected with AFB1's interference with lipid metabolism and pigment deposition. The livers of hens in groups 0-AF and 2-AF showed very low mycotoxin concentrations that were significantly different (P < 0.01). The highest levels observed were those in the livers of the hens receiving the diet supplemented with the mycotoxin alone. AFB1 did not exert any significant effects on the hepatic MFO activities examined.

Virological and immunological responses to a once-a-day antiretroviral regimen with didanosine, lamivudine and efavirenz

Current antiretroviral drugs cannot eradicate HIV infections, and persons living with HIV are often faced with very demanding daily therapeutic schedules that can induce poor adherence. More conveniently dosed and patient-friendly regimens are needed. We investigated, in this 48-week pilot study, a once-a-day highly active antiretroviral therapy regimen of didanosine, lamivudine and efavirenz. Seventy-five consecutive antiretroviral-naive subjects were enrolled. Over the 48-week period, plasma HIV-RNA levels declined sharply, with a median decrease at the end of the observation time >3.4 log copies/ml. The proportion of patients achieving a plasma HIV-RNA level below the limit of detection (50 copies/ml) was 77% (intention to treat analysis) at the end of the study period. The mean CD4 cell count increased steadily over time from 251 to 459 cells/microl. Antiviral efficacy was similar in patients with a baseline HIV-RNA level above or below 100,000 copies/ml. However, patients with a baseline CD4 cell count <200 cells/microl showed a significantly worse virological response than that observed in patients with higher baseline CD4 counts. Overall 15 patients interrupted therapy. In four cases treatment interruption was due to lack of treatment response; three additional patients were lost to follow-up or withdrew informed consent. Eight patients stopped therapy because of adverse events. The once-daily combination of didanosine, lamivudine and efavirenz resulted in sustained viral suppression and was well-accepted by patients. This regimen may offer advantages in selected difficult-to-treat populations, allows directly observed therapy and can be a safe and effective alternative in antiretroviral-naive patients. These encouraging pilot results need to be confirmed in a comparative clinical trial.

Myositis ossificans traumatica of the temporal muscle: a case report

Myositis ossificans traumatica (MOT) is a pathological condition characterized by extraskeletal formation of bony tissue, induced by violent or repeated trauma. Reports of this pathology occurring in the region of the head and neck are rare, and even more so in the muscles of mastication. We present the case of patient with MOT of the temporal muscle, the etiology of which seems to be related to traumatic manipulations during dental treatment. A review of the literature is presented and the surgical approach, which resolved this case is discussed.

Carbon emissions. The economic benefits of the Kyoto Protocol

The third Conference of the Parties in Kyoto set the target of reducing greenhouse-gas emissions by an average of 5.3% with respect to 1990 values by 2008-2012. One of the main objections to the protocol's ratification is that compliance would pose an unbearable economic burden on the countries involved. But we show here that this is not the case if costs apart from the direct costs of energy production are also considered. Costs are also incurred in rectifying damage to human health, material goods, agriculture and the environment related to greenhouse-gas emissions.

[Organizational appropriateness of recoveries: results of the evaluation of recoveries by AEP/PRUO at the Careggi Hospital in Florence in 1995-1998]

The organizational appropriateness of hospital stays is an expression of a hospital's efficiency and aim of the management control. The AEP (American Version)/PRUO (Italian Version) protocol is specific for measuring the organizational appropriateness of hospital stays. The aim of this study is the comparative analysis of the organizational appropriateness of hospital stays in Careggi Hospital of Florence and in all hospital Departments in 1995 and 1998. In 1998 the AEP/PRUO protocol was applied to 2148 samples of hospital stays out of 38,968 eligible hospitalizations, and in 1995 a sample of 1989 hospital stays out of 35,108. In 1998 2,148 admissions and 15,338 days of hospitalization were tested. In 1995, 1989 admission days and 12,264 days of hospitalization were tested, 63 departments were studied. In 1995 the first edition of the protocol was applied, in 1998 the second. A sample of 218 of the 1998 hospital stays was tested with both editions to evaluate the impact of differences. In 1998, with the second edition of the protocol, the inappropriateness rate of admission days and hospitalization days and the rate of in-patients inappropriate hospital stays was respectively 38.0%, 43.8% and 18.5%. Compared with 1995 results, the rates increased +6.2%, 6% and +7.5% respectively. Instead, with the first edition of the protocol, the rates were 29.7%, 37.6% and 10.7% and, compared with 1995, they were reduced -2.1%, -0.6% and -0.3%. The longitudinal multilevel analysis has allowed the evaluation of the performance of each department.