Hyperbaric Oxygen Therapy plus Hypofractionated Stereotactic Radiotherapy in Recurrent Glioblastoma

PURPOSE/OBJECTIVE(S)

Hypoxia is thought to play a role in tumor development, angiogenesis and growth, and resistance to chemotherapy, antiangiogenic therapy and radiotherapy (RT) in a large number of human cancers. Brain tumors, especially highly aggressive GBM with its necrotic tissue, are more likely to be affected by hypoxia. The median partial pressure of oxygen (PO2) of high-grade gliomas in patients under anesthesia was approximately 5-7 mmHg, with a significant proportion of PO2 values <2.5 mmHg. The radiosensitivity of brain tumors could potentially be increased by performing hyperbaric oxygenation (HBO) before the RT session. We propose an innovative approach to improve the efficacy of accelerated hypofractionated Stereotactic Radiotherapy (HSRT) after HBO (HBO-RT) for the treatment of recurrent HGG (rHGG). The primary objective of this study is to evaluate the disease control rate (DCR) at 3 months. The secondary Objectives are: - Safety assessment (acute and late toxicity). - Overall Survival (OS), - Progression Free Survival (PFS).

MATERIALS/METHODS

We enrolled 14 patients (aged >18 years) with rHGG detected using MRI. A total dose of 15-25 Gy was administered in daily 5-Gy fractions for 3-5 consecutive days after daily HBO.

RESULTS

Median follow-up from re-irradiation was 22.8 months (range: 2.0-24.2 months). The disease control rate 3-months after HBO-RT was 50% (23.0-76.9). Six- and 12-month Progression-free survival was 35.7% (95% CI: 13-59.4) and 10.7% (95% CI: 0.8-35.4), respectively. Median overall survival of HBO-RT was 10.7 months (95% CI: 6.6-24.2). No acute or late neurologic toxicity >grade (G)2 was observed.

CONCLUSION

HSRT combined to HBO seems effective and safe in the treatment of rHGG.

Pathophysiology of respiratory failure in patients with osteogenesis imperfecta: a systematic review

INTRODUCTION

Respiratory failure is a major cause of death in patients with Osteogenesis Imperfecta. Moreover, respiratory symptoms seem to have a dramatic impact on their quality of life. It has long been thought that lung function disorders in OI are mainly due to changes in the thoracic wall, caused by bone deformities. However, recent studies indicate that alterations in the lung itself can also undermine respiratory health.

OBJECTIVES

Is there any intrapulmonary alteration in Osteogenesis Imperfecta that can explain decreased pulmonary function? The aim of this systematic literature review is to investigate to what extent intrapulmonary or extrapulmonary thoracic changes contribute to respiratory dysfunction in Osteogenesis Imperfecta.

METHODS

A literature search (in PubMed, Embase, Web of Science, and Cochrane), which included articles from inception to December 2020, was performed in accordance with the PRISMA guidelines.

RESULTS

Pulmonary function disorders have been described in many studies as secondary to scoliosis or to thoracic skeletal deformities. The findings of this systematic review suggest that reduced pulmonary function can also be caused by a primary pulmonary problem due to intrinsic collagen alterations.

CONCLUSIONS

Based on the most recent studies, the review indicates that pulmonary defects may be a consequence of abnormal collagen type I distorting the intrapulmonary structure of the lung. Lung function deteriorates further when intrapulmonary defects are combined with severe thoracic abnormalities. This systematic review reveals novel findings of the underlying pathological mechanism which have clinical and diagnostic implications for the assessment and treatment of pulmonary function disorders in Osteogenesis Imperfecta.KEY MESSAGESDecreased pulmonary function in Osteogenesis Imperfecta can be attributed to primary pulmonary defects due to intrapulmonary collagen alterations and not solely to secondary problems arising from thoracic skeletal dysplasia.Type I collagen defects play a crucial role in the development of the lung parenchyma and defects, therefore, affect pulmonary function. More awareness is needed among physicians about pulmonary complications in Osteogenesis Imperfecta to develop novel concepts on clinical and diagnostic assessment of pulmonary functional disorders.

Vertebral fracture assessment (VFA) for monitoring vertebral reshaping in children and adolescents with osteogenesis imperfecta treated with intravenous neridronate

PURPOSE

The study was aimed at monitoring vertebral bodies changes with the use of Vertebral Fracture Assessment (VFA) in children and adolescents affected by osteogenesis imperfecta (OI) during treatment with intravenous neridronate.

METHODS

60 children and adolescents (35 males and 25 females; age 1-16 years) with OI type I, III and IV were included in the study. Intravenous neridronate was administered at the dose of 2 mg/kg every 3 months in all patients. Lumbar spine (LS) bone mineral density (BMD) and VFA by dual X-ray absorptiometry (DXA) were assessed every 6 months up to 24 months during treatment. VFA with vertebral morphometry (MXA) was used to calculate the three indices of vertebral deformity: wedging, concavity and crushing. Serum calcium, phosphate, parathyroid hormone (PTH), 25-hydroxy-vitamin D [25(OH)D], total alkaline phosphatase (ALP), bone alkaline phosphatase (BALP) and urinary C-terminal telopeptide of type 1 collagen (CTx) were measured at any time point.

RESULTS

Mean LS BMD values significantly increased at 24 months compared to baseline (p < 0.0001); the corresponding Z-score values were -1.28 ± 1.23 at 24 months vs -2.46 ± 1.25 at baseline; corresponding mean Bone Mineral Apparent Density (BMAD) values were 0.335 ± 0.206 vs 0.464 ± 0.216. Mean serum levels of ALP, BALP and CTx significantly decreased from baseline to 24 months. By MXA, we observed a significant 19.1% reduction of the mean wedging index of vertebral reshaping at 12 months, and 38.4% at 24 months (p < 0.0001) and of the mean concavity index (16.3% at 12 months and 35.9% at 24 months; p < 0.0001). Vertebral reshaping was achieved for 66/88 (75%) wedge fractures and 59/70 (84%) concave fractures, but there were 4 incident mild fractures. Finally, VF rate was reduced at 24 months compared to baseline: 37/710 (5.2%) vs 158/710 (22.2%).

CONCLUSION

Our study demonstrates the utility of VFA as a safe and alternative methodology in the follow-up of children and adolescents with OI.

Ultrastructure study of skin fibroblasts in patients with Ehlers-Danlos Syndrome (EDS): preliminary results

AIM OF THE STUDY

To investigate, in vivo and in vitro, the fibroblast-to-myofibroblast transition in patients with hypermobile Ehlers-Danlos Syndrome (EDS). To analyze the dermis of patients with classical form of EDS (cEDS) and with hEDS, to identify qualitative and/or quantitative differences in ECM component and ultrastructural changes in collagen.

MATERIALS AND METHODS

Seven subjects, aged over 18, two with cEDS and five with hEDS underwent two skin biopsy. One sample was prepared for transmission electron microscopy (TEM), the other for immunofluorescence. The diameter of collagen fibers was measured with TEM. Fibrils were analyzed in four patients: the two with cEDS and two with hEDS. For each patient, the diameter of n=250 collagen fibrils was measured. αSMA was used as specific marker for myofibroblast to highlight their presence in vivo in the skin of patients with hEDS.

RESULT

IF observation could not assess an increased expression of αSMA in hEDS patients, which showed no statistical difference compared to classic form patients. The major result from the analysis of TEM images is the clear difference in ECM composition between the two forms of EDS: ECM in hEDS is optically more dense and more prominently composed of elastic fibers.

CONCLUSION

Our study provides the following important evidence: 1) the absence in vivo of dermal fibroblasts in patients with hEDS, demonstrated by αSMA negativity; 2) the presence of statistically significant changes in the diameter of collagen fibrils between the classic and the hypermobile forms.

Clinical value of negative 68Ga-PSMA PET/CT in the management of biochemical recurrent prostate cancer patients

PURPOSE

To evaluate the clinical value of ⁶⁸Ga-PSMA PET/CT negativity in patients with biochemical recurrent prostate cancer (BCR).

METHODS

One hundred three BCR patients (median age, 70 years; median PSA, 0.47 ng/mL) with negative ⁶⁸Ga-PSMA PET/CT, followed up for at least 1 year, were retrospectively identified in a database of 1003 consecutive patients undergoing ⁶⁸Ga-PSMA PET/CT for BCR. Clinical recurrence (CR) was determined or excluded on follow-up imaging selected as per clinical practice. Clinical recurrence-free survival (CRFS) was computed from the date of negative ⁶⁸Ga-PSMA PET/CT to the date of evident disease; frequencies of CRFS were described as per ISUP patient subset (subset 1: ISUP grades 1 and 2; subset 2: ISUP grade 3; subset 3: ISUP grades 4 and 5) and other conventional variables.

RESULTS

In 57 patients out of 103 (55.3%), CR was detected in the prostatic fossa (45.6%), nodes (38.6%), and bone (15.8%). The median CRFS was 15.4 months (range, 12.1-20.5), with a CRFS at 12 months in 61.4% of cases (range, 50.9-70.4) whereas the 24-month CRFS was 34.8% (range, 24-45.8). ISUP subset 1 benefited from significantly longer CRFS compared to subset 2 and subset 3 (median CRFS, 20.5 months, 12.6 months, and 12.1 months, respectively). ISUP subset 3 had significantly poorer 24-month CRFS (9.3%) compared to subset 1 (47.8%) and subset 2 (33.5%). At the univariate and multivariate analyses, the ISUP subset was the only significant risk factor for clinical relapse; ISUP subset 3 and subset 2 patients held a higher risk of CR compared to subset 1 patients (HR of 2.75 [1.35-5.57] for subset 3 versus subset 1; HR of 2.08 [1.11-3.88] for subset 2 versus subset 1).

CONCLUSION

⁶⁸Ga-PSMA PET/CT negativity in early BCR patients (PSA < 0.5 ng/mL) with low-grade primary prostate cancer (ISUP1 and 2) may support the exploration of a clinical surveillance approach in future prospective studies.

Marangoni convection of a viscous fluid over a vibrating plate

This research presents a new insight into Marangoni convection through investigating, both numerically and analytically, the surface tension driven instability activated by a coupled effect of a vibrating plate and viscous dissipation. A horizontal, thin fluid layer is bounded from below by an impermeable, adiabatic plate that vibrates in the horizontal direction. The upper boundary is modelled by a free surface subject to a thermal boundary condition of the third kind (Robin). The internal heat generation due to viscous dissipation yields a vertical, potentially unstable temperature gradient. The linear stability analysis of the stationary terms of the basic state is performed. The perturbed flow, in the form of plane waves, is superimposed onto the basic state. The obtained system of ordinary differential equations is solved numerically by means of the Runge–Kutta method coupled with the shooting method. For the two limiting cases, the isothermal upper boundary and adiabatic upper boundary, the analytical solutions of the eigenvalue problem are obtained. The values of the critical parameter, which identifies the threshold for the onset of Marangoni convection, are presented.

The Horton-Rogers-Lapwood problem for an inclined porous layer with permeable boundaries

A formulation of the Horton-Rogers-Lapwood problem for a porous layer inclined with respect to the horizontal and characterized by permeable (isobaric) boundary conditions is presented. This formulation allows one to recover the results reported in the literature for the limiting cases of horizontal and vertical layer. It is shown that a threshold inclination angle exists which yields an upper bound to a parametric domain where the critical wavenumber is zero. Within this domain, the critical Darcy-Rayleigh number can be determined analytically. The stability analysis is performed for linear perturbations. The solution is found numerically, for the inclination angles above the threshold, by employing a Runge-Kutta method coupled with the shooting method.

Bisphosphonates therapy in children with Osteogenesis imperfecta: clinical experience in oral surgery

Objectives

To define the possible complications of oral surgery in childhood in patients affected by type 1 Osteogenesis imperfecta (OI) and treated with bisphosphonates (BP).

Methods

The study was conducted among 20 patients in childhood with an age range 8-14 (12 ♂ e 8 ♀) affected by OI. Patients were initially evaluated at the Policlinico Umberto I, University Hospital of Rome, Rare Disease Center Skeletal Dysplasia-Bone Metabolic Pathologies and after at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry.

Results

From this experience, we showed that a proper patient management from the medical and dental point of view can protect these patients from the risk of post-operative problems, such as onj, soft tissue flogos, intraoral and extraoral fistulas, failure to heal the post-extractive alveolus, infections, post-operative pain and pathological fractures. The follow-up, ranging from a minimum of 2 years to a maximum of 5 years, have not demonstrated the presence of particular complications or healing defects.

Conclusions

The clinical experiences observed in these patients are encouraging because no postoperative complications have been observed compared to patients non-affected by OI.

Clinical and biochemical response to neridronate treatment in a patient with osteoporosis-pseudoglioma syndrome (OPPG)

Osteoporosis-pseudoglioma syndrome (OPPG) is a rare autosomal recessive syndrome characterized by juvenile-onset osteoporosis and ocular abnormalities due to a low-density lipoprotein receptor-related protein 5 (LRP5) gene mutation. Treatment with bisphosphonates, particularly with pamidronate and risedronate, has been reported to be of some efficacy in this condition. We report on a patient with OPPG due to an LRP5 gene mutation, who showed an encouraging response after a 36-month period of neridronate therapy. We report a case of a patient treated with bisphosphonates. Bisphosphonates should be administered in OPPG patients as a first-line therapy during early childhood.

Serum creatine kinase isoenzymes in children with osteogenesis imperfecta

This study evaluates serum creatine kinase isoenzyme activity in children with osteogenesis imperfecta to determine its usefulness as a biochemical marker during treatment with bisphosphonate. The changes of creatine kinase (CK) isoenzyme activity during and after discontinuation therapy were observed. These results could be useful in addressing over-treatment risk prevention.

INTRODUCTION

The brain isoenzyme of creatine kinase (CKbb) is highly expressed in mature osteoclasts during osteoclastogenesis, thus plays an important role in bone resorption. We previously identified high serum CKbb levels in 18 children with osteogenesis imperfect (OI) type 1 treated for 1 year with bisphosphonate (neridronate). In the present study, serum CK isoenzymes were evaluated in the same children with continuous versus discontinued neridronate treatment over a further 2-year follow-up period.

METHODS

This study included 18 children with OI type 1, 12 with continued (group A) and 6 with ceased (group B) neridronate treatment. Auxological data, serum biochemical markers of bone metabolism, bone mineral density z-score, and serum total CK and isoenzyme activities were determined in both groups.

RESULTS

Serum CKbb was progressively and significantly increased in group A (p < 0.004) but rapidly decreased to undetectable levels in group B. In both groups, the cardiac muscle creatine kinase isoenzyme (CKmb) showed a marked decrease, while serum C-terminal telopeptide (CTx) levels were almost unchanged.

CONCLUSIONS

This study provides evidence of the cumulative effect of neridronate administration in increasing serum CKbb levels and the reversible effect after its discontinuation. This approach could be employed for verifying the usefulness of serum CKbb as a biochemical marker in patients receiving prolonged bisphosphonate treatment. Moreover, the decreased serum CKmb levels suggest a systemic effect of these drugs.

Reliability of vertebral fractures assessment (VFA) in children with osteogenesis imperfecta

The aim of this study is to evaluate the diagnostic accuracy of vertebral fractures assessment (VFA) in comparison with conventional radiography in identifying vertebral fractures in children and adolescents affected by OI. On 58 patients (33 males, 25 females; age range 1-18 years; 41 children and 17 adolescents) with osteogenesis imperfecta (OI type I, n = 44, OI type III, n = 4; OI type IV, n = 10), lateral spine images by radiographs and by dual-energy X-ray absorptiometry (DXA) were acquired. For vertebral fracture diagnosis, plain radiographs were used as "gold standard" and VFA and morphometric X-ray absorptiometry (MXA) were performed. The visualized vertebrae were 738 (97.9%) by radiographs and 685 (90.9%) by DXA of a total of 754 vertebrae from T4 to L4. VFA and MXA identified, respectively, 129 (74%) and 116 (66%) of the 175 vertebral fractures detected by radiographs. Radiographs identified 36 patients with vertebral fractures, VFA 35 and MXA 41 (6 false positives). On a per vertebra basis, radiographs and VFA had elevated agreement (93.9%; k score 0.81, 95% CI 0.76-0.86), that resulted slightly lower for MXA (90.6%; k score 0.72, 95% CI 0.65-0.78). VFA and MXA demonstrated high sensitivity (95.6 and 94.1 %, respectively) while specificity was 100% for VFA and 90.6% for MXA on a per patient basis; the agreement was excellent for VFA (98.3%; k score 0.96, 95% CI 0.89-1.03) and good for MXA (87.9%; k score 0.73, 95% CI 0.55-0.91). The diagnostic performance parameters resulted better for VFA (sensitivity 95.6%; specificity 100%; PPV 100%; NPV 97.2%), than for MXA (sensitivity 94.1%; specificity 85.4%; PPV 72.7%; NPV 97.2%). The results of our study demonstrate the reliability of VFA for diagnosis of vertebral fractures in children with OI suggesting its use as a more safe and practical alternative to conventional radiography.

Patulin determination in apples with rotten areas

Patulin is a mycotoxin produced by Penicillium and Aspergillus species, and in particular by P. expansum in apple-rotting fungus. In this work, we evaluated the patulin content in apples with rotten areas of different sizes (with green and/or blue moulds), and we studied the diffusion behaviour of patulin into unspoiled areas of the apples. An analytical procedure based on high-performance liquid chromatography with UV detection was used to analyse 35 apples with rotten areas. Separations were performed on a 250×4.6 mm i.d. C18 analytical column of 5 µm diameter. Acetonitrile/water (5:95) was used as the mobile phase at a flow rate of 1.5 ml/min and the elution was monitored by UV absorption at 275 nm, performed at 40 °C. The detection limit by HPLC-UV detector for pure standard was 6.7 ng/ml and the quantification limit was 0.03 µg/ml. The affected areas represented different percentages of the total weight of the whole apple and ranged from 2.5 to 52.3%. Three apples had patulin concentrations below the limit of detection; the remaining 32 apples had varying patulin levels (from 1.01 to 120.40 mg/kg). To evaluate if the mycotoxin could migrate to the areas not yet affected by rot, we analysed the unspoiled portion of each apple, showing 1.91 µg/kg as the median concentration of patulin and the highest value of 5,020 µg/kg; these results confirmed that patulin could migrate through apple tissue that has not yet been spoiled.

Patulin biodegradation using Pichia ohmeri and Saccharomyces cerevisiae

The effectiveness of Pichia ohmeri and Saccharomyces cerevisiae in the biodegradation of patulin was evaluated in vitro. Patulin is a toxin produced by Penicillium expansum, the predominant fungal contaminant in post-harvest apple. The biodegradation experiment was carried out in culture medium (Yeast Medium broth, YM) and commercial apple juice. These substrates were artificially contaminated with patulin previously produced by P. expansum strain 2 in malt extract broth and purified over a silica gel column. The YM broth was inoculated with P. ohmeri 158 with proved anti-P. expansum activity, whereas the apple juice was inoculated with dried Saccharomyces cerevisiae cells. The residual patulin in contaminated substrates was determined by reversed-phase HPLC. P. ohmeri 158 in YM broth degraded over 83% of the initial 223 µg (8.92 µg/ml) of patulin after incubation at 25 °C for two days under static conditions; after five days of incubation, this percentage was greater than 99%, and patulin levels fell below the limit of detection after 15 days. In the apple juices inoculated with 0.25 g/l of commercial dried S. cerevisiae cells (corresponding 1.8 x 107 cells/ml), 96% of patulin was degraded (initial contamination of 4.5 µg/ml of patulin) after 143 hours of incubation at 25 °C under static conditions. However, 90% degradation occurred when the juice was contaminated with 7.0 µg/ml under the same conditions, indicating that the biodegradation rate is concentrationdependent. The effective biodegradation of patulin using P. ohmeri 158 and S. cerevisiae demonstrates a promising application for innocuous yeast isolated from natural microbiota in the biological control, which can prevent both fruit spoilage and P. expansum mycotoxin contamination.

An apparatus for simultaneous thermodynamic and optical measurements, with large temperature excursions

We report the design and realization of an integrated system for measuring, at the same time, the thermodynamic and spectroscopic features of nanoporous materials interesting for hydrogen storage purposes. The whole investigation cycle, from thermal activation to the actual investigation of uptake and release of hydrogen, is carried out in the same vacuum tight vessel, equipped with an optical window, whose temperature can range between 10 and 750 K, up to a maximum pressure of 50 bars. The system has been designed to investigate properties of carbon nanotubes but its use can be extended to any kind of nanoporous sample such as, for example, carbon nanofibers, zeolytes, metal organic frameworks, and similar materials.

Absence of severe recurrent infections in glycogen storage disease type Ib with neutropenia and neutrophil dysfunction

We describe a 10-year-old boy with glycogen storage disease type Ib (GSD Ib) with neutropenia and neutrophil dysfunction who never suffered from severe recurrent infections. Lymphocyte subpopulations and assay of intracellular cytokines (IL-2, IL-4 and IFN-gamma) showed a pattern of lymphocyte activation suggesting a shift of T(H)1/T(H)2 balance towards a T(H)1 response. This is the first report of GSD Ib without severe recurrent infections in spite of neutropenia and neutrophil dysfunction.

Microscopic self-dynamics in liquid hydrogen and in its mixtures with deuterium

We have measured the dynamic structure factor of liquid parahydrogen, pure and mixed with deuterium, in various thermodynamic conditions using incoherent inelastic neutron scattering. The experiments were carried out on TOSCA-II, a new time-of-flight, inverse-geometry, crystal-analyzer spectrometer. After an accurate data reduction, the high-energy parts of the neutron spectra recorded in backward scattering were studied through the modified Young and Koppel model, from which the mean kinetic energy values for a hydrogen molecule were estimated. In addition the low-energy parts of the neutron spectra recorded in forward scattering were analyzed in the framework of the Gaussian approximation and fitted through a Levesque-Verlet model for the velocity autocorrelation function. Thus various physical quantities are determined and compared with accurate path integral Monte Carlo simulations. Despite the excellent quality of these fits, the velocity autocorrelation functions derived from the forward-scattering data appear totally unable to properly describe the backward-scattering ones. These findings prove an unquestionable breakdown of the Gaussian approximation in semiquantum liquids. The present results appear of great interest and suggest further investigation on the limits of the widely used Gaussian approximation.

Density of phonon states in solid parahydrogen from inelastic neutron scattering

We have measured the inelastic neutron scattering spectrum of solid parahydrogen (at low pressure and T=13.3 K) using the thermal original spectrometer with cylindrical analyzers spectrometer at the ISIS pulsed neutron source (UK). From the experimental spectrum we have obtained the parahydrogen density of phonon states which has been compared with the estimates available in the literature. The present determination improves substantially the previous experimental scenario from the point of view of both statistics and accuracy. The comparison with the most recent estimate obtained from a quantum mechanical simulation of the molecular dynamics calls for an improvement of the computational methods..

Fatty acid profile of oesophageal mucosa in children with gastro-oesophageal reflux disease

BACKGROUND

Polyunsaturated fatty acids, as precursors of eicosanoids, are involved in the pathogenesis of oesophageal mucosal damage and healing.

AIMS

To evaluate a possible role of polyunsaturated fatty acids in the pathogenesis of gastro-oesophageal reflux, we assayed fatty acids profile of oesophageal mucosal specimens obtained by endoscopy in children without oesophageal disease and children affected by gastro-oesophageal reflux disease.

PATIENTS

Eighteen children with normal 24-h oesophageal pH monitoring (GOR- group) and 18 children with gastro-oesophageal reflux disease (GOR+ group, eight with oesophagitis and 10 without), were included in the study.

METHODS

Fatty acids were extracted from oesophageal mucosal specimens obtained by endoscopy and assayed by gas chromatography.

RESULTS

In the GOR+ group we observed an increased percentage of mucosal polyunsaturated fatty acids, mainly arachidonic and docosohexaenoic acids (p<0.01), without differences between groups with and without oesophagitis. Significant positive correlation was found between reflux index and docosahexaenoic acid (r=0.805; p<0.001).

CONCLUSIONS

The results obtained show that the current methods are able to reveal changes between normal and pathological mucosa that could be relevant in the pathogenesis of gastro-oesophageal reflux disease.

Direct experimental access to microscopic dynamics in liquid hydrogen

We have obtained the double-differential incoherent neutron scattering cross section of liquid and solid parahydrogen in various thermodynamic conditions using TOSCA, a time-of-flight, inverse geometry, crystal analyzer spectrometer, operating at the pulsed neutron source ISIS. The measured cross section provides direct experimental access to the self part of the center-of-mass inelastic structure factor of the parahydrogen molecules in the system. Data have been corrected for the experimental effects and then analyzed in the framework of the Young-Koppel model and the Gaussian approximation. The velocity autocorrelation functions and their energy spectra have been obtained from a fitting procedure, making use of the quantum generalized Langevin equation and of model memory functions, and finally compared to the most recent results of both molecular centroid dynamics and self-consistent quantum mode-coupling theory. Some dynamic quantities were also related to simple equilibrium properties and simulated through a standard path integral Monte Carlo code. Results are very interesting but still urge for further developments of theoretical and dynamic simulation approaches, as well as for more extensive experimental efforts.

Increased taurine content in esophageal mucosa of children affected by gastroesophageal reflux

We studied the possible involvement of mucosal amino acid metabolism in the pathogenesis of gastroesophageal reflux disease in children. Eighteen children with gastroesophageal reflux disease (8 with reflux esophagitis and 10 without) and 10 children with normal 24-h esophageal pH monitoring as a comparative group underwent esophagogastroduodenoscopy with biopsies. Plasma and esophageal mucosa amino acids were assayed by liquid chromatography. In children affected by gastroesophageal reflux disease we found an increase of mucosal taurine (P < 0.01) and a decrease of serine (P < 0.01). No differences were noted between patients with and without esophagitis. Significant positive correlations (P < 0.001; r = 0.626) were found between mucosal taurine content and reflux index. Plasma amino acid concentrations did not show any significant differences among groups. Our results indicate that biochemical alterations precede the histological findings of inflammation, likely reflecting the adaptive response of the esophageal mucosa to the gastric contents exposure.

Sandifer's syndrome in a breast-fed infant

Sandifer's syndrome is a rare manifestation of gastroesophageal reflux (GER) in children, occurring in association with abnormal movements of the head, neck, and upper part of the trunk. Out of 65 children with Sandifer's syndrome described in literature, only 2 were breast-fed. We report on a 15-day-old breast-fed girl affected by Sandifer's syndrome. Pathological GER was diagnosed with 24 h pH esophageal monitoring. In our patient, all the symptoms of Sandifer's syndrome disappeared when she was cow's milk formula-fed. The role of food allergy to dietary proteins ingested by a lactating mother is discussed.

Determination of urinary orotic acid and uracil by capillary zone electrophoresis

We describe a simple method for measuring orotic acid and uracil concentration in urine by capillary zone electrophoresis in 20 mM Na-borate buffer, pH 9.2. The method was applied for studying a patient with HHH (hyperomithinemia, hyperammonemia and homocitrullinuria) syndrome. A high value of uracil excretion was found during periods of relatively low orotic acid excretion and normal ammonemia. The orotic acid level in urine was increased by increasing protein intake.

Supporting CPR development with the commercial off-the-shelf systems evaluation technique: defining requirements, setting priorities, and evaluating choices

This article describes the circumstances that led the Department of Defense (DoD) to adopt a standard streamlined business process to support its computer-based patient record (CPR) system. The DoD used the commercial off-the-shelf systems evaluation technique (COSSET) to accomplish this goal.

Usefulness of cyanide-nitroprusside test in detecting incomplete recessive heterozygotes for cystinuria: a standardized dilution procedure

We present the results of a cyanide-nitroprusside test (CNT) after a standardized dilution procedure of urine samples and report the efficiency of this method in detecting heterozygotes for cystinuria when applied on an open pediatric population. In the preliminary study we assayed by quantitative determination of amino acids 162 urine samples from a hospital population identifying 24 type III heterozygotes and 2 type II heterozygotes for cystinuria. The classic CNT gave 38 false positive results and 5 false negative results showing a sensitivity and specificity of 0.808 and 0.721, respectively. When progressively diluted, all samples of heterozygotes remained CNT positive up to a creatinine concentration of 90 mg/dl. At this level of dilution 31 out of 38 false positive turned to negative, thus obtaining a specificity of 0.922 without a lowering of the sensitivity in detecting heterozygotes. The standardized dilution at 90 mg/dl of creatinine concentration was applied to 74.7% of a population of 1024 schoolchildren. In this way 163 out of 210 positive results were eliminated and thus the specificity of CNT rose from 0.789 to 0.953. On the basis of these results, the method proposed can be regarded as reliable and useful for a screening program in detecting heterozygotes for cystinuria.

Effect of D-ribose on purine synthesis and neurological symptoms in a patient with adenylosuccinase deficiency

Oral supplementation of 10 mmol/kg/day of D-ribose to a patient with an inherited deficit of adenylosuccinase, severe psychomotor retardation, and epilepsy caused a marked increase in plasma concentration and urinary excretion of urate, while minor changes in succinylpurine levels were observed. D-Ribose administration was accompanied by a slight improvement of behaviour and a progressive reduction of seizure frequency, which increased dramatically upon two attempts to withdraw the drug. Substitution of D-ribose with an equivalent amount of D-glucose did not result in an increase of seizure frequency.

[Jejunal enteral feeding in a severe case of reflux esophagitis in an infant with Pierre-Robin syndrome]

A case of Pierre-Robin syndrome associated with gastroesophageal reflux and oesophagitis is described. The infant was firstly fed with a hydrolysed-casein formula by gastrostomy, but there was not any improvement of his clinical status, in spite of an appropriate nutrient intake. For this reason, a jejunal enteral feeding, with a semi-elemental formula and then with a hydrolysed-casein formula was started. During this nutritional treatment, the infant showed an adequate weight gain and after 52 days the weight increased from 2880 g to 4580 g.

Erythrocyte and plasma levels of glutamate and aspartate in children affected by migraine

In this study we determined plasma and erythrocyte amino acids in children affected by migraine, in order to evaluate glutamate and aspartate metabolism in the pathogenesis of this disorder. Fifteen children with migraine with aura (mean age +/- SD = 10.3 +/- 1.56), 19 children with migraine without aura (mean age +/- SD = 10.4 +/- 1.48) and 16 healthy normal controls (mean age +/- SD 10.6 +/- 1.53) were investigated. In both migraine groups there were significantly lower plasma glutamate and aspartate levels and significantly higher erythrocyte/plasma concentration (E/P) ratios of these amino acids with respect to the controls. Erythrocyte aspartate concentrations were significantly elevated in migraine children compared to the controls, while erythrocyte glutamate concentrations showed no significant differences between groups. Similar results were observed in both migraine groups. These results seem to suggest the presence of a higher activity of the erythrocytes' glutamate/aspartate transport system that could reflect a similar alteration at the neuronal/glial cell level in the CNS. Our study suggests an imbalance of the excitatory amino acid turnover in the pathogenesis of migraine in children.

Abnormal intestinal permeability in children with autism

We determined the occurrence of gut mucosal damage using the intestinal permeability test in 21 autistic children who had no clinical and laboratory findings consistent with known intestinal disorders. An altered intestinal permeability was found in 9 of the 21 (43%) autistic patients, but in none of the 40 controls. Compared to the controls, these nine patients showed a similar mean mannitol recovery, but a significantly higher mean lactulose recovery (1.64% +/- 1.43 vs 0.38% +/- 0.14; P < 0.001). We speculate that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.

Rapid gas-chromatographic assay of lactulose and mannitol for estimating intestinal permeability

We developed a gas-chromatographic method to determine urinary mannitol and lactulose. The procedure for purification of urine by a resin was optimized for purification of analytes and high recovery; the aliquot of resin chosen (500 mg) was kept in contact with the urine for 1 min. The recoveries of mannitol and lactulose were > 85% at concentrations that include both normal and pathological values. Sugars were converted to oximes before the silylation step to avoid multiple peaks for the anomeric forms. The calibration was linear over the range 0.1-1 microgram of sugar injected. Analytical recovery of the sugars ranged from 90% to 95.3% for mannitol and from 90.4% to 95.8% for lactulose. The mean within-day imprecision (CV) was 6.2% for mannitol and 4.7% for lactulose; the between-day CV was 6.7% for mannitol and 5.1% for lactulose. A lactulose/mannitol ratio of 0.035 completely differentiated 28 normal children and 28 children with active gluten-sensitive enteropathy, whose mean ratios were 0.022 (SD 0.007) and 0.084 (SD 0.054), respectively.

Rapid gas-chromatographic assay of lactulose and mannitol for estimating intestinal permeability

We developed a gas-chromatographic method to determine urinary mannitol and lactulose. The procedure for purification of urine by a resin was optimized for purification of analytes and high recovery; the aliquot of resin chosen (500 mg) was kept in contact with the urine for 1 min. The recoveries of mannitol and lactulose were &gt; 85% at concentrations that include both normal and pathological values. Sugars were converted to oximes before the silylation step to avoid multiple peaks for the anomeric forms. The calibration was linear over the range 0.1-1 microgram of sugar injected. Analytical recovery of the sugars ranged from 90% to 95.3% for mannitol and from 90.4% to 95.8% for lactulose. The mean within-day imprecision (CV) was 6.2% for mannitol and 4.7% for lactulose; the between-day CV was 6.7% for mannitol and 5.1% for lactulose. A lactulose/mannitol ratio of 0.035 completely differentiated 28 normal children and 28 children with active gluten-sensitive enteropathy, whose mean ratios were 0.022 (SD 0.007) and 0.084 (SD 0.054), respectively.

Low serum tryptophan to large neutral amino acids ratio in idiopathic infantile autism

The serum tryptophan to large neutral amino acids ratio (Try/LNAA) is considered a reliable marker of tryptophan availability for brain serotonin synthesis. A dysfunction of brain serotonergic activity has been postulated to exist in autistic disorder and supported by recent studies. On this basis, we determined the serum amino acids levels in 40 children with idiopathic infantile autism as well as in 46 control children. A significantly lower serum Try/LNAA ratio was observed in the autistic subjects compared to the normal controls. In 14 autistic children (35%) this ratio was 2 SD below the mean value obtained in the control group. These results suggest that a low brain tryptophan availability due to a low serum Try/LNAA ratio could be one of the possible mechanisms involved in the alteration of serotonergic function in autism.

Child with manifestations of dermotrichic syndrome and ichthyosis follicularis-alopecia-photophobia (IFAP) syndrome

We report on a boy with short stature, mental retardation, seizures, follicular ichthyosis, generalized alopecia, hypohydrosis, enamel dysplasia, photophobia, congenital aganglionic megacolon, inguinal hernia, vertebral, renal and other anomalies, and a normal chromosome constitution. The clinical findings include all the features that dermotrichic and ichthyosis follicularis-alopecia-photophobia (IFAP) syndrome have in common and in addition those that characterize IFAP syndrome (photophobia, recurrent respiratory infections, etc.), those that are present only in dermotrichic syndrome (nail anomalies, hypohydrosis, megacolon, vertebral defects, etc.) and additional ones (enamel dysplasia, renal anomalies, inguinal hernia, etc.). Two maternal uncles were referred as being affected by alopecia and ichthyosis suggesting X-linked recessive transmission. Various hypotheses concerning the relationship between the 2 syndromes and the present case are discussed.

[Atherosclerosis and pediatrics. Role of nutrition of healthy children]

In the last few years many authors have studied atherosclerosis prevention in paediatrics. In our paper the most recent advances concerning the role of dietary intake in the normal child are described. Human milk and "prudent" diet with low intake of lipids and dietary cholesterol are discussed.