Synergistic Effect between SARS-CoV-2 Wave and COVID-19 Vaccination on the Occurrence of Mild Symptoms in Healthcare Workers

BACKGROUND

Since the beginning of the pandemic, five variants of epidemiological interest have been identified, each of them with its pattern of symptomology and disease severity. The aim of this study is to analyze the role of vaccination status in modulating the pattern of symptomatology associated with COVID-19 infection during four waves.

METHODS

Data from the surveillance activity of healthcare workers were used to carry out descriptive analysis, association analyses and multivariable analysis. A synergism analysis between vaccination status and symptomatology during the waves was performed.

RESULTS

Females were found at a higher risk of developing symptoms. Four SARS-CoV-2 waves were identified. Pharyngitis and rhinitis were more frequent during the fourth wave and among vaccinated subjects while cough, fever, flu syndrome, headache, anosmia, ageusia, arthralgia/arthritis and myalgia were more frequent during the first three waves and among unvaccinated subjects. A correlation was found between vaccination and the different waves in terms of developing pharyngitis and rhinitis.

CONCLUSION

Vaccination status and viruses' mutations had a synergic effect in the mitigation of the symptomatology caused by SARS-CoV-2 in healthcare workers.

Spatiotemporal variation in urban overheating magnitude and its association with synoptic air-masses in a coastal city

Urban overheating (UO) may interact with synoptic-scale weather conditions. The association between meteorological parameters and UO has already been a subject of considerable research, however, the impact of synoptic-scale weather conditions on UO magnitude, particularly in a coastal city that is also near the desert landmass (Sydney) has never been investigated before. The present research examines the influence of synoptic-scale weather conditions on UO magnitude in Sydney by utilizing the newly developed gridded weather typing classification (GWTC). The diurnal, and seasonal variations in suburban-urban temperature contrast (ΔT) in association with synoptic-scale weather conditions, and ΔT response to synoptic air-masses during extreme heat events are investigated in three zones of Sydney. Generally, an exacerbation in UO magnitude was reported at daytime over the years, whereas the nocturnal UO magnitude was alleviated over time. The humid warm (HW), and warm (W) air-masses were found primarily responsible for exacerbated daytime UO during extreme heat events and in all other seasons, raising the mean daily maximum ΔT to 8-10.5 °C in Western Sydney, and 5-6.5 °C in inner Sydney. The dry warm (DW), and W conditions were mainly responsible for urban cooling (UC) at nighttime, bringing down the mean daily minimum ΔT to - 7.5 to - 10 °C in Western Sydney, and - 6 to - 7.5 °C in inner Sydney. The appropriate mitigation technologies can be planned based on this study to alleviate the higher daytime temperatures in the Sydney suburbs.

Analyzing the local and climatic conditions affecting the urban overheating magnitude during the Heatwaves (HWs) in a coastal city: A case study of the greater Sydney region

Urban overheating coincides with Heatwaves (HWs) and the thermal stress might get amplified in cities. To predict the interactions between urban overheating and HWs, the surface energy balance response to HWs is crucial. HW is a regional phenomenon and the climatic conditions may influence the local conditions to alter the energy budget contrast between a city and its adjacent peripheral areas. The interactions between the urban overheating and HWs are explored in a coastal city (Sydney Australia), also in the proximity of dry landmass, while considering the site characteristics, distance from the coast, and the population density. A positive response between urban overheating and HWs is reported. Advective heat flux in the form of a dualistic circulation system is found responsible for exacerbating the urban overheating magnitude (ΔT) during the HWs and altering the available energy balance. Land-coastal distance is also found as an important contributor in magnifying the urban-suburban temperature contrast. Considering the future urbanization in western Sydney, surfaces capable of retaining higher moisture content are prescribed to reduce the occurrence of extreme HW events. Activation of the ventilation corridor for the coastal wind penetration in western Sydney is another recommendation of this study.

Predicting the magnitude and the characteristics of the urban heat island in coastal cities in the proximity of desert landforms. The case of Sydney

The urban heat island is a vastly documented climatological phenomenon, but when it comes to coastal cities, close to desert areas, its analysis becomes extremely challenging, given the high temporal variability and spatial heterogeneity. The strong dependency on the synoptic weather conditions, rather than on city-specific, constant features, hinders the identification of recurrent patterns, leading conventional predicting algorithms to fail. In this paper, an advanced artificial intelligence technique based on long short-term memory (LSTM) model is applied to gain insight and predict the highly fluctuating heat island intensity (UHII) in the city of Sydney, Australia, governed by the dualistic system of cool sea breeze from the ocean and hot western winds from the vast desert biome inlands. Hourly measurements of temperature, collected for a period of 18 years (1999-2017) from 8 different sites in a 50 km radius from the coastline, were used to train (80%) and test (20%) the model. Other inputs included date, time, and previously computed UHII, feedbacked to the model with an optimized time step of six hours. A second set of models integrated wind speed at the reference station to account for the sea breeze effect. The R² ranged between 0.770 and 0.932 for the training dataset and between 0.841 and 0.924 for the testing dataset, with the best performance attained right in correspondence of the city hot spots. Unexpectedly, very little benefit (0.06-0.43%) was achieved by including the sea breeze among the input variables. Overall, this study is insightful of a rather rare climatological case at the watershed between maritime and desertic typicality. We proved that accurate UHII predictions can be achieved by learning from long-term air temperature records, provided that an appropriate predicting architecture is utilized.

Time series analysis of ambient air-temperature during the period 1970-2016 over Sydney, Australia

Providing evidence of potential changes in the climate has become increasingly important as it is the first step towards adopting mitigation and adaptation measures and planning for urban resilience. In this study a statistical analysis of the ambient air temperature time series over Sydney, Australia during 1970-2016 has been carried out with the aim to investigate potential changes towards higher temperatures. The dataset has been statistically analyzed using different techniques, concluding that the investigation should be performed on a monthly basis. A persistence analysis was conducted using different statistical approaches to investigate the dependence between consecutive monthly and daily ambient air temperature values. A trend analysis of the ambient air temperature and degree days time series has been conducted using linear regression to estimate the linear trend (slope) and its statistical significance (using a Student-t-test) and the Kendall-Mann test to identify the time at which the tendency starts to occur as well as the time after which it becomes statistically significant.

Splenomegaly as the First Manifestation of Thyroid Cancer Metastases

We report the case of a 65-year-old man who developed a symptomatic splenomegaly due to spleen metastasis from thyroid follicular carcinoma. In 1982, at the age of 53, the patient had undergone a thyroid lobectomy for a cold node, followed one year later by a second intervention for a microfollicular adenoma. He was subsequently administered thyroid suppressive therapy with no further follow-up. The diagnosis of spleen metastases from thyroid cancer was first suspected on the basis of history, high serum thyroglobulin (Tg) levels, and the presence of pulmonary 99Tc uptake. The patient underwent a splenectomy, during which vast infiltration involving the diaphragm, spleen, stomach, colon and pancreas, was found. Histological and immunohistochemical results showed that the spleen and diaphragm metastases derived from thyroid follicular carcinoma. Radioiodine uptake by the pulmonary metastases confirmed the thyroid source. Retrospective re-evaluation of the thyroid tissue removed in 1983 revealed a histological pattern consistent with follicular carcinoma, which could not be unequivocally attributed to the widely or minimally invasive form. To our knowledge this is the first report of splenomegaly as the first manifestation of thyroid cancer metastases. In this paper cases of splenomegaly due to metastatic spread are reviewed and the management of the present case is discussed.

Adhesion and activation molecules expressed by human natural killer cells

Our study concerns the expression and the regulation of adhesion and activation receptors on human NK cells. In particular we provide evidence on: a) the expression on fresh human NK cells of VLA-4, VLA-5 and VLA-6, extracellular matrix (ECM) receptors of integrin family capable of mediating their adhesion to FN and LM; b) the role of PKC on the regulation of CD16, a differentiation antigen associated with FcγR type III expressed by all NK cells, which mediate ADCC activity and trigger lymphokine production.

From methylene blue (methylthionine chloride) to Al-Ghorab procedure: the therapy of priapism (our experience)

OBJECTIVE

The better knowledge concerning the anatomo-physiology of erection has brought important changes to the management of priapism. We experimented with a staged therapeutic protocol forthis condition.

MATERIALS AND METHODS

17 patients, aged from 27 to 71 (mean age 43) were treated for ischemic priapism; the pathogenesis was idiopathic in 9 cases, in 4 cases secondary to intracavernous injection (IcI) of PGE1, in 2 cases to papaverine Icd, in 1 case to haemolympho-pathy and in another patient to treatement with heparin. Cavernous PO2, PCO2 and pH were checked. All patients underwent removal of 100 cc of blood, irrigation with NaHCO3 solution of the cavernous corpora and Methylen blue (MB) IcI 10 mg every 5 minutes 10 times, repeated twice.

RESULTS

From 3 to 6 hours from the beginning of therapy, detumescence was achieved in 10 cases. In 5 cases the priapism persisted and we administered adrenaline 20 pg every 5-10 minutes: 2 cases had detumescence respectively in 5 and 7 hours whereas in the patient with leukaemia the erection persisted and we desisted from further therapy; in 2 other cases the erection persisted and we did a distal cavernosum-glans shunt and the detumescence a was achieved in 30 and 58 hours respectively. In the last 2 cases, before adrenaline we administered an IcI of ethylephrine 5 mg every 5 minutes for 4-5 times but finally we had to perform a shunt. In all cases, during the treatment, and during the following 6-8 hours, we administered 200 mg of MB intravenous.

CONCLUSIONS

The introduction of oral drugs has changed the epidemiology of priapism. A better knowledge of the molecular mechanisms that govern the cavernous contraction and myorelaxation has allowed us to use adrenergic drugs and also the MB. This staged therapeutic protocol goes from a less invasive therapy (irrigation with NaHCO3, MB, ethylephrine, adrenaline) to a surgical procedure which must not be delayed and this progression could allow a reduction in the collateral effects.

[Investigation on health status of silica exposed workers in "cotto Fiorentino" companies]

The manufactured in "cotto" is typical of Chianti Fiorentino with about 400 employees. In 2005. the UF PISLL encountered an exposure to silica more than TLV, particularly for some tasks; were prescribed interventions of prevention and was undertaken an investigation of the occupational health status with occupational health physician. We observed 227 workers, 208 males and 19 females, with average age of 43 years and average age working of 15 years. The habit of smoking tobacco was higher than for the general population. The assessment of exposure to silica has been detected for 59 workers (mean 0.05 mg / mc); at pulmonary function testing resulted: 10 with airway obstruction and 4 airflow limitation; by 140 chest X - ray acquired 1 was interstitial pulmonary disease and 1 was bronchopneumonia. Among the diseases not related to exposure to silica, emerging 42 cases of low back pain, 28 hearing loss, 7 with hypertension. Non uniformity in health surveillance and diagnostic criteria highlights the need to cooperate between occupational doctor in public prevention and control service and qualified occupational doctor to ensure a standard of quality in the prevention of disease in exposed to silica.

The use of bipolar PlasmaKinetic resectoscope in endoscopic resection of the prostate: our experience

Prostatic endoscopic resection (TURP) is a reference method in the treatment of prostatic obstruction.

In the past decades, the method used a monopolar resectoscope. In the last years, various technologies have been studied to improve the efficacy of endoscopic resection. As per our experience, we have thence ascertained the variations of the hematic crasis and of the mictional asset in TURP patients treated with bipolar knives.

20 patients underwent bipolar plasmakinetic resection of the prostate. Their age ranged between 58 yrs and 82 yrs (av: 70.2 yrs), the adenoma volume, checked with TR ultrasound scanning, was between 33 and 44 cc (av: 37.6), the Qmax was between 6.4 and 9.0 mL/min (av.: 7.42 mL/min). A 24Ch resectoscope and spinal anesthesia were used. Bleeding during resection was never relevant; therefore resection never had to be stopped. After about 36 hours from surgery, the patients’ sanguification was checked again: a 6.53% reduction of the number of erythrocytes, compared to pre-surgery data, was observed, together with a 6.73% decrease of hemoglobin concentration, and a 6.3% decrease of hematocrit. Continuous irrigation was suspended during the first day, catheter was removed on the 48th hour in 15 cases, and on the 72nd in 5 cases: the patients were discharged on day 3 in 16 cases, and on day 4 in 4 cases. A flux evaluation was performed after 3 months, which showed a Qmax between 16.6 and 24 mL/min (av.: 19.11), with a significant increase in the maximum flow rate.

The use of the new technologies in prostatic endoscopic resection has allowed us to improve the efficacy of such a method. Above all, the use of a bipolar electrosurgical knife enables us to associate a basal hemostasis with the resection of the prostatic tissue. Thus, the hematic loss is low, as we have been able to ascertain also in our own experience. This gave us the possibility to quickly stop continuous irrigation and to early remove the catheter. This way, hospitalization was sensibly reduced (av. 76.8 hours). The maximum flow rate, in the short term, has been good. We have been able, in our experience, to assess that this technology represents a useful guarantee to improve the results of prostatic endoscopic resection.

Perineural invasion in prostatic carcinoma treated with radical prostatectomy: the role of TR systematic biopsy

Perineural invasion (PNI) is a morphological entity which has been known for many years, though its significance in prostatic neoplasms has only been studied recently. Therefore, we tried to assess, with the help our experience, its presence and its significance. Ninety-four patients, aged between 49 and 74 (average 65.8)--with a PSA between 2.69 and 52 ng/ml (average 11.44)--underwent RP for prostatic carcinoma; 58 patients had stage T2 and 36 had T3. 48 patients had Gleason 7 or higher, and 46 had G 6 or lower. Fifty patients (53,1%) were PNI+ and 44 (46,9%) PNI-. Between the two groups there was no significant difference as to age (1" group: average age 67 years; 2nd group: 68) and PSA (1st group: average 9.73 ng/ml, 2nd group: average 8,17) (Z 0,639). The distribution according to the stage showed that 24 patients (48%) PNI+ were T2 and 26 (52%) PNI+ T3, 34 (77.2%) PNI- T2 and 10 (22%) PNI- T3 and therefore 72,23% of the T3's were PNI+ and 41.3% of the T2's were PNI+; 34 patients (70.8%) with G>7 were PNI+ and 14 (29.16%) PNI-, 16 patients (34,78%) with G<6 were PNI+ and 30 (65.2%) PNI-. Among the PNI+ 50 patients, 36 had undergone biopsy in our hospital, and therefore we re-examined the operation tissue and found out that 16 (44%) were biopsy PNI+ while for 22 (55.5%) it was not possible to assess the PNI on the biopsy tissue. PNI is an important morphological element in the staging of prostatic cancer and is connected with the disease negative prognostic factors: in fact, it can be traced with a high frequency in stage diseases and higher Gleasons. It does not seem to be connected with PSA, above all for values between 4 and 20 ng/ml. We think that a very important element to be stressed is the fact that this condition is not always detected with biopsy (about 45%) and this does not allow, in such cases, an adequate therapy plan. Also our experience seems to confirm that, therefore, in spite of the above said limits, it is advisable to search PNI both with biopsy--in order to have a further prognostic element and therefore arrange the most suitable therapy plan--and on the surgery piece, in order to better determine the biological nature of the disease and to be able to suggest adequate integrative therapies.

A more effective TR systematic biopsy of the prostate associated with power doppler ultrasonography (PDU): technical and morphological aspects

OBJECTIVES

It is by now ascertained how PDU improves the effectiveness of systematic biopsy of the prostate. We have attempted to find better technical and imaging methods to optimise results.

MATERIAL AND METHODS

We associated echo-biopsy with PDU on 131 patients. 64 patients (48.85%) showed prostate Ca. Their age was between 53 and 84 (av. 71.7) with PSA ranging from 1.14 and 59.7 (r. 9.,55 +/- 11.99 ng/ml). We then tried to locate in each sector areas of altered vascularization.

RESULTS

In 34 cases (53.12%) we found hypo/hyper/iso reflecting areas surrounded by numerous vessels and crossed by one or more vascular branches (usually 2-3). In 8 cases (12.5%) we found hypo/hyper vascular echogenic virtually avascular, i.e. only a small perforating or surrounding branch. In 13 cases (20%) we found an aspecific and often widespread hyper-vascularization not associated to echographically atypical areas, bilateral in 4 cases. In 9 cases (14%) we did not find evident vascular alterations during PDU. Through the correlation of power Doppler ultrasonography images with histology we noticed that the area of altered vascularization was positive to Ca in 38 patients (59.37%) whereas the same was not true in 5 patients (7.8%), and finally in 21 patients (32.8%) the echo-doppler results (12 hypervascular and 9 "normal") was too aspecific to allow any kind of histomorphologic correlation.

DISCUSSION

There are no pathognomonic patterns detectable through PDU for prostate Ca; although in the light of the above data it is safe to assume the existence of PDU detectable vascular alterations that in a good number of cases are not always neoplastic but prostatic disease which often coincide (about 60%) with cancer. The association of systematic biopsy and PDU helps highlight these areas thereby considerably improving diagnoses.

The association of TR systematic echobiopsy of the prostate with power Doppler (PDU) in borderline PSA patients

OBJECTIVE

TR systematic biopsy of the prostate is currently a method to diagnose prostate cancer, though with limited reliability. Many ancillary procedures have been put forward to improve its effectiveness, and PDU appears a very promising one Wehave attempted to verify whether PDU and eighth core TR biopsy together can ihcrease reliability especially in those patients with PSA values between 4 and 10 ng/ml.

MATERIAL AND METHODS

Two groups of patients suffering from altered PSA and/or a palpable prostatic nodule underwent eighth core TR biopsy of the prostate. The first group was composed by 56 patients aged 55-82 (av.69.39) with PSA values ranging between 0.87 and 94.91 ng/ml (11.45 +/- 10.14) of which 29 had a palpable nodule. The second group was constituted by 96 patients aged 49-84 (av.69.84) with PSA values ranging between 1.14 and 59.7 ng/ml (12.8 +/- 11.66) of which 55 had a palpable nodule. The first group underwent eighth core TR biopsy, the second group TR biopsy and PDU.

RESULTS

Twenty-five patients of the first group (44.64%) showed prostate cancer and 48 of the second (50%) were prostate cancer positive. We then divided them according to their PSA: 33 belonging to the first group (biopsy without PDU) had PSA values ranging between 4 and 9.6 ng/ml (7.59 +/- 1.61) and 13 (39.39%) were positive to Ca; 56 patients belonging to the second group (biopsy with PDU) had PSA values ranging between 4.09 and 9.66 ng/ml (7.02 +/- 1.56) and 26 (46.42%) were positive to Ca. We also ran tests with other groups of patients according to their PSA values although the above findings remained the most significant.

CONCLUSIONS

Compared to other similarly interesting but more complex procedures, PD is easy to learn and easy to perform. Literature already shows how it can effectively be associated with systematic TR biopsy. On the basis of the above data we can conclude that PDU realistically improves reliability of eighth core TR biopsy--though not replace it--especially for those patients with PSA values between 4 and 10 ng/ml.

Power Doppler Ultrasonografy (Pdu) as an Additional Tool to Increase Reliability of Systematic Biopsy of the Prostate

Diagnosis of prostate cancer has until recently relied primarily on eight core TR biopsy.

Tests are being carried out to verify whether PDU can effectively aid such diagnosis thereby reducing the number of biopsies and tissue samplings.

This has also been our attempt.

Two groups of patients were examined for increased PSA with or without a palpable prostatic nodule. The first group was composed by 52 patients between 55 and 83 years of age (av. 69.57) with PSA values between 0.87 and 94.91 ng/mL (r.8.085) of which 29 (55.75%) showed a palpable nodule. All patients underwent prostatic eight core TR ecobiopsy.

The second group was composed by 56 patients between 49 and 84 years of age (av.69.19) with PSA values between 1.14 and 59.7ng/mL (r.8.74) of which 33 (58.97%) showed a palpable nodule. This group of patients underwent a PDU just before TR biopsy in order to assess prostatic blood supply and locate possible alterations. Prostatic volume in both groups was never higher than 50 cc. Of the first group 25 patients (48.08%) were prostate cancer positive. Of the second group 31 patients (55.36%) were positive to a biopsy for prostate cancer. In addition 22 out of the 31 showed a vascular irregularity.

From the evidence above (tests carried out by the same operator with two homogeneous groups of patients-Wilcoxon test-) it is clear that PDU usefully worked in diagnosing a higher number of prostate cancers.

Diagnostic sensitivity and specificity was markedly increased by the association of PDU and TR biopsy.

Characterization of two outer membrane protein antigens of Porphyromonas gingivalis that are protective in a murine lesion model

Porphyromonas gingivalis is a key periodontal pathogen that has been implicated in the aetiology of chronic adult periodontitis. The aim of this study was to characterize two potential vaccine candidates (PG32 and PG33) identified from a previous genomic sequence analysis. Gene knockout studies suggested that these proteins play an important role in bacterial growth and are transcriptionally linked. Analysis of 14 laboratory and clinical isolates of P. gingivalis found that in all strains, both genes were present with a high level of conservation and that the two proteins were also expressed in vitro. Truncated recombinant PG32 and PG33 proteins were produced in Escherichia coli in an attempt to increase the solubility of the proteins while retaining their native conformation. While most of the truncated proteins remained insoluble, two truncated proteins showed good solubility and high levels of protection in the P. gingivalis murine lesion model and may be considered as potential vaccine candidates for further testing in models of human periodontal disease.

The Role of Histopathologic Grading in the Staging of Localized Prostate Cancer

One of the most important parameters in the staging of prostate Cancer is the Gleason Grading, although the Gleason assessed In biopsy is not always the same as the final grading. We have therefore tried to find out whether the use of histopathologic grading might offer some extra information about the biological nature of prostate Cancer. 53 patients underwent a radical open prostatectomy for prostate Cancer. Mean age was 66.16ys; pre-biopsy PSA was 1.92-47 ng/mL.

Histopathologic grading was assessed on the biopsy tissue, while grading, Gleason and the pathological stage were assessed on the operation piece.

The 53 patients were classified according to their bioptic grading (BG), postoperative grading (PG), stage and PSA. BG=PG in 33 cases (62.26%).

17 patients (30.07%) showed a BG<PG and 3 (3.77%) BG>PG.

If we analyze such data according to the stage: 1T1c:GB=GP. 9T2a: 6(66.6%)GB=GP, 2GB<GP and 1GB>GP.

19T2b:10(52.63%)GB=GP, 9(47.3%)GB<GP. 11T2c:11GB=GP. 13T3: 5GB=GP, 6GB<GP and 2GB>>GP. Prostate carcinoma staging still shows a large number of limits related to the unpredictability of neoplasm behaviour. The present trend is to use several parameters. We think that the use of the histopathologic grade can be a useful tool to be added to the ones we already employ. We think histopathologic grading should be used with other grading methods, instead of replacing Gleason, which is still quite effective.

[The meaning and usefulness of spiral CT for radiolucent ureteric stones diagnosis: our experience]

The aim of this work was to report some case histories on the usefulness of spiral TC, used for several years both to diagnose renal colic and urinary lithiasis and to study radio lucent stones that are often difficult to be detected with traditional radiology. 13 patients, aged between 31 and 76 (average age: 54.2), were therefore examined. Eight of them had a ureteral colic when examined, while five patients had shown symptoms some days before being hospitalised in our ward. In all cases, ultrasonography showed a significant hydronephrosis, while direct radiography of the urinary tract could not detect any images that could be associated with radio-opaque lithiasis. All patients therefore underwent an abdominal spiral TC with no contrast medium within 24 hours after hospitalisation. The confrontation between the results obtained by ultrasonography and those obtained by spiral TC, showed the usefulness of the former method to detect stones located in the proximal ureter or in its intramural tract, while the latter could detect the lithiasis of the proximal ureter in 3 cases (23%), of the mid ureter in 2 cases (15.3%), and of the distal ureter in 8 cases (61%). The stones had, approximately, a 5 mm diameter in 5 cases. In 6 cases the diameter was between 6 and 10 mm, and more than 1 cm in 2 cases. Both methods proved to be equally accurate in the assessment of the hydronephrosis degree and of the thickness of the renal parenchyma. The therapy was medical in 2 cases and open surgery in 3 cases, while 8 patients were treated with ureterolitholapaxy with a ballistic searcher. The usefulness of TC in the study of urolithiasis nowadays is supported by a large literature which clearly supplies with documentary evidence the high sensitivity and specificity of such a method in diagnosing the presence of urolithiasis in general and above all of ureteric stones. Such a method not only makes an accurate evaluation of the stones location possible, but it can also assess the calculi dimensions and the indirect signs of the functionality of the kidney affected, without having to use the contrast medium. This method needs very limited execution times and allows a diagnostic of possible collateral pathologies. The main disadvantage of spiral TC, if compared to conventional radiology, is that the patient is exposed to a larger quantity of ionizing radiations, although such an inconvenience will be overcome by the new and more technologically advanced machines. According to our experience, though based on a limited number of cases, spiral TC allowed us to get a quick diagnosis of radio-lucent lithiasis, to see the seat and dimensions of the calculi and finally to chose the most effective treatment. We can therefore think of a diagnostic protocol, for ureteral colics with hydronephrosis or complicated by hyperpyrexia or sepsis, with spiral TC in order to have a quick diagnosis and start the most effective therapy in case an ultrasonographic research should not result diriment.

[Acceptability and safety of transrectal prostatic 8-core biopsy]

The safety of sextant prostate biopsy has already been documented since the end of the 90's. As a higher efficacy of biopsy has been proved when increasing the number of samples taken, we have tried to assess the safety and tolerability of prostatic 8-core biopsy. From January to December 2001, 204 patients, aged between 50 and 88 (average 70) with a PSA between 0.74 and 196 ng/ml (10 +/- 9.25), underwent in 8-core prostate biopsy. After biopsy, the patients were given an oral antibacterial for 3 days. After taking the samples, patients were interviewed about the tolerability of the biopsy, and especially about the following: I. A feeling of irritation (77 patients, 37.7%); 2. A slight pain (72 patients, 35.29%); 3. A moderate pain (32 patients, 15.68%); 4. Intense pain (23 patients 11.27%). After 20 days all patients came back and were interviewed again about possible complications (biopsy was Ca positive in 86 cases, 42.15%). 153 patients (75%) reported a slight hematuria for an average period of 5 days; 88 patients (43.13%) showed slight anal-rectal hematic discharges, mainly after defecation efforts. It was never necessary to hospitalize any patients because of complications. 71 patients (34.8%) reported a perineal pain which disappeared after 24-48 hours. 175 patients reported having had an ejaculation after biopsy and 158 (90.2%) of them showed hematospermia. 4 patients (2%) had a short period temperature and only 2 (0.98%) were hospitalized for hyperpyrexia with symptoms of genitourinary sepsis. It has been proved that TR prostate biopsy is almost exclusively followed by minor complications, major ones being an exception. A biopsy with more than six samples (8-10-12) shows a higher number of minor complications (hematospermia and hematuria). The fact that a higher number of samples proves this method to be significantly more suitable, pays off all the problems. Also, such a casistics makes us think that prostatic 8-core biopsy is generally well tolerated (73% of patients reported either irritation or slight pain) and fairly safe, as complications are mainly minor ones. We must therefore underline the suitability, good tolerability and safety of the TR prostatic 8-core biopsy.

Ubiquitination and degradation of Syk and ZAP-70 protein tyrosine kinases in human NK cells upon CD16 engagement

Syk and ZAP-70 nonreceptor protein tyrosine kinases (PTKs) are essential elements in several cascades coupling immune receptors to intracellular responses. The critical role of these kinases in promoting the propagation of intracellular signaling requires a tight regulation of their activity, thus the existence of a negative feedback loop regulating their expression can be hypothesized. Herein, we have investigated whether ubiquitin-dependent proteolysis could be a mechanism responsible for controlling the fate of Syk and ZAP-70 after their immunoreceptor-induced activation. We found that both Syk and ZAP-70 become ubiquitinated in response to aggregation of the low affinity Fc receptor for IgG (CD16) on human natural killer cells. We confirmed the identity of the major in vivo ubiquitinated kinase species by performing an in vitro ubiquitination assay. In addition, we found that after CD16 stimulation, ubiquitinated forms of Syk and ZAP-70 associate with the receptor complex. After CD16 engagement, we also observed a decrease in the stability of Syk and ZAP-70 PTKs that is counteracted by pretreatment with either proteasome or lysosomal inhibitors. Moreover, in the presence of the proteasome inhibitor, epoxomicin, we observed an accumulation of ubiquitinated forms of both kinases. Our findings provide evidence of ligand-induced ubiquitination of nonreceptor PTKs belonging to the Syk family and propose the ubiquitin-dependent proteasome-mediated degradation pathway as a mechanism for attenuating the propagation of intracellular signaling initiated by immune receptor engagement.

Co-existence of cutaneous T-cell lymphoma and B hairy cell leukemia

A primary cutaneous form of peripheral T-cell lymphoma (PTCL) and a low grade B-cell non-Hodgkin's lymphoma that was classified as a variant of hairy cell leukemia (HCL) were simultaneously diagnosed in a 79-year-old woman by both phenotypic and genotypic analyses. The coexistence of a T- and B-cell lymphoma in the same patient is rare, and, to our knowledge, this particular association has not been previously described. The patient was referred to our Department for evaluation of multiple cutaneous itchy, reddish plaques; laboratory analyses disclosed a lymphocytosis, that presented 6 years earlier. A bone marrow aspirate showed a 50% B-cell interstitial infiltrate, while a skin biopsy surprisingly revealed a PTCL. Clonality of both neoplastic processes was assessed by Southern blot analysis. The indolent clinical course of the cutaneous disease, and the low and stable number of circulating neoplastic T cells supported the diagnosis of a mycosis fungoides (MF)-like PTCL. Possible oncogenic events and/or putative underlying viral infections which could have played a role in the occurrence of B- and T-cell non-Hodgkin's lymphomas in the same patient are discussed.

Cutting edge: functional role for proline-rich tyrosine kinase 2 in NK cell-mediated natural cytotoxicity

Protein tyrosine kinase activation is one of the first biochemical events in the signaling pathway leading to activation of NK cell cytolytic machinery. Here we investigated whether proline-rich tyrosine kinase 2 (Pyk2), the nonreceptor protein tyrosine kinase belonging to the focal adhesion kinase family, could play a role in NK cell-mediated cytotoxicity. Our results demonstrate that binding of NK cells to sensitive target cells or ligation of beta2 integrins results in a rapid induction of Pyk2 phosphorylation and activation. By contrast, no detectable Pyk2 tyrosine phosphorylation is found upon CD16 stimulation mediated by either mAb or interaction with Ab-coated P815 cells. A functional role for Pyk2 in natural but not Ab-mediated cytotoxicity was demonstrated by the use of recombinant vaccinia viruses encoding the kinase dead mutant of Pyk2. Finally, we provide evidence that Pyk2 is involved in the beta2 integrin-triggered extracellular signal-regulated kinase activation, supporting the hypothesis that Pyk2 plays a role in the natural cytotoxicity by controlling extracellular signal-regulated kinase activation.

Both adhesion to immobilized vitronectin and FcepsilonRI cross-linking cause enhanced focal adhesion kinase phosphorylation in murine mast cells

Murine mast cells adhere spontaneously to plate-bound vitronectin (VNPB) via alphav-containing integrins, and this adhesive interaction results in an augmented interleukin-3 (IL-3)-dependent mast-cell proliferation. In this report we demonstrate that the activation of murine mast cells through alphav-integrin, as well as through the high affinity immunoglobulin E (IgE) receptor (FcepsilonRI), results in enhanced tyrosine phosphorylation of focal adhesion kinase (FAK), a cytoplasmic protein tyrosine kinase involved in mitogenic and oncogenic signal transduction. While mast cell adhesion to VNPB resulted in enhanced FAK phosphorylation, treatment with soluble vitronectin (VNSOL) failed to do so. Spontaneous mast cell adhesion to entactin (EN) did not induce tyrosine phosphorylation of FAK, demonstrating that not all adhesive interactions lead to the same sequence of biochemical events. Because FAK has intrinsic tyrosine kinase activity, we examined whether activating mast cells via alphav-integrins, or via FcepsilonRI-cross-linking stimulated the in vitro kinase activity of FAK. Both pathways were found independently to activate FAK in mast cells and together appeared additive. Protein kinase C depletion in mast cells and calcium depletion in the medium caused decreased tyrosine phosphorylation of FAK, indicating that optimal tyrosine phosphorylation of FAK is regulated by both pathways. These data are consistent with the conclusion that the tyrosine phosphorylation of FAK represents at least one example of a point of convergence in the intracellular tyrosine phosphorylation cascades induced by alphav integrin-and FcepsilonRI-mediated signal transduction pathways in mast cells.

Tyrosine kinase-dependent ubiquitination of CD16 zeta subunit in human NK cells following receptor engagement

We investigated whether aggregation of the low-affinity immunoglobulin G receptor (CD16) on human NK cells results in receptor ubiquitination. We found that the CD16 zeta subunit becomes ubiquitinated in response to receptor engagement. We then investigated whether protein tyrosine kinase (PTK) activation is required for CD16-mediated receptor ubiquitination. Pretreatment with the PTK inhibitor genistein substantially decreased ligand-induced zeta ubiquitination, suggesting a requirement for PTK activation in receptor ubiquitination. We further analyzed PTK involvement in controlling receptor ubiquitination by using the vaccinia virus expression system. Overexpression of wild-type active lck, but not a kinase-deficient mutant, enhanced both ligand-induced tyrosine phosphorylation and ubiquitination of the CD16 zeta subunit. Taken together, our data demonstrate that CD16 engagement induces zeta chain ubiquitination and strongly suggest a role for lck in regulating this modification.

Idiopathic thrombocytopenic purpura treated with steroid therapy does not prevent acute myocardial infarction: a case report

We report the case of a 65-year-old man affected by idiopathic thrombocytopenic purpura, who developed an acute myocardial infarction after 2 years of steroid therapy. Thrombocytopenia was initially recognized 11 years earlier, and became severe during the past 2 years [platelets (PLTS) 10000-30000/microl]. He was treated with steroids, initially to perform a surgical procedure (prednisone 75 mg/day), subsequently to maintain a platelet count of about 50000/microl (prednisone 12.5 mg/day). After 1 year of treatment, he began to complain about exertional angina and dyspnea. His blood pressure became elevated and cholesterol level raised. The exercise electrocardiogram, previously manifesting ischaemic changes, normalized after 1 month of steroid wash-out; however, steroid therapy was reinstituted (prednisone 5 mg per day). One year later, he suffered an infero-lateral non-Q-wave myocardial infarction. It seems likely that the severe coronary atherosclerosis present in our patient developed despite a low platelet count, under the spur of a heavier risk factor profile. Steroid therapy could have had a role as a precipitating agent of the acute event, and the opportunity of alternative treatments is considered.

Blood pressure measurement in haemodialysis patients

Several studies suggest that the 24 hour ambulatory blood pressure monitoring (ABPM) predicts left ventricular hypertrophy more accurately than conventional blood pressure measurement (CBPM) with mercury sphygmomanometer. We estimated the left ventricular mass by M-mode echocardiography in 58 patients on regular haemodialysis treatment during the midweek haemodialysis (HD) interval. ABPM was recorded during the 24 hours preceding the dialysis session and the average of values were compared with the average of the 13 pre HD CBPM recorded by nurses during the month preceding the echocardiography study. The two types of BP measurements correlated significantly with each other, (systolic BP r = 0.62; p < 0.001 and diastolic BP r = 0.74; p < 0.001). The correlation of left ventricular mass with pre-HD systolic BP was stronger (r = 0.54; p < 0.001) than with 24h-systolic BP (r = 0.33; p < 0.01). The overall accuracy of prediction was also similar (68% for pre HD-CBPM; 67% for 24h-ABPM). Measurements of diastolic BP did not correlate significantly with LVM. Our data suggest that 24h-ABPM does not offer any advantage over pre HD-CBPM in predicting left ventricular hypertrophy in HD patients.

La sindrome da incompetenza cavernosa e l'ipogonadismo secondario dell'andromiosi: Condizioni correlate o concomitanza occasionale?: Venous leakage syndrome and “andromiosis” hypogonadism: Are they correlated or are they an occasional coincidence?

The study of available case histories enables us to formulate some interesting hypotheses on the relationship between andropause hypogonadism and cavernous incompetence erectile deficit. Such conditions may well be connected to a similar degenerative or aging process which, provided both conditions are present, may be responsible for the worsening of the erectile deficit. Correction of the hormone deficit does not produce any recovery of spontaneous erectile activity but it significantly improves response to standard treatment for impotence.

Selective binding of shc-SH2 domain to tyrosine-phosphorylated zeta but not gamma-chain upon CD16 ligation on human NK cells

Fc gamma RIII (CD16) is a hetero-oligomeric receptor composed of a ligand-binding alpha subunit associated with homo- or heterodimers of the TCR zeta- and Fc epsilon RI gamma-chains. We have previously demonstrated that CD16 ligation promotes complex formation between tyrosine-phosphorylated shc and Grb2, leading to activation of ras signaling pathway in human NK cells. Here we report that CD16 engagement induces rapid shc association with the tyrosine-phosphorylated receptor complex in human NK cells. In vitro binding studies demonstrate that this interaction is mediated by the shc-SH2 domain, and immunodepletion experiments indicate that the zeta- but not the gamma-chain has the capability to mediate this association. Jurkat cell clones expressing CD16-zeta or -gamma homodimers have been used to gain more information about the mechanism of shc/CD16 association. Our data show that, while engagement of both receptors induces tyrosine phosphorylation of shc and Grb2 recruitment, shc-SH2/receptor complex association is evident only in CD16-zeta but not in CD16-gamma transfectants. Overall, our data demonstrate that the adaptor protein shc can be recruited to the activated CD16 complex by interaction with tyrosine-phosphorylated zeta-chain in a SH2-dependent manner. These results also provide further support to the notion that zeta- and gamma-chains might couple to different biochemical pathways.

Selective binding of shc-SH2 domain to tyrosine-phosphorylated zeta but not gamma-chain upon CD16 ligation on human NK cells

Fc gamma RIII (CD16) is a hetero-oligomeric receptor composed of a ligand-binding alpha subunit associated with homo- or heterodimers of the TCR zeta- and Fc epsilon RI gamma-chains. We have previously demonstrated that CD16 ligation promotes complex formation between tyrosine-phosphorylated shc and Grb2, leading to activation of ras signaling pathway in human NK cells. Here we report that CD16 engagement induces rapid shc association with the tyrosine-phosphorylated receptor complex in human NK cells. In vitro binding studies demonstrate that this interaction is mediated by the shc-SH2 domain, and immunodepletion experiments indicate that the zeta- but not the gamma-chain has the capability to mediate this association. Jurkat cell clones expressing CD16-zeta or -gamma homodimers have been used to gain more information about the mechanism of shc/CD16 association. Our data show that, while engagement of both receptors induces tyrosine phosphorylation of shc and Grb2 recruitment, shc-SH2/receptor complex association is evident only in CD16-zeta but not in CD16-gamma transfectants. Overall, our data demonstrate that the adaptor protein shc can be recruited to the activated CD16 complex by interaction with tyrosine-phosphorylated zeta-chain in a SH2-dependent manner. These results also provide further support to the notion that zeta- and gamma-chains might couple to different biochemical pathways.

Transitional cell carcinoma of the upper urinary tract: Our experience with regard to diagnosis

Transitional cell carcinoma of the upper urinary tract is rare and presents quite interesting diagnostic and therapeutic problems. Available case studies, in accordance with literature on the subject, show how diagnosis relies on the combination of several data obtained from both traditional radiological methods and complementary tests. The importance of urography and retrograde ureteropyelography in providing morphological information is therefore fundamental and should be emphasised. It is advisable, however, to combine these data with those from urinary cytology, ultrasonography and to a lesser extent from CT scan, to be more sure of the nature and the extent of the disease.

The Release of Tissue Factor Pathway Inhibitor and Platelet Factor 4 After Heparin Injection in Patients with Thrombocytosis

Platelet factor 4 (PF4) and tissue factor pathway inhibitor (TFPI) are two proteins with high affinity for heparin. They are each stored in platelets, as well as on endothelial cell surfaces, from where both are displaced or released following an injection of heparin with a rapid and marked increase in serum levels. Prior work has demonstrated that the platelet count is one of the factors affecting the levels of heparin-releasable PF4. We therefore characterized the response to a dose of intravenous heparin previously demonstrated to completely displace PF4 from the non-platelet pool in subjects with normal or increased platelet counts. Seventeen patients with essential thrombocytosis (ET), 10 patients with polycythemia vera and high platelet counts (PV-H), 7 patients with polycythemia vera and normal platelet counts (PV-N) and 10 controls received an initial bolus of 40 I.U./kg of unfractionated heparin, followed 2 hours later by a 2nd bolus of a fixed dose of 1000 I.U. TFPI activity did not show any variation among the different groups, either before (TFPI) or after (HR-TFPI) the first bolus of heparin: ET, TFPI 92.6 ± 21.5%, HR-TFPI 298.3 ± 165.8; PV-H, TFPI 91.5 ± 32.0, HR-TFPI 210 ± 1.0; PV-N, TFPI 69.4 ± 24.0, HR-TFPI 203.0 ± 79.0; C, TFPI 109.5 ± 33.5, HR-TFPI 234.0 ± 60.4. TFPI activity returned to basal values prior to the 2nd injection of heparin, which again elicited a rise in TFPI, albeit smaller due to the lower level of heparin injected. In contrast to the lack of any difference between groups with respect to TFPI, the level of heparin-releasable PF4 (HR-PF4) was significantly higher in ET and PV-H patients compared to PV-N patients or controls. However when normalized for platelet count, both PV-H and PV-N had HR-PF4 levels after the 1st heparin injection that were significantly higher than observed in ET patients (PV-H 1.163 + 0.108, PV-N 1.411 + 0.019, ET 0.737 + 0.086 ng/10/3 platelets) supporting an increased platelet activation in PV. Thus, although platelets contain approximately 5-10% of the total amount of TFPI in plasma, they do not affect the major intravascular pool of TFPI mobilizable by heparin. However, since the concentration at the site of vessel wall injury is enhanced several-fold, TFPI could play a role in competing with PF4 to limit thrombus formation in patients with high platelet count.

IgE receptor (Fc epsilon RI) and signal transduction

This review suggests a model in which both beta- and gamma-chains synergize in the initiation of Fc epsilon RI signal transduction function. Receptor aggregation by antigens induces activation of lyn, which is already bound to the Fc epsilon RI beta-chain under resting conditions. Whilst activated, lyn would phosphorylate the tyrosine residues in the Fc epsilon RI gamma-chain. This phosphorylation would be responsible for the recruitment of syk (probably via its SH2 domains) as well as other signalling molecules. Syk kinase would then be activated by the engagement of its SH2 domains and/or its phosphorylation. Syk could then interact with and activate (through phosphorylation) downstream effector molecules.

Syk-dependent phosphorylation of Shc. A potential link between FcepsilonRI and the Ras/mitogen-activated protein kinase signaling pathway through SOS and Grb2

Antigen receptors on T- and B-cells activate Ras through a signaling pathway that results in the tyrosine phosphorylation of Shc and the formation of a complex of Shc with the Grb2 adaptor protein. The high affinity receptor for immunoglobulin E (FcepsilonRI) in cultured mast (RBL-2H3) cells has been reported to function differently. Here we show to the contrary that engagement of FcepsilonRI with antigen leads to increased tyrosine phosphorylation of Shc and the association of Shc with Grb2 and other proteins (p120 and p140). Like the FcepsilonRI-mediated activation of the mitogen-activated protein kinase cascade, these responses are dependent on the tyrosine kinase Syk; they are enhanced by overexpression of Syk and are blocked by expression of dominant-negative Syk. Sos is constitutively associated with Grb2 in these cells but dissociates from Shc on stimulation with antigen. These reactions are rapid, reversible, and associated with the activation of Ras. Therefore, the Syk-dependent tyrosine phosphorylation of Shc and its association with Grb2 may provide a pathway through Sos for activation of Ras by FcepsilonRI.

Persistence of tyrosine-phosphorylated FcepsilonRI in deactivated cells

Engagement of the high affinity IgE receptor (FcepsilonRI) with a multimeric antigen leads to immediate tyrosine phosphorylation of its beta and gamma subunits, recruitment, and activation of the tyrosine kinase Syk, and later to cell degranulation. Monovalent hapten treatment reverses these events, resulting in receptor dephosphorylation and an abrupt arrest of cell degranulation. Thus far, it has been assumed that there is a direct linkage between receptor tyrosine phosphorylation, Syk activation and phosphorylation, and cell degranulation. However, we show here that when FcepsilonRI receptors are cross-linked for extended periods of time, hapten-mediated receptor dephosphorylation is delayed. These receptors, which remain tyrosine-phosphorylated despite the addition of hapten, are progressively targeted to a Triton X-100-insoluble fraction, suggesting their progressive association with the membrane skeleton. In contrast to FcepsilonRI receptors, hapten-induced Syk dephosphorylation and the consequent arrest of degranulation are not affected by prolonged cross-linking. Thus, some tyrosine-phosphorylated receptors persist in deactivated cells. We propose that, with time, some tyrosine-phosphorylated receptors become unaccessible to phosphatases and, in addition, unable to activate Syk. This inactive status of tyrosine-phosphorylated FcepsilonRI may be the result of membrane skeleton compartmentalization. However, another population of clustered receptors that includes the ones most recently formed is still immediately sensitive to hapten deactivation. This latter population is critical in maintaining Syk activity and cell degranulation. The shift from a transiently active state of phosphorylated receptors toward an inactive state could be a general mechanism of desensitization also utilized by other antigen receptors.

The association of radical prostatectomy and adjuvant hormone therapy can represent a valid option in the treatment of locally advanced prostatic cancer (T3b-c)?

Locally advanced prostatic cancer is a pathological condition not uncommonly found, especially during radical prostatectomy due to an understaged pathology. It is therefore important to find a pattern of therapeutic behaviour in order to be able to offer the patient the most suitable treatment. An analysis of current case histories tallies with other recent statistical evaluations and allows us to state with increasing certainty that the combination of radical prostatectomy, when technically feasible, with a supporting hormone therapy offers numerous advantages in terms of life span, free-from-disease intervals and quality of life compared to the single therapies. It is therefore interesting to examine the role that such therapy plays in the treatment of locally advanced prostatic cancer.

[Normalization of the prolactin values during alfa-interferon therapy: the considerations with a female patient with anti-HCV-positive chronic hepatitis and prolactin-secreting hypophyseal microadenoma]

We report the case of a 45-year-old woman suffering from anti-hepatitis C virus (HCV) positive chronic active hepatitis and amenorrhea-galactorrhea syndrome due to a prolactin-secreting pituitary microadenoma. She was repeatedly given alpha-interferon for hepatitis, and a concomitant normalization of plasma prolactin levels, with disappearance of the related symptoms, was observed during the treatment. Further experience is needed in order to verify the therapeutical effectiveness of alpha-interferon on prolactin-secreting tumors.

B non-Hodgkin's lymphoma in a haemophilia patient with idiopathic CD4+ T-lymphocytopenia

We report here a case of an HIV-uninfected, anti-hepatitis C virus (HCV) positive haemophiliac, who was transfused with blood and intermediate purity factor VIII concentrates. Since 1988, a progressive decline in the CD4+ T-cell count was recorded, and in 1993 a B-cell non-Hodgkin's lymphoma (B-NHL) was diagnosed. The morphological appearance of the tumor with features of intermediate/mantle zone lymphoma, and the absence of EBV sequences within the tumor, ruled out the occurrence of a typical "opportunistic" lymphoma. However it is possible that the blood product therapy and its infectious complications may have played a role on immune function impairment.

The combined implant of an endourethral prosthesis and artificial sphincter in post-operative urethral strictures involving the external sphincter

— Urethral strictures still represent one of the most difficult urological pathologies to treat. This report deals with two cases of post-operative urethral strictures involving the external sphincter treated with a combined implant of an endourethral prosthesis and an artificial sphincter AMS-800. Two years after the implant, the urodynamic equilibrium is satisfactory. The relatively high cost of the treatment requires really favourable results in particularly motivated subjects.

Pharmacocavernosometry as a functional diagnostic test of venous leakage

During 1994, 20 patients underwent pharmacocavernosometry because of suspected venous leakage. Only two patients showed evident signs of this syndrome. However, in another 10 patients, who did not show cavernosometric signs of venous leakage, cavernosography manifested opacity of the pudendal veins. Therapy for the two above-mentioned cases was surgical ligation of the crural vessels and of the dorsal vein. Short-term results have been substantially satisfactory. Analysing these cases and taking into account the latest bibliographic references, a prevalently functional pathogenesis of venous leakage can be proposed. Pharmacocavernosometry, as a functional diagnostic exam, although limited, could be the best test presently available to diagnose this syndrome. Cavernosography, being a more anatomic exam, could appear much less significant. The therapy to be proposed is surgery, on its own or supported by pharmacoprosthesis.

Different roles for the Fc epsilon RI gamma chain as a function of the receptor context

The high affinity immunoglobulin E receptor (Fc epsilon RI) and the B and T cell antigen receptors (TCR) are multimeric complexes containing subunits with cytoplasmic antigen recognition activation motifs (ARAMs). The presence of multiple motifs may be a way to amplify a single signal or provide independent activation modules. Here we have compared the signaling capacity of the same Fc epsilon RI gamma motif in the context of two different receptors, Fc epsilon RI and TCR/CD3, simultaneously reconstituted on the surface of the same zeta-deficient T cell line. Both reconstituted receptors mediate early (phosphorylation) and late (interleukin [IL]-2 release) signals. Mutation of the two tyrosine residues of ARAM gamma alters early signaling by both receptors, but the set of substrates phosphorylated via ARAM gamma is different for each receptor and is thus dependent on the receptor context. Furthermore, the mutations prevent Fc epsilon RI- but not TCR/CD3-mediated IL-2 release. These data demonstrate that ARAM gamma is necessary for allowing both receptors to phosphorylate the complete set of substrates, and that the CD3 complex, unlike the Fc epsilon RI beta chain, contains activation modules capable of compensating for the absence of a functional ARAM gamma in generating late signals such as IL-2 release.

[Proposal for using mechanical staplers with Polysorb in creation of orthotopic neobladder]

After radical cysto-prostatectomy the bladder substitute is made from an ileal segment, opened along its antimesenteric border and folded; the results are in general good. The success of this procedure demands attention to detail, hemostasis and gentle handling of tissue so this surgery depends an unusual degree of commitment to meticulous technique. The very low rate complications, obtained with mechanical sutures in gastrointestinal surgery, incited the Authors using the staplers GIA and TA Polysorb for detubularized ileal segment. They are very manageable, easy to use and the follow-up shows the absence of urinary stone; so the team approach is less tedious and strenuous. The Authors present their results of 11 neobladder-staplers made with 35 cm of detubularized ileal segment without folding.

Anti-hepatitis C virus serology in patients affected with congenital coagulation defects: a comparative study using three second generation ELISA tests

We determined the prevalence of anti-hepatitis C virus (HCV) antibodies in 34 patients affected with congenital coagulation disorders attending the Haemophilia Centre of Padua, Italy. Serological tests were carried out by three second generation enzyme linked immunosorbent assays (ELISA), two based on recombinant proteins (Ortho and Abbott) and one based on synthetic peptides (Behring) as antigenic substrate. The repeatedly reactive specimens were further assayed by the supplemental 4-antigen recombinant immunoblot assay (RIBA) (Chiron and Ortho). Moreover, we performed the dot-blot Matrix test (Abbott) on the samples showing discrepant results by the three ELISA tests. Twenty-six patients (76.5%) were anti-HCV positive using all three ELISA tests; 25 were confirmed by the supplemental RIBA test, the other one was indeterminate. Two samples were in a gray-zone only using the anti-HCV ELISA Abbott. These were positive by the RIBA; in contrast, such samples showed no reactivity with the Matrix test. In accordance with the current literature, these data show an equivalence between the 2nd generation screening tests (ELISA), at least when applied to a high risk population as in the present study. Further, these screening tests demonstrated a reliable specificity, since most of the ELISA-reactive specimens were confirmed by the supplemental RIBA test. In contrast, combined use of the anti-HCV tests could be useful when high sensitivity is requested, as in the case of blood donor pretransfusion screening.