Development of ISB 1442, a CD38 and CD47 bispecific biparatopic antibody innate cell modulator for the treatment of multiple myeloma

Antibody engineering can tailor the design and activities of therapeutic antibodies for better efficiency or other advantageous clinical properties. Here we report the development of ISB 1442, a fully human bispecific antibody designed to re-establish synthetic immunity in CD38+ hematological malignancies. ISB 1442 consists of two anti-CD38 arms targeting two distinct epitopes that preferentially drive binding to tumor cells and enable avidity-induced blocking of proximal CD47 receptors on the same cell while preventing on-target off-tumor binding on healthy cells. The Fc portion of ISB 1442 is engineered to enhance complement dependent cytotoxicity, antibody dependent cell cytotoxicity and antibody dependent cell phagocytosis. ISB 1442 thus represents a CD47-BsAb combining biparatopic targeting of a tumor associated antigen with engineered enhancement of antibody effector function to overcome potential resistance mechanisms that hamper treatment of myeloma with monospecific anti-CD38 antibodies. ISB 1442 is currently in a Phase I clinical trial in relapsed refractory multiple myeloma.

Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait

PURPOSE

To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales.

METHODS

This cross-sectional study involved 22 adults between 18 and 70 years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128 Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences.

RESULTS

Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT.

CONCLUSIONS

In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.

The pre-launch on-ground characterization of Ma_MISS spectrometer for ExoMars-Rosalind Franklin Rover mission. II. Radiometric calibration

The Ma_MISS miniaturized spectrometer is integrated within the Drilling System of the ExoMars Rosalind Franklin Rover for Mars exploration. Here we focus on the on ground calibration campaign to obtain radiometric and linearity calibrations of the Ma_MISS instrument, while the first paper dealt with the spectral calibration [De Angelis et al., Rev. Sci. Instrum. 93, 123704 (2022)]. The experimental setup used to carry out radiometric calibration is described, as are the methods used for data processing and key parameter retrieval. In particular, the Spectrometer Transfer Function (Responsivity), Signal-to-Noise Ratio, and detector linearity are determined. In a third paper [De Sanctis et al., Planet. Sci. J. 3, 142 (2022)], validation of the Ma_MISS calibration results through spectral measurements performed on rock and synthetic targets during the radiometric calibration campaign is described.

Constraining the Rosalind Franklin Rover/Ma_MISS Instrument Capability in the Detection of Organics

The Mars Multispectral Imager for Subsurface Studies (Ma_MISS) instrument is a miniaturized visible and near-infrared spectrometer that is integrated into the drilling system of the ESA Rosalind Franklin rover, which is devoted to subsurface exploration on Mars. Ma_MISS will acquire spectral data on the Martian subsurface from excavated borehole walls. The spectral data collected by Ma_MISS on unexposed rocks will be crucial for determination of the composition of subsurface rocks and optical and physical properties of materials (i.e., grain size). Ma_MISS will further contribute to a reconstruction of the stratigraphic column and acquire data on subsurface geological processes. Ma_MISS data may also inform with regard to the presence of potential biomarkers in the subsurface, given the presence of organic matter that may affect some spectral parameters. In this framework, we performed a wide range of measurements using the laboratory model of the Ma_MISS to investigate mineral/organic mixtures in different proportions. We prepared mixtures by combining kaolinite and nontronite with glycine, asphaltite, polyoxymethylene, and benzoic acid. These organic compounds show different spectral characteristics in the visible and near-infrared; therefore their presence can be detected by the Ma_MISS instrument. Our results indicate that the Ma_MISS instrument can detect organic material down to abundances of around 1 wt %. In particular, the data collected on low-concentration mixtures show that, by analyzing sediments with a grain size smaller than the Ma_MISS spatial resolution, the instrument can still discern those points where organic matter is present from points with exclusive mineral composition. The results also show that a collection of multiple contiguous measurements on a hypothetical borehole wall could help indicate the presence of organic matter in clay-rich soils if present.

Therapeutic educational workshops for caregivers of patients with severe acquired brain injury

Abstract

Severe acquired brain injury (sABI) leads to a wide range of functional limitations in cognitive, moto and behavioural abilities. These changes impact the patient's family in terms of the feeling of emotional and physical health, social life and financial condition. Caregivers are often intensely involved in the patient's management exposing them to negative effects of caregiving including stress, mood disorders and decreased quality of life. Implementing forms of active involvement of caregivers in the rehabilitative program could be useful. Thus, in the present study, therapeutic educational workshops (TEWs) for caregivers during the post-acute intensive hospitalization were organized during the post-acute intensive hospitalization of patients with sABI. The caregivers were asked to participate in the workshops to actively involve them in the patient's care and neurorehabilitation program. Each workshop session provided indications regarding the management of the patient with aphasia, neglect, behavioural and swallowing disorders. A questionnaire of 22 items has been designed in order to represent possible indicators of usefulness and effectiveness of the TEWs. The primary aim of this study was to develop a reliable and valid questionnaire able to assess the caregivers' satisfaction with the modalities of carrying out the TEW as a novel activity during the post-acute hospitalization of patients with sABI. The second aim was to assess the caregivers' satisfaction with the utility of the TEW as a tool to enhance their skills in the management of patients' disabilities. 100 caregivers of patients with sABI who attended at least one TEW session and completed the questionnaire were included in the analysis. In conclusion the administered questionnaire has proven to be a valid and reliable tool to evaluate sABI caregivers' satisfaction with TEW. Moreover, caregivers were satisfied with the organization of the TEW and with their usefulness in the management of the patients with sABI.

The pre-launch on-ground characterization of Mars Multispectral Imager for Subsurface Studies (Ma_MISS) spectrometer for ExoMars rover mission: Spectral calibration

The Ma_MISS spectrometer is integrated within the drilling system of the Rosalind Franklin ExoMars rover. This paper reports the on-ground calibration campaign performed on the spectrometer. Here, we focus on the spectral calibration of the instrument. The experimental setup used to carry out calibration is described, and the methods used for data processing and key parameters retrieval are explained. In particular, the spectral parameters such as (i) pixel central wavelengths, (ii) spectral response function, (iii) spectral resolution, (iv) sampling, and (v) range are determined. In a follow-up paper, the linearity and radiometric calibrations are described, while in De Sanctis et al. [Planet. Sci. J. 3, 142 (2022)], the validation of spectral measurements performed on synthetic and natural rock targets is presented.

Introduction to a community dataset from an infrasound array experiment at Mt. Etna, Italy

Volcanic activity represents a hazard to population and infrastructure worldwide. The study of acoustic waves in the atmosphere by volcanic activity is growing in popularity as an effective tool to monitor and understand the mechanisms of eruptions. In 2019, we deployed two 6-element infrasound arrays at Mt. Etna, Italy, one of the most active volcanoes in the world. Our experiment captured a range of acoustic signals associated with diverse activity ranging from background degassing to energetic Strombolian explosions, lava flows, and atmospheric injection of volcanic ash. Here, we present a description of this valuable, publicly available, research dataset. We document the design and scope of the experiment, report on data availability, and present a brief summary of the activity observed at Mt. Etna during our deployment aiming to facilitate future use of these valuable data. This dataset is the first example of open data from a multiple infrasound array experiment at Mt. Etna and one of the few available globally.

Measurement(s)	acoustic waves • volcanic activity
Technology Type(s)	infrasound
Sample Characteristic - Environment	volcano
Sample Characteristic - Location	Mount Etna

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.15144996

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

The effects of aquatic therapy during post-acute neurorehabilitation in patients with severe traumatic brain injury: a preliminary randomized controlled trial

OBJECTIVE

The primary aim is to verify the effectiveness of an aquatic training (AT) in inpatients with severe Traumatic Brain Injury (sTBI) on balance. The secondary aims are to explore the effects on gait, activities of daily living, and quality of life, comparing to a land-based conventional protocol.

METHODS

Two-arm, randomized controlled trial. Twenty inpatients with sTBI, Glasgow Coma Scale score ≤8, and Level of Cognitive Functioning ≥7 were recruited and randomly assigned to the aquatic therapy group (ATG) or to the Conventional Training Group (CTG). Patients underwent 12 individual rehabilitation sessions (3 days/week, 4 weeks), in a rehabilitation pool during the post-acute intensive neurorehabilitation. The primary outcome measure was the Berg Balance Scale (BBS). Secondary outcome measures were the Modified Barthel Index (MBI), Disability Rating Scale (DRS), Tinetti Gait Balance Scale (TBG) and Quality of Life After Brain Injury (QOLIBRI). All the evaluations were performed at the baseline and after 4 weeks of training.

RESULTS

The within-subjects analysis showed a significant improvement both in ATG and CTG in MBI, BBS, TBG, and QOLIBRI.

CONCLUSION

Our results may support the use of AT during post-acute phase to improve motor functions and quality of life in patients with sTBI.

Effectiveness of a sensor-based technology in upper limb motor recovery in post-acute stroke neurorehabilitation: a randomized controlled trial

Sensor-based technological therapy devices could be a possible neurorehabilitation strategy for motor rehabilitation in patients with stroke during the post-acute hospitalization, especially for treating upper extremities function limitations. The audio-visual feedback devices are characterized by interactive therapy games that allow training the movement of shoulders, elbows, and wrist, measuring the strength and the active range of motion of upper limb, registering data in an electronic database to quantitatively monitoring measures and therapy progress. This study aimed to investigate the effects of sensor-based motor rehabilitation in add-on to the conventional neurorehabilitation for improving the upper limb functions in patients with subacute stroke. Thirty-seven patients were enrolled in the study and randomly assigned to the experimental group and the control group. The training consisting of twelve sessions of upper limb training compared with twelve sessions of upper limb sensory-motor training, without robotic support. Both rehabilitation programs were performed for 40 minutes three times a week, for 4 weeks, in addition to conventional therapy. All patients were evaluated at the baseline (T0) and after 4 weeks of training (T1). The within-subject analysis showed a statistically significant improvement in both groups in all clinical scales. The analysis of effectiveness revealed that, compared with baseline (T0), the improvement percentage in the Modified Barthel Index was greater in the experimental group than the control group. The use of a sensor-based training with audio-video-feedback could be a useful complementary strategy for improving upper limb motor functions in patients with stroke during post-acute neurorehabilitation.

Design, development, and testing of an environmental P-T cell for infrared spectroscopy measurements

Water absorption bands due to superficially adsorbed molecules often dominate the near-infrared spectra of particulate minerals and rocks, when measured in the laboratory in the reflectance mode. In order to remove this, the spectral effect is thus necessary to acquire spectra of samples in vacuum and at higher temperatures. With the aim to accomplish this task, we developed an environmental cell to perform infrared spectroscopic measurements at controlled pressure-temperature conditions. Currently the cell allows one to measure reflectance spectra in the temperature range from room values up to 300 °C (573 K), in the pressure range of 10³-10^-6 mbar. The acquisition of spectra continuously in two distinct phases, namely, during a preliminary pumping stage (at room T) and subsequently during a heating stage (in vacuum), permits to highlight and characterize separately the effect of pressure and temperature on infrared spectra.

Characterization of moderate ash-and-gas explosions at Santiaguito volcano, Guatemala, from infrasound waveform inversion and thermal infrared measurements

The rapid discharge of gas and rock fragments during volcanic eruptions generates acoustic infrasound. Here we present results from the inversion of infrasound signals associated with small and moderate gas-and-ash explosions at Santiaguito volcano, Guatemala, to retrieve the time history of mass eruption rate at the vent. Acoustic waveform inversion is complemented by analyses of thermal infrared imagery to constrain the volume and rise dynamics of the eruption plume. Finally, we combine results from the two methods in order to assess the bulk density of the erupted mixture, constrain the timing of the transition from a momentum-driven jet to a buoyant plume, and to evaluate the relative volume fractions of ash and gas during the initial thrust phase. Our results demonstrate that eruptive plumes associated with small-to-moderate size explosions at Santiaguito only carry minor fractions of ash, suggesting that these events may not involve extensive magma fragmentation in the conduit.

Malignant ventricular arrhythmias induction by programmed electrical stimulation of the right ventricular outflow tract only during type 1 Brugada ECG maximization

OBJECTIVE

The role of electrophysiology study in Brugada syndrome (BS) sudden cardiac death risk stratification remains controversial and seems to depend on the phenotypic expression of the channelopathy. Ajmaline has a key role in the diagnosis of BS. We observed that programmed electrical stimulation (PES) of the right ventricular outflow tract (RVOT), only when type 1 BS ECG is unmasked by ajmaline administration, induces ventricular arrhythmias.

CASE REPORT

We describe a case of ventricular fibrillation induction by PES of the RVOT when type 1 BS ECG is revealed by ajmaline, in a patient with a baseline dynamic intermittent type 1 and 2 BS ECG.

CONCLUSIONS

The heterogeneous clinical presentations of BS are due to the underlying mechanisms. PES of the RVOT during positive ajmaline test maximizes the channelopathy and therefore sudden cardiac death risk-stratification in BS.

Heart Failure in a Dedicated Outpatient Clinic: Results after 58 Month Follow-Up. Can it be Enough?

Incidence of chronic heart failure (HF) is rapidly increasing, approaching a 10 per 1000 rate after 65 years of age. In the last decades, despite pharmacological, interventional and supportive innovations, HF prognosis remained poor, with about 30% of death within one year from the diagnosis. Current guidelines recommend for these patients management programs providing follow-up through dedicated outpatient clinic. Limits of these programs are represented by great difficulties in getting patients adherence, being still too elevated the rate of abandonments. In this paper, we analyzed the impact of 58 months of activity in our dedicated to heart failure outpatient clinic on mortality, hospitalization and abandonment rate. 477 HF patients (346 M, 72.5%, mean age 69.6 years) were enrolled. Mean follow-up and visit were 18.2 and 2.6 months respectively. Total mortality rate was 11.5%, 4% of patients per year. Total hospitalizations for acute HF were 212 and, among all patients left in follow-up, the number of hospitalizations for acute de-compensation significantly decreased from 0.49/patient/year before enrollment to 0.29/patient/year during follow-up (p=0.015). Patients who abandoned outpatient clinic were 94 (19%, 1 abandonment every 23 days), mostly observed over the first months of activity. In conclusion, our patients experienced a major decrease in rates of acute de-compensation and need of in-hospital admissions.

Ventricular fibrillation induction and diffuse abnormal ST-segment response to ajmaline in a patient with apparent pre-existing dynamic right bundle branch block

OBJECTIVE

ST-segment elevation in the right precordial electrocardiography (ECG) leads in Brugada syndrome (BS) can be unmasked by class I anti-arrhythmic drugs (sodium channel blockers) administration. It is still debated whether this ECG pattern is better explained by abnormal repolarization or ventricular conduction and depolarization. Conduction diseases can conceal type 1 BS-like ECG in standard V1-V3 leads. ECG alterations were found also in alternative leads. The role of electrophysiology study (EPS) in sudden cardiac death risk stratification remains controversial, and could depend on the phenotypic expression of the cardiac sodium channels disease.

CASE REPORT

We describe unmasked diffuse J-point and ST-segment anomalies in peripheral and precordial ECG leads and ventricular fibrillation (VF) induction by EPS after ajmaline administration in a patient with pre-existing atypical right bundle branch block (RBBB) concealing subtle anomalies in standard V1-V3 leads. RBBB was influenced by the underlying BS-like ECG associating repolarization anomaly and pre-existing conduction disease. EPS induced VF when RBBB was associated with BS-like ECG, and failed to induce VF when RBBB was present alone.

CONCLUSIONS

BS phenotype heterogeneity requires further studies to improve the knowledge of its pathophysiological mechanisms associated with conduction diseases in order to better identify an individual therapy and prognostic stratification.

Efficacy of calcium channel blockers in the treatment of the myocardial bridging: a pilot study

BACKGROUND

Myocardial Bridging (MB) is defined as a segment of a major epicardial coronary artery, the "tunnelled artery", that goes intramurally through the myocardium beneath the muscle bridge.

MATERIALS AND METHODS

A 69-year-old male patient with a story of arterial hypertension and dyslipidemia in treatment with converting enzyme inhibitors (ACE-I), antiplatelet therapy and HMG-CoA reductase inhibitors and calcium channel blockers, presented with anginal-like chest pain and dyspnea. The coronary angiography showed a myocardial bridging and no hemodynamically significant coronary artery disease.

RESULTS

On admission in our Department, the exercise cyclo ergometer test was significant for > 3 mm ST segment depression in the anterior and lateral leads (V3, V4, V5, V6) associated with chest pain. The coronary angiography revealed a 40% stenosis of the distal tract of the right coronary artery (RCA), a 30% stenosis of the proximal tract of the left anterior descending artery (LAD) and 40% of the proximal tract of the first diagonal branch. A 30% stenosis in the middle tract of the left circumflex coronary artery (LCX) was then detected. A marked systolic localized narrowing (90%) on the middle tract of the LAD, after the second diagonal branch (a myocardial bridge) was also detected. After eight months, the exercise cyclo ergometer test using a standard Bruce protocol was normal and, after sixteen months, no significant coronary artery disease (< 50%) and no myocardial bridging were detected by the coronary 64-multislice spiral computed tomography. Two years later, the patient was readmitted to our Department because of angina-like chest pain during light exertion in the last two months. The coronary angiography of the right system revealed a 30% stenosis of the proximal tract and a 50% stenosis of the distal tract of the RCA. The coronary angiography of the left system showed a 30% stenosis of the proximal tract of the LAD and 85% of the middle tract of the first diagonal branch. A 40% stenosis in the middle tract of the left circumflex coronary artery (LCX) was then detected. No MB of the middle tract of the LAD was detected, and a bare metal stent (Presillion 2.5 x 12 mm) was deployed in the middle tract of the first diagonal branch.

CONCLUSIONS

After 2 years, the administration of the calcium channel blockers has been effective in the treatment of the MB but no effect on the atherosclerotic plaque growth has been demonstrated.

Functional changes cardiovascular: normobaric activity and microgravity in young healthy human subjects

BACKGROUND

The cardiovascular system works to maintain homeostasis through a series of adaptive responses to physiological requirements. Different self-regulatory mechanism prevent the effects induced by hydrostatic pressure changes on oncotic pressure caused by postural changes. Gravity exerts a strong influence on the postural changes with implications on the cardiovascular system. In orbit, gravity (+Gz) is responsible of mass redistribution of circulating blood flow. The aim of this study was the evaluation of the adaptive responses of cardiovascular system to postural changes with and without the use of the Lower Body Negative Pressure (LBNP). We considered that pressure changes that occur in human body in orbit can be simulated experimentally with use of Tilt-Test (Clino/ortho; Clino/head-down; head-down/ortho). This investigation could be useful for studying the influence on astronauts of long flights.

SUBJECTS AND METHODS

We studied in 12 months, 30 young healthy volunteers (20 males, 10 female) during postural change tests. In the first evaluation they were submitted to tilt-test for 40 minutes, remaining in head-up +60 degrees (this state corresponds to a kind of gravitational stress +Gz) and in head-down to -30 degrees (-Gz) for 20 minutes. During the second assessment (after 5 +/- 1 days) all volunteers wear a device that simulate a state of LBNP at -20 mmHg. Afterwards, they were processed to 20 minutes in Head Down -8 degrees and after 2 hours of rest to 20 minutes at -15 degrees. Volunteers were monitored measuring blood pressure, heart rate and by Transthoracic Echocardiogram (TTE).

RESULTS

Collected data were elaborated by a statistical analysis. We observed during orthostatic position for 40 min (+60 degrees) without LBNP, lower diameters and volumes of left and right ventricular (p < 0.05) and an increase in heart rate in comparison with the baseline conditions in clinostatism. Despite the reduction of preload volume, the mean value of cardiac output does not vary significantly. In Trendelemburg (-15 degrees) data show a non-significant variation (p > 0.05) of left and right ventricular diameters and volumes, while cardiac output and systolic blood pressure varies significantly (p < 0.05) compared to clinostatic and orthostatic position. With LBNP in head down to -8 degrees and -15 degrees, systolic and diastolic arterial pressure, ventricular volumes and cardiac output were unchanged if compared to values obtained in clinostatism with and without LBNP. If compared to -30 degrees in Trendelemburg without LBNP, data reached statistical significance (p < 0.05).

CONCLUSIONS

The cardiovascular system and the autonomic nervous system, respond to postural changes and to volemia alterations, maintaining the physiological cardiac output, in order to preserve the metabolic requirements of body.

Serum transforming growth factor β1 during diabetes development in non-obese diabetic mice and humans

Recent data show that regulatory cells with transforming growth factor (TGF)-β1-dependent activity are able to restore self-tolerance in overtly diabetic non-obese diabetic (NOD) mice. Thus, TGF-β1 seems to have a relevant role in protection from autoimmune diabetes. Our aim was to investigate the possible significance of serum TGF-β1 measurement in the natural history of diabetes in NOD mice, as well as in children positive for at least one islet-related antibody. Serum TGF-β1 (both total and active) was measured by enzyme-linked immunosorbent assay at monthly intervals in 26 NOD mice during the spontaneous development of diabetes and, on a yearly basis, in nine siblings of patients with type 1 diabetes (T1D) with a follow-up of 4 years. Diabetes appeared between the 12th week of age and the end of the study period (36 weeks) in 17 mice. TGF-β1 serum level variations occurred in the prediabetic period in both NOD mice and humans and diabetes diagnosis followed a continuing reduction of active TGF-β1 (aTGF-β1) serum levels. In mice, aTGF-β1 serum levels measured at 4 weeks of age correlated positively with severity of insulitis, and negatively with percentage of insulin-positive cells. Our findings suggest that in NOD mice serum TGF-β1 levels during the natural history of the diabetes reflect the course of islet inflammation. The measurement of aTGF-β1 in islet-related antibody-positive subjects may provide insights into the natural history of prediabetic phase of T1D.

The usefulness of the prognostic inflammatory and nutritional index (PINI) in a haemodialysis population

BACKGROUND AND AIM

Protein-Energy Wasting and inflammation are the principal risk factors of haemodialysis complications. We evaluated the reliability of a simple and non expensive test, the Prognostic Inflammatory and Nutritional Index (PINI), for regular screening of maintenance haemodialysis (MHD) patients in order to detect early onset of inflammation and malnutrition.

METHODS AND RESULTS

121 adult patients on maintenance dialysis were followed up for 32 months and screened every 6 months for PINI, calculated as alpha1-Acid Glycoprotein (alpha1-AG)xC-Reactive Protein (CRP)/AlbuminxTransthyretin. PINI score < or =1 was considered normal. Patients were stratified according to their PINI score: 86 patients (71.66%) had a normal score, whereas 35 (28.33%) had PINI > or = 1. The latter also had higher CRP levels, despite no clinical evidence of inflammation at the time of enrolment. Survival in patients with normal PINI was similar to patients with normal CRP, while in patients with abnormal PINI it was significantly lower than in patients with low serum albumin (p<0.05) or elevated CRP (p<0.05). After follow-up, all surviving MHD patients with PINI > or = 1 had at least one cardiovascular event vs 2.5% of patients with PINI > or = 1.

CONCLUSION

The assessment of PINI can reliably identify MHD patients at higher risk of mortality and morbidity even in the absence of overt Malnutrition-Inflammation Complex Syndrome (MICS). This simple test appears to be more sensitive and specific of the single components, and not expensive, so that it could be routinely used to identify patients with sub-clinical inflammation and/or malnutrition.

Inhaled ammonium persulphate inhibits non-adrenergic, non-cholinergic relaxations in the guinea pig isolated trachea

BACKGROUND

Persulphates can act both as irritants and sensitizers in inducing occupational asthma. A dysfunction of nervous control regulating the airway tone has been hypothesized as a mechanism underlying bronchoconstriction in asthma.

OBJECTIVES

It was the aim of this study to investigate whether inhaled ammonium persulphate affects the non-adrenergic, non-cholinergic (NANC) inhibitory innervation, the cholinergic nerve-mediated contraction or the muscular response to the spasmogens, carbachol or histamine, in the guinea pig epithelium-free, isolated trachea.

METHODS

Male guinea pigs inhaled aerosols containing ammonium persulphate (10 mg/m(3) for 30 min for 5 days during 3 weeks). Control animals inhaled saline aerosol. NANC relaxations to electrical field stimulation at 3 Hz were evaluated in whole tracheal segments as intraluminal pressure changes. Drugs inactivating peptide transmission, nitric oxide synthase, carbon monoxide production by haem oxygenase-2 and soluble guanylyl cyclase were used to assess the involvement of various inhibitory neurotransmitters. Carbachol and histamine cumulative concentration-response curves were obtained.

RESULTS

In both groups, nitric oxide and carbon monoxide participated to the same extent as inhibitory neurotransmitters. In exposed animals, the tracheal NANC relaxations were reduced to 45.9 +/- 12.1% (p < 0.01). The cholinergic nerve-mediated contractions to electrical field stimulation and the muscular response to histamine were not modified by ammonium persulphate exposure. The muscular response to carbachol was unaffected up to 1 microM. Conversely, the response to the maximal concentration of carbachol (3 microM) was increased (p < 0.01).

CONCLUSION

Ammonium persulphate inhalation at high concentrations impairs the nervous NANC inhibitory control in the guinea pig airways. This may represent a novel mechanism contributing to persulphate-induced asthma.

Contraindications for whole body vibration training: a case of nephrolitiasis

The use of whole body vibration (WBV) training is becoming more widespread both among athletes and the general public for improving muscle performance. The biological and mechanical effects of WBV are not completely understood and numerous contraindications, that can be identified while obtaining the patient's clinical history, must be taken into consideration. Nephrolithiasis, which often remains asymptomatic for an indefinite time, is not reported in the medical literature as a contraindication to WBV. This paper reports a case of significant morbidity following one session of WBV training in a patient with asymptomatic nephroli-thiasis.

[Exposure to ammonium persulphate by inhalation: effect on the NANC inhibitory neurotransmitters in the guinea pig trachea]

To evaluate the effect of ammonium persulphate (AP) inhalation on NANC inhibitory (i-NANC) neurotransmitters of guinea pig airways, we exposed eight guinea pigs to AP (1 mg/m3), by aerosol inhalation for 30 minutes daily for three weeks. Control animals inhaled saline aerosol. After the last exposure, the isolated trachea was mounted in an organ bath and electrically stimulated in the presence of hyoscine, piperoxane and propranolol. The i-NANC responses were evaluated as decreases in intraluminal pressure and expressed as area under the curve (AUC, Pa x seconds). The isolated tracheae were treated with a-chymotrypsin, L-NAME, zinc protoporphyrin IX and ODQ, that inhibit the production or action of the single neurotransmitters, like peptides, NO and CO. In the exposed individuals, the NANC relaxations were below 50%, as compared to controls (P < 0.01). NO and CO were the neurotransmitters responsible for all the i-NANC responses, in similar proportions either in exposed individuals or in controls. In conclusion, ammonium persulphate exposure impairs the i-NANC control of airway tone without specifically affecting any neurotransmitter.

Is rasburicase an effective alternative to allopurinol for management of hyperuricemia in renal failure patients? A double blind-randomized study

Recent epidemiological studies provide a clear evidence that hyperuricemia is associated with hypertension, coronary heart disease, left ventricular hypertrophy and progression of renal disease. Aim of our study was to assess the effect of low dosage of recombinant urate oxidase on hyperuricemia in renal failure patients that already receiving allopurinol. Our study group consisted of 43 renal failure patients, 23 women and 20 men. The mean age was 74 years (range 36-90 years). The following variables were studied on admission: serum creatinine, blood urea nitrogen and serum uric acid. Intravenous rasburicase was administered at a dose of 0.02 mg/kg/day on 3 consecutive days in patients with serum uric acid between 8-10 mg/dl, on 5 consecutive days in patients with serum uric acid between 10-15 mg/dl and on 7 consecutive days in patients with serum uric acid > 15 mg/dl. Uric acid levels were assayed after 48 hours and 7 days after rasburicase treatment. Mean values of uric acid levels after 48 hours were 2.47 mg/dl (+/- 1.58) in men and 2.77 mg/dl (+/- 2.24) in woman, where'as mean values of uric acid levels after 7 days were 4.45 mg/dl (+/- 2.0) in men and 5.75 mg/dl (+/- 1.9) in woman. No significant relationship were found between uric acid and creatinine as before as well after therapy. There were no side effects in all patients included in the study. After 7 days, the rasburicase therapy showed more antihyperuricemic effect in men (59%) than in women (46%).

[Hyperhomocysteinemia and alternate vitamin supplementation]

BACKGROUND

Treatment with folic acid and vitamin B 12 appears to be effective in lowering total plasma Homocysteine (tHcy) concentration, but whether vitamin B 12 alone decreases tHcy in patients with normal vitamin B 12 status is still unknown. The aims of the present study were to explore the effect of alternate vitamin supplementation with folic acid or vitamin B 12 on tHcy concentrations in haemodialysis (HD) patients, and to compare changes in tHcy concentrations with MTHFR genotype.

METHODS

74 patients, 44 men and 30 women, were recruited and randomized blindly into two groups of 37 subjects each. The first group was initially treated with vitamin B 12 for two months, and with folic acid for the following two months; the second group was supplemented in the reverse order. In both groups the treatment was followed by a 2-month washout period. tHcy levels were measured at the beginning of treatment (T0), after two months (T1), four months (T2), and at the end of the washout period (T3). Vitamin B 12 and folate were taken at T0 and T3.

RESULTS

The genotype frequency was: C/C 37%, C/T 34%, T/T 29%. tHcy decreased in both groups following the alternate vitamins therapy. This decrease was greater for the T/T genotype (p<0.05) and was more significant when the treatment start-ed with folic acid (p<0.01). Moreover, after the washout period, tHcy increased remarkably without significant differences between diffusive and convective techniques. Folate levels at the end of study appeared to be reduced in haemodialysis patients. Vitamin B 12 concentration significantly increased in patients on diffusive haemodialysis, confirming the fundamental role of membrane performance.

CONCLUSION

The alternate vitamin treatment demonstrated the importance of folate therapy and the secondary contribution of vitamin B 12 in lowering tHcy in HD patients.

Determination of endocrine disrupting chemicals in environmental solid matrices by extraction with a non-ionic surfactant (Tween 80)

A readily applicable method based on extraction by aqueous non-ionic surfactant solutions (Tween 80) and RP-HPLC coupled to fluorescence detection, has been developed for the simultaneous determination of the phenolic endocrine disrupting chemicals (EDCs) nonylphenol (NP), nonylphenol monoethoxylate (NP1EO) and nonylphenol diethoxylate (NP2EO) and bisphenol A (BPA) in environmental solid matrices. Clean up of sample extracts was performed on Si-C18 solid phase extraction (SPE) cartridges. The overall Tween 80 extraction-SPE-RP-HPLC procedure was validated for accuracy and precision by analyzing sediment samples spiked with known amounts of EDCs. Recoveries for NP, NP1EO, NP2EO and BPA and limits of detection are in agreement with conventional extraction methods. The developed methodology was successfully applied to the analysis of target compounds in Italian river sediments, river suspended matter and benthonic macroinvertebrate organisms (oligochaetes Lumbriculus variegatus). Results confirmed that this relatively simple procedure performed satisfactorily in the determination of phenolic EDCs in environmental solid matrices of different complexity and that it can be a suitable alternative method to conventional systems even for routine analyses.

Postpartum thyroiditis is associated with fluctuations in transforming growth factor-beta1 serum levels

Postpartum thyroiditis (PPT) is characterized by a rapid evolution and recovery of euthyroidism. Therefore, it can represent a good model to study early cytokine fluctuations in autoimmune thyroid diseases. TGFbeta1 is an immunosuppressive cytokine, as it inhibits T and B cell proliferation, natural killer cell cytotoxic activity, and the generation of T cell cytotoxicity. The aim of this study was to assess serum concentrations of TGFbeta1 during pregnancy and to study possible serum fluctuations of this cytokine during the different phases of PPT. Thyroid biochemical pattern, antithyroid autoantibodies (ATA), and total and active TGFbeta1 (aTGFbeta1) serum concentrations were evaluated in 63 pregnant women. Thirty-four of them were ATA(+), and 29 were ATA(-). Twenty of the 34 ATA(+) women were followed in the postpartum year. Nine of these 20 women developed PPT; 11 remained euthyroid. All of the PPT women became euthyroid during the follow-up. Our results showed 1) detectable serum levels of aTGFbeta1 in 50% of ATA(+) pregnant women, suggesting that the presence of autoantibodies may characterize a favorable condition for TGFbeta1 activation; and 2) decreased total TGFbeta1 and increased aTGFbeta1 serum levels during the active phase of PPT in ATA(+) women. This seems to suggest that inflammation may be responsible for TGFbeta1 activation and autoantibody increase because of antigen release. Although further studies of women with persistent hypothyroidism after the postpartum year are needed, the possibility that the enhanced activation of TGFbeta1 may contribute to resolution of thyroid inflammation postpartum cannot be excluded.

A population-based study on the frequency of additional congenital malformations in infants with congenital hypothyroidism: data from the Italian Registry for Congenital Hypothyroidism (1991-1998)

In the last decade a high frequency of other congenital anomalies has been reported in infants with congenital hypothyroidism (CH) detected by neonatal screening. In the present study the occurrence of additional congenital malformations (CM) in the population of CH infants detected in Italy between 1991 and 1998 (n = 1420) was investigated. In Italy all of the centers in charge of screening, treatment, and follow-up of CH adhere to the Italian National Registry of infants with CH. In this study a high prevalence of additional CM (8.4%), more than 4-fold higher than that reported in the Italian population (1-2%), was found in the population of CH infants. Cardiac anomalies represented the most frequent malformations associated with CH, with a prevalence of 5.5%. However, a significant association between CH and anomalies of nervous system, eyes, and multiple CM was also observed. In conclusion, the significantly higher frequency of extrathyroidal congenital malformations reported in the CH infants than in the general population represents a further argument supporting the role of a genetic component in the etiology of CH. Investigations of the molecular mechanisms underlying developmental events of formation of thyroid and other organs represent critical steps in the knowledge of CH etiology.

Molecular characterization of a rare hemoglobin variant: Hb-Hinsdale: beta139(H17)ASN-->Lys

The authors describe the characteristics of a rare hemoglobin mutant found in a young female. She carries the aminoacid replacement of Hb-Hinsdale:beta139(H17)ASN-->Lys, which was identified at molecular level. This case, clinically and hematologically symptomless, is identical, but genetically independent, to the cases first described in an American family.

[Congenital forms of hypothyroidism: study of risk factors and preventive interventions]

Maternal and child health represents one of the most relevant fields of interest in public health and particular attention is given to congenital pathologies. In Italy, the incidence of congenital hypothyroidism (CH) is 1:3200 live birth. CH is diagnosed at birth by neonatal thyroid screening. This allows a precocious onset of substitutive therapy which avoids severe psychomotor deficits in infants with CH. Moreover, the newborn screening program have permitted to identify transient disorders of thyroid function in newborns. These are essentially due to neonatal, maternal and environmental risk factors, especially iodine deficiency. The National Register (NR) of infants with CH was established in 1987. The aim of the NR is to provide disease surveillance and to monitor efficiency and effectiveness of neonatal screening. Furthermore, the NR represents an useful tool for developing epidemiological studies to identify possible environmental and/or familial risk factors of CH.

[Transient congenital hypothyroidism in iodine deficiency areas. Gruppo di Studio per il Registro Nazionale degli Ipotiroidei Congeniti]

On the basis of data collected in the National Register of infants with congenital hypothyroidism (CH), a mean incidence of 1 case of CH to 3200 live births has been estimated in Italy. Nevertheless a higher incidence (> 1:2000) than national mean value has been observed in several districts of our country. The aim of this study was to verify a possible occurrence of transient hypothyroidism (TH) in these areas. Results of our study showed that the proportion of infants with thyroid in situ was significantly higher in the areas with very high CH incidence than in the remaining parts of the country. Also serum TSH levels at confirmation showed a less severe hypothyroidism in infants of these areas when compared with the other CH infants. Furthermore, preliminary results of diagnosis reevaluation showed 58% of TH in the areas with CH incidence > 1:2000. Lower percentages of TH have been observed in the other areas in relation to the decreasing of CH incidence. Most of the high CH incidence areas are historically affected by iodine deficiency. This observation supports the hypothesis that iodine deficiency can contribute to the occurrence of transient disorders of thyroid function in our population and stresses the need of promoting diffusion of an adequate iodine prophylaxis.

[Effects of the combined deficiency of selenium and iodine on thyroid function]

Recent studies reported the role of several trace elements in health and disease. The role of iodine deficiency in thyroid dysfunction is well known. Also the selenium deficiency has been reported to be correlated to thyroid dysfunctions. In fact, although the major role of selenium is related to the glutathione peroxidase system, which protects cellular structures from oxidative damages, selenium plays also an important role in thyroid hormone metabolism as an essential component of the three deiodinase. These regulate inter-conversion of active and inactive forms of iodothyronines. Several studies have been carried out to establish the role of combined selenium and iodine deficiency. This review aims to provide information on the relationship between selenium and iodine intake and thyroid function. Furthermore, the state of art on the effects of the combined deficiency of selenium and iodine is also provided.

Occurrence of anti-thyroid autoantibodies in children vertically infected with HIV-1

Autoimmune phenomena, especially occurrence of non organ-specific autoantibodies, are common in congenitally acquired HIV infection, mostly in the symptomatic stages of the disease. Anti-thyroid autoantibodies detected in adult patients represent the only type of organ-specific autoantibodies reported in HIV infection. As far as we know, occurrence of these autoantibodies has not been observed in HIV infected children. In this study thyroid biochemical pattern and possible occurrence of anti-thyroid autoantibodies were investigated in 40 vertically HIV infected, 18 seroreverted and 22 healthy children. 34% of HIV infected symptomatic children showed anti-thyroglobulin antibodies. Asymptomatic patients, seroreverted and healthy controls did not show any anti-thyroid antibodies at the time of the study. High Tg levels were observed in 38% of the 40 HIV infected patients and high TSH concentrations were found in 27.5% of the HIV children. High TSH values were more frequently observed in the infected children with moderate or severe immunocompromised status. Thyroxine binding globulin levels were high in 68% of the HIV children and in 22% of the seroreverted. The finding of anti-thyroid autoantibodies in congenital HIV infected children confirms the thyroid's involvement in HIV infection and provides more information about the wide spectrum of autoimmune phenomena observed in the infection.

[Adrenal metastasis of choroidal melanoma: a case report]

We report on the case of a 32 years old man submitted to right eye enucleation twelve years before for a choroidal melanoma. We observe a metastases located in the left adrenal gland. The blood-tests, the TAC of the abdomen did not show other localizations, while during laparotomy were discovered metastases in the pancreas and in the omentum. In this case, the age of tumor's development, the age of clinical manifestation, the period between the enucleation and the appearance of the metastases and their localization are exceptions to the normal biological behaviour of the choroidal melanoma.

[Anesthesia of the brain stem after a retrobulbar block. Description of 2 cases]

The Authors report two cases of central nervous system complications after retrobulbar block. These complications have a 0.044% incidence in 4500 subsequent cases of retrobulbar blockade studied from 1981 to 1990. The Authors attribute the respiratory arrest and coma to direct access of the anesthetic to the central nervous system along the subdural space in the optic nerve sheath.

Impaired recovery of brain muscarinic receptor sites following an adaptive down-regulation induced by repeated administration of diisopropyl fluorophosphate in aged rats

Potential age-related differences in the recovery rate of brain cholinesterase activity (ChE) and muscarinic acetylcholine receptor binding sites (mAChRs) following reduction induced by repeated treatment with diisopropyl fluorophosphate (DFP) were evaluated in Sprague-Dawley rats. Male 3- and 24-month old rats were s.c. injected with DFP (doses in mg/kg: first 1.1, two of 0.7 and four of 0.35) on alternate days for 2 weeks and killed 48 hr and 7, 14, 21, 28 and 35 days after the last treatment. In the hippocampus and striatum, but not in the cerebral cortex, of control rats there was a significant age-related decline of ChE activity and maximal density of 3H-QNB binding sites (Bmax). The repeated administration of DFP during the first week caused a syndrome of cholinergic stimulation both in aged and young rats. The syndrome was more pronounced, in terms of intensity and duration (for many hours after each injection), in aged than in young animals resulting in 40 and 12% mortality, respectively; during the second week the syndrome attenuated in the two age-groups. The percentage inhibition of brain ChE at the end of DFP treatment (about 70%) did not differ between young and surviving aged rats. The down-regulation of mAChRs (without changes in affinity) was present in the three brain regions of both young and aged rats (from 20 to 40%). Factorial analysis of variance (2 ages x 2 recoveries ANOVA) showed significant differences for age, recovery rate, and significant interaction between age and recovery rate, both for ChE and mAChRs in the three brain areas. For example, cortical ChE in young rats reached pretreatment levels within 3 weeks, while hippocampal and striatal ChE activity recovered within 4 weeks; at these intervals ChE activity in aged rats was still considerably reduced (except in the striatum). Cortical and striatal mAChRs in young rats almost normalized within 1 week and hippocampal mAChR binding sites normalized within 2 weeks; at these intervals Bmax in aged rats were markedly below control levels. The overall data indicate that the recovery rate to normal baseline levels of ChE activity and mAChRs, following the termination of repeated treatment with the antiChE agent, is impaired in brain of aged rats. The delay in recovery rate is particularly evident in the cerebral cortex.

Neuropathy secondary to vitamin E deficiency in acquired intestinal malabsorption

A patient with acquired intestinal malabsorption developed a motor-sensory polyneuropathy with a recurrent remittent course, normal CSF and reduced motor and sensory conduction velocities. Nerve biopsy showed axonal changes. Serum DL-alpha-tocopherol was abnormally low. Six months supplementation with vitamin E was followed by normalization of DL-alpha-tocopherol serum levels and clinical and electrophysiological improvement.

[Comparison of different methods for the identification of groups of streptococci]

The Streptococci, isolated from 500 mucus-pharyngeal tampons, have been tested, for a group identification, by means of four different techniques in order to value the specificity and reliability in comparison with more traditional and, sometimes, more complex tests; such as Maxted and Lancefield. The most suitable method for routine researchers of microbiology laboratories is the one based on the extraction, by means of enzyme obtained from Streptomyces Griseus, of streptococci antigens before starting their serum identification, possible for A-B-C-D-F-G groups (Streptex). On the contrary, the method based on the links of group-specific antibodies with the A protein of the surface of Staphylococci Cowan I, has resulted more defective because Streptococci D and F cannot be grouped, and less specific because of frequent co-agglutinations.