Microbiome mapping in beef processing reveals safety-relevant variations in microbial diversity and genomic features

The microbiome of surfaces along the beef processing chain represents a critical nexus where microbial ecosystems play a pivotal role in meat quality and safety of end products. This study offers a comprehensive analysis of the microbiome along beef processing using whole metagenomics with a particular focus on antimicrobial resistance and virulence-associated genes distribution. Our findings highlighted that microbial communities change dynamically in the different steps along beef processing chain, influenced by the specific conditions of each micro-environment. Brochothrix thermosphacta, Carnobacterium maltaromaticum, Pseudomonas fragi, Psychrobacter cryohalolentis and Psychrobacter immobilis were identified as the key species that characterize beef processing environments. Carcass samples and slaughterhouse surfaces exhibited a high abundance of antibiotic resistance genes (ARGs), mainly belonging to aminoglycosides, β-lactams, amphenicols, sulfonamides and tetracyclines antibiotic classes, also localized on mobile elements, suggesting the possibility to be transmitted to human pathogens. We also evaluated how the initial microbial contamination of raw beef changes in response to storage conditions, showing different species prevailing according to the type of packaging employed. We identified several genes leading to the production of spoilage-associated compounds, and highlighted the different genomic potential selected by the storage conditions. Our results suggested that surfaces in beef processing environments represent a hotspot for beef contamination and evidenced that mapping the resident microbiome in these environments may help in reducing meat microbial contamination, increasing shelf-life, and finally contributing to food waste restraint.

Improved sampling and DNA extraction procedures for microbiome analysis in food-processing environments

Deep investigation of the microbiome of food-production and food-processing environments through whole-metagenome sequencing (WMS) can provide detailed information on the taxonomic composition and functional potential of the microbial communities that inhabit them, with huge potential benefits for environmental monitoring programs. However, certain technical challenges jeopardize the application of WMS technologies with this aim, with the most relevant one being the recovery of a sufficient amount of DNA from the frequently low-biomass samples collected from the equipment, tools and surfaces of food-processing plants. Here, we present the first complete workflow, with optimized DNA-purification methodology, to obtain high-quality WMS sequencing results from samples taken from food-production and food-processing environments and reconstruct metagenome assembled genomes (MAGs). The protocol can yield DNA loads >10 ng in >98% of samples and >500 ng in 57.1% of samples and allows the collection of, on average, 12.2 MAGs per sample (with up to 62 MAGs in a single sample) in ~1 week, including both laboratory and computational work. This markedly improves on results previously obtained in studies performing WMS of processing environments and using other protocols not specifically developed to sequence these types of sample, in which <2 MAGs per sample were obtained. The full protocol has been developed and applied in the framework of the European Union project MASTER (Microbiome applications for sustainable food systems through technologies and enterprise) in 114 food-processing facilities from different production sectors.

Fermented foods, their microbiome and its potential in boosting human health

Fermented foods (FFs) are part of the cultural heritage of several populations, and their production dates back 8000 years. Over the last ~150 years, the microbial consortia of many of the most widespread FFs have been characterised, leading in some instances to the standardisation of their production. Nevertheless, limited knowledge exists about the microbial communities of local and traditional FFs and their possible effects on human health. Recent findings suggest they might be a valuable source of novel probiotic strains, enriched in nutrients and highly sustainable for the environment. Despite the increasing number of observational studies and randomised controlled trials, it still remains unclear whether and how regular FF consumption is linked with health outcomes and enrichment of the gut microbiome in health-associated species. This review aims to sum up the knowledge about traditional FFs and their associated microbiomes, outlining the role of fermentation with respect to boosting nutritional profiles and attempting to establish a link between FF consumption and health-beneficial outcomes.

Gut production of GABA by a probiotic formula: an in vitro study

The objective of this study was to evaluate the influence of a probiotic formula on the production of neuroactive compounds in different parts of the colon in batch culture and in vitro gut simulator experiments. Thirteen lactic acid bacterial strains, belonging to the species Levilactobacillus brevis, Lactiplantibacillus plantarum, Lacticaseibacillus paracasei, Ligilactobacillus salivarius, Streptococcus thermophilus, were characterised for their in vitro ability to produce neurotransmitters. L. brevis P30021 and L. plantarum P30025 were selected based on their capability to produce γ-aminobutyric acid (GABA) and acetylcholine in vitro. A probiotic formulation with potential psychobiotic activity was prepared and tested in a batch culture of human microbiota monitoring the formation of GABA and acetylcholine. Samples of the three colonic tracts were taken from the Simulator of the Human Intestinal Microbiota (SHIME®) evaluating the production of GABA and other neurotransmitters by LC-MS. Short chain fatty acids (SCFA) by GC and microbiota composition by 16S rRNA gene sequencing were also determined. Probiotic supplementation led to the formation of GABA and acetylcholine with a decrease in glutamate concentrations in the in vitro batch fermentation. Production of GABA after the treatment with probiotics was confirmed in the SHIME® short-term experiment. No differences in short-chain fatty acids were observed up to 72 h of fermentation. Different microbiota composition was found in the three different parts of the colon, with a higher abundance of Veillonellaceae in the ascending colon vessels. The probiotic-exposed microbiota showed higher levels of Bacteroides, a gut microbe associated with anti-inflammatory activities and a potential GABA producer. Results demonstrate the impact of the tested probiotic formula on gut microbiota structure and GABA production. In conclusion, the probiotic treatment changed the microbiota composition and increased neuroactive metabolites production, indicating promising potential as psychobiotics, even if further clinical evidence is needed to confirm the effectiveness of these probiotics in improving mental health.

Microbiome dynamics, antibiotic resistance gene patterns and spoilage-associated genomic potential in fresh anchovies stored in different conditions

Fresh fish is a highly perishable product and is easily spoiled by microbiological activity and chemical oxidation of lipids. However, microbial spoilage is the main factor linked with the rapid fish sensorial degradation due to the action of specific spoilage organisms (SSOs) that have the ability to dominate over other microorganisms and produce metabolites responsible for off-flavours. We explored the microbial dynamics in fresh anchovies stored in different packaging (air, modified atmosphere, under vacuum) and temperatures (0, 4 and 10 °C) using shotgun metagenomics, highlighting the selection of different microbial species according to the packaging type. Indeed, Pseudoalteromonas nigrifaciens, Psychrobacter cryohalolentis and Ps. immobilis, Pseudomonas deceptionensis and Vibrio splendidus have been identified as the main SSOs in aerobically stored anchovies, while Shewanella baltica, Photobacterium iliopiscarium, Ps. cryohalolentis and Ps. immobilis prevailed in VP and MAP. In addition, we identified the presence of spoilage-associated genes, leading to the potential production of biogenic amines and different off-flavors (H2S, TMA). In particular, the abundance of microbial genes leading to BA biosynthesis increased at higher storage temperature, while those related to H2S and TMA production were enriched in aerobically and VP packed anchovies, suggesting that MAP could be an effective strategy in delaying the production of these compounds. Finally, we provided evidence of the presence of a wide range of antibiotic resistance genes conferring resistance to different classes of antibiotic (β-lactams, tetracyclines, polymyxins, trimethoprims and phenicols) and highlighted that storage at higher temperature (4 and 10 °C) boosted the abundance of ARG-carrying taxa, especially in aerobically and MAP packed fish.

Psychrotrophic Bacteria Equipped with Virulence and Colonization Traits Populate the Ice Cream Manufacturing Environment

Several microbial taxa have been associated with food processing facilities, and they might resist by attaching on tools and equipment even after sanitation procedures, producing biofilms that adhere to the surfaces and might embed other microorganisms, including spoilers and pathogens. There is increasing evidence that these communities can be transferred to the final product. To explore the microbial contamination routes in a facility producing ice creams, we collected foods and environmental swabs from industrial surfaces of equipment and tools and performed taxonomic and functional analyses of the microbial DNA extracted from the environmental samples. Our results suggest that complex communities dominated by psychrotrophic bacteria (e.g., Pseudomonas and Acinetobacter spp.) inhabit the food processing environment, and we demonstrate that these communities might be transferred from the surfaces to the products. Functional analysis performed on environmental samples highlighted the presence of several genes linked to antimicrobial resistance and adherence on abiotic surfaces; such genes were more abundant on food contact (FC) than on other surfaces. Metagenome-assembled genomes (MAGs) of Pseudomonas stutzeri showed genes linked with biofilm formation and motility, which are surely linked to colonizing capabilities in the processing lines. The study highlights clear potential advantages of applying microbiome mapping in the food industry for source tracking of microbial contamination and for planning appropriate ad hoc sanitization strategies. IMPORTANCE Several microbial species might permanently establish in food processing facilities, thus contributing to food loss. In fact, food contact surfaces might transfer microorganisms to intermediates and products, potentially representing a hazard to human health. In this work, we provide evidence of the existence of complex microbial communities overcoming sanitation in an ice cream-producing facility. These communities harbored several genes that could potentially lead to attachment to surfaces and antimicrobial resistance. Also, prediction of routes of contamination showed that several potential spoilage taxa might end up in the final product. Importantly, in this work, we show that mapping the environmental microbiome is a high-resolution technique that might help food business operators ensure food quality and safety through detection of potentially hazardous microorganisms.

Milk protein digestion and the gut microbiome influence gastrointestinal discomfort after cow milk consumption in healthy subjects

Many healthy people suffer from milk-related gastrointestinal discomfort (GID) despite not being lactose intolerant; the mechanisms underpinning such condition are unknown. This study aimed to explore milk protein digestion and related physiological responses (primary outcome), gut microbiome and gut permeability in 19 lactose-tolerant healthy nonhabitual milk consumers [NHMCs] reporting GID after consuming cow milk compared to 20 habitual milk consumers [HMCs] without GID. NHMCs and HMCs participated in a milk-load (250 mL) test, underwent blood sample collection at 6 time points over 6 h after milk consumption and collected urine samples and GID self-reports over 24 h. We measured the concentrations of 31 milk-derived bioactive peptides (BAPs), 20 amino acids, 4 hormones, 5 endocannabinoid system mediators, glucose and the dipeptidyl peptidase-IV (DPPIV) activity in blood and indoxyl sulfate in urine samples. Subjects also participated in a gut permeability test and delivered feces sample for gut microbiome analysis. Results showed that, compared to HMCs, milk consumption in NHMCs, along with GID, elicited a slower and lower increase in circulating BAPs, lower responses of ghrelin, insulin, and anandamide, a higher glucose response and serum DPPIV activity. The gut permeability of the two groups was similar, while the habitual diet, which was lower in dairy products and higher in the dietary-fibre-to-protein ratio in NHMCs, possibly shaped the gut microbiome; NHMCs exhibited lower abundance of Bifidobacteria, higher abundance of Prevotella and lower abundance of protease-coding genes, which may have reduced protein digestion, as evidenced by lower urinary excretion of indoxyl sulfate. In conclusion, the findings showed that a less efficient digestion of milk proteins, supported by a lower proteolytic capability of the gut microbiome, may explain GID in healthy people after milk consumption.

Therapeutic effects elicited by the probiotic Lacticaseibacillus rhamnosus GG in children with atopic dermatitis. The results of the ProPAD trial

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% of the pediatric population associated with alteration of skin and gut microbiome. Probiotics have been proposed for AD treatment. The ProPAD study aimed to investigate the therapeutic effects of the probiotic Lacticaseibacillus rhamnosus GG (LGG) in children with AD.

METHODS

In total, 100 AD patients aged 6-36 months were enrolled in a randomized, double-blind, controlled trial to receive placebo (Group A) or LGG (1 x 10¹⁰ CFU/daily) (Group B) for 12 weeks. The primary outcome was the evaluation of the efficacy of LGG supplementation on AD severity comparing the Scoring Atopic Dermatitis (SCORAD) index at baseline (T0) and at 12-week (T12). A reduction of ≥8.7 points on the SCORAD index was considered as minimum clinically important difference (MCID). The secondary outcomes were the SCORAD index evaluation at 4-week (T16) after the end of LGG treatment, number of days without rescue medications, changes in Infant Dermatitis Quality Of Life questionnaire (IDQOL), gut microbiome structure and function, and skin microbiome structure.

RESULTS

The rate of subjects achieving MCID at T12 and at T16 was higher in Group B (p < .05), and remained higher at T16 (p < .05)The number of days without rescue medications was higher in Group B. IDQOL improved at T12 in the Group B (p < .05). A beneficial modulation of gut and skin microbiome was observed only in Group B patients.

CONCLUSIONS

The probiotic LGG could be useful as adjunctive therapy in pediatric AD. The beneficial effects on disease severity and quality of life paralleled with a beneficial modulation of gut and skin microbiome.

Specific Microbial Communities Are Selected in Minimally-Processed Fruit and Vegetables according to the Type of Product

Fruits and vegetables (F&V) products are recommended for the daily diet due to their low caloric content, high amount of vitamins, minerals and fiber. Furthermore, these foods are a source of various phytochemical compounds, such as polyphenols, flavonoids and sterols, exerting antioxidant activity. Despite the benefits derived from eating raw F&V, the quality and safety of these products may represent a source of concern, since they can be quickly spoiled and have a very short shelf-life. Moreover, they may be a vehicle of pathogenic microorganisms. This study aims to evaluate the bacterial and fungal populations in F&V products (i.e., iceberg lettuces, arugula, spinaches, fennels, tomatoes and pears) by using culture-dependent microbiological analysis and high-throughput sequencing (HTS), in order to decipher the microbial populations that characterize minimally-processed F&V. Our results show that F&V harbor diverse and product-specific bacterial and fungal communities, with vegetables leaf morphology and type of edible fraction of fruits exerting the highest influence. In addition, we observed that several alterative (e.g., Pseudomonas and Aspergillus) and potentially pathogenic taxa (such as Staphylococcus and Cladosporium) are present, thus emphasizing the need for novel product-specific strategies to control the microbial composition of F&V and extend their shelf-life.

The Effect of Weaning with Adult Food Typical of the Mediterranean Diet on Taste Development and Eating Habits of Children: A Randomized Trial

Mediterranean Diet (Med Diet) is one of the healthiest dietary patterns. We aimed to verify the effects of weaning (i.e., the introduction of solid foods in infants previously fed only with milk) using adult foods typical of Med Diet on children eating habits, and on the microbiota composition. A randomized controlled clinical trial on 394 healthy infants randomized in a 1:1 ratio in a Med Diet group weaned with fresh; seasonal and tasty foods of Med Diet and control group predominantly weaned with industrial baby foods. The primary end point was the percentage of children showing a good adherence to Med Diet at 36 months. Secondary end points were mother’s changes in adherence to Med Diet and differences in children gut microbiota. At 36 months, children showing a good adherence to Med Diet were 59.3% in the Med Diet group and 34.3% in the control group (p < 0.001). An increase in adherence to the Med Diet was observed in the mothers of the Med Diet group children (p < 0.001). At 4 years of age children in the Med Diet group had a higher gut microbial diversity and a higher abundance of beneficial taxa. A Mediterranean weaning with adult food may become a strategy for early nutritional education, to develop a healthy microbiota, to prevent inflammatory chronic diseases and to ameliorate eating habits in children and their families.

Beam energy recovery for fusion and collector design for tests on compact sources

The next fusion project DEMO, which will be the evolution of the experimental fusion reactor [International Tokamak Experimental Reactor (ITER)], would require a high efficient energy production. As in ITER, DEMO will use fast Neutral Beam (NB) injectors to increase the plasma temperature needed for the fusion reaction. A way to recover the electric energy production efficiency in DEMO could be the beam energy recovery in the NB production, which is produced by a D^- beam, neutralized by a gas cell with 60% efficiency. A compact energy recovery device with an axisymmetric cylindrical ion collector that uses only decelerating electric fields combined with the beam space charge effect has been recently proposed. It can be used for a test on the beam of the NIO1 (Negative Ion Optimization 1) source, a compact ion source (scaled down from ITER size sources) that has been developed at INFN-LNL and Consorzio RFX (Padua). The detailed collector design to be used on one of the beamlets of the NIO1 source within typical space limitation is presented and discussed here. Furthermore, a preliminary trajectory simulation for a beam with a rectangular geometry similar to the beam used in ITER to verify the beam recovery for a nonaxial symmetric geometry is also shown.

Beam and installation improvements of the NIO1 ion source

The NIO1 (Negative Ion Optimization phase 1) source can provide continuous beam operation, which is convenient for systematic parameter and equipment studies. Even in the pure volume production regime, the source yield was found to depend on conditioning procedures. Magnetic configuration tests continued adding magnets to the existing setup; the filter field component B_x has been progressively extended to span the -12 to 5 mT range, and as a trend, source performances improved with |B_x|. The progress of camera beam diagnostics and of the quality of the volume-produced H^- beam is also shown. The status, off-line results, and reliability of a first NIO1 cesium oven are discussed; other upgrades in preparation (cavity ring down spectrometer, the end calorimeter, and conceptual tests of the energy recovery system) are also listed.

Apathy in Parkinson's disease: differences between caregiver's report and self-evaluation

Apathy is a state of diminished goal-directed speech, motor activity and emotions. The prevalence of apathy in Parkinson's disease (PD) ranges from 16 to 62%. Several studies have investigated the relationships between apathy and other dimensions of PD, but little is known about possible discrepancies between self-evaluation (SE) and caregiver reporting (CR) of this symptom. The aim of this study is twofold: 1) to investigate the differences in apathy evaluations according to the point of view from which apathy is reported (SE vs CR); 2) to identify the possible relationships between each of the two evaluations (SE and CR) and cognitive and affective dimensions of PD. Forty-eight patients with PD were assessed using the Apathy Evaluation Scale (AES) in its SE and CR versions (AES-SE and AES-CR); cognitive, affective and behavioral symptoms were also assessed. AES-SE scores were significantly higher than AESCR ones. Neither AES version correlated with depression, whereas both correlated with motor impairment, disease stage and behavioral symptoms. Mini-Mental State Examination and Frontal Assessment Battery scores showed significant negative correlations only with AES-SE scores. Our findings suggest that the point of view from which apathy is seen can lead to significant discrepancies, even when using the same tool. This should be taken into account in order to obtain correct assessment of this disabling and distressing symptom.

Brainstem Astrocytomas: The Radiosurgical Approach

Between 1987 and 1998, radiosurgery was performed on 20 cases of brainstem gliomas in patients of ages varying from eight months to 56 years, 11 of whom had low grade tumours and nine malignant growths. Six of the cases were children (ranging from eight months to 16 years). Six of the patients had undergone histological examinations. In fourteen cases, diagnosis of infiltrating brainstem tumour, and the distinction between high and low grade gliomas, was determined clinically and in particular through neuroradiology. In the histologically determined cases there was a pylocytic astrocytoma, a fibrillary astrocytoma, an astrocytoma II, two anaplastic astrocytomas and an angioglioma. The mean 25 mm target dose was 15 Gy in low grade tumours and 36 Gy in malignant gliomas. Of the 11 low grade tumour cases, nine patients are in an excellent state of health after follow-ups of between eight and 17 years. The average survival rate for high grade tumour cases was slightly more than 12 months (with a range of four to 25 months). In two cases of low grade glial tumour, the patients had previously undergone unsuccessful fractionated irradiation. The results presented lead to the conclusion that: 1) in cases of diffuse glioma, radiosurgery vs neurosurgery or even fractionated irradiation does not even appear to be an option, but merely a simple decision to use a new form of treatment; 2) neurosurgery may perhaps be an alternative in selected focal or exophytic tumours; 3) neuroradiology techniques, which are also classic methods for distinguishing the specific nature of glial tumours, ‘naturally’ relegate routine brainstem tumour biopsy to the pages of neurosurgical history.

[Aging and sexuality in women]

A large number of biological, psycho-relational and socio-cultural factors are related to women's sexual health and they may negatively affect the entire sexual response cycle inducing significant changes in sexual desire, arousal, orgasm and satisfaction during the entire reproductive life span. In spite of the high prevalence of sexual problems with increasing age, sexual retirement is not an inevitable consequence of the passage of time and a high proportion of men and women remains sexually active well into later life, a result of changing attitudes toward sexuality and the availability of effective treatments for sexual dysfunction. Population-based studies reported an age-related decline of sexual functioning and an additional adverse effect of menopausal status. Ageing per se interferes with the level of sexual performance, but sexual behaviour of midlife and older women is highly dependent on several factors such as general physical and mental well-being, quality of relationship and life situation. Sex hormones, mainly low levels of estradiol, are relevant for the lack of sexual awareness and vaginal receptivity in naturally menopausal women. Even diminished levels of androgens, as it more frequently occurs in surgically menopausal women, has a negative impact on desire and sexual responsiveness. Several hormonal treatments have been used locally or systemically to alleviate sexual symptoms, especially by using estrogen plus androgen preparations and tibolone, with noticeable results on drive, enjoyment, lubrication, ability to reach orgasm and initiation of sex. However, sexual counseling and individualized management is mandatory to obtain meaningful and long-lasting results in clinical practice.

Historia magistra vitae (Cic. De or. 2.36). The Prime Objective of Radiosurgery in Acoustic Neurinomas

The central question of stereotaxic radiosurgery in acoustic neurinomas is how to pinpoint its main objective: is it a better alternative to neurosurgery or an option when surgery is unfeasible? This study is a continuation of the article published in 1995 in Acta Neurochirurgica, but benefits from greater experience, more complete analysis and longer supervision of results. The conclusions that can be drawn to date from our own findings and from others in the literature are the following: radiosurgery can be used not only to prevent neurinoma growth and at the same time to preserve the patient's neurological conditions without the risk of complications, but it can also be counted on to provide a cure. However, radiosurgery as an excising device is more insidious than the microsurgical scalpel, since the narrow beam of radiation, directed to a limited target without opening the skull, is invisible. The expression coined by Lars Leksell regarded precisely the innovation he himself conceived in the 'closed skull operation', with reference to its use in cases of acoustic neurinoma as an alternative to traditional surgery. Hence, whatever technique or instruments are involved, it is always a question of interventional neuroradiology or minimally invasive neurosurgery.

Placental barrier breakage in preeclampsia: ultrastructural evidence

OBJECTIVE

It is known that the placenta acts as an immunological barrier between the mother and fetal "graft" allowing two antigenically different organisms to tolerate one another. Preeclampsia may be considered as a fetal rejection consequent to severe damage at placental endothelial and syncytiotrophoblast level. In order to verify this placental barrier damage we undertook the present study by electron microscopy.

STUDY DESIGN

14 placentae from preeclaptic women, and the same number of placentae from healthy controls were examined.

RESULTS

The results showed that endothelial cells from preeclamptic placentae express various and severe alterations, consisting of swollen and bulbous cytoplasm, degenerated inter-endothelial junctions with consequent crossing of fetal blood cells outside the vessels.

CONCLUSIONS

These lesions could be the ultrastructural evidence of the placental barrier breakage leading to rejective reaction we presumed to be basis of preeclampsia.

HLA-DR in couples associated with preeclampsia: background and updating by DNA sequencing

The placenta acts as an immunological barrier between the mother and the fetal "graft", allowing two antigenically different organisms to tolerate one another. In placentae from preeclamptic women, we have demonstrated, by an ultrastructural assessment and an immunohistochemical study, a placental barrier breakage leading to the mixing of maternal and fetal antigenically different blood. This condition could be responsible for the triggering of a maternal rejection reaction that we presume to be at the basis of the preeclamptic syndrome. Thus, we have investigated the Human Leukocyte class II DR antigens (HLA-DR), whose role in self and non-self recognition is well known, in women with preeclampsia, their partners and in control couples using the serological Terasaki tecnique. The results showed a statistically significant increase of HLA-DR homozygosity and a reduced antigenic variety in the preeclamptic women and their partners with respect to controls. In this update, we have examined the 2nd exon of the human gene, HLA-DRB1, on the short arm of the chromosome 6 using DNA sequence-based typing (S-BT) PCR in 56 preeclamptic couples and 64 control couples. The results have confirmed the significant excess of HLA-DR homozygosity in couples associated with preeclampsia versus controls. From our results, it emerges that HLA-DR homozygosity and the reduced antigenic variety seem to be associated to a major risk for preeclampsia, which further appears to be a "couple's disease".

Radiosurgery in the management of pediatric brain tumors

A total of 114 patients with benign and malignant intracranial tumors were treated by Valentino at the Flaminia Radiosurgical Center using a Philips 6-MeV linear accelerator between 1987 and 1995. The tumor locations break down as follows: 36 in the cerebral hemispheres, 14 in the region of the hypothalamus/optic chiasm, 21 in the III ventricle/pineal region, 3 in the basal ganglia, 27 in the posterior fossa, 13 in the brain stem. Seventy-nine patients had multivariate/combined treatment consisting of surgery or biopsy followed by chemotherapy, radiotherapy and/or radiosurgery. Thirty-five were not operated on or biopsied but were treated primarily by radiosurgery, which was associated with chemotherapy and conventional radiotherapy. The short- and long-term results were evaluated separately for each pathology in an attempt to derive guidelines for future treatment. For tumors of the pineal region, we are of the opinion that radiosurgery is the treatment of choice in children and that more than one-third of patients can be cured by this means. The remaining patients require surgery and/or chemotherapy in addition. For medulloblastomas radiosurgery may be useful to control local recurrence if coupled with chemotherapy. In the case of ependymomas, partly because of the extreme malignancy of the lesions in our series, radiosurgery did not succeed in controlling local recurrence. We fear that limiting treatment to radiosurgery, rather than prescribing conventional radiotherapy when indicated, could permit CNS seeding. For craniopharyngiomas radiosurgery proved useful for controlling solid remnants. In glial tumors radiosurgery helped either to "sterilize" the tumor bed after removal or to treat remnants of the lesions in critical areas; for diffuse brain stem gliomas it should be considered the treatment of choice.

Tumour response and morphological changes of acoustic neurinomas after radiosurgery

Twenty-seven of the 1560 patients treated by radiosurgery during the period 1984-1993 had acoustic neurinomas. Four cases were excluded from this study because they had a follow-up of less than 2 years. There were 24 neurinomas treated in 23 patients as one patient had a bilateral tumour. Seven patients underwent radiosurgery for a recurrent tumour (already operated on once or twice), while it was the first treatment for 16 patients. The tumour volume ranged from 1.99 cm3 to 18.30 cm3, and the patient follow-up was from 2 to 8 years. To determine the target on CT/NMR for linear accelerator stereotactic irradiation, the Greitz-Bergström non-invasive head fixation device was used. It was again adopted for subsequent serial imaging, and for repeat radiosurgery when necessary. The total peripheral tumour dose ranged from 12 to 45 Gy. In 9 patients there was a reduction in tumour volume varying from 39 to 100%, while 14 of the neurinomas appeared stable after an average follow-up of 3 years. In one patient there was an increase in size of the tumour. Variable morphological changes were present in 66% of the neurinomas treated. Radiosurgery is indicated as an alternative to microsurgery for inoperable patients and for those who refuse surgery, for recurrent tumours, and as a post-operative complementary treatment for partially removed tumours. A gradual approach to radiosurgery, depending on tumour response, allows a greater efficacy with minimal risk. In the present series no complications were observed. Hearing was preserved at almost the same level as that prior to radiosurgery in all patients.

The results of radiosurgical management of 139 single cerebral metastases

Between March 1984 and June 1993, linac radiosurgery was performed in 139 patients for single brain metastases, using the non-invasive (Greitz-Bergström) head fixation system. This atraumatic system was utilized for subsequent stereotactic CT/NMR staging to obtain strictly comparable neuro-imaging. Thus, tumour response was evaluated precisely and radiosurgery repeated (straight after the diagnostic sitting), as needed. No hospitalization or anaesthesia was necessary. The 25 mm target was the maximum size to avoid the risk of radiation induced reactions. In metastases exceeding this limit single doses were directed at more than one target at the same session. Focusing upon single or multiple targets was facilitated by 3-D stereotactic NMR. The results after one single sitting were compared with those obtained after staged sittings in the same patients. Radiosurgery achieved disappearance or shrinkage of the metastasis with resolution of the oedema and mid-line shift in 86% of the 139 patients treated. In 47% of them, however, the success was the result of repeat radiosurgery and staged sittings. The non-invasive procedure is the keystone to optimize the radiosurgical results.

Cardiovascular adaptation to cyclosporine-induced hypertension

Arterial hypertension is a complication of cyclosporine therapy in heart transplant recipients. We studied cardiovascular adaptation to cyclosporine-induced hypertension by determining haemodynamic and echocardiographic indexes in 25 cardiac transplant recipients matched by mean arterial pressure, age, sex, height and weight to 25 patients with established essential hypertension. Twenty-five normotensive subjects matched by age, sex and body habitus were used as controls. Systemic vascular resistance was 15% higher (P = 0.07) and cardiac and stroke volume indices were 20% and 25% lower (P < 0.01), respectively, in the hypertensive cardiac transplant recipients compared with patients with essential hypertension. Patients with essential hypertension and hypertensive cardiac transplant recipients had greater posterior wall thickness and left ventricular mass index than normotensive subjects (P < 0.01); however, hypertensive cardiac transplant recipients had a greater left ventricular mass (245 +/- 7 vs. 223 +/- 8 g, P < 0.05) than patients with markedly established essential hypertension. Left ventricular ejection fraction was significantly lower in hypertensive cardiac transplant recipients when compared with either normotensives or patients with established essential hypertension. These results indicate that established essential and cardiac transplant hypertension are associated with markedly increased systemic vascular resistance. However, after heart transplantation, hypertension is associated with higher systemic vascular resistance, lower cardiac output, stroke volume and stroke work compared with patients with established essential hypertension at the same level of mean arterial pressure. The cardiac adaptation to cyclosporine-induced hypertension has more severe concentric left ventricular hypertrophy and impaired left ventricular systolic performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetic resonance guided radiosurgery in children: tridimensional extrapolation from isodose neuroimaging superimposition

In stereotactic radiosurgery, thin external beams of ionizing radiation concentrated in a single dose onto a sharply defined target are employed to treat lesions within the brain, avoiding doses which may produce unwanted damage to the surrounding healthy tissue. The dynamic irradiation technique used with the linear accelerator employs variable arcs of irradiation rotating around the isocenter of the target. The technique of stereotactic magnetic resonance (MR) guided radiosurgery is supported by a dedicated computerized system for treatment planning simulation. The system, based on a personal computer, allows the acquisition, reconstruction, and visualization of the target volume from MR images, and permits calculation and visualization of a three-dimensional dose distribution directly superimposed upon MR images of the lesion. The desired goal of destroying neoplastic tissue without damaging cerebral parenchyma is of particular importance in children. Consequently, adapting the three-dimensional isodose profiles to the morphology of the lesion to be treated is crucial. From this, the importance of the computer simulation is evident, as it permits one to go deeply into the study of isodose distribution, changing beam collimation, and the number and amplitude of arcs of irradiation.

Linear accelerator and Greitz-Bergstrom's head fixation system in radiosurgery of single cerebral metastases. A report of 86 cases

Between 1984 and 1991 86 patients with single cerebral metastases underwent linear accelerator radiosurgery using the atraumatic and reproducible Greitz-Bergström head-fixation device. Routine one-month follow-up documented disappearance of the tumour in 16 patients, with resolution of the oedema and ventricular shift. Shrinkage of the metastasis occurred in 51 patients. In 9 patients the tumour remained stable, in 7 there was progression of tumour size. Among the patients showing shrinkage of the tumour or unchanged tumour volume, repeated radiosurgery resulted in disappearance of the metastasis in 5 and further shrinkage in 28. In 14 patients routine stereotactic CT follow-up study led to the detection of a new metastasis, again treated with excellent results. Local recurrence occurred in 2 patients and radiation necrosis in the target area in 5 patients. Radiosurgery thus proves to be an appropriate alternative to surgery. The versatility of our non-invasive and painless method permits CT staging (which we consider essential) without hospitalization of the patient.

The results of radiosurgical management of 72 middle fossa meningiomas

Of 812 patients with intracranial tumours treated by radiosurgery during the period 1984-1990, 129 had meningiomas. Of these latter, 72 had middle fossa meningiomas. Patients with meningiomas treated by us since March 1990 are not included in this report since we established the investigative principle of a minimum of 30 months follow-up. Seventeen of the 72 patients were treated after incomplete surgical resection, and 21 for tumour regrowth. In 34 patients, radiosurgery was the primary treatment. The tumour volume was calculated by the ellipsoid method. It ranged from 0.588-76.346 ml. Radiosurgery was performed using the non-invasive stereotactic fixation head device (Greitz-Bergström) adapted to the Fixster frame, and dynamic irradiation performed with the linear accelerator, using especially designed collimators. The total tumour dose for each patient ranged from 15-45 Gy. The minimum follow-up was 2 1/2 years and the maximum 8 years. In 50 patients there was tumour shrinkage ranging from 24-91% of the initial tumour volume. Shrinkage was associated with central tumour necrosis in 11 of these 50 patients. In 18 patients the tumour volume remained stable. In 2 patients there was tumour progression and in 2 there was regrowth after initial reduction of tumour volume. There were no significant treatment complications. Radiosurgery is preferable to re-operation in recurrent meningiomas and indicated after incomplete surgical removal. In high risk patients, as well as in "unresectable" meningiomas, it is an obvious alternative to microsurgery.

Nucleolar organizer regions: preliminary results of the clinical use of a new marker for prostatic carcinoma (40 cases)

It is a widely diffused opinion that moving backwards in time the moment of the diagnosis of cancer of prostate, so that the tumor is detected earlier than normal, means that the treatment would be more effective than the one adopted in the usual times of diagnosis. For this reason the earlier diagnosis of prostate cancer has become more and more a compulsory target of the modern urologist, at a time of booming of the third age, of increased lifetime expectancy, of significant elevation of prostate cancer rate and of the persistent uncertainty of the efficacy of available treatments. Theoretically the mortality rate of prostate cancer can be reduced by the prevention programs and by the improvements of treatment methods, but the 'earlier' diagnosis is certainly an easier and less expensive strategy to achieve the same objective. The authors have evaluated the argyrophilic-nucleolar organizer region (Ag-NOR) proteins on 40 cases of adenocarcinoma of prostate collected through a multicentric program in France and in Italy. The Ag-NOR have been stained with silver technique set up by Ploton and Derenzini while the quantitative index has been evaluated by a semiautomatic system partially commercially available, partially modified by the authors. The conclusions: (a) the Ag-NOR index is a simple and reproducible method; (b) the Ag-NOR staging system corresponds to Gleason's grading; (c) the Ag-NOR elevation is a reliable marker of increased cell proliferation and is detectable much earlier than the morphologic changes of Gleason's classification.

A new marker for early detection and indicator of progression of cancer of the bladder. Preliminary results with Ag-NOR index in 38 cases of superficial bladder cancer

The multiform biology of superficial bladder tumors, both morphologically and evolutively, and the lack of reliable predictors of progression have led the authors to study the Ag-NOR proteins as a new marker of these tumors. It is well known that particularly the low-grade superficial tumors frequently relapse on the same histologic and proliferative module. Their potential of progression is probably present at the time of the first manifestation of the disease or it can show itself along the relapsing evolution with classic modifications translating the cellular dedifferentiation. The NOR index, set up by the authors, has several advantages: firstly, it corresponds to a functional value of normal and neoplastic cells; secondly, it can be used also with paraffin blocks. Another advantage is the semiautomatic lecture, reproducible also in the urinary cytology, mainly of low-grade tumors, reducing the number of false-negatives. The conclusion of the study of 38 cases of superficial bladder cancer has induced the authors to believe that an increased NOR index is a reliable 'marker' of their progression. Therefore, the authors suggest the use of the NOR activity for the surveillance of the urothelial disease and for a more logical therapeutic strategy.

Postoperative radiosurgery of pituitary adenomas

From 1984-1990, 52 patients with pituitary adenomas had postoperative radiosurgery for incomplete surgical removal or regrowth of the tumor. The atraumatic Greitz-Bergström fixation head device was adopted for the stereotactic procedure and irradiation was performed with a linear accelerator. Because of the variability of the tumor response, a 10-20 Gy single dose was directed at 1-2 targets and radiosurgery repeated if the result was unsatisfactory. The median radiation dose was 30 Gy. No adverse effects occurred. Regression of pretreatment symptoms caused by tumor mass was observed in 67% of patients. GH and PRL activity decreased in 20 patients, was stable in 11 and increased in 2 prolactinomas. CT studies showed disappearance of the tumor in 4 patients and shrinkage in 36. Postoperative radiosurgery is a valuable method of treatment whenever pituitary surgery has been incomplete.

New directions in percutaneous intervention for peripheral vascular disease

Balloon angioplasty is a safe and effective alternative to surgical reconstruction or bypass in selected patients with symptomatic iliofemoral and popliteal atherosclerosis. The current literature suggests an expanding role for balloon angioplasty in patients with symptomatic tibioperoneal disease as well as upper extremity claudication and subclavian steal syndrome. Newer percutaneous devices such as atherectomy, intravascular stents, and laser angioplasty may further broaden the indications for percutaneous intervention by improving their safety and long-term benefit. The latest advances in percutaneous intervention for peripheral vascular disease are reviewed.

Radiosurgery in cerebral tumours and AVM

In collaboration with the Institute of Neurosurgery, La Sapienza Rome University, we have treated 214 patients with stereotactic irradiation. The series began in March 1984 and includes 198 cerebral tumours of different histology and 16 AVM. 73% of the patients had been operated on before irradiation. From this first experience the following considerations can be drawn: (a) radiosurgery is not an alternative to neurosurgery except for particular cases; neurosurgery is therefore essential because the smaller the target area the higher the efficiency of stereotactic irradiation; (b) compared to conventional radiotherapy, damage to the brain is minimized as shown by NMR. The follow-up time is too short to allow any definite conclusion. However, positive effects have been observed in malignant gliomas and single metastases. In craniopharyngiomas and pituitary adenomas, tumour growth was arrested or decreased with the disappearance of the tumour in 3 adenomas and 1 craniopharyngioma. With regard to the response of meningiomas to irradiation we have shown that radiosurgery is able to cause a decrease in tumour size as well as reduced contrast enhancement, probably due to vascular changes and fibrosis. In AVM the efficiency of radiosurgery has been further confirmed.

Digitalized venous angiography in the investigation of the neck vessels

An X-ray imaging system, using digital subtraction techniques, has been developed. The authors relate the results of a comparative study in 20 patients, affected by cervical occlusive vascular disease, whose arterial cervical system has been investigated both by conventional angiography and intravenous digital subtraction angiography. Indications, advantages and limitations of this new computerized apparatus are discussed.

[Albright's syndrome. Report of a case, complicated by pleural effusion and diabetes]

A case of Albright's disease in a 54-yr-old man is presented. A brief account of the nosological placement of the disease is followed by a review of the relevant literature, with particular reference to the clinical, anatomo-pathological, and aetiopathogenetic aspects. The salient points of the reported case were: 1) extensive cutaneous hyperpigmentation; 2) polyostotic fibrous dysplasia involving the skull, humeri, femurs, and pelvis; 3) voluminous bilateral costal cysts, with greater extension on the right; 4) right pleural effusion; 5) diabetes; 6) mental under-development; 7) 1/4 balanced translocation.

[Use of a synchronized protocol of cytostatic drugs in the treatment of advanced lung cancer]

A synchronised programme consisting of VCR, CTX and MTX has been employed in 57 patients suffering fom lung carcinoma. Average survival was 10.6 months and overall tolerance was good. The best indications are intermittent long-term treatment and retreatment of patients with cancer recalcitrant to the same drugs. With the simplification of cell kinetics study techniques, more meaningful results can be expected in the application of this treatment programme.