Prevalence of 2-year "No evidence of disease activity" (NEDA-3 and NEDA-4) in relapsing-remitting multiple sclerosis. A real-world study

BACKGROUND

No evidence of disease activity (NEDA) is becoming a gold standard in the evaluation of disease modifying therapies (DMT) in relapsing-remitting multiple sclerosis (RRMS). NEDA-3 status is the absence of relapses, new activity on brain MRI, and disability progression. NEDA-4 meets all NEDA-3 criteria plus lack of brain atrophy.

OBJECTIVE

Aim of this study was to investigate the prevalence of two-year NEDA-3, NEDA-4, six-month delayed NEDA-3 (6mdNEDA-3), and six-month delayed NEDA-4 (6mdNEDA-4) in a cohort of patients with RRMS. Six-month delayed measures were introduced to consider latency of action of drugs.

METHODS

Observational retrospective monocentric study. All the patients with RRMS starting DMT between 2015 and 2018, and with 2-year of follow-up, were included. Annualized brain volume loss (a-BVL) was calculated by SIENA software.

RESULTS

We included 108 patients, the majority treated with first line DMT. At 2-year follow-up, 35 % of patients were NEDA-3 (50 % 6mdNEDA-3), and 17 % NEDA-4 (28 % 6mdNEDA-4). Loss of NEDA-3 status was mainly driven by MRI activity (70 %), followed by relapses (56 %), and only minimally by disability progression (7 %).

CONCLUSION

In our cohort 2-year NEDA status, especially including lack of brain atrophy, was hard to achieve. Further studies are needed to establish the prognostic value of NEDA-3 and NEDA4 in the long-term follow-up.

Telephone interviews among a cohort of gambling patients at the time of COVID-19

Introduction

Background: Little is known about the modifications in gambling patterns during the Covid-19 pandemic, which has shown signs of increase, particularly for individuals with preexisting gambling problems.

Objectives

Our aim was to assess the behaviour of a cohort of patients in the Trentino Region.

Methods

A semi structured questionnaire containing Hamilton Depression Rating Scale as well as open-ended questions on gambling activities, specifically online gambling, was administred over the telephone. The survey was administred for two months over the lockdown period (april-june 2020) and took approximately 20 minutes to complete.

Results

About 50 responsens were collected. Data are currently been analyzed and will be avaiable at the time of the Congress.

Conclusions

Will be show at the time of the Congress.

Disclosure

No significant relationships.

Towards an improved early diagnosis of neurodegenerative diseases: the emerging role of in vitro conversion assays for protein amyloids

Tissue accumulation of abnormal aggregates of amyloidogenic proteins such as prion protein, α-synuclein, and tau represents the hallmark of most common neurodegenerative disorders and precedes the onset of symptoms by years. As a consequence, the sensitive and specific detection of abnormal forms of these proteins in patients' accessible tissues or fluids as biomarkers may have a significant impact on the clinical diagnosis of these disorders. By exploiting seeded polymerization propagation mechanisms to obtain cell-free reactions that allow highly amplified detection of these amyloid proteins, novel emerging in vitro techniques, such as the real-time quaking-induced conversion assay (RT-QuIC) have paved the way towards this important goal. Given its high accuracy in identifying misfolded forms of prion protein from Creutzfeldt-Jakob disease (CJD) CSF, RT-QuIC has already been included in the diagnostic criteria for the clinical diagnosis of sporadic CJD, the most common human prion disease. By showing that this assay may also accurately discriminate between Lewy body disorders and other forms of parkinsonisms or dementias, more recent studies strongly suggested that CSF RT-QuIC can also be successfully applied to synucleinopathies. Finally, preliminary encouraging data also suggested that CSF RT-QuIC might also work for tau protein, and accurately distinguish between 3R- and 4R tauopathies, including Pick's disease, progressive supranuclear palsy, and corticobasal degeneration. Here we will review the state of the art of cell-free aggregation assays, their current diagnostic value and putative limitations, and the future perspectives for their expanded use in clinical practice.

Detection of prions in skin punch biopsies of Creutzfeldt-Jakob disease patients

Prion real‐time quaking‐induced conversion (RT‐QuIC) is an ultrasensitive assay detecting pathological aggregates of misfolded prion protein in biospecimens. We studied 71 punch biopsy skin samples of 35 patients with Creutzfeldt–Jakob disease (CJD), including five assessed in vitam. The results confirmed the high value of skin prion RT‐QuIC for CJD diagnosis (89% sensitivity and 100% specificity) and support its use in clinical practice. Preliminary data based on a limited number of cases suggest that prion‐seeding activity in the skin varies according to the prion strain, being higher in sporadic CJD subtypes linked to the V2 strain (VV2 and MV2K) than in typical CJDMM1.

Diagnostic value of surrogate CSF biomarkers for Creutzfeldt-Jakob disease in the era of RT-QuIC

Prion real-time quaking-induced conversion (RT-QuIC) is emerging as the most potent assay for the in vivo diagnosis of Creutzfeldt-Jakob disease (CJD), but its full application, especially as a screening test, is limited by suboptimal substrate availability, reagent costs, and incomplete assay standardization. Therefore, the search for the most informative cerebrospinal fluid (CSF) surrogate biomarker is still of primary importance. We compared the diagnostic accuracy of CSF protein 14-3-3, measured with both western blot (WB) and enzyme-linked immunosorbent assay (ELISA), total (t)-tau and neurofilament light chain protein (NfL) alone or in combination with RT-QuIC in 212 subjects with rapidly progressive dementia in which we reached a highly probable clinical diagnosis at follow-up or a definite neuropathological diagnosis. T-tau performed best as surrogate CSF biomarker for the diagnosis of CJD (91.3% sensitivity and 78.9% specificity). The 14-3-3 ELISA assay demonstrated a slightly higher diagnostic value compared to the WB analysis (76.9% vs. 72.2%), but both methods performed worse than the t-tau assay. NfL was the most sensitive biomarker for all sCJD subtypes (> 95%), including those with low values of t-tau or 14-3-3, but showed the lowest specificity (43.1%). When ELISA-based biomarkers were adopted as screening tests followed by RT-QuIC, t-tau correctly excluded a higher number of non-CJD cases compared to NfL and 14-3-3 ELISA. Our study showed that among the CSF surrogate biomarkers of potential application for the clinical diagnosis of CJD, t-tau performs best either alone or as screening test followed by RT-QuIC as a second-level confirmatory test.

Prion-related peripheral neuropathy in sporadic Creutzfeldt-Jakob disease

OBJECTIVE

To assess whether the involvement of the peripheral nervous system (PNS) belongs to the phenotypic spectrum of sporadic Creutzfeldt-Jakob disease (sCJD).

METHODS

We examined medical records of 117 sCJDVV2 (ataxic type), 65 sCJDMV2K (kuru-plaque type) and 121 sCJDMM(V)1 (myoclonic type) subjects for clinical symptoms, objective signs and neurophysiological data. We reviewed two diagnostic nerve biopsies and looked for abnormal prion protein (PrP^Sc) by western blotting and real-time quaking-induced conversion (RT-QuIC) in postmortem PNS samples from 14 subjects.

RESULTS

Seventy-five (41.2%) VV2-MV2K patients, but only 11 (9.1%) MM(V)1, had symptoms or signs suggestive of PNS involvement occurring at onset in 18 cases (17 VV2-MV2K, 9.3%; and 1 MM(V)1, 0.8%) and isolated in 6. Nerve biopsy showed a mixed predominantly axonal and demyelinating neuropathy in two sCJDMV2K. Electromyography showed signs of neuropathy in half of the examined VV2-MV2K patients. Prion RT-QuIC was positive in all CJD PNS samples, whereas western blotting detected PrP^Sc in the sciatic nerve in one VV2 and one MV2K.

CONCLUSIONS

Peripheral neuropathy, likely related to PrP^Sc deposition, belongs to the phenotypic spectrum of sCJDMV2K and VV2 and may mark the clinical onset. The significantly lower prevalence of PNS involvement in typical sCJDMM(V)1 suggests that the PNS tropism of sCJD prions is strain dependent.

Regional pattern of microgliosis in sporadic Creutzfeldt-Jakob disease in relation to phenotypic variants and disease progression

AIMS

The aim of this study was to describe the regional profiles of microglial activation in sporadic Creutzfeldt-Jakob disease (sCJD) subtypes and analyse the influence of prion strain, disease duration and codon 129 genotype.

METHODS

We studied the amount/severity and distribution of activated microglia, protease-resistant prion protein (PrP^Sc ) spongiform change, and astrogliosis in eight regions of 57 brains, representative of the entire spectrum of sCJD subtypes.

RESULTS

In each individual subtype, the regional extent and distribution of microgliosis significantly correlated with PrP^Sc deposition and spongiform change, leading to subtype-specific 'lesion profiles'. However, large differences in the ratio between PrP^Sc load or the score of spongiform change and microglial activation were seen among disease subtypes. Most significantly, atypical sCJD subtypes such as VV1 and MM2T showed a degree of microglial activation comparable to other disease variants despite the relatively low PrP^Sc deposition and the less severe spongiform change. Moreover, the mean microglial total load was significantly higher in subtype MM1 than in MM2C, whereas the opposite was true for the PrP^Sc and spongiform change total loads. Finally, some sCJD subtypes showed distinctive regional cerebellar profiles of microgliosis characterized by a high granular/molecular layer ratio (MV2K) and/or a predominant involvement of white matter (MVK and MM2T).

CONCLUSIONS

Microglial activation is an early event in sCJD pathogenesis and is strongly influenced by prion strain, PRNP codon 129 genotype and disease duration. Microglial lesion profiling, by highlighting strain-specific properties of prions, contributes to prion strain characterization and classification of human prion diseases, and represents a valid support to molecular and histopathologic typing.

Involvement of the P2X7-NLRP3 axis in leukemic cell proliferation and death

Lymphocyte growth and differentiation are modulated by extracellular nucleotides and P2 receptors. We previously showed that the P2X7 receptor (P2X7R or P2RX7) is overexpressed in circulating lymphocytes from chronic lymphocytic leukemia (CLL) patients. In the present study we investigated the P2X7R/NLRP3 inflammasome axis in lymphocytes from a cohort of 23 CLL patients. P2X7R, ASC and NLRP3 were investigated by Western blot, PCR and transfection techniques. P2X7R was overexpressed and correlated with chromosome 12 trisomy in CLL patients. ASC mRNA and protein were also overexpressed. On the contrary, NLRP3 was dramatically down-modulated in CLL lymphocytes relative to lymphocytes from healthy donors. To further investigate the correlation between P2X7R, NLRP3 and cell growth, NLRP3 was silenced in THP-1 cells, a leukemic cell line that natively expresses both NLRP3 and P2X7R. NLRP3 silencing enhanced P2X7R expression and promoted growth. On the contrary, NLRP3 overexpression caused accelerated apoptosis. The P2X7R was also up-modulated in hematopoietic cells from NLRP3-KO mice. In conclusion, we show that NLRP3 down-modulation stimulates P2X7R expression and promotes growth, while NLRP3 overexpression inhibits cell proliferation and stimulates apoptosis. These findings suggest that NLRP3 is a negative regulator of growth and point to a role of the P2X7R/NLRP3 axis in CLL.

Emerging roles of P2X receptors in cancer

Tumor microenvironment composition strongly conditions cancer growth and progression, acting not only at cancer itself but also modifying its interactions with immune, endothelial and nervous cells. Extracellular ATP and its receptors recently gained increasing attention in the oncological field. ATP accumulates in cancer milieu through spontaneous release, tumor necrosis or chemotherapy exerting a trophic activity on cancer cells, modulating the cross talk among tumor, and surrounding tissues. Accordingly, ATP gated P2X receptors emerged as central players in tumor development, invasion, progression and related symptoms. Indeed, P2X receptors are expressed and are functional not only on tumor cells but also in immune-infiltrate and nearby neurons. In this review, we summarize recent findings on P2X receptors role in tumor cell differentiation, bioenergetics, angiogenesis, metastasis and associated pain, giving an outline of the potential anti-neoplastic activity of receptor agonists and antagonists.

The P2X7 receptor directly interacts with the NLRP3 inflammasome scaffold protein

The P2X7 receptor (P2X7R) is a known and powerful activator of the NOD-like receptor (NLR)P3 inflammasome; however, the underlying pathways are poorly understood. Thus, we investigated the molecular mechanisms involved. The effect of P2X7R expression and activation on NLRP3 expression and recruitment was investigated by Western blot, RT-PCR, coimmunoprecipitation, and confocal microscopy in microglial mouse cell lines selected for reduced P2X7R expression and in primary cells from P2X7R(-/-) C57BL/6 mice. We show here that P2X7R activation by ATP (EC₅₀ = 1 mM) or benzoyl-ATP (EC₅₀ = 300 μM) and P2X7R down-modulation caused a 2- to 8-fold up-regulation of NLRP3 mRNA in mouse N13 microglial cells. Moreover, NLRP3 mRNA was also up-regulated in primary microglial and macrophage cells from P2X7R(-/-) mice. Confocal microscopy and immunoprecipitation assays showed that P2X7R and NLRP3 closely interacted at discrete subplasmalemmal sites. Finally, P2X7R stimulation caused a transient (3-4 min) cytoplasmic Ca(2+) increase localized to small (2-3 µm wide) discrete subplasmalemmal regions. The Ca(2+) increase drove P2X7R recruitment and a 4-fold increase in P2X7R/NLRP3 association within 1-2 min. These data show a close P2X7R and NLRP3 interaction and highlight the role of P2X7R in the localized cytoplasmic ion changes responsible for both NLRP3 recruitment and activation.

Accelerated tumor progression in mice lacking the ATP receptor P2X7

The ATP receptor P2X7 (P2X7R or P2RX7) has a key role in inflammation and immunity, but its possible roles in cancer are not firmly established. In the present study, we investigated the effect of host genetic deletion of P2X7R in the mouse on the growth of B16 melanoma or CT26 colon carcinoma cells. Tumor size and metastatic dissemination were assessed by in vivo calliper and luciferase luminescence emission measurements along with postmortem examination. In P2X7R-deficient mice, tumor growth and metastatic spreading were accelerated strongly, compared with wild-type (wt) mice. Intratumoral IL-1β and VEGF release were drastically reduced, and inflammatory cell infiltration was abrogated nearly completely. Similarly, tumor growth was also greatly accelerated in wt chimeric mice implanted with P2X7R-deficient bone marrow cells, defining hematopoietic cells as a sufficient site of P2X7R action. Finally, dendritic cells from P2X7R-deficient mice were unresponsive to stimulation with tumor cells, and chemotaxis of P2X7R-less cells was impaired. Overall, our results showed that host P2X7R expression was critical to support an antitumor immune response, and to restrict tumor growth and metastatic diffusion.

P2X receptors: New players in cancer pain

Pain is unfortunately a quite common symptom for cancer patients. Normally pain starts as an episodic experience at early cancer phases to become chronic in later stages. In order to improve the quality of life of oncological patients, anti-cancer treatments are often accompanied by analgesic therapies. The P2X receptor are adenosine triphosphate (ATP) gated ion channels expressed by several cells including neurons, cancer and immune cells. Purinergic signaling through P2X receptors recently emerged as possible common pathway for cancer onset/growth and pain sensitivity. Indeed, tumor microenvironment is rich in extracellular ATP, which has a role in both tumor development and pain sensation. The study of the different mechanisms by which P2X receptors favor cancer progression and relative pain, represents an interesting challenge to design integrated therapeutic strategies for oncological patients. This review summarizes recent findings linking P2X receptors and ATP to cancer growth, progression and related pain. Special attention has been paid to the role of P2X2, P2X3, P2X4 and P2X7 in the genesis of cancer pain and to the function of P2X7 in tumor growth and metastasis. Therapeutic implications of the administration of different P2X receptor blockers to alleviate cancer-associated pain sensations contemporarily reducing tumor progression are also discussed.

Dieback and Mortality of Pinus radiata Trees in Italy Associated with Phytophthora cryptogea

Pinus radiata D. Don is a forest tree species native to the Monterey Baja in California. Due to its rapid growth and desirable lumber and pulp qualities, between 1960 and 1980, about 12,000 ha of P. radiata were planted in Sardinia, Italy. The only disease reported on this conifer species has been Diplodia pinea, which causes tip and branch dieback (3). In January 2012, dieback and mortality of 25-year-old radiata pine trees were observed in a reforestation area of about 20 ha located in northern Sardinia (40°43'N, 9°22'E, 600 m a.s.l.). Symptoms included chlorosis, reddish-brown discoloration of the whole crown or dieback starting in the upper crown and progressing downward through the crown, and necrotic bark tissues at root collar. Approximately 25% of the trees were affected. In a first attempt, a Phytophthora species was consistently isolated from the rhizosphere of 23 symptomatic trees, which included necrotic fine roots using oak leaves as bait (4). Afterwards, it was also isolated from phloem samples taken from the margins of fresh lesions at the stem base and upper roots of affected trees using synthetic mucor agar medium (1). Isolation from soil samples of six healthy pine trees randomly selected in the site did not yield any Phytophthora isolate. On carrot agar (CA), Phytophthora colonies were stellate to slightly radiate with limited aerial mycelium. Sporangia were obpiryform, non-papillate, and non-caducous, measuring 46.9 to 51.2 × 29.1 to 32.6 μm (l:b ratio 1.9). Hyphal swellings were formed in chains or clusters; chlamydospores were not observed. These isolates had cardinal temperatures of <5°C, 25°C, and 35°C, respectively. Their morphological and cultural features were typical of Phytophthora cryptogea Pethybridge & Lafferty. They were heterothallic and produced oogonia with amphyginous antheridia when paired with an A2 mating type tester strain of P. cryptogea. This identity was corroborated by sequence analysis of the internal transcribed spacer (ITS) region of the rDNA. BLAST searches showed 99% homology with sequences of P. cryptogea available in GenBank (DQ479410 and HQ697245). The ITS sequence of a representative isolate (PH101) was submitted to GenBank (Accession Nos. KC603895). The strain PH101 was stored in the culture collection of the Department of Agriculture at the University of Sassari. Pathogenicity of isolate PH101 was verified by inoculating five freshly cut logs of radiata pine (1 m long and 15 cm diam.) with a 5-mm agar plug taken from the margin of 4-day-old culture grown on CA (4). The plug was inserted in a 5-mm hole made through the bark with a cork borer. Five control logs were inoculated with sterile CA. All logs were incubated in a growth chamber at 20°C. Phloem lesion sizes were assessed after 1 month and measured 9.7 ± 5.5 cm² (average ± standard deviation). Control logs had no lesions. The pathogen was re-isolated from the lesions, thus fulfilling Koch's postulates. P. cryptogea has been previously reported in Australia, causing decline of radiata pine trees in wet and flooded soils (2). To our knowledge, this is the first report of P. cryptogea on P. radiata trees in Europe. References: (1) C. M. Brasier and S. A. Kirk. Plant Pathol. 50:218, 2001. (2) M. Bumbieris. Aust. J. Bot. 24:703, 1976. (3) A. Franceschini et al. Informatore Fitopatologico 1:54, 2006. (4) B. Scanu et al. For. Pathol. 43:340, 2013.

Diet and physical activity "defeated" Tuberil® in treatment of childhood obesity

AIM

Childhood obesity is remarkably spreading worldwide, involving both industrialized and low-income countries. Its prevalence, outcome and socioeconomic impact call for the attention of medical community. We conducted a monocentric, open, two-arm, parallel-group study to evaluate the efficacy at reducing appetite and increasing dietary compliance of obese children of Tuberil®, a weight-loss supplement derived from potato and devoid of side effects.

METHODS

We recruited participants, children with BMI ≥ 85th, through direct referrals in pediatrician's surgeries. Children were randomized to receive Tuberil® (group A) or nothing (group B), following a chronological order (A-B-A-B). Every child received a nutritionally balanced diet and had to record their appetite and to describe their meals in a diary.

RESULTS

Even if we found a significant reduction in BMI, weight and waist circumference in both groups, no statistically significant differences between groups were noted. We did not found any significant differences in appetite between group A and B.

CONCLUSION

Our data show that Tuberil® has no efficacy neither in reducing appetite in children nor in increasing dietary compliance. We believe that only a nutritionally balanced diet and our attention in verifying their compliance led to the reduction in BMI, weight and waist circumferences noted in our series.

TNFα levels and macrophages expression reflect an inflammatory potential of trigeminal ganglia in a mouse model of familial hemiplegic migraine

Latent changes in trigeminal ganglion structure and function resembling inflammatory conditions may predispose to acute attacks of migraine pain. Here, we investigated whether, in trigeminal sensory ganglia, cytokines such as TNFα might contribute to a local inflammatory phenotype of a transgenic knock-in (KI) mouse model of familial hemiplegic migraine type-1 (FHM-1). To this end, macrophage occurrence and cytokine expression in trigeminal ganglia were compared between wild type (WT) and R192Q mutant Ca_V2.1 Ca²⁺ channel (R192Q KI) mice, a genetic model of FHM-1. Cellular and molecular characterization was performed using a combination of confocal immunohistochemistry and cytokine assays. With respect to WT, R192Q KI trigeminal ganglia were enriched in activated macrophages as suggested by their morphology and immunoreactivity to the markers Iba1, CD11b, and ED1. R192Q KI trigeminal ganglia constitutively expressed higher mRNA levels of IL1β, IL6, IL10 and TNFα cytokines and the MCP-1 chemokine. Consistent with the report that TNFα is a major factor to sensitize trigeminal ganglia, we observed that, following an inflammatory reaction evoked by LPS injection, TNFα expression and macrophage occurrence were significantly higher in R192Q KI ganglia with respect to WT ganglia. Our data suggest that, in KI trigeminal ganglia, the complex cellular and molecular environment could support a new tissue phenotype compatible with a neuroinflammatory profile. We propose that, in FHM patients, this condition might contribute to trigeminal pain pathophysiology through release of soluble mediators, including TNFα, that may modulate the crosstalk between sensory neurons and resident glia, underlying the process of neuronal sensitisation.

Functional crosstalk in culture between macrophages and trigeminal sensory neurons of a mouse genetic model of migraine

Background

Enhanced activity of trigeminal ganglion neurons is thought to underlie neuronal sensitization facilitating the onset of chronic pain attacks, including migraine. Recurrent headache attacks might establish a chronic neuroinflammatory ganglion profile contributing to the hypersensitive phenotype. Since it is difficult to study this process in vivo, we investigated functional crosstalk between macrophages and sensory neurons in primary cultures from trigeminal sensory ganglia of wild-type (WT) or knock-in (KI) mice expressing the Cacna1a gene mutation (R192Q) found in familial hemiplegic migraine-type 1. After studying the number and morphology of resident macrophages in culture, the consequences of adding host macrophages on macrophage phagocytosis and membrane currents mediated by pain-transducing P2X3 receptors on sensory neurons were examined.

Results

KI ganglion cultures constitutively contained a larger number of active macrophages, although no difference in P2X3 receptor expression was found. Co-culturing WT or KI ganglia with host macrophages (active as much as resident cells) strongly stimulated single cell phagocytosis. The same protocol had no effect on P2X3 receptor expression in WT or KI co-cultures, but it largely enhanced WT neuron currents that grew to the high amplitude constitutively seen for KI neurons. No further potentiation of KI neuronal currents was observed.

Conclusions

Trigeminal ganglion cultures from a genetic mouse model of migraine showed basal macrophage activation together with enhanced neuronal currents mediated by P2X3 receptors. This phenotype could be replicated in WT cultures by adding host macrophages, indicating an important functional crosstalk between macrophages and sensory neurons.

Effects of LPS on P2X3 receptors of trigeminal sensory neurons and macrophages from mice expressing the R192Q Cacna1a gene mutation of familial hemiplegic migraine-1

A knockin (KI) mouse model with the R192Q missense mutation in the Cacna1a gene commonly detected in familial hemiplegic migraine was used to study whether trigeminal ganglia showed a basal inflammatory profile that could be further enhanced by the lipopolysaccharide (LPS) toxin. Adenosine-5'-triphosphate (ATP)-gated purinergic ionotropic receptor 3 (P2X3) currents expressed by the large majority of trigeminal sensory neurons were taken as functional readout. Cultured R192Q KI trigeminal ganglia showed higher number of active macrophages, basal release of tumor necrosis factor alpha (TNFα), and larger P2X3 receptor currents with respect to wild type (WT) cells. After 5 h application of LPS in vitro, both WT and R192Q KI cultures demonstrated significant increase in macrophage activation, very large rise in TNFα mRNA content, and ambient protein levels together with fall in TNFα precursor, suggesting potent release of this inflammatory mediator. Notwithstanding the unchanged expression of P2X3 receptor protein in WT or R192Q KI cultures, LPS evoked a large rise in WT neuronal currents that recovered faster from desensitization. Basal R192Q KI currents were larger than WT ones and could not be further augmented by LPS. These data suggest that KI cultures had a basal neuroinflammatory profile that might facilitate the release of endogenous mediators (including ATP) to activate constitutively hyperfunctional P2X3 receptors and amplify nociceptive signaling by trigeminal sensory neurons.

Synergic effect of retinoic acid and extremely low frequency magnetic field exposure on human neuroblastoma cell line BE(2)C

The aim of the present study was to assess whether exposure to a sinusoidal extremely low frequency magnetic field (ELF-MF; 50 Hz, 1 mT) can affect proliferation and differentiation in the human neuroblastoma cell line BE(2)C, which is representative of high risk neuroblastomas. Cells were subjected to ELF-MF exposure in the presence or absence of a neuronal differentiating agent (all-trans-retinoic acid, ATRA) for 24-72 h. In each experiment, ELF-MF-exposed samples were compared to sham-exposed samples. Cells exposed to ELF-MF combined with retinoic treatment showed a decreased cellular proliferation and an increased proportion of G(0)/G(1) phase cells compared to cells exposed to either treatment alone. Moreover, ELF-MF- and ATRA-treated cells showed more differentiated morphological traits (a higher neurite number/cell, an increased neurite length), together with a significant increase of mRNA levels of p21(WAF1/CIP1) and cdk5 genes, both involved in neuronal differentiation. In addition, the expression of cyp19 gene, which is involved both in neuronal differentiation and stress response, was evaluated; cyp19 gene expression was enhanced by ATRA treatment and significantly enhanced further by ELF-MF exposure combined with ATRA. In conclusion, our data suggest that ELF-MF exposure can strengthen ATRA effects on neuroblastoma cells.

A New Phytophthora sp. Causing Root and Collar Rot on Pistacia lentiscus in Italy

Lentisk (Pistacia lentiscus L., Anacardiaceae) is an evergreen shrub that is widespread over the Mediterranean Region. The species is also cultivated as an ornamental plant in Italy. In August 2008, a survey carried out in a forest nursery in Sardinia (39°57'N, 9°13'E) revealed the presence of symptoms such as wilting and desiccation of foliage associated with root and collar rot on 1- to 3-year-old potted seedlings of lentisk. Approximately 30% of 1,500 potted plants were affected. A Phytophthora sp. was consistently isolated from infected roots on synthetic mucor agar medium. Colonies on carrot agar (CA) were stellate to slightly radiate with low aerial mycelium. Growth occurred from 6 to 38°C, with an optimum around 30°C (mean radial growth rate was 11.8 mm per day). Sporangia were produced abundantly in unsterile pond water; they were nonpapillate, persistent, ellipsoid to obpyriform, (57.8-) 80.5 (-100.5) × (30.2-) 39.3 (-51.5) μm, with a length/breadth ratio of 2.0:1, proliferating internally or externally. Hyphal swellings were spherical to irregular and frequently produced in chains. Chlamydospores were not observed. Isolates were heterothallic and produced oogonia with amphigynous antheridia when paired with A2 mating type of Phytophthora drechsleri and P. cryptogea. Cultural and morphological features were in close agreement with those recently published for Phytophthora sp. "niederhauserii" (4). The rDNA internal transcribed spacer (ITS) sequence (ITS1-5.8S-ITS2) of a representative isolate (LEN1) was submitted to GenBank (Accession No. GU119914) and BLAST searches showed 100% similarity with sequences of P. sp. "niederhauserii" deposited in GenBank (Accession Nos. GQ848201 and EU244850). The strain LEN1 was stored in the culture collection of the Department of Plant Protection at the University of Sassari. Its pathogenicity was verified by inoculating 10 1-year-old lentisk seedlings grown in pots. A mycelial plug (3 to 4 mm²) taken from the margin of a 4-day-old culture grown on CA was put in a shallow wound (~3 mm) made by a sterile scalpel at the root collar of each seedling. All plants were kept in a greenhouse at 25°C in natural daylight. After 20 days, inoculated plants began to show symptoms similar to those observed on naturally infected plants. Five control plants inoculated with sterile CA plugs did not develop any disease symptoms. The pathogen was reisolated from infected tissues, thus fulfilling Koch's postulates. P. sp. "niederhauserii" has not been formally described, however, so far there have been several reports of this species in Europe (1,3). Previously, other Phytophthora spp. were reported associated with lentisk root rot in Italy (2). To our knowledge, this is the first report of P. sp. "niederhauserii" on Pistacia lentiscus and it emphasizes the susceptibility of the Mediterranean species to this new pathogen. References: (1) A. Józsa et al. Plant Pathol. 59:1166, 2010. (2) G. Magnano Di San Lio et al. Micol. Ital. 21:3, 1992. (3) E. Moralejo et al. Plant Pathol. 58:100, 2009. (4) A. Pérez-Sierra et al. Plant Dis. 94:534, 2010.

First Report of Phytophthora pseudosyringae Associated with Ink Disease of Castanea sativa in Italy

Since December 2008, a severe outbreak of ink disease has been observed in a chestnut grove in the Sardinia Region in Italy (40°01'N, 9°13'E, 1,200 m above sea level). Trees have shown symptoms such as microphylly and yellowish foliage as well as necrosis on the main roots and collar. Isolations were made from infected roots and soil using green apples as baits. Small pulp pieces were cut from the lesions that developed in the apples and plated on Phytophthora selective medium (1). In addition to Phytophthora cambivora, another Phytophthora sp. was detected from 60% of 25 symptomatic trees sampled. Colonies subcultured onto carrot agar (CA) were generally appressed and stellate. Growth occurred from 2 to 26°C with an optimum at 20°C (mean radial growth rate of 4.5 mm/day). Sporangia were produced abundantly in unsterile pond water; they were semipapillate, rarely bipapillate, limoniform or ovoid, occasionally caducous with short pedicels (<5 μm), and 35.2 to 58.1 (46.3) × 22.1 to 35.3 (31.9) μm, with a length/breadth ratio of 1.5:1. Catenulate hyphal swellings were frequently present, whereas no chlamydospores were observed. Isolates produced numerous homothallic oogonia with diameters from 23.7 to 31.7 (27.3) μm. Antheridia were predominantly paragynous. Cultural and morphological features were in close agreement with those described for P. pseudosyringae (2). Identity was confirmed by analysis of the internal transcribed spacer region (ITS1-5.8S-ITS2) of rDNA. BLAST searches at GenBank showed 100% identity with reference sequences of P. pseudosyringae (Accession Nos. AY230190 and EU074793). The representative sequence of one P. pseudosyringae strain (CST2A), stored in the culture collection of the Department of Plant Protection-University of Sassari, was submitted to GenBank (Accession No. GU460375). Koch's postulates were fulfilled by inoculating 10 5-month-old chestnut seedlings grown in pots. One shallow cut was made into the bark on the main stem and an agar plug colonized by P. pseudosyringae was inserted beneath the flap. Seedlings were kept at the laboratory at temperatures varying from 16 to 22°C and watered as necessary. After 20 days, extensive, sunken, necrotic lesions measuring 27.2 ± 1.9 mm (mean + standard error) developed around the inoculation sites. Control plants inoculated with sterile CA plugs did not show any disease symptoms. The pathogen was consistently reisolated from infected tissues. P. pseudosyringae has recently been reported as the causal agent of stem necroses on chestnut seedlings in a nursery in Spain (3). To our knowledge, this is the first report of P. pseudosyringae on Castanea sativa in Italy. References: (1) C. M. Brasier and S. A. Kirk. Plant Pathol. 50:218, 2001. (2) T. Jung et al. Mycol. Res. 107:772, 2003. (3) C. Pintos Varela et al. Plant Dis. 91:1517, 2007.

First Report of Diplodia scrobiculata Causing Canker and Branch Dieback on Strawberry Tree (Arbutus unedo) in Italy

Strawberry tree, family Ericaceae, is an evergreen shrub or small tree that grows in the Mediterranean Region. In spring 2009, a survey was conducted to study the fungi associated with canker and branch dieback of strawberry tree in a natural stand located on Caprera Island (41°12'N, 9°27'E), Italy. Fungal isolates obtained from live twigs and branches showing sunken necrotic bark lesions were identified as Diplodia scrobiculata J. de Wet, Slippers & M.J. Wingf. on the basis of morphological features (1). On potato dextrose agar (PDA) at 25°C, D. scrobiculata isolates developed white colonies with appressed mycelium that became dark gray after 4 to 6 days and formed pycnidia after 2 weeks on sterile Pinus radiata needles placed on the PDA surface. The conidia were dark brown with zero to three septa, clavate with truncate base, and measured 31.1 to 41.9 (36.8) × 11.3 to 16.3 (12.6) μm, with a length/width ratio of 2.9 ± 0.1 (mean ± standard error) (n = 50). Identity was confirmed by analysis of the internal transcribed spacer region (ITS1-5.8S-ITS2) of rDNA. BLAST searches in GenBank showed 100% similarity with reference sequences of D. scrobiculata (GenBank Nos. AY160200, EU220438, EU220444, and EU392283). The representative sequence of one D. scrobiculata strain (BL5), stored in the culture collection of the Department of Plant Protection at the University of Sassari, was deposited in GenBank (Accession No. GU722102). Pathogenicity of strain BL5 was tested by stem inoculation on eight 2-year-old strawberry tree seedlings maintained in a greenhouse at 18 to 26°C. A mycelial plug (3 to 4 mm²) taken from the margin of an actively growing colony on PDA was put in a shallow wound (~3 mm) made by a scalpel on the basal part of the stem of each seedling. Four weeks after inoculation, the seedlings displayed dark brown-to-black discoloration, measuring 1.7 ± 0.6 cm (mean ± standard error) of the bark and wood tissues of the stems. The pathogen was successfully reisolated from symptomatic stem tissues, thus fulfilling Koch's postulates. Three control seedlings inoculated with sterile PDA plugs remained asymptomatic. These results demonstrate the active role played by D. scrobiculata in the aetiology of the canker and branch dieback observed on strawberry tree. D. scrobiculata is generally recognized as a weak pathogen of gymnosperms worldwide (2), however, it has recently been reported on olive in Italy (3). To our knowledge, this is the first report of D. scrobiculata on strawberry tree. Currently, further investigations are in progress to determine the possible role of biotic and abiotic factors in the development of this disease. References: (1) J. De Wet et al. Mycol. Res. 107:557, 2003. (2) J. De Wet et al. Mol. Phylogenet. Evol. 46:116, 2008. (3) C. Lazzizera et al. Fungal Divers. 31:63, 2008.

First Report of Canker Disease Caused by Botryosphaeria parva on Cork Oak Trees in Italy

A survey was carried out in the spring of 2003 to study the fungi associated with declining trees in a cork oak (Quercus suber L.) forest located in Sassari Province, Sardinia, Italy (40°52'N, 9°01'E) at an altitude of 150 m (above sea level). Several isolates obtained from live twigs and branches showing sunken necrotic bark lesions were identified as Fusicoccum parvum Pennycook & Samuels (teleomorph Botryosphaeria parva Pennycook & Samuels). Neither pycnidia nor ascomata were observed on the symptomatic samples collected. On potato dextrose agar (PDA) at 25°C, the isolates developed an aerial and compact mycelium, initially white but becoming gray after 4 to 6 days, and produced pycnidia after 1 month on sterile cork oak twigs placed on the surface of PDA. Conidia from culture were hyaline, ellipsoidal to fusiform, externally smooth, thin walled, nonseptate, 12 to 19 (15.5) × 5.5 to 8.5 (6.5) μm, with length/width ratio of 2.4 ± 0.1 (mean ± standard error). Identity was confirmed by analysis of the nucleotide sequences of the internal transcribed spacer (ITS) from the rRNA repeat and the translation elongation factor 1-alpha (EF1-α), as done elsewhere (1,4). BLAST searches at GenBank showed a high identity with reference sequences (ITS: >99%; EF1-α: 100%). Representative sequences of both regions were deposited at GenBank (ITS: Accession No. DQ487157; EF1-α: Accession No. DQ487158). Pathogenicity tests were carried out on seven 2-year-old cork oak seedlings maintained in a greenhouse at 14 to 26°C with the B. parva strain CBS 119937 obtained in this study. A mycelial plug (3 to 4 mm²) taken from the margin of an actively growing colony on PDA was put in a shallow wound made by a scalpel on the basal part of the stem of each seedling. Sterile PDA plugs were placed into similar wounds on three control seedlings. The inoculation points were wrapped in Parafilm to retain moisture for 1 week. After 4 weeks, all seedlings inoculated with B. parva died and showed a collapse of the stem cortical tissues associated with dark brown discolorations and vascular necrosis measuring 10.9 ± 0.4 cm. No symptoms were visible in the control seedlings. The pathogen was reisolated from all the inoculated seedlings, thus fulfilling Koch's postulates. The results confirm the virulence of this fungus and point to its possible involvement in the aetiology of cork oak decline. B. parva is a cosmopolitan, plurivorous pathogen causing disease in several hosts of economic importance, such as grapevine (3), kiwi (2), and Eucalyptus spp. trees (1). To our knowledge, this is the first report of B. parva causing canker disease on cork oak trees. References: (1) A. Gezahgne et al. S. Afr. J. Bot. 70:241, 2004. (2) S. R. Pennycook and G. J. Samuels. Mycotaxon 24:445, 1985. (3) A. J. L. Phillips. Phytopathol. Mediterr. 41:3, 2002. (4) B. Slippers et al. Mycologia 96:83, 2004.

Umbilical cord blood collection in Cesarean section: a comparison before and after placental delivery

Fetal stem cells transplants depend on nucleated cells from fetal blood. This study was a prospective randomized trials to compare the collection of fetal blood by gravity into a bag containing anticoagulant, before and after delivery of the placenta. The obstetric and the newborn characteristics in the two group were not significantly different. The mean volume of fetal blood collected while the placental was still in utero was 74.93+/-7.1 ml as against 35.78+/-3.6 ml for collection of fetal blood after delivery of the placenta.

Benign cystic lymphoepithelial lesion of the parotid gland an unusual presentation of the acquired immunodeficiency syndrome

This article presents a case of a young, otherwise asymptomatic male patient with a parotid gland enlargement. The initial clinical history did not reveal any risk factors related with HIV infection. A fine needle aspiration biopsy of the lesion showed a benign cystic lymphoepithelial lesion of the parotid gland. This once unusual lesion of the salivary gland has been recently associated with infection by the human immunodeficiency virus (HIV) and is presently encountered with increased frequency in the clinical practice. The knowledge of the association between these two entities led, in this case, to the diagnosis of HIV infection in an otherwise asymptomatic patient. Early detection of HIV infection is of vital importance since it has been demonstrated that prompt treatment of these patients with AZT slows down the progression of the disease.

[Comparison of methods: gastro-duodenal manometry and study of gastric emptying]

Traditionally, the stomach is regarded as two functional unit regions: 1) a proximal portion mainly involved in receptive relaxation and emptying of liquids; and 2) a distal portion that grinds, mixes and empties solids. Manometric and radioisotopic studies have been employed to construct such a physiological model. More recently, ad hoc designed studies have led to the identification of other factors that contribute to the regulation of gastric emptying. Antral, intestinal and pyloric motility, fundic tone and antropyloroduodenal coordination appear to be all involved in the regulation of gastric emptying. Nowadays, no single technique can simultaneously measure those parameters. Gastroduodenal manometry can be regarded as the most advanced technique, in studying gastrointestinal motility. Nevertheless, fundic tone, which is an important determinant of gastric emptying, cannot be concurrently recorded.

[Specific detection of urinary sympathomimetic amines for control of anti-doping by gas chromatography-mass spectroscopy]

A specific, sensitive and reliable gas chromatography-mass spectrometry (GC-MS) technique for detection of sympathomimetic amines following urinary extraction is proposed. Amphetamine, phentermine, ephedrine, mephenorex, methylphenidate, benzphetamine, clobenzorex and internal standard (fenfluramine) are extracted from urines at pH 7.0 using elution by chloroform-isopropanol on C18 cartridges. Derivatization followed by GC-MS analysis allows identification of these drugs founded on relative retention times and mass spectra. The quantitation limit for derivatizable drugs was found to be 200 ng/ml and 500 ng/ml for underivatizable drugs.