Polycomb-mediated repression of EphrinA5 promotes growth and invasion of glioblastoma

Glioblastoma (GBM) is the most common and most aggressive intrinsic brain tumour in adults. Integrated transcriptomic and epigenomic analyses of glioblastoma initiating cells (GIC) in a mouse model uncovered a novel epigenetic regulation of EfnA5. In this model, Bmi1 enhances H3K27me3 at the EfnA5 locus and reinforces repression of selected target genes in a cellular context-dependent fashion. EfnA5 mediates Bmi1-dependent proliferation and invasion in vitro and tumour formation in an allograft model. Importantly, we show that this novel Polycomb feed-forward loop is also active in human GIC and we provide pre-clinical evidence of druggability of the EFNA5 signalling pathway in GBM xenografts overexpressing Bmi1.

Polycomb-mediated repression of EphrinA5 promotes growth and invasion of glioblastoma

Introduction

The epigenetic regulator Bmi1 is essential for the self-renewal of neural stem cells (NSC), and highly expressed in glioblastoma (GBM) stem/initiating cells (GIC), where knockdown significantly reduces tumour growth in xenograft models. We have used a combined genome-wide and target gene-driven approach to identify EphrinA5 (EfnA5) as a mediator of Bmi1 function in mouse and human GIC.

Methods and results

We compared mGIC, from a PTEN/p53 deletion mouse model, to matched NSC. Combined ChIPSeq and RNASeq showed a differential redistribution of the repressive PRC mark H3K27me3 in mGIC, and that transcriptional regulation is Bmi1-dependent in a proportion of H3K27me3 marked genes. Subsequently, using shRNA knockdown, we show that Bmi1 regulates cell morphology, proliferation and migration/invasion via repression of EfnA5 in mGIC, and that the same mechanism is essential for GBM development in an allograft model. To confirm the translational potential of the BMI1/EFNA5 pathway we examined published RNA microarray, RNAseq and single-cell RNAseq datasets and found a significant inverse relationship between BMI1 and EFNA5. Finally, we show that BMI1 also regulates cell proliferation via repression of EFNA5 in primary human GIC in vitro.

Conclusions

We present evidence from a mouse model, human expression datasets and human primary cells showing that the Bmi1-EfnA5 pathway plays a prominent regulatory role in GIC. As the anti-proliferative role of BMI1 silencing is mediated by de-repression of EFNA5 in hGIC, precision targeting of Ephrin signalling, for example with agents that mimic EFNA5 action, could be an effective therapeutic tool in human GBM overexpressing BMI1.

Local pesticide use intensity conditions landscape effects on biological pest control

Complex landscapes including semi-natural habitats are expected to favour natural enemies thereby enhancing natural pest biocontrol in crops. However, when considering a large number of situations, the response of natural biocontrol to landscape properties is globally inconsistent, a possible explanation being that local agricultural practices counteract landscape effects. In this study, along a crossed gradient of pesticide use intensity and landscape simplification, we analysed the interactive effects of landscape characteristics and local pesticide use intensity on natural biocontrol. During 3 years, using a set of sentinel prey (weed seeds, aphids and Lepidoptera eggs), biocontrol was estimated in 80 commercial fields located in four contrasted regions in France. For all types of prey excepted weed seeds, the predation rate was influenced by interactions between landscape characteristics and local pesticide use intensity. Proportion of meadow and length of interface between woods and crops had a positive effect on biocontrol of aphids where local pesticide use intensity was low but had a negative effect elsewhere. Moreover, the landscape proportion of suitable habitats for crop pests decreased the predation of sentinel prey, irrespectively of the local pesticide use intensity for weed seeds, but only in fields with low pesticide use for Lepidoptera eggs. These results show that high local pesticide use can counteract the positive expected effects of semi-natural habitats, but also that the necessary pesticide use reduction should be associated with semi-natural habitat enhancement to guarantee an effective natural biocontrol.

PARP inhibitors enhance replication stress and cause mitotic catastrophe in MYCN-dependent neuroblastoma

High-risk and MYCN-amplified neuroblastomas are among the most aggressive pediatric tumors. Despite intense multimodality therapies, about 50% of these patients succumb to their disease, making the search for effective therapies an absolute priority. Due to the important functions of poly (ADP-ribose) polymerases, PARP inhibitors have entered the clinical settings for cancer treatment and are being exploited in a variety of preclinical studies and clinical trials. PARP inhibitors based combination schemes have also been tested in neuroblastoma preclinical models with encouraging results. However, the expression of PARP enzymes in human neuroblastoma and the biological consequences of their inhibition remained largely unexplored. Here, we show that high PARP1 and PARP2 expression is significantly associated with high-risk neuroblastoma cases and poor survival, highlighting its previously unrecognized prognostic value for human neuroblastoma. In vitro, PARP1 and 2 are abundant in MYCN amplified and MYCN-overexpressing cells. In this context, PARP inhibitors with high 'PARP trapping' potency, such as olaparib or talazoparib, yield DNA damage and cell death preceded by intense signs of replication stress. Notwithstanding the activation of a CHK1-CDC25A replication stress response, PARP-inhibited MYCN amplified and overexpressing cells fail to sustain a prolonged checkpoint and progress through mitosis in the presence of damaged DNA, eventually undergoing mitotic catastrophe. CHK1-targeted inhibition of the replication stress checkpoint exacerbated this phenotype. These data highlight a novel route for cell death induction by PARP inhibitors and support their introduction, together with CHK1 inhibitors, in therapeutic approaches for neuroblastomas with high MYC(N) activity.

Role of sphingosine kinase/S1P axis in ECM remodeling of cardiac cells elicited by relaxin

The initiation and progression of heart failure is linked to adverse cardiac remodeling of the extracellular matrix (ECM) during disease mainly through the deregulation of myocardial metalloproteinases (MMPs). Relaxin (RLX), a peptide hormone acting as a physiological cardiac effector, is a key regulator of ECM remodeling in reproductive and nonreproductive tissues. Studying primary cultures of mouse cardiac muscle cells and rat H9c2 cardiomyoblasts, we have obtained evidence for a new signaling pathway activated by RLX to induce ECM remodeling that involves the bioactive sphingolipids sphingosine-1-phosphate (S1P) and ceramide. In both cell populations, recombinant human RLX increased sphingosine kinase activity and S1P formation, whereas sphingomyelin and ceramide content were decreased in [(3)H]serine-labeled cells. According to the literature, RLX promoted MMP-2 and MMP-9 expression/release. Pharmacological inhibition of sphingolipid metabolism and silencing of sphingosine kinase 1, the enzyme responsible for S1P formation, were able to prevent MMP expression/release elicited by the hormone and induce the expression of tissue inhibitor of MMPs. In addition, we found that sphingolipid signaling is required for the regulation of connective tissue growth factor, a member of the CCN 1-3 family of genes that are involved in cell proliferation and differentiation. Finally, the induction of cardiomyoblast maturation induced by RLX was also found to be counteracted by inhibition of S1P formation. In conclusion, these findings provide a novel mechanism by which RLX acts on cardiac ECM remodeling and cardiac cell differentiation and offer interesting therapeutic options to prevent heart fibrosis and to favor myocardial regeneration.

The MRN complex is transcriptionally regulated by MYCN during neural cell proliferation to control replication stress

The MRE11/RAD50/NBS1 (MRN) complex is a major sensor of DNA double strand breaks, whose role in controlling faithful DNA replication and preventing replication stress is also emerging. Inactivation of the MRN complex invariably leads to developmental and/or degenerative neuronal defects, the pathogenesis of which still remains poorly understood. In particular, NBS1 gene mutations are associated with microcephaly and strongly impaired cerebellar development, both in humans and in the mouse model. These phenotypes strikingly overlap those induced by inactivation of MYCN, an essential promoter of the expansion of neuronal stem and progenitor cells, suggesting that MYCN and the MRN complex might be connected on a unique pathway essential for the safe expansion of neuronal cells. Here, we show that MYCN transcriptionally controls the expression of each component of the MRN complex. By genetic and pharmacological inhibition of the MRN complex in a MYCN overexpression model and in the more physiological context of the Hedgehog-dependent expansion of primary cerebellar granule progenitor cells, we also show that the MRN complex is required for MYCN-dependent proliferation. Indeed, its inhibition resulted in DNA damage, activation of a DNA damage response, and cell death in a MYCN- and replication-dependent manner. Our data indicate the MRN complex is essential to restrain MYCN-induced replication stress during neural cell proliferation and support the hypothesis that replication-born DNA damage is responsible for the neuronal defects associated with MRN dysfunctions.

Aflatoxin B1 Risk Management in Parmigiano Reggiano Dairy Cow Feed

This study investigated aflatoxin B1 (AFB1) contamination in dairy cow feed and the risk management of AFB1 content in concentrates undertaken by feed industries in the Parmigiano Reggiano area. Data on aflatoxin contamination risk management applied in 29 feed industries were collected and the AFB1 content of 70 feed samples was analysed. Data were collected within the framework of a quality control programme promoted by the Parmigiano Reggiano Consortium in 2013 and 2014. Audit results showed that the control procedures to prevent AFB1 contamination mainly focused on maize and its by-products. AFB1 concentration resulted lower than 5 ppb [legal European Union (EU) limit] in all samples; in one out of 70 samples, AFB1 content was 3.8 ppb and in all the other samples it was lower than 3 ppb. Results showed that AFB1 risk management applied by Italian feed industries effectively monitors AFB1 levels in feed below the EU legal limit.

Gossypol Content of Cotton Free Commercial Feed for Dairy Cows

Gossypol is a yellow pigment occurring in all parts of cotton plants, with the highest levels found in seeds, and it exhibits a variety of toxic effects. Few data are available on the content of gossypol in the commercial complementary feed and in feed raw materials. The present study was focused on the investigation of the presence of free gossypol in commercial complementary feed not containing cotton. A total of 50 samples of commercial complementary feed for dairy cows were performed in 29 feed mills both using and not using cotton as feed material. The free gossypol contamination resulted under the detection limit of the technique (4 mg/kg) in 12 out of 50 samples analysed and ranged from 4 to 20 mg/kg in 28 samples. In 10 samples the level of free gossypol ranged from 20 to 29.5 mg/kg. Average contamination of samples was 12.2±9.2 SD mg/kg. No significant difference (P=0.571) was shown in free gossypol concentration between feed produced in cotton free plants and in plants where cotton is used as feed material. Free gossypol content detected in the present study allows considering complementary feed for dairy cows not at risk. On the other hand, the detection of free gossypol in cotton free complementary feed, probably attributable to cross contamination of feed materials upstream of the feed mill, should be further investigated.

A cross selectional survey in a critical care: the job satisfaction and functioning team of the health professionals

BACKGROUND AND AIM OF THE WORK

Health care workers, especially those who are part of the OS core, are essential in the delivery of services, as they represent the institution at the time of the contact with the user and they represent also the image of the organization. Health administrations, therefore, are called to improve the performance through a better motivation and satisfaction of the staff, in view of two strategic aspects: job satisfaction of professionals and team collaboration.

METHOD

Between January and September 2014, a survey at the OU (UUOO) intensive care and sub intensive has been made inside three hospitals in Emilia Romagna. It' s been a multicentre cross-sectional quantitative study by administering a self-report questionnaire designed to investigate the different constructs. On 742 questionnaires were spread 454 professionals gave it back  (response rate = 73%). Of those, 273 (60.1%) were nurses, 119 (26.2%) were physicians and 62 (13.7%) were healthcare operators. 62 (13.7%) Job Satisfaction was measured with the McCloskey Mueller Satisfaction Scale. Team Functioning was measured with the Index of Interprofessional Team Collaboration.

RESULTS

Results from MANOVA indicated that physicians were less satisfied of scheduling than both nurses and healthcare operators. For professional opportunities, instead, healthcare operators showed the lower level of satisfaction. The participants seem to perceive a high level of team effectiveness and therefore the professionals involved in the care of critically ill patients than the two dimensions analysed, (reflection between the processes and interdependent roles), also state a greater tendency to respect the roles interdisciplinary, maintaining their professional autonomy and a lower tendency to use critical thinking to act professionally in order to improve the effectiveness of care provided.

CONCLUSION

The study results oriented healthcare administrators, to take paths that feed the job satisfaction and the collaboration of professionals by developing the aspects investigated. Considering the shared perception among the professions studied, compared to the constructs under investigation, it seems to be clear how the routes should be designed in a systematic order to involve, in an integrated way the best professionals (nurses, doctors and OSS) involved in taking managing critical patients. No statistically significant difference have been found between these three professions considered, on most dimensions of job satisfaction investigated (relations between colleagues, 'social interactions, work-family balance, time work organization and working professional opportunity). There is a difference between two specific factors: the work time planning organization and wich is seen less by the nurses, while the job opportunities that are perceived less from the OOS.

SUMO1 in human sperm: new targets, role in motility and morphology and relationship with DNA damage

In studies carried out previously, we demonstrated that small ubiquitin-like modifier 1 (SUMO1) is associated with poor sperm motility when evaluated with a protocol that reveals mostly SUMO1-ylated live sperm. Recently, with another protocol, it has been demonstrated that SUMO is expressed in most sperm and is related to poor morphology and motility, suggesting that sumoylation may have multiple roles depending on its localisation and targets. We show herein, by confocal microscopy and co-immunoprecipitation, that dynamin-related protein 1 (DRP1), Ran GTPase-activating protein 1 (RanGAP1) and Topoisomerase IIα, SUMO1 targets in somatic and/or germ cells, are SUMO1-ylated in mature human spermatozoa. DRP1 co-localises with SUMO1 in the mid-piece, whereas RanGAP1 and Topoisomerase IIα in the post-acrosomal region of the head. Both SUMO1 expression and co-localisation with the three proteins were significantly higher in morphologically abnormal sperm, suggesting that sumoylation represents a marker of defective sperm. DRP1 sumoylation at the mid-piece level was higher in the sperm of asthenospermic men. As in somatic cells, DRP1 sumoylation is associated with mitochondrial alterations, this protein may represent the link between SUMO and poor motility. As SUMO pathways are involved in responses to DNA damage, another aim of our study was to investigate the relationship between sumoylation and sperm DNA fragmentation (SDF). By flow cytometry, we demonstrated that SUMO1-ylation and SDF are correlated (r=0.4, P<0.02, n=37) and most sumoylated sperm shows DNA damage in co-localisation analysis. When SDF was induced by stressful conditions (freezing and thawing and oxidative stress), SUMO1-ylation increased. Following freezing and thawing, SUMO1-Topoisomerase IIα co-localisation and co-immunoprecipitation increased, suggesting an involvement in the formation/repair of DNA breakage.

Surgical treatment of congenital nasolacrimal duct obstructions in Italy

AIM

The aim of this study to present the surgical treatments performed in Italy for congenital nasolacrimal duct obstruction.

METHODS

This was a retrospective review of the Ministry of Health database for groups aged 0-1 and 1-4 years from 1999 through 2005.

RESULTS

During the study period, a total of 9081 surgical procedures was performed on children 0-4 years of age, 2739 of which on infants under 1 year of age and 6342 on children 1-4 year-old; 8067 (88.8%) of these interventions were represented by nasolacrimal duct probing, 2556 of which in infants under one year of age and 5511 in the 1-4 year age group. Total number of the other surgical techniques was 984, 183 of which among infants younger than one year of age and 801 among children aged 1-4 years. The seven-year mean number of surgical treatments corresponds to a rate of 7.3/10000 live births for infants <1 year old and 4.3/10000 for children aged 1-4 years.

CONCLUSION

When congenital nasolacrimal duct obstructions do not improve spontaneously, probing resulted the more common surgical treatment performed. Our data are related exclusively to infantile inpatients and cases managed on an office basis are not included. Consequently, our figures cannot be considered indicative of the incidence of this pathology in Italy. However, the mean number per 10000 of surgical procedures may represent, in our opinion, a useful indicator for the more severe forms of congenital lacrimal drainage system pathologies.

[Crohn's disease surgery: problems of postoperative recurrence]

Crohn's disease is associated with high rates of postoperative recurrence. By 10 years postoperatively a high percentage of patients suffer clinical relapses (as many as 75% and above) and many of these (up to 45%) require re-intervention. The aim of the study was to identify, among the various potentially predictive factors, those which today can be considered real risk factors for postoperative recurrence. A review of the literature of the last two decades was carried out. Factors related to the patient, disease, type of surgery and pharmacological treatment were analysed. The relapse rate we recorded was 41.17% (28 of 62 patients operated on in the last 20 years and included in an average 6-year follow-up (range: 1-19 years). Significant predictive factors, in adition to duration of the follow-up and smoking, are also the location of the disease in the colon, extent more than 100 cm and the absence of postoperative pharmacological prophylaxis. The high incidence of postoperative recurrence in Crohn's disease mandates a strict follow-up (clinical, laboratory and instrumental monitoring). Identifying patients at increased risk would enable physicians to implement a rational pharmacological prophylaxis.

Appendectomy or right hemicolectomy in the treatment of appendiceal carcinoid tumors?

AIMS AND BACKGROUND

Carcinoids of the appendix continue to be of interest, despite their low incidence. There is still considerable controversy surrounding these tumors, especially with regard to the role of right hemicolectomy in the surgical management. The aim of this work was to explicate the current therapeutic knowledge and to review the criteria for the indications of appendectomy or hemicolectomy.

METHODS

The records of patients who underwent appendectomies from 1990 to 2000 were analyzed. Seven patients were included in the study. The clinical data were reviewed for demographic details, tumor size, localization in the appendix, histological patterns and surgical procedures. All patients underwent appendectomy including removal of the mesenteriolum, and in one of them a right hemicolectomy was performed 3 weeks later. The mean follow-up was 7 years (range, 4-14). Follow-up data included symptoms, urinary 5-hydroxyindoleacetic acid, ultrasound examination, computerized tomography, and octreotide scanning.

RESULTS

Seven patients (0.9% of all appendectomies) were reported to have carcinoid tumors of the appendix. They were 3 men and 4 women with a mean age of 29 years. All patients were admitted for appendicitis. None suffered from the carcinoid syndrome. The site of the tumor was the apex of the appendix in 4 cases, the body in 2 cases and the base in 1 case. Mean tumor diameter was 8 mm (range, 5-29 mm); in 6 patients it was <2 cm. Treatment was appendectomy in all cases; additional right hemicolectomy was necessary in one case because of a tumor of more than 2 cm with invasion of the mesoappendix and lymph nodes. The 7-year survival rate is 100%. Six patients are without disease, while 1 patient (the one who underwent a right hemicolectomy) developed metastases in the liver 6 years after the operation. This patient, who was treated with a liver resection, is still alive.

CONCLUSIONS

According to current guidelines, an appendectomy may be performed for small carcinoid tumors (<1 cm). Reasons for more extensive surgery than appendectomy are tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index. The criteria that direct us towards major (hemicolectomy) or minor surgery (appendectomy) are controversial. Tumor size is still considered the most important prognostic factor, with a presumed increase in the risk of metastasis for tumors greater than 2.0 cm. The accepted treatment of such tumors is a right hemicolectomy. However, there is no evidence demonstrating a survival benefit for right hemicolectomy over simple appendectomy in patients with carcinoids greater than 2.0 cm in diameter.

Penetrating keratoplasty in a newborn: case report and analysis of current surgical trends in Italy

PURPOSE

The aims of this study were to describe bilateral penetrating keratoplasty (PK) in a newborn and to analyze the data of PKs performed in Italy during the 5-year period 1999-2003 in children under 4 years of age.

METHODS

A male newborn had PK at age 3 months and 5 months for near-blindness secondary to severe congenital corneal clouding in both eyes. The infant''s explanted corneas were subjected to histochemical and ultrastructural analyses. Data regarding the number of PKs performed in Italy on 0-4-year-olds were obtained from the Web site of the Italian Ministry of Health.

RESULTS

The postoperative courses were uncomplicated, and 42 months of follow-up data show bilateral graft transparency and substantial improvement in visual acuity despite high-grade myopia and nystagmus. At the ultrastructural level, the main alterations involved the endothelial cells and Descemet membrane. A total of 45 PKs were performed in Italy on patients 0-4 years old from 1999 through 2003; only nine involved babies under 1 year of age.

CONCLUSIONS

In babies with congenital corneal opacities, early PK can reduce severe amblyopia. However, the risk of intra- and postoperative complications in PK is high. Based on the 42-month follow-up, the anatomic and functional results achieved in the current patient are satisfactory despite the presence of nystagmus and postoperative high-grade myopia. This study shows that PKs are rarely performed, in Italy, in children aged 0-4 years, and very few are done during the first year of life.

[Transcutaneous excision of the submandibular and sublingual glands: notes on anatomy and surgical technique]

Removal of the submandibular and sublingual glands requires in-depth knowledge of the anatomy and scrupulous technique for the purposes of limiting the functional and aesthetic damage, which is unjustifiable above all in the treatment of benign lesions (sialodenitis, lithiasis). After presenting the main aspects of the surgical anatomy of the submandibular space, the operative technique for its dissection with removal of the submandibular gland and excision of the sublingual gland is described. The complexity of the anatomical structures that may be involved in submandibular and sublingual gland lesions is the cause of unsatisfactory functional and aesthetic outcomes in some cases. The most feared complications are lesions to nerve formations, due both to the resulting deficits and the possible legal implications.

Analgesic effect of watching TV during venipuncture

AIMS

To assess the analgesic effect of passive or active distraction during venipuncture in children.

METHODS

We studied 69 children aged 7-12 years undergoing venipuncture. The children were randomly divided into three groups: a control group (C) without any distraction procedure, a group (M) in which mothers performed active distraction, and a TV group (TV) in which passive distraction (a TV cartoon) was used. Both mothers and children scored pain after the procedure.

RESULTS

Main pain levels rated by the children were 23.04 (standard deviation (SD) 24.57), 17.39 (SD 21.36), and 8.91 (SD 8.65) for the C, M, and TV groups, respectively. Main pain levels rated by mothers were 21.30 (SD 19.9), 23.04 (SD 18.39), and 12.17 (SD 12.14) for the C, M, and TV groups, respectively. Scores assigned by mothers and children indicated that procedures performed during TV watching were less painful (p<0.05) than control or procedures performed during active distraction.

CONCLUSION

TV watching was more effective than active distraction. This was due either to the emotional participation of the mothers in the active procedure or to the distracting power of television.

[Excision of a schwannoma of the neck: surgical technique]

We present a case of schwannoma of the neck in 49 year old man, symptomatic (paresthesia, cervical mass and dysphagia). After ultrasonography and magnetic resonance of the neck, the patient was operated and excision of the lesion was completely performed. The operation was performed through a cervical approach: the nerves and the vascular and muscular structures were carefully isolated and preserved. The tumour arised from the cervical sympathetic chain. The diagnosis of schwannoma was possible only by histopathologic examen. After 48 months no local recurrence or postoperative complication related to intervention were found. These lesions are uncommon. The identification of the nerve is often difficult until the operation, which is the treatment of choice for the schwannoma.

[Carcinoid tumors of the appendix: when right colectomy?]

Three cases of carcinoid tumour of the appendix (about 0,3 % of all performed appendectomies) has induced the Authors to a review of the literature with the aim to underline the most important biological and pathological findings and the current clinic and therapeutic knowledges. The diagnosis before surgery is rarely made; it is formulated incidentally in most patients by the histological exam during the operation for an appendicitis or during other surgical procedures. The kind of surgical intervention, that is the entity of the surgical demolition, for the treatment of the carcinoid tumours of the appendix is still controversial: appendectomy or right colectomy? It is possible identify, also during the operation for an appendicitis or for other abdominal lesions, criteria that can orient toward a major surgery (size of the neoplasia, subserosal lymphatic invasion, infiltration of the serosa, diffusion in the meso-appendix, location in closeness of the base of the appendix, invasion of the the locoregional lymph nodes, presence of metastases, section ?margins, number of mitoses, cellular pleiomorfism).

[Abdominal emergency surgery in the geriatric patients. Our experience]

The ageing process of general population implies new socio-sanitary problems. Indications for surgical intervention have been modified and enhanced. As far as elective surgery is concerned, the results in elderly subjects do not seem alarming, whereas less satisfactory results have been registered in the patients who underwent an emergency surgical intervention, where nowadays morbidity and mortality still turn out to be high. The Authors have reported their experience of emergency surgery in the geriatric patient. From 1982 to 2002, 718 pts (361 males, 50.3% and 357 females, 49.7%; average age 50 yrs, range 5-92) underwent emergency surgical interventions for abdominal lesions. The pts were subdivided in two groups: group A (> 65 years; 190 pts, 87 males and 103 females; average age 72 yrs, range 66-92); control group B (<65 years; 528 pts, 274 males and 254 females; average age 43 yrs, range 5-65). The results were assessed in terms of morbidity and of the operative and post-operative mortality. Postoperative morbidity proved to be equal to 25.7% (36.3% in the group A, 21.9% in the group B), while intraoperative mortality equal to 0.27%. Postoperative mortality resulted equal to 12.1% (significantly higher in group A pts -- 16.8%- than in group B pts --10.4%). The mortality of the 190 pts belonging to group A was higher in the pts which were presenting respectively 1, 2, 3 or more concomitant diseases. The progressive percentage increase in the number of interventions on elderly pts not only can be due to the demographic increase of old people, but it can also be linked to a change in the surgeon's attitude. At the present time, while elective geriatric surgery implies an acceptable mortality rate (5-8 %), emergency geriatric surgery has not notably modified the prognosis in the last decades and mortality has turned out to be still high (20-30%). We think that it will be possible to obtain better results through geriatric surgery only by reducing emergency interventions as much as possible. In order to do so, it will be important to insist on intervening before the illness, during its natural evolution, requires actions which cannot be postponed. This would lead to positive results not only in terms of mortality and morbidity, which are still considered as the main targets, but also as far as the period of the stay in hospital and costs are concerned.

[Surgical treatment of Crohn's disease complications. Our experience]

Thirty-five patients with Crohn's Disease (CD) were observed: 18 have been treated with medical therapy and 17 (48.6%) underwent to surgical treatment : 1) intolerance to the medical treatment in 5.9% (1 case); 2) local complications in 94.1% (16 cases: 6 stenosis, 2 occlusions, 3 abscesses, 3 fistulas, 1 perforation with peritonitis, 1 case toxic megacolon). The operations have been 19: resective interventions 14 (bowel and/or colon resections), conservative interventions 5. The mortality was 0, the morbidity 35,29%. The incidence of the recurrences in a follow up of 5 year was 42,9%. The Authors conclude that the surgery, indicated for the treatment of complications, can be resective surgery (perforating Crohn disease: fistulas, abscess) or conservative surgery (stenosing Crohn disease: stenosis). Recently the conservative intervention are proposed in the treatment of fistulas and abscesses too, but when the inflammation is mild and in patients that underwent to extensive intestinal resection with risk of short bowel syndrome.

[Role of aortofemoral bypass in the management of unilateral iliac occlusive disease. A follow-up study of 95 patients over a 25-year period]

BACKGROUND

To evaluate the results in a series of patients submitted to aortofemoral bypass due to an unilateral iliac occlusion.

METHODS

Retrospective follow-up study. A total of 95 patients underwent, between 1975 and 2000, aortofemoral bypass because of unilateral iliac occlusion. Most of them (71 patients) were claudicants, Fontaine stage II b, while 12 complained rest pain and 12 suffered ischemic ulcers. Mean follow-up was 128 months (min 2.5 - max 292).

RESULTS

Immediate success was obtained in 88 cases (92.6%), 7 patients were submitted to early redo with restored patency in 6 cases. One month global patency was gained in 98.9% (94 cases). The mean Ankle-brachial index (ABI) improvement was 0.35. At a mean follow-up of 128 months the cumulative patency was 90.8%. During the follow-up, 15 graft occlusions were observed, followed by 9 successful reoperations achieving a 5-year secondary patency of 92.1%. The contralateral iliac artery evolved toward an occlusion in 10 patients (10.5%) during a long time observation (104 months average).

CONCLUSIONS

The unilateral aortofemoral bypass confirmed an excellent long term outcome regarding effectiveness and graft related complications. The low contralateral occlusion rate, in our series, does not justify a more aggressive approach as first surgical option.

Octyl 2-cyanoacrylate tissue adhesive in experimental scleral buckling

PURPOSE

In this experimental study, a sutureless scleral buckling was performed by using a tissue adhesive glue to fixate a silicone band to the sclera. In fact, one of the major risks of traditional scleral buckling is accidental perforation of the bulb, which is more frequent when the sclera is extremely thin as it is in newborns or in eyes with high myopia or scleromalacia.

METHODS

An encircling band of silicone, which is generally anchored to the sclera itself, was sutured in 36 rabbit eyes to three small silastic patches that had been glued to the sclera, at the level of the equator, using octyl 2-cyanoacrylate tissue adhesive. In this manner the anchoring sutures passed through silicone and silicone. The band was tightened to produce buckling of the sclera and its ends were glued together using the same adhesive.

RESULTS

Examination of the eyes from 15 days to 6 months after surgery revealed that the buckle was stable, with no signs of slippage, in 33 eyes. In the remaining 3 (one examined after 15 days, 2 examined after 45 days), one of the three support patches had become detached but there was still no evidence of slippage.

CONCLUSIONS

The stability of the buckle up to six months after surgery suggests that this new adhesive might be used for sutureless surgery in certain types of retinal detachment, such as that associated with stage 4 ROP in which the encircling band has to be removed after several months.

Iris vascular changes in newborns of diabetic mothers

Routine ophthalmic examinations of 600 full-term neonates, including 54 born to mothers with insulin-dependent diabetes mellitus and 12 whose mothers had developed gestational diabetes, revealed significant tortuosity and dilatation of the iris vessels in over half of the infants born to diabetic mothers. Ninety percent of the newborns in the diabetic group presented hypoplasia of the iris stroma and pupil dynamics were altered in 85%. The vessel changes resolved spontaneously within 2 weeks after birth. These changes, which have also been observed in cocaine-intoxicated newborns, should raise the suspicion of adverse vascular effects in the fetus caused by maternal diabetes.

An ultrasonographic study of stage-5 retinopathy of prematurity

BACKGROUND

In preterm infants with severe retinopathy of prematurity, there is often a discrepancy between ophthalmic ultrasound findings and the ophthalmoscopic and/or intraoperative aspect of the eye.

METHODS

Six preterm infants (8 eyes) with stage-5 retinopathy of prematurity were examined with standardized ophthalmic echography (A and B scans) shortly before undergoing open-sky vitrectomies. Sonographic findings were evaluated according to four A-scan and four B-scan criteria used to diagnose retinal detachment in adults and compared to intraoperative findings.

RESULTS

Although the retinal detachments and vitreal proliferation found in all 8 eyes at surgery were almost identical, the sonographic aspects varied widely: 3/8 satisfied most of the criteria used in adults, 3/8 presented two criteria only and the remaining 2 were negative for all criteria used.

CONCLUSION

The variability in the ultrasonographic aspects of these preterm eyes may depend on the degree of maturity of the preterm retina at the time of examination, with more mature retinas presenting greater reflectivity and therefore greater visibility in the sonographic exam.

Oxygen-induced retinopathy in the newborn rat: morphological and immunohistological findings in animals treated with topical timolol maleate

Oxygen-induced retinopathy (OIR) similar to that seen in premature infants can be produced in newborn rats by exposure to 80% oxygen for the first 5 days of life, with subsequent recovery for 7 days in a room air environment. Previous studies have shown that the latter phase is associated with degeneration of retinal astrocytes. In the absence of astrocytes, the vascular endothelial growth factor (VEGF) is produced by the neurons of the inner retina. In this study, immunohistochemical methods were used to assess retinal expression of VEGF protein in ratlings exposed to the above protocol, with and without simultaneous treatment with topical timolol maleate. Intraocular pressure (IOP) and arterial pressure were measured. The severity of OIR was also evaluated in retinal flat mounts after India ink perfusion. The mean IOP was 8.25 +/- 0.32 mm Hg in untreated ratlings and 5.15 +/- 0.24 mm Hg in timolol-treated animals. OIR in retinas from the timolol group was less severe than that seen in untreated ratlings. VEGF protein expression was almost completely absent in the latter group. Retinas from timolol-treated animals expressed VEGF protein, though the level was inferior to that found in controls raised under room air conditions. In conclusion, these data seem to indicate that experimental OIR can be attenuated by a reduction of the IOP during and after oxygen supplementation. It is possible that these effects are due to improved ocular perfusion pressure, which would mitigate the hypoxic insult to the retina during the room air recovery period.

Octyl 2-cyanoacrylate in sutureless surgery of extraocular muscles: an experimental study in the rabbit model

BACKGROUND

Sutureless surgery for strabismus eliminates the risk of perforating the ocular bulb in patients with extremely thin sclerae. Thus far, however, the results obtained with tissue adhesives such as the cyanoacrylates instead of sutures have been less than satisfactory.

METHODS

A new adhesive, octyl 2-cyanoacrylate, was tested in 36 rabbit eyes in which the superior rectus was recessed 5 mm. In 36 other eyes the same operation was performed using 5/0 Vicryl sutures. Animals were killed 1, 3, 5, 15, 30 and 45 days after surgery. One eye from each animal was used for histopathological examination of the reinserted muscle and sclera, while the other was used in a tensiometric test to measure how many grams of weight were needed to detach the muscle from its new insertion site.

RESULTS

The tensile strength of the bond achieved with the cyanoacrylate adhesive was 94+/-12 g 1 day after surgery (vs 238+/-19 g in the suture group) and 520+/-24 g after 45 days (vs 576+/-27 g with sutures). No cases of slippage, muscle detachment, or local tissue reactions were observed in either group. There were no differences in histological findings between the eyes of the two groups.

CONCLUSIONS

Although further study will be necessary before this technique can be used in humans, our findings indicate that octyl 2-cyanoacrylate is superior to the cyanoacrylate adhesives used in the past in terms of adhesion and holding power; given its favorable toxicity profile, this product may offer interesting applications in the future.

Refractive errors and ocular motility disorders in preterm babies with and without retinopathy of prematurity

Ocular motility, refraction and visual acuity (VA) were evaluated at the age of 4 years in 136 preterm infants with gestational ages (GAs) at birth of less than 32 weeks. Group 1 (non-retinopathy of prematurity, ROP) included 87 children that had never developed ROP. Group 2 contained 19 children whose ROP had regressed spontaneously. Group 3 (cryo-ROP) was composed of 30 patients who had undergone cryotherapy for severe ROP. Strabismus was found in 13.9% of the total population. chi(2) analysis revealed that strabismus was significantly (p < 0.01) associated with prematurity (i.e. GA <29 weeks), ROP and cryotherapy. Myopia of more than 3 dpt was significantly (p < 0.001) more common in the cryo-ROP infants than in the regressed-ROP and non-ROP groups. The distribution of hypermetropia was similar in all three groups. VA was measured with the E chart. Of the 272 eyes examined, 251 (92.3%) displayed VA of more than 20/25. The majority of these eyes were from the non-ROP group (65.4%), 15.3% had regressed ROP and 21.1% belonged to the cryo-ROP group. Fifteen eyes (8 non-ROP, 3 regressed ROP and 4 cryo-ROP) presented VAs between 20/25 and 20/60. VA of less then 20/60 was found in 6 eyes (2 non-ROP, 1 regressed ROP, 3 cryo-ROP). Cryotherapy did not appear to preclude the development of good VA.

Intraocular pressure in premature babies in the first month of life

PURPOSE

The purpose of this work was to study the values of intraocular pressure (IOP) in premature babies during the first month of life.

METHODS

Using a hand-held applanation tonometer, IOP was measured in 40 eyes of 20 preterm infants (gestational age ranging from 26 to 32 weeks) shortly after birth and at weekly intervals for the first month of life.

RESULTS

IOP values in preterm infants ranged from 7.6 to 18.3 mm Hg. The mean IOP decreased during the study period from 13.25+/-2.86 mm Hg to 10.96+/-2.01 mm Hg (P< .001).

CONCLUSIONS

Although the values of IOP found in this study are by no means within the range that is considered to be pathologic for newborns, the possible lack of the decreasing tendency of IOP observed during the first month of life could have, in a given case, some clinical implications. Because systemic blood pressure in preterm infants is already quite low, even a moderately elevated IOP during the first weeks of life might in some cases result in a significant reduction of the ocular perfusion pressure. The latter might play a contributory role in the development of retinopathy of prematurity by decreasing the blood supply to the peripheral retinal tissues.

An MTP inhibitor that normalizes atherogenic lipoprotein levels in WHHL rabbits

Patients with abetalipoproteinemia, a disease caused by defects in the microsomal triglyceride transfer protein (MTP), do not produce apolipoprotein B-containing lipoproteins. It was hypothesized that small molecule inhibitors of MTP would prevent the assembly and secretion of these atherogenic lipoproteins. To test this hypothesis, two compounds identified in a high-throughput screen for MTP inhibitors were used to direct the synthesis of a highly potent MTP inhibitor. This molecule (compound 9) inhibited the production of lipoprotein particles in rodent models and normalized plasma lipoprotein levels in Watanabe-heritable hyperlipidemic (WHHL) rabbits, which are a model for human homozygous familial hypercholesterolemia. These results suggest that compound 9, or derivatives thereof, has potential applications for the therapeutic lowering of atherogenic lipoprotein levels in humans.