Waveguide scattering antennas made by direct laser writing in bulk glass for spectrometry applications in the short-wave IR

A buried straight waveguide perturbed periodically by six antennas composed of submicronic cylinder voids is entirely fabricated using ultrafast laser photoinscription. The light scattered from each antenna is oriented vertically and is detected by a short-wave IR camera bonded to the surface of the glass with no relay optics. The response of each antenna is analyzed using a wavelength tunable laser source and compared to simulated responses verifying the behavior of the antenna. These results show the good potential of the direct laser writing technique to realize monolithic embedded detectors by combining complex optical functions within a 3D design. A wavelength meter application with a spectral resolution of 150 pm is proposed to demonstrate this combination.

Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience

Objective

The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation.

Methods

This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI).

Results

NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome.

Conclusion

SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them

INTRODUCTION AND AIMS

Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation.

MATERIALS AND METHODS

A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment.

RESULTS

The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs.

CONCLUSIONS

A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Efficient point-by-point Bragg gratings fabricated in embedded laser-written silica waveguides using ultrafast Bessel beams

We demonstrate highly efficient Bragg gratings written point-by-point by sequential single-pulse ultrashort Bessel laser beams in laser photoinscribed single-mode waveguides in bulk fused silica. The use of chirped non-diffractive Bessel beams determines a strong Bragg resonance in a weak-to-strong transitional regime, augmenting to a record value of 40  dB/cm at 1550 nm in the third order. The Bessel-induced refractive index modulation is negative and localized to sub-micrometer (200 nm) transverse scales. The strong light confinement in Bessel beams ensuring uniform one-dimensional void conditions thus allows for enhanced precision in the Bragg grating waveguide design. We demonstrate flexible fabrication of multiplexed waveguide gratings for multiple and tunable spectral resonances.

Near infrared spectro-interferometer using femtosecond laser written GLS embedded waveguides and nano-scatterers

Guided optics spectrometers can be essentially classified into two main families: based on Fourier transform or dispersion. In the first case, an interferogram generated inside an optical waveguide and containing the spectral information is sampled using spatially distributed nanodetectors. These scatter quasi-non-perturbingly light into the detector that is in contact with the waveguide, helping to reconstruct the stationary wave. A dedicated FFT processing is needed in order to recover the spectrum with high resolution but limited spectral range. Another way is to directly disperse the different wavelengths to different pixels, either introducing differential optical path in the same propagation plane (multiple Mach-Zehnder interferometers or Arrayed Waveguides Gratings), or using a periodic structure to perpendicularly extract the optical signal confined in a waveguide (photonic crystals or surface gratings), and by means of a relay optics, generate the spectrum on the Fourier plane of the lens, where the detector is placed. Following this second approach, we present a laser-fabricated high-resolution compact dispersive spectro-interferometer (R>2500, 30nm spectral range at λ = 1560nm), using four parallel waveguides that can provide up to three non-redundant interferometric combinations. The device is based on guided optics technology embedded in bulk optical glass. Ultrafast laser photoinscription with 3D laser index engineering in bulk chalcogenide Gallium Lanthanium Sulfide glass is utilized to fabricate large mode area waveguides in an evanescently-coupled hexagonal multicore array configuration, followed by subsequent realization of nanoscaled scattering centers via one dimensional nanovoids across the waveguide, written in a non-diffractive Bessel configuration. A simple relay optics, with limited optical aberrations, reimages the diffracted signal on the focal plane array, leading to a robust, easy to align instrument.

Low-power-threshold photonic saturable absorber in nonlinear chalcogenide glass

We experimentally demonstrate controllable nonlinear modulation of optical guiding in ultrafast laser-written evanescently coupled waveguide arrays in bulk gallium lanthanum sulfide chalcogenide glass. The intensity-dependent response is validated by simulating light propagation in waveguide arrays with instantaneous Kerr nonlinearity using a discrete-continuous spatiotemporal unidirectional Maxwell equation model. The intensity-driven modulation of transmission in multicore structures acts as a potential saturable absorber at kilowatt threshold levels.

Large-mode-area infrared guiding in ultrafast laser written waveguides in sulfur-based chalcogenide glasses

Current demands in astrophotonics impose advancing optical functions in infrared domains within embedded refractive index designs. We demonstrate concepts for large-mode-area guiding in ultrafast laser photowritten waveguides in bulk Sulfur-based chalcogenide glasses. If positive index contrasts are weak in As2S3, Ge doping increases the matrix rigidity and allows for high contrast (10(-3)) positive refractive index changes. Guiding with variable mode diameter and large-mode-area light transport is demonstrated up to 10 μm spectral domain using transverse slit-shaped and evanescently-coupled multicore traces.

A-1012G promoter polymorphism of vitamin D receptor gene is associated with psoriasis risk and lower allele-specific expression

Psoriasis is caused by a combination of genetic, immunologic, and environmental factors. The vitamin D receptor (VDR) is involved in antiproliferative and prodifferentiation pathways in keratinocytes and exerts immunosuppressive effects. We aimed to investigate possible associations between VDR polymorphisms and psoriasis susceptibility and to evaluate functional effects of potential psoriasis-associated polymorphisms. We genotyped 108 patients with psoriasis and 268 healthy controls at 5 VDR polymorphisms (A-1012G, FokI, BsmI, ApaI, and TaqI) by TaqMan allelic-discrimination real-time polymerase chain reaction. We found a significant increased overall risk of psoriasis for the VDR A-1012G promoter polymorphism (odds ratio [OR]=2.43, 95% confidence interval [CI]: 1.15-5.13; p=0.05). A significant higher frequency (p=0.035) of the A allele was found in psoriatic cases compared with controls. In a case-case analysis, a statistically significant association between A-1012G and family history emerged (p=0.033). Furthermore, a significant association of A-1012G risk genotypes with a lower expression of VDR mRNA emerged (p=0.0028). Our data show that VDR promoter A-1012G polymorphism is associated with psoriasis risk and suggest that this polymorphism may modulate psoriasis risk by affecting VDR expression.

Large mode area waveguides with polarization functions by volume ultrafast laser photoinscription of fused silica

We present optical designs allowing large mode area light guiding by ultrafast laser photoinscription of bulk fused silica. If usual concepts are based on large core and depressed cladding, evanescently coupled multicore waveguides with coherent mode superposition can be effective solutions, where the introduction of nanostructured defects determines additional polarization functions.

Association of low-penetrance alleles with male breast cancer risk and clinicopathological characteristics: results from a multicenter study in Italy

It is well-known that male breast cancer (MBC) susceptibility is mainly due to high-penetrance BRCA1/2 mutations. Here, we investigated whether common low-penetrance breast cancer (BC) susceptibility alleles may influence MBC risk in Italian population and whether variant alleles may be associated with specific clinicopathological features of MBCs. In the frame of the Italian Multicenter Study on MBC, we genotyped 413 MBCs and 745 age-matched male controls at 9 SNPs annotating known BC susceptibility loci. By multivariate logistic regression models, we found a significant increased MBC risk for 3 SNPs, in particular, with codominant models, for rs2046210/ESR1 (OR = 1.71; 95 % CI: 1.43-2.05; p = 0.0001), rs3803662/TOX3 (OR = 1.59; 95 % CI: 1.32-1.92; p = 0.0001), and rs2981582/FGFR2 (OR = 1.26; 95 % CI: 1.05-1.50; p = 0.013). Furthermore, we showed that the prevalence of the risk genotypes of ESR1 tended to be higher in ER- tumors (p = 0.062). In a case-case multivariate analysis, a statistically significant association between ESR1 and ER- tumors was found (OR = 1.88; 95 % CI: 1.03-3.49; p = 0.039). Overall, our data, based on a large and well-characterized MBC series, support the hypothesis that common low-penetrance BC susceptibility alleles play a role in MBC susceptibility and, interestingly, indicate that ESR1 is associated with a distinct tumor subtype defined by ER-negative status.

A multicenter phase II randomized trial of docetaxel/gemcitabine versus docetaxel/capecitabine as first-line treatment for advanced breast cancer: a Gruppo Oncologico Italia Meridionale study

OBJECTIVE

To evaluate two docetaxel-based regimens as first-line treatment in advanced breast cancer patients.

METHODS

Patients were randomly assigned to docetaxel/gemcitabine (arm A: docetaxel 75 mg/m(2) on day 1, gemcitabine 1,000 mg/m(2) on days 1 and 8) or docetaxel/capecitabine (arm B: docetaxel 75 mg/m(2) on day 1, capecitabine 1,250 mg/m(2) twice daily on days 1-14); both chemotherapy regimens were repeated every 21 days. The primary objective of the study was to evaluate the response rate.

RESULTS

Seventy-two patients were enrolled (36 each in arms A and B). Responses according to intention-to-treat analysis were as follows: arm A, 41.7% [95% confidence interval (CI) 25.6-57.8]; arm B, 38.9% (95% CI 23-54.8). Median progression-free survival was 10.9 months (95% CI 8.1-13.7) in arm A and 10 months (95% CI 8.8-11.2) in arm B. Overall survival was 26 months (95% CI 22.0-30.0) in arm A and 28 months (95% CI 23.4-32.6) in arm B. Both treatments were well tolerated; myelosuppression was the dose-limiting toxicity, with grade 3-4 neutropenia in 13.8 and 19.4% of the patients in arms A and B, respectively. No relevant differences in other toxicities were observed in the two arms, except for diarrhea (13.9%) and hand-foot syndrome (11.1%), which occurred only in arm B.

CONCLUSIONS

Both regimens were active and well tolerated in advanced breast cancer.

Diet assessment and the screening for osteoporosis: a survey in a healthy menopause population

AIM

The aim of this study was to investigate about diet assessment in the screening for osteoporosis.

METHODS

In 1,441 women (group A, mean age 53.5 years, mean time from menopause 3.92(+/-4.33)] the number of daily/weekly servings/cups of different foods has been collected. In 71 women (group B, mean age 59 years, mean time from menopause 6 years) diet was assessed through a detailed questionnaire. Demographic and clinical data and dietary habits were related to bone mineral density (BMD) values, using Student t-test and the chi2 test.

RESULTS

Group A: borderline/reduced BMD 40%, the percentage increasing with age and the duration of menopause (P<0.001). BMI within normal range 56.28%. BMD values were positively associated with Body Mass Index (BMI, P<0.001), education level (P<0.005), job (P<0.01), oral contraceptives use (P<0.001), negatively with family history of osteoporosis (P<0.05). BMD values showed a positive relation with the number of eggs per week (P<0.05), positive not significant trends were observed with dairy products, vegetables, red and white meat intake. A low/reduced BMD was related to low calcium food intake in less than 50% of the women. Group B: borderline/reduced BMD 55%; BMD showed positive trends, not significant, with daily calcium intake, BMI, physical exercise. Estimated calcium intake less than 700 mg/day was found in 33% of the sample.

CONCLUSION

Diet assessment is not useful in the screening for osteoporosis. In women with borderline or reduced BMD, diet assessment helps to detect those at low calcium intake who need calcium supplementation, alone or in combination with other treatments.

Coherent and incoherent radial THz radiation emission from femtosecond filaments in air

We show that the THz radiation emitted in the radial direction by a femtosecond filament created in air is linearly polarized and coherent. By applying an electric field along the filament axis this THz radiation is strongly enhanced and becomes incoherent and not polarized.

Association between the BRCA2 N372H variant and male breast cancer risk: a population-based case-control study in Tuscany, Central Italy

BACKGROUND

Male breast cancer (MBC) is a rare disease and little is known about its aetiology. Germ-line mutations of BRCA2 and, at lower frequency, of BRCA1 are implicated in a relatively small proportion of MBC cases. Common polymorphic variants in BRCA1 and BRCA2 genes may represent breast cancer (BC) susceptibility alleles and could be associated with a modestly increased risk of MBC at population level. Considering the relevant role of BRCA2 in MBC, we investigated whether the BRCA2 N372H variant, representing the only common non-synonymous polymorphism in BRCA2, might modulate the risk of BC in male populations.

METHODS

A case-control study was performed comparing a population-based series of 99 MBC cases, characterized for BRCA1 and BRCA2 mutations, with 261 male population controls, all residing in Tuscany, Central Italy. All MBC cases and controls were genotyped for the BRCA2 N372H allele by TaqMan allelic discrimination assays. To evaluate the genotype specific risk of the BRCA2 N372H variant, MBC carriers of germ-line BRCA1/2 mutations were excluded from the analyses.

RESULTS

No association emerged in univariate and age-adjusted analyses. Age-specific analyses suggested an increased risk for the HH homozygous genotype in subjects younger than 60 years. A statistically significant interaction emerged between this genotype and age (p = 0.032). When analyses were restricted to MBC cases enrolled in the first 4 years following diagnosis, a recessive model showed a significantly increased risk of MBC in HH subjects younger than 60 years (OR = 5.63; 95% CI = 1.70;18.61).

CONCLUSION

Overall, our findings, although based on a relatively small series, suggest that the BRCA2 HH homozygous genotype might be positively associated with an increased risk of MBC in men younger than 60 years.

Foam sclerotherapy with Fibrovein (STD) for the treatment of hemorrhoids, using a flexible endoscope

AIM

This case study was designed to evaluate foam sclerotherapy of hemorrhoidal disease using a flexible endoscope.

METHODS

We treated 250 patients of grade II-IV hemorrhoids with Sotradecol foam. To obtain sclerosing foam, we used a special foam kit, which produced a stable and standardized sclerosing foam. The quantity of foam injected into the hemorrhoids was 1 to 2 cc with a total of 6 cc for each session. Variables to assess efficacy of treatment were: pain, bleeding and prolapse.

RESULTS

Generally, bleeding and hemorrhoidal prolapse were resolved with at most two sclerotherapy sessions. However, pain usually had disappeared after the first session. No complications such as mucosal erosions at the foam injection site, formation of abscesses, bacteraemia, or fistulas occurred.

CONCLUSION

The advantages of sclerosing foam are its adhesiveness and compactness, its greater volume, its increased spasm generation, and the greater sclerosing power. Sclero-therapy with foam makes it possible to reach optimal results with small amounts of sclerosing agent and fewer risks of complications.

Conical forward THz emission from femtosecond-laser-beam filamentation in air

We attribute a strong forward directed THz emission from femtosecond laser filaments in air to a transition-Cherenkov emission from the plasma space charge moving behind the ionization front at light velocity. Distant targets can be easily irradiated by this new source of THz radiation.

Amplification of femtosecond laser filaments in Ti:sapphire

Femtosecond laser filamentation is studied in a broadband amplifying medium, sapphire doped with electronically excited Ti ions. Evidence for fluence amplification of self-guided pulses, increase of filamentation length, as well as a lowering of the input laser power necessary for filamentation is reported.

A complex pattern of mutations and abnormal splicing of Smad4 is present in thyroid tumours

Sensitivity to transforming growth factor-beta is impaired in thyroid tumours. Similar to Mad -- Mother Against Decapentaplegic-(Smad)4 is frequently altered in cancers, but its involvement in this system is unknown. We analysed 56 thyroid tumours of various histotypes for Smad4 mutations by PCR-SSCP and sequencing, linking them to Smad4 reactivity as examined by immunohistochemistry (IHC), and 29 of them also for abnormalities in RNA expression due to alternative splicing. In all, 15/56 cases (27%), both benign and malignant lesions, harbour alterations of Smad4 coding sequence. We found several novel intragenic mutations (13 missense, two silent, one frameshift and one large insertion-deletion), with high incidence in the linker region. A subset of mutated tumours failed to express Smad4 protein by IHC. We have also detected four alternatively spliced tumour-associated Smad4 isoforms, lacking portions of the linker region, and three more due to unreported internal exon-exon rearrangements. Smad4 is both frequently mutated and deregulated by aberrant splicing in thyroid tumours and these alterations may contribute as an early event to thyroid tumorigenesis.

Different Expressivity of BRCA1 and BRCA2: Analysis of 179 Italian Pedigrees with Identified Mutation

Mutations in BRCA1 and BRCA2 show different expressivity with respect to cancer risk, and allelic heterogeneity may be present in both genes. We collected 179 pedigrees with identified germline mutation (104 BRCA1 and 75 BRCA2), ascertained in six collaborating centers of the Italian Consortium for Hereditary Breast and Ovarian Cancer. Significant heterogeneity was detected for several variables, and a logistic regression model including age of diagnosis in the proband, presence of ovarian cancer in the family, presence of prostate or pancreatic cancer in the family, and presence of male breast cancer in the family proved to be effective in predicting the presence of a mutation in a gene rather than the other. Excess of familial aggregation of both breast and ovarian cancer was observed in both genes. Proportion of ovarian cancer was increased in the 5' portion of BRCA1, and presence of prostate or pancreatic cancer in a family was correlated with presence of ovarian cancer in BRCA2.

Phase I/II study of gemcitabine plus mitoxantrone as salvage chemotherapy in metastatic breast cancer

The purpose of this study was to determine the maximum-tolerated dose of gemcitabine plus mitoxantrone in women with metastatic breast cancer (MBC) and to evaluate activity and toxicity of this combination in a phase II trial. Sixty-three patients with MBC, previously treated with chemotherapy including anthracycline and/or taxanes, were treated with mitoxantrone 10 or 12 mg m(-2) intravenously on day 1 plus gemcitabine in escalating doses from 600 to 1200 mg m(-2) intravenously on days 1 and 8, every 3 weeks. In phase I, on 23 patients entered on study, dose-limiting toxicity occurred at the dosage of 1200 mg m(-2) gemcitabine and 10 mg m(-2) mitoxantrone, with three out of five patients developing grade 4 neutropenia. In phase II, with gemcitabine administered at 1000 mg m(-2) and mitoxantrone at 10 mg m(-2), 12 (30%) out of 40 assessable patients responded, even if no complete response was obtained. Moreover, stable disease was observed in eight (20%) patients. The median time to treatment failure was 22 weeks (range, 2-33), and median survival was 42 weeks (range, 2-92). Grade 3 and 4 neutropenia were observed in 12 (30%) and one (2.5%) cases respectively; grade 3 thrombocytopenia was observed in two patients (5%), grade 2 mucositis in two patients (5%), grade 3 anaemia in two patients (5%), grade 3 alopecia in one patient (2.5%) and asymptomatic cardiotoxicity in three patients (8%), respectively. In conclusion, the doses of 10 mg m(-2) (day 1) for mitoxantrone and 1000 mg m(-2) for gemcitabine (days 1-8) every 3 weeks resulted active and safe in MBC. Further investigations in less heavily pretreated patients are warranted.

[Expression of steroid receptors and DNA synthesis in male breast cancer]

Using a double-labeling immunocytochemical-autoradiographic assay we studied 18 male breast carcinomas to evaluate the cell kinetic and receptor status in neoplastic cells during S-Phase and to detect possible differences with respect to 21 female breast cancers, from a previously, published study. In male breast cancer, the tumor receptor content and ER/PgR expression in neoplastic cells during S-Phase was higher (p = 0.01) than that in corresponding female tumor while tumoral cell proliferation was lower, but not significantly. In the previous reported study on female breast cancer we demonstrated that proliferative activity was higher in receptor negative cell population both for ER and PgR. Conversely, in male tumor, that difference was only present in relation to the expression of PgR: in fact, the proliferative activity was higher in PgR negative than in PgR positive cells (Anova Test: p = 0.04) while no difference was evidenced between ER negative versus ER positive cells. Moreover, the arrest of DNA synthesis, expressed as percentage of cells without 3H-Tdr labeling, was not related to either the ER or PgR expression, while in female breast cancer it was higher in PgR positive than ER positive cell population. Our data confirmed differences between males and females regarding the receptor status and cell cycle S-Phase in breast cancer. The poorer prognosis of the male breast carcinoma might be related to ineffective therapies which do not consider these differences in the biological profile of the male tumor. The Authors indicate that prognostic and predictive tissutal markers, detected by immunocytochemical methods and useful for therapeutic programming in the female breast cancer have a different significance in the male breast cancer and stress the need for different therapeutic strategies specific for male breast cancer.

BRCA1 and BRCA2 mutation status and tumor characteristics in male breast cancer: a population-based study in Italy

To investigate at the population level the impact of BRCA1/BRCA2 gene alterations in male breast cancer, we analyzed a population-based series of 25 male breast cancer cases from Florence, Central Italy. We combined mutational screening with the study of germ-line allele transcript levels and of tumor-associated losses of heterozygosity. Screening by protein truncation test and single-strand conformational polymorphism assay, followed by sequencing, revealed 4 pathogenetic mutations (4 of 25 = 16%; 95% confidence interval, 5-37%), 1 in BRCA1 and 3 in BRCA2, including mutations recurring in Central Italy (BRCA1 3345delAG and BRCA2 6696delTC). The a priori probability of carrying a mutation, estimated using BRCAPRO software, showed a good agreement between expected and observed mutations (14% versus 16%). A 7-fold association between germ-line mutations and family history of breast-ovarian cancer emerged. To investigate associations between BRCA1/BRCA2 status and clinicopathological characteristics, we analyzed the histopathological and immunophenotypic parameters of the tumors. A significant association emerged between mutation carrier status and high histological grade (P = 0.02). Furthermore, one BRCA2 carrier was affected with Paget's disease, an extremely rare male breast cancer histotype. Overall, BRCA1/2 mutations were observed to be strongly associated with positive c-erbB-2 immunostaining (P = 0.004). To evaluate germ-line allele expression, we used primer extension assays targeting frequent BRCA1 and BRCA2 polymorphisms. A BRCA2 allele transcript imbalance was found in one of four heterozygotes tested, all of them negative for germ-line mutations. BRCA1 transcript imbalances were not detected in nine heterozygotes analyzed. Losses of heterozygosity at one or more of nine loci in the BRCA2 region were found in 8 of 22 tumors tested. Interestingly, a case that was negative for BRCA1/BRCA2 germ-line mutations and that had a priori mutation probability <10% showed loss of heterozygosity at all three of the intragenic BRCA2 markers analyzed, which could be related to a somatic involvement of BRCA2. No losses of heterozygosity were detected at BRCA1. In conclusion, constitutional BRCA1/BRCA2 mutations accounted for 16% of the male breast cancer cases in this area of Central Italy. The detection of a BRCA2 germ-line transcript imbalance and of a somatic loss of BRCA2 among the cases that resulted negative for germ-line mutations suggests a role of this gene more relevant than indicated by conventional mutational analysis. A distinct pattern of characteristics indicative of aggressive behavior, including high-grade and c-erbB-2 expression, was evident in tumors from germ-line BRCA2 mutation carriers. This suggests that phenotypic characteristics may contribute to the identification of hereditary BRCA2-related male breast cancers and that these tumors might share a unique molecular pathway of cancer progression.

Subcellular localization of the BRCA1 gene product in mitotic cells

The product of the hereditary breast cancer susceptibility gene BRCA1 is a multifunctional protein involved in the maintenance of genomic integrity, in transcriptional coactivation, and in the control of cell growth. BRCA1-deficient cells manifest chromosomal instability. During mitosis, BRCA1 is known to interact with gamma-tubulin in the centrosomes, key elements of the mitotic spindle. Using confocal microscopy and immunogold electron microscopy, we investigated the distribution of endogenous BRCA1 relative to mitotic spindle markers in breast cancer cells. By confocal analysis, BRCA1 and beta-tubulin colocalized to microtubules of the mitotic spindle and to the centrosomes. Immunogold electron microscopy confirmed these results and further revealed that BRCA1 and alpha-tubulin codistributed to the walls of the centrioles and to pericentriolar fibers at centrosomes. During chromatid segregation, codistribution was also detected along individual spindle microtubules and at sites of insertion of microtubules on chromosomes. At cytokinesis, BRCA1 and alpha-tubulin codistributed to the midbody. Coimmunoprecipitation supported the association of full-length BRCA1 with alpha- and beta-tubulin. These results are consistent with an involvement of BRCA1 in the dynamics of the mitotic spindle and in the segregation of duplicated chromosomes.

p53 expression is decreased in primary breast carcinomas with microsatellite instability

p53 and p185 expression in primary breast cancer with microsatellite instability (MSI) is still largely unexplored. To investigate the relationship between these oncoproteins and the pathways of genomic instability, we examined 52 primary invasive breast cancers stratified by the presence and absence of MSI. We determined the status of eight microsatellite loci using radioactive and silver staining methods, and evaluated the immunohistochemical expression of p53 and p185 in a consecutive series of Italian cancer patients characterized by clinical-pathological and biological parameters. Nineteen cases (36.5%) were MSI-positive in at least two loci. p53 was expressed in 15 cases (28.8%) and p185 in eight (15.4%). MSI-positive tumors were inversely correlated with p53 expression (p = 0.0007); in addition, the percent of p53-expressing cells decreased as the number of MSI-positive loci increased. MSI-positive tumors were correlated with a larger tumor size (p = 0.04), lymph-node metastasis (p = 0.001), and advanced clinical stage (p = 0.0006). These data demonstrate the existence of two subsets of primary breast cancers: one characterized by MSI, the other by p53 expression. MSI-positive patients had a more advanced and/or aggressive disease.

Red meat, family history, and increased risk of gastric cancer with microsatellite instability

Microsatellite instability (MSI) occurs frequently in sporadic gastric cancer (GC) and may define a distinctive molecular pathway of carcinogenesis. We evaluated the role of dietary risk factors in GC according to MSI status. A large series of 382 GC cases and 561 controls were originally identified in a population-based case-control study carried out in the high-risk area around Florence, Italy; 126 GC patients were typed for MSI status. A MSI+ phenotype was detected in 43 of 126 cases (34.1%), whereas 83 cases were classified as MSI-. A multinomial logistic regression model was used to compare the two subgroups of GC classified according to MSI status in the same analysis, with all of the available population controls. A case-case approach was also used. The risk of MSI+ tumors was positively associated with high consumption of red meat and meat sauce and negatively associated with consumption of white meat. A positive association was also seen with total protein and nitrite intake, whereas no relation was found with micronutrient intake. Risk was especially high among subjects reporting both a positive GC family history and a high consumption of red meat (odds ratio, 25.7; 95% confidence interval, 6.4-102.8). For MSI- tumors, a significant protective effect was associated with frequent consumption of citrus and other fresh fruit, garlic, legumes, vegetables, and olive oil and with high intake of beta-carotene and other antioxidants and sugar, whereas positive associations were seen with protein and sodium intake. In summary, a specific dietary pattern emerged for MSI+ gastric tumors, suggesting that factors related to red meat consumption are involved in this pathway, particularly among individuals with a positive family history. In contrast, the risk of MSI- tumors was strongly reduced by the frequent consumption of fresh fruit and vegetables.

Routine surveillance endomyocardial biopsy continues to detect significant rejection late after heart transplantation

BACKGROUND

The need for continued surveillance endomyocardial biopsies beyond the first year after cardiac transplantation is controversial. We evaluated the incidence of rejections requiring treatment (International Society Heart and Lung Transplantation grade 3A or greater) in patients 5 years or more after heart transplantation.

METHODS

We conducted a retrospective chart review of all patients who underwent at least 1 endomyocardial biopsy at our center 5 years or more after heart transplantation.

RESULTS

A total of 461 biopsies were performed in 77 patients 5 or more years after heart transplantation. Nine episodes of grade 3A or greater rejection were identified in 8 of 77 patients (10%). During the first year, 7.6% of biopsies were grade 3A or greater. Grade 3A rejection occurred in approximately 3.5% to 4% of biopsies during years 2 to 7. The overall incidence of procedural related complications at our institution was < 0.5%.

CONCLUSION

Endomyocardial biopsies continue to detect clinically significant rejection beyond 5 years after cardiac transplantation. The overall incidence of procedural related complications requiring treatment was low and none was life threatening. The absence of early rejection does not predict freedom from late rejection. Therefore, we continue to recommend surveillance biopsies in cardiac transplant recipients late after transplantation.

Angiographic and clinical follow-up of percutaneous revascularization for transplant coronary artery disease

BACKGROUND

There are limited data on the use of percutaneous revascularization techniques for transplant coronary artery disease (CAD).

METHODS

Medical records and angiographic results for cardiac transplant patients undergoing percutaneous revascularization at Emory University Hospital were reviewed. Procedural results, results of angiography 4Eth 6 months after intervention, and clinical follow-up were recorded.

RESULTS

Nineteen patients underwent 51 interventions. Thirty-eight lesions (75%) were de novo and 13 (25%) were restenotic. All patients had hypertension, 37% had diabetes, 79% had elevated lipid levels, and 53% had at least one episode of moderate to severe allograft rejection (grade 3A or greater). The primary procedural success rate was 100% with no major complications. Six-month restenosis rate (defined as > 50%) was 49%. At 23+/-17 months follow-up, 6 patients were dead or retransplanted (31%). Thirteen patients were alive without retransplantation (9 New York Heart Association class I, 3 class II, 1 class III).

CONCLUSION

Percutaneous revascularization is safe and has a high initial procedural success rate in patients with transplant CAD. However, the restenosis rate in this population remains higher than reported for atherosclerotic coronary disease and the long-term prognosis remains poor.

Effectiveness of infection control measures in controlling a nosocomial outbreak of multidrug-resistant tuberculosis among HIV patients in Italy

SETTING

Between October 1992 and February 1994, 33 cases of multidrug-resistant tuberculosis (MDR-TB) were diagnosed among patients infected by the human immunodeficiency virus (HIV) and hospitalised in an HIV ward in Milan, Italy. This outbreak was part of a much larger outbreak, begun in another hospital and probably transferred through a patient.

OBJECTIVE

To evaluate risk factors for transmission and the effectiveness of infection control measures.

DESIGN

1) Active follow-up of exposed patients, 2) cohort study among HIV-infected patients exposed to MDR-TB cases before and after the implementation of control measures, 3) screening of close contacts of MDR-TB cases, and 4) molecular typing by restriction fragment length polymorphism (RFLP) analysis.

RESULTS

The risk of MDR-TB was higher in patients with lower CD4+ lymphocyte percentages and longer duration of exposure. No difference in the daily risk was observed for in-patients vs day-hospital patients or by room distance from an infectious case. Of the 90 patients exposed before the implementation of infection control measures (i.e., October 1992-June 1993) 26 (28.9%) developed MDR-TB, whereas none of the 44 patients exclusively exposed after implementation developed MDR-TB, despite the continuing presence of infectious MDR-TB cases in the ward.

CONCLUSION

Simple control measures were effective in significantly reducing nosocomial transmission among patients.

BRCA1 and BRCA2 mutations in central and southern Italian patients

Protein truncation test (PTT) and single-strand conformation polymorphism (SSCP) assay were used to scan the BRCA1 and BRCA2 genes in 136 unrelated Italian breast/ovarian cancer patients. In the sample tested, BRCA1 and BRCA2 equally contributed to site-specific breast cancer patients who reported one to two breast cancer-affected first-/ second-degree relative(s) or who were diagnosed before age 40 years in the absence of a family history of breast/ovarian cancer. BRCA1 and BRCA2 mutations were mostly found in patients with disease diagnosis before and after age 50 years, respectively. Moreover, in cases with familial clustering of site-specific breast cancer, BRCA1 mostly accounted for tumours diagnosed before age 40 years and BRCA2 for tumours diagnosed after age 50 years. The BRCA1 and BRCA2 mutation spectrum was consistent with a lack of significant founder effects in the sample of patients studied.

Mutations at coding mononucleotide repeats in gastric cancer with the microsatellite mutator phenotype

We analysed 50 gastric carcinomas (GCs) to verify whether mutations at coding repeats were associated with microsatellite instability (MSI). The tumors included: ten cases with no MSI, 14 cases with MSI = 1 locus, 13 cases with MSI = two loci and 13 cases with MSI > or = 3 loci. We investigated coding repeats within the TGF-beta RII, IGFIIR, BAX, hMSH6, hMSH3 and BRCA2 genes. The TGF-beta RII, IGFIIR, BAX, hMSH6 and hMSH3 repeats were altered in 11 (22%), five (10%), four (8%), 16 (32%) and five (10%) cases respectively. Mutations occurred only in MSI-positive (MSI+) tumors and correlated with increasing MSI levels. No alterations of the BRCA2 repeat were found. Mutations in genes other than hMSH6 were strongly associated to hMSH6 mutations, suggesting a key role of this gene. The non-coding BAT-26 and E-Cadherin 3' UTR poly(A)8/(T)15 repeats were analysed in 44 of the 50 cases. Novel tumor-associated alleles were observed only in MSI-positive GCs and were in most cases associated with mutations at coding repeats. Further investigations with BAT-40 confirmed that four cases manifested mononucleotide repeat alterations restricted to hMSH6 and one case to TGF-beta RII. A subset of tumors with MSI at two or more dinucleotide loci resulted negative for mutations at coding and non-coding mononucleotide repeats.

Microsatellite instability in gastric cancer is associated with tumor location and family history in a high-risk population from Tuscany

We studied the presence of microsatellite instability (MSI) in a series of 108 gastric cancers (GCs) previously identified in an epidemiological study carried out in a high-risk area around Florence. To investigate associations between MSI and GC family history, 34 cases (31.5%) who had a GC-affected first-degree relative were included in the series. A family history positive for colorectal cancer was reported quite rarely (5.6%). The analysis of 6 microsatellite loci in DNA from paired normal tissue and tumor samples microdissected from paraffin-embedded specimens revealed varying degrees of instability: 56 cases (51.8%) did not show instability at any of the 6 loci; 19 (17.6%) showed instability at 1 locus; 16 (14.8%) showed instability at 2 loci; 11 (10.2%) showed instability at 3 loci; 4 (3.7%) showed instability at 4 loci; and 2 (1.9%) showed instability at 5 loci. The replication error-positive (RER+) phenotype, defined as the presence of MSI at 2 or more loci, had a frequency of 30.6% (33 of 108) and tended to be positively associated with female sex, intestinal histological type, advanced tumor stage, vascular invasion, positive GC family history, and blood group of A type. No correlation emerged between age at diagnosis and RER+ phenotype, whereas a significant association with the RER+ phenotype was shown by the antral location. A multivariate analysis adjusting for a selected group of potential confounding factors confirmed the strong association of the RER+ phenotype with the antral location (P = 0.001) and with a positive GC family history (P < 0.05). Survival analyses at 5 and 8 years showed no difference between RER+ and RER- patients, even when corrected for stage distribution. By the microdissection technique, we also used microsatellite allele patterns to investigate intratumoral heterogeneity and genetic relationships between tumors and adjacent dysplasia and/or intestinal metaplasia. Areas of metaplasia and dysplasia demonstrated MSI only in cases with MSI-positive tumors. In MSI-positive tumors, there was consistent evidence of intratumoral microsatellite allele heterogeneity, indicating the presence of genetically divergent tumor cell clones within the same neoplasm.

Microsatellite instability is correlated with lymph node-positive breast cancer

We analyzed 81 cases of primary breast carcinoma and 7 cases of fibroadenoma for microsatellite instability at eight loci. Twenty-seven cases (33.3%) manifested aberrant microsatellite alleles: 7 (8.6%) at one locus and 20 (24.7%) at two or more loci [tumors with replication error-positive (RER+) phenotype]. No evidence of microsatellite instability was observed in fibroadenomas. We investigated correlations between RER+ phenotype and clinicopathological characteristics of the carcinomas. The RER+ phenotype was statistically associated with large tumor diameter; of 19 RER+ tumors with measured size, 16 were > 2 cm, compared to 28 of 58 tumors with no evidence of microsatellite instability or with shifts in allele sizes limited to one locus (P </= 0.005, chi2 test). Consistently, there was also a strong statistical association between RER+ phenotype and lymph node metastasis; 14 of 19 RER+ tumors with known lymph node status were N+, compared to 15 of 59 tumors with no evidence of microsatellite instability or with allele shifts limited to one locus (P </= 0.0002, chi2 test). Correlations with age of patients, proliferative activity, histotype (ductal versus lobular), and grade of differentiation were not statistically significant, although the RER+ phenotype was more frequent in lobular and high-grade ductal carcinomas, in carcinomas with high proliferative activity, and in carcinomas from patients </=50 years. Data concerning cancer(s) in first and/or second degree relatives were available for 66 cases, including 33 positive and 33 negative for family history of cancer. No correlations were detected between RER+ phenotype and family history of cancer. In conclusion, our results indicate that in breast cancer, microsatellite instability is associated with clinicopathological parameters that are considered predictors of recurrent disease and aggressive behavior.

A new method to measure cardiac inositol levels in intact animals

Inositol levels have been studied in cellular cultures and recently by perfusion of isolated hearts. The study was aimed to assess inositol turnover in rabbit hearts from intact animals. Thirty rabbits were injected i.v. three times (every 12 hr) with 25 microCi/kg of myo-3H-inositol. The rabbits 12 hr after the last injection were killed and the hearts perfused according to Langerdorff technique. Systolic and diastolic ventricular pressures (SVP, DVP), dp/dt, and coronary flow (CFl) were measured. The hearts (n = 14) were perfused under aerobic conditions and 16 hearts under ischemic conditions for 30 min. In addition, 5 hearts were perfused under aerobic conditions for 10 min, and 6 hearts were perfused under ischemic conditions for 10 min. Samples of myocardial tissue were taken from both groups at the end of 10-min and 30-min period of perfusion, and cAMP and inositol phosphates were assayed. The hearts subjected to ischaemia showed changes of cAMP and 3H-inositol. The cAMP was higher in the ischaemic (10 min and 30 min) than the control hearts, 0.22 +/- 0.09 and 0.21 +/- 0.08 versus 0.41 +/- 0.12 and 0.49 +/- 0.11 pmol 10(6) cells, respectively (p < .05, p < .001. The inositol trisphosphate was higher in control than ischemic hearts (10 min, 30 min), 0.42 +/- 0.02 and 0.39 +/- 0.01 versus 0.31 +/- 0.01 and 0.23 +/- 0.02 (percent of radioactivity) respectively, p < .001. Our data suggest that 3H-inositol may be studied by i.v. administration to intact animals. The ischemia was performed to verify the validity of this new technique.

Association between reduced lymphocyte beta-adrenergic receptors and left ventricular dysfunction in young obese subjects

This study was designed to evaluate total (t) and surface (s) beta-adrenergic receptors (BAR) density and their relationships with left ventricular function in young obese subjects. BAR density, plasma insulin, catecholamines and left ventricular function were evaluated in 27 young obese subjects (BMI > 30.5 kg/m2 for males and > 27.3 kg/m2 for females) without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) and in 20 lean controls (BMI < 25 kg/m2 for males and < 24.7 kg/m2 for females). Both groups were matched for gender, age and body height. BAR density was evaluated according to Böyum and De Blasi methods. Plasma catecholamines by high perfusion liquid chromatography and fasting immunoreactive plasma insulin (IRI) levels by RIA were also measured. Casual (c) and 24 h ambulatory mean blood pressure (MBP/24h) were determined. Radionuclide angiocardiography was used to measure left ventricular ejection fraction (LVEF), peak filling rate (PFR), time to PFR (tPFR), cardiac output (CO) and stroke volume (SV). Total left ventricular mass (LVM), indexed for height (LVM/H), left ventricular diastolic dimension (LVDD) and interventricular septal (IVS) thickness by echocardio-graphic study were calculated. LVEF, PFR, BARt, BARs were significantly lower (P < 0.0001) and plasma IRI, CO, SV (P < 0.0001), LVM (P < 0.003), LVM/H (P < 0.004), LVDD (P < 0.02) and tPFR (P < 0.02) were significantly higher in obese subjects than in lean controls. BARt and BARs correlated inversely with BMI, SV and LVDD.(ABSTRACT TRUNCATED AT 250 WORDS)

Lymphocyte beta-adrenergic receptors in young subjects with peripheral or central obesity: relationship with central haemodynamics and left ventricular function

This study was designed to evaluate total (t) and surface (s) beta-adrenergic receptor (BAR) density and their relationship with central haemodynamics and left ventricular function in young subjects with central or peripheral obesity. A total of 31 obese subjects (BMI > or = 30.5 kg.m-2 for males and > or = 27.3 kg.m-2 for females) aged less than 40 years and without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) were studied. Nine had peripheral obesity and 22 central obesity according to WHR values; there were 20 lean controls (BMI < 25 kg.m-2 for males and < 24.7 kg.m-2 for females). Casual (c) and 24 h ambulatory mean blood pressures (MBP-24 h) were determined. BAR density was evaluated according to Böyum and De Blasi methods. Plasma catecholamines by high perfusion liquid chromatography and fasting immunoreactive plasma insulin (IRI) were also measured by RIA. Radionuclide angiocardiography was used to determine central haemodynamics and both systolic and diastolic left ventricular function. Total peripheral resistances (TPR) and intravascular volumes were also determined. Echocardiographic study was used to measure LVM, LVM.h-1, LVDD and IVS. Left ventricular ejection fraction (LVEF), peak filling rate (PFR), BARt and BARs were significantly lower (P < 0.05) and cardiac output, cardiac volumes, LVM, LVM. h-1 and time to PFR significantly higher (P < 0.05) in both obese groups than in lean controls. Plasma IRI was significantly (P < 0.05) higher in both obese groups whereas plasma norepinephrine was higher only in central obese.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of captopril on lymphocytic beta-adrenergic receptors in normal and hypoxic conditions

BACKGROUND

During heart failure, due to increased level of circulating norepinephrine, the number of beta-adrenergic receptors (beta-AR), both at the cardiac and the lymphocytic level, is reduced (down-regulation). Captopril, an ACE-inhibitor containing an SH group appears capable of resetting beta-AR when used in patients with heart failure. Our study was aimed at checking whether captopril exerts a direct effect upon the beta-AR, possibly through its SH group by disulphur binding with cysteine residues located at the binding sites for catecholamines.

METHODS

The study was carried out in vitro on human lymphocytes obtained from healthy volunteers: 10 males (mean age, 34 years; range, 25-45) and 10 females (mean age, 34 years; range 26-48). Lymphocytes were randomly divided in two groups of equal size. Group I were controls; in Group II cells were incubated with three different doses of captopril: 1, 10, and 100 microM. Control lymphocytes and those treated with 10 microM of captopril were exposed to 1 microM isoproterenol. The number of total and surface beta-AR, and the sequestration of beta-AR from isoproterenol under normoxic conditions and after 20 h of hypoxia were checked. Furthermore, the content of cAMP was assayed both in basal conditions and after stimulation with 10 microM and 100 microM isoproterenol and forskolin, respectively.

RESULTS

Total beta-AR: 1082 +/- 133 (controls) vs. 1174 +/- 94 (treatment with 1 microM captopril), vs. 1237 +/- 88 (10 microM captopril), vs. 1092 +/- 105 (100 microM captopril). Surface beta-AR: 84 +/- 4.41% (controls) vs. 90.5 +/- 2.1% (10 microM captopril). Basal cAMP: 1.21 +/- 0.4 (controls) vs. 1.23 +/- 0.5 pmol/10 cells (1 microM captopril), 1.05 +/- 0.6 pmol/10 cells (10 microM captopril), 1.15 +/- 0.4 pmol/10 cells (100 microM captopril). After 10 microM isoproterenol: controls 4.10 +/- 0.8 vs. 4.30 +/- 0.9 pmol/10 cells (1 microM captopril), 4.15 +/- 0.7 pmol/10 cells (10 microM captopril), 3.50 +/- 1.0 pmol/10 cells (100 microM captopril). After 100 microM forskolin: controls 13.2 +/- 3.1 vs. 11.2 +/- 3.1 pmol/10 cells (1 microM captopril), 13.1 +/- 4.2 pmol/10 cells (10 microM captopril), 12.6 +/- 2.9 pmol/10 cells (100 microM captopril). Neither of these differences were significant. Lymphocytic beta-AR exposed to hypoxia did not show any significant difference. Exposure to captopril did not cause any further alteration on beta-AR sequestration.

CONCLUSIONS

Captopril does not seem to exert any direct action upon lymphocyte beta-AR from healthy volunteers. Moreover, captopril does not modify cAMP storage either in basal conditions or after stimulation with isoproterenol or forskolin. Therefore our data suggest that action of captopril on beta-AR is probably due to the inhibition of both systemic and tissue ACE-system.

The Neurobehavioral Cognitive Status Examination: psychometric properties in use with psychiatric inpatients

The present investigation sought to enhance clinical utility of the Neurobehavioral Cognitive Status Examination (NCSE; Northern California Neurobehavioral Group, Inc.) by providing reference scores for an inpatient psychiatric sample and assessing construct validity. A total of 866 patients (aged 15-92 years) received an NCSE 2 to 4 days after admission. Examination of means, standard deviations, z scores, and percent who passed each screening item revealed consistently poorer performance for psychiatric patients relative to the original normative sample. Pearson product-moment correlations between age and each NCSE subtest similarly yielded significant negative correlations, particularly on tests predicted to be differentially sensitive to aging. Intercorrelations between subtests, however, failed to yield expected patterns of performance. We conclude that the NCSE provides a moderately valid screening instrument for cognitive impairment.

[Action of retinol on viable cell recovery and clonogenic potential of HTC cells after in vitro hyperthermia]

The aim of this study was to investigate if the association of both hyperthermic and Retinol treatment of HTC hepatoma cells could be useful in antitumor therapy. Treatment with 5 microM Retinol was carried out before or after hyperthermia (42 degrees C or 44 degrees C, one hour; in the latter case it was performed in cells already thermo-selected. We took into consideration two parameters, i.e. the number of the collected vital cells (evaluated by the trypan blue-exclusion test) and the clonal efficiency of these cells (calculated as number of colonies obtained from 250 cells cultured for 5 days). Thermal treatment alone caused a decrease of the number of the collected vital cells and of their clonal efficiency only in the cell cultures incubated at 44 degrees C. Instead the control thermo-selected cells, both at 42 degrees C and at 44 degrees C, showed both decreased clonal efficiency and yield of the vital cells. Compared with the control cultures treated with 0.1% Ethanol, used as vitamin A solvent, only cell cultures treated with Retinol before hyperthermia showed a decreased number of collected viable cells, nevertheless their clonal efficiency was unchanged.