TAPSE/SPAP ratio stratifies mortality risk in mild-to-moderate idiopathic pulmonary fibrosis

BACKGROUND: Due to paucity of literature data, we aimed at evaluating the prognostic role of the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP) in idiopathic pulmonary fibrosis (IPF) patients without severe pulmonary hypertension and at assessing its correlation with effective arterial elastance index (EaI). METHODS: Multi-instrumental data obtained in 60 IPF patients (73.2 ± 6.8 years) and 60 matched controls were retrospectively analysed. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality and re-hospitalisations for all-causes over medium-term follow-up. RESULTS: ;At baseline, TAPSE/SPAP was significantly lower in patients with IPF than in controls (0.36 ± 0.25 vs. 0.77 ± 0.18 mm/mmHg; P < 0.001). TAPSE/SPAP was inversely correlated with EaI (r = -0.96) in IPF patients. During follow-up (3.5 ± 1.5 years), 21 patients died and 25 were re-hospitalised due to cardiopulmonary causes. TAPSE/SPAP was independently associated with both primary (HR 0.79, 95%CI 0.65-0.97) and secondary (HR 0.94, 95%CI 0.92-0.97) endpoints. A TAPSE/SPAP ratio of <0.20 and <0.44 mm/mmHg showed the greatest sensitivity and specificity for predicting primary (AUC 0.98) and secondary (AUC 0.99) endpoints, respectively. CONCLUSIONS: TAPSE/SPAP is a strong predictor of adverse outcomes in mild-to-moderate IPF. The strong correlation between TAPSE/SPAP and EaI might be an expression of a systemic fibrotic process which involves the heart, lungs and circulation.

COVID-19 and cardiovascular system: not only heart but also vascular. The effects of the infection on arterial stiffness

Background

SARS-CoV-2 determines a framework of multi-organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.

Methods

This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid-19 who undergone PWV measurement during the follow-up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.

Results

PWV values were higher in Covid-19 group comparing to hypertension group (10.5±3.0 m/s VS 8.9±2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R=−0.302; p<0.001).

Conclusions

SARS-CoV-2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow-up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long-term cardiovascular risk.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy

P389 COVID–19 AND CARDIOVASCULAR SYSTEM: NOT ONLY HEART BUT ALSO VASCULAR. THE EFFECTS OF THE INFECTION ON ARTERIAL STIFFNESS

Introduction

SARS–CoV–2 determines a framework of multi–organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.

Methods

This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid–19 who undergone PWV measurement during the follow–up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.

Results

PWV values were higher in Covid–19 group comparing to hypertension group (10.5 ± 3.0 m/s VS 8.9 ± 2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R= –0.302; p < 0.001).

Conclusions

SARS–CoV–2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow–up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long–term cardiovascular risk.

Associations of sarcopenia with hematologic toxicity, treatment intensity, and healthcare utilization in patients with metastatic colorectal cancer

84

Background: We evaluated the impact of baseline sarcopenia on hematologic toxicity, treatment intensity, and healthcare utilization in patients with mCRC receiving FOLFOX or FOLFIRI. Methods: We retrospectively analyzed patients with mCRC who received care at our institution from 1/2011-11/2018 and were part of a biobanking protocol. Included adults received either first-line palliative FOLFOX- or FOLFIRI-based regimens and were followed for 6 months. We categorized sarcopenia based on skeletal muscle index measured at diagnosis of metastatic disease and pre-defined sex-specific cutoff values (F < 39 cm2/m2, M < 55cm2/m2). Our primary aim was to evaluate the association of sarcopenia and hematologic toxicity, defined as the incidence of grade ≥3 (G≥3) neutropenia, thrombocytopenia, or anemia (NCI CTCAE v5.0). Secondary endpoints included treatment intensity (dose reductions, treatment delays, relative-dose intensity [RDI]), and healthcare utilization (ED visits and/or hospitalizations). Bivariate analyses were used to evaluate associations between baseline sarcopenia and outcomes. Results: 126 of 177 screened patients met inclusion criteria (70 (56%) males, median age 61 yrs (range, 29-85)). 59 (46.8%) patients were sarcopenic. More patients received FOLFOX than FOLFIRI (92 [73.0%] vs. 34 [27.0%]). At baseline, patients had a median weight 76.9kg (IQR, 70.0-90.4 kg), BMI 26.6 kg/m2 (IQR, 24.1-30.5 kg/m2), and BSA 1.90 m2 (IQR, 1.72-2.01 m2). The incidence of G≥3 hematologic toxicity was 39.0% vs. 23.9% in sarcopenic and non-sarcopenic patients, respectively (p = 0.06). Patients with sarcopenia experienced higher incidence of G≥3 neutropenia (30.5% vs. 14.9%, p = 0.03), while G≥3 thrombocytopenia was similar (3.4% vs. 1.5%). The incidence of dose reductions and treatment delays did not differ significantly (86.4% vs. 89.5%, 72.9% vs. 71.6%, respectively). RDI was decreased for the 5FU bolus (52.5% vs. 65.0%, p = 0.02). Rates of ED visits (32.2% vs. 19.4%, p = 0.10) and hospitalizations (32.2% vs. 26.9%, p = 0.51) did not differ compared between patients with and without sarcopenia. Conclusions: Patients with mCRC and baseline sarcopenia receiving FOLFOX- or FOLFIRI experienced a higher incidence of G≥3 neutropenia and lower 5FU bolus treatment intensity. Studies are needed to understand how best to adjust treatment according to patients’ muscle mass.

VIP conditions human endometrial receptivity by privileging endoplasmic reticulum stress through ATF6α pathway

Endometrial stromal cells undergo endoplasmic reticulum (ER) stress and unfolded protein response (UPR) during the decidualization linked with the inflammation and angiogenesis processes. Considering VIP (vasoactive intestinal peptide) induces the decidualization program, we studied whether modulates the ER/UPR pathways to condition both processes for embryo implantation. When Human Endometrial Stromal Cell line (HESC) were decidualized by VIP we observed an increased expression of ATF6α, an ER stress-sensor, and UPR markers, associated with an increase in IL-1β production. Moreover, AEBSF (ATF6α -inhibitor pathway) prevented this effect and decreased the expansion index in the in vitro model of implantation. VIP-decidualized cells also favor angiogenesis accompanied by a strong downregulation in thrombospondin-1. Finally, ATF6α, VIP and VPAC2-receptor expression were reduced in endometrial biopsies from women with recurrent implantation failures in comparison with fertile. In conclusion, VIP privileged ATF6α-pathway associated with a sterile inflammatory response and angiogenesis that might condition endometrial receptivity.

Impact of the Reticular Stress and Unfolded Protein Response on the inflammatory response in endometrial stromal cells

During decidualization, endometrial stromal cells undergo reticular stress (RS) and unfolded protein response (UPR), allowing the endoplasmic reticulum-expansion and immunomodulators production. Physiological RS generates the activation of sensing proteins, inflammasome activation and mature-IL-1β secretion, associated with pro-implantatory effects. We focus on the impact of RS and UPR on decidualized cells and whether they induce a physiological sterile inflammatory response through IL-1β production. Human endometrial stromal cell line (HESC) after decidualization treatment with MPA + dibutyryl-cAMP (Dec) increased the expression of RS-sensors (ATF6, PERK and IRE1α) and UPR markers (sXBP1 and CHOP) in comparison with Non-dec cells. Then we found increased NLRP3 expression in Dec cells compared with Non-dec cells. In fact STF-083010 (an IRE1α inhibitor) prevented this increase. Downstream, increased levels of active caspase-1 on Dec cells were detected by FAM-Flica Caspase-1 associated with an increase in IL-1β production. Moreover, the treatment with STF-083010 decreased the invasion index observed in Dec cells, evaluated by an in vitro model of implantation. In endometrial biopsies from recurrent spontaneous abortion patients an increased expression of IRE1α was found in comparison with fertile women; while recurrent implantation failure samples showed a lower expression of sXBP1, TXNIP and NLRP3 than fertile women, suggesting that RS/UPR tenors might condition endometrial receptivity.

Acetylcholine contributes to control the physiological inflammatory response during the peri-implantation period

BACKGROUND

Maternal antigen-presenting cells attracted to the pregnant uterus interact with trophoblast cells and modulate their functional profile to favour immunosuppressant responses. Non-neuronal cholinergic system is expressed in human cytotrophoblast cells and in immune cells with homeostatic regulatory functions.

AIM

The aim of this work was to evaluate whether non-neuronal acetylcholine conditions maternal monocyte and DC migration and activation profiles.

METHODS

We used an in vitro model resembling maternal-placental interface represented by the co-culture of human trophoblast cells (Swan-71 cell line) and monocytes or DC.

RESULTS

When cytotrophoblast cells were treated with neostigmine (Neo) to concentrate endogenous acetylcholine levels, monocyte migration was increased. In parallel, high levels of IL-10 and decreased levels of TNF-α were observed upon interaction of maternal monocytes with trophoblast cells. This effect was synergized by Neo and was prevented by atropine, a muscarinic acetylcholine receptor antagonist. Similarly, trophoblast cells increased the migration of DC independently of Neo treatment; however, enhanced IL-10 and MCP-1 synthesis in trophoblast-DC co-cultures with no changes in TNF-α and IL-6 was observed. In fact, there were no changes in HLA-DR, CD86 or CD83 expression. Finally, trophoblast cells treated with Neo increased the expression of two antigen-presenting cells attracting chemokines, MCP-1, MIP-1α and RANTES through muscarinic receptors, and it was prevented by atropine.

CONCLUSIONS

Our present results support a novel role of acetylcholine synthesized by trophoblast cells to modulate antigen-presenting cell migration and activation favouring an immunosuppressant profile that contributes to immune homeostasis maintenance at the maternal-foetal interface.

Monocytes from Sjögren's syndrome patients display increased vasoactive intestinal peptide receptor 2 expression and impaired apoptotic cell phagocytosis

Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by salivary and lacrimal gland dysfunction. Clinical observations and results from animal models of SS support the role of aberrant epithelial cell apoptosis and immune homeostasis loss in the glands as triggering factors for the autoimmune response. Vasoactive intestinal peptide (VIP) promotes potent anti-inflammatory effects in several inflammatory and autoimmune disease models, including the non-obese diabetic (NOD) mouse model of SS. With the knowledge that VIP modulates monocyte function through vasoactive intestinal peptide receptors (VPAC) and that immune homeostasis maintenance depends strongly upon a rapid and immunosuppressant apoptotic cell clearance by monocytes/macrophages, in this study we explored VPAC expression on monocytes from primary SS (pSS) patients and the ability of VIP to modulate apoptotic cell phagocytic function and cytokine profile. Monocytes isolated from individual pSS patients showed an increased expression of VPAC2 subtype of VIP receptors, absent in monocytes from control subjects, with no changes in VPAC1 expression. VPAC2 receptor expression could be induced further with lipopolysaccharide (LPS) in pSS monocytes and VIP inhibited the effect. Moreover, monocytes from pSS patients showed an impaired phagocytosis of apoptotic epithelial cells, as evidenced by reduced engulfment ability and the failure to promote an immunosuppressant cytokine profile. However, VIP neither modulated monocyte/macrophage phagocytic function nor did it reverse their inflammatory profile. We conclude that monocytes from pSS patients express high levels of VPAC2 and display a deficient clearance of apoptotic cells that is not modulated by VIP.

Adenoma, advanced adenoma and colorectal cancer prevalence in asymptomatic 40- to 49-year-old subjects with a first-degree family history of colorectal cancer

AIM

First-degree relatives (FDRs) of patients with colorectal cancer (CRC) have an increased CRC risk. Few studies have addressed if adenoma and advanced adenoma risk is increased among individuals, 40-49 years of age, with a family history of CRC. Therefore, the aim of the study was to define the prevalence and location of adenoma, advanced adenoma and CRC, according to age, in asymptomatic individuals with a family history of CRC.

METHOD

Retrospective study of asymptomatic FDRs, 40 to ≥70 years of age undergoing first screening colonoscopy over a 3-year period, of CRC patients.

RESULTS

Among 464 individuals studied, the prevalence of adenoma and advanced adenoma was 18.1% and 6.4%, respectively. According to age intervals, the prevalences of adenoma and advanced adenoma were 14% and 3.5%, respectively, in subjects 40-49 years of age; 14.4% and 6.3%, respectively, in subjects 50-59 years of age; 27% and 8%, respectively, in subjects 60-69 years of age; and 25% and 14%, respectively, in subjects ≥70 years of age; no significant difference was found among the four groups. No difference in lesion location was found, with similar numbers of preneoplastic lesions being present in the right colon and the left colon. CRC was diagnosed in three (0.64%) subjects, one of whom was in the 40-49 years age group.

CONCLUSION

In our population of FDRs of CRC patients, 40-49 years of age, the prevalences of adenoma and advanced adenoma were similar to those observed in older subjects with the same CRC risk. Our data support the current indication to perform screening colonoscopy earlier than 45 years of age in subjects at high CRC risk.

Defects in the vasoactive intestinal peptide (VIP)/VPAC system during early stages of the placental-maternal leucocyte interaction impair the maternal tolerogenic response

Successful embryo implantation occurs followed by a local inflammatory/T helper type 1 (Th1) response, subsequently redirected towards a tolerogenic predominant profile. The lack of control of this initial local inflammatory response may be an underlying cause of early pregnancy complications as recurrent spontaneous abortions (RSA). Considering that vasoactive intestinal peptide (VIP) mediates anti-inflammatory and tolerogenic effects in several conditions we hypothesized that VIP might contribute to tolerance towards trophoblast antigens during the early interaction of maternal leucocytes and trophoblast cells. In this study we investigated VIP/VPAC system activity and expression on maternal peripheral blood mononuclear cells (PBMCs) after interaction with immortalized trophoblast cells (Swan-71 cell line) as an in-vitro model of feto-maternal interaction, and we analysed whether it modulates maternal regulatory T cell (T(reg))/Th1 responses. We also investigated the contribution of the endogenous VIP/VPAC system to RSA pathogenesis. VIP decreased T-bet expression significantly, reduced monocyte chemotactic protein-1 (MCP-1) and nitrite production in co-cultures of PBMCs from fertile women with trophoblast cells; while it increased the frequency of CD4(+) CD25(+) forkhead box protein 3 (Foxp3)(+) cells, transforming growth factor (TGF)-β expression and interleukin (IL)-10 secretion. These effects were prevented by VIP-specific antagonist. Interestingly, PBMCs from RSA patients displayed significantly higher T-bet expression, lower T(reg) frequency and lower frequency of VIP-producer CD4 lymphocytes after the interaction with trophoblast cells. Moreover, the patients displayed a significantly lower frequency of endometrial CD4(+) VIP(+) cells in comparison with fertile women. VIP showed a Th1-limiting and T(reg) -promoting response in vitro that would favour early pregnancy outcome. Because RSA patients displayed defects in the VIP/VPAC system, this neuropeptide could be a promising candidate for diagnostic biomarker or surrogate biomarker for recurrent spontaneous abortions.

Vasoactive intestinal peptide/vasoactive intestinal peptide receptor relative expression in salivary glands as one endogenous modulator of acinar cell apoptosis in a murine model of Sjögren's syndrome

Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by a progressive oral and ocular dryness that correlates poorly with the autoimmune damage of the glands. It has been proposed that a loss of homeostatic equilibrium in the glands is partly responsible for salivary dysfunction with acinar cells involved actively in the pathogenesis of SS. The non-obese diabetic (NOD) mouse model of Sjögren's syndrome develops secretory dysfunction and early loss of glandular homeostatic mechanisms, with mild infiltration of the glands. Based on the vasodilator, prosecretory and trophic effects of the vasoactive intestinal peptide (VIP) on acini as well as its anti-inflammatory properties we hypothesized that the local expression of VIP/vasoactive intestinal peptide receptor (VPAC) system in salivary glands could have a role in acinar cell apoptosis and macrophage function thus influencing gland homeostasis. Here we show a progressive decline of VIP expression in submandibular glands of NOD mice with no changes in VPAC receptor expression compared with normal mice. The deep loss of endogenous VIP was associated with a loss of acinar cells through apoptotic mechanisms that could be induced further by tumour necrosis factor (TNF)-α and reversed by VIP through a cyclic adenosine-5'-monophosphate (cAMP)/protein kinase A (PKA)-mediated pathway. The clearance of apoptotic acinar cells by macrophages was impaired for NOD macrophages but a shift from inflammatory to regulatory phenotype was induced in macrophages during phagocytosis of apoptotic acinar cells. These results support that the decline in endogenous VIP/VPAC local levels might influence the survival/apoptosis intracellular set point in NOD acinar cells and their clearance, thus contributing to gland homeostasis loss.

[Efficacy of Lactobacillus Rhamnosus GR-1 and of Lactobacillus Reuteri RC-14 in the treatment and prevention of vaginoses and bacterial vaginitis relapses]

AIM

The aim of this study was to investigate the efficacy of the use of Lactobacillus rhamnosus GR-1 and of Lactobacillus reuteri RC-14 administrated orally in the treatment and prevention of vaginoses and bacterial vaginitis relapses.

METHODS

The study enrolled 50 women in good health, aged between 18 and 48 years, with assessed diagnosis of bacterial vaginosis and vaginitis. The women were randomized in two groups: group A comprised 25 patients with bacterial vaginitis and group B comprised 25 patients with vaginosis. Each patient was administered an antibiotic therapy and subsequently a therapy with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 (Dicoflor Elle, Dicofarm, Roma, Italy) with two tablets daily for 15 days. After one week from the end of the therapy all patients have been controlled by vaginal swab and microscopic analysis of vaginal secretion.

RESULTS

At the end of the study 46 patients had a complete Lactobacilli recolonization, two patients had no colonization and two dropped out. The results showed that 92% of the enrolled patients benefited from the treatment.

CONCLUSION

The results of the present study shows that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken orally, were helpful in vaginosis and bacterial vaginitis treatment and in relapse prevention, as they can re-establish the vaginal ecosystem remarkably.

Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability

BACKGROUND

While conventional oesophagogastroduodenoscopy is frequently performed under sedation to improve acceptability, transnasal oesophagogastroduodenoscopy would appear to be less invasive.

STUDY AIMS

To compare diagnostic accuracy, feasibility, acceptability and safety of transnasal oesophagogastroduodenoscopy without sedation versus conventional oesophagogastroduodenoscopy under sedation.

PATIENTS

Following anxiety assessment, 30 dyspeptic patients underwent transnasal oesophagogastroduodenoscopy under local anaesthesia (lidocaine) and conventional oesophagogastroduodenoscopy under conscious sedation (i.v. midazolam) on two consecutive days. Transnasal oesophagogastroduodenoscopy was performed with an ultrathin and conventional oesophagogastroduodenoscopy with a standard endoscope.

METHODS

Safety, evaluated by monitoring cardio-respiratory functions. Acceptability, rated according to discomfort and preference between the two examinations. Diagnostic accuracy evaluated taking into account endoscopic patterns and adequacy of biopsy specimens for histology. Feasibility, defined according to endoscopic performance, quality of images and overall opinion of the endoscopist. Only gastric biopsies were evaluated.

RESULTS

All patients but one who refused conventional oesophagogastroduodenoscopy underwent both transnasal oesophagogastroduodenoscopy and conventional oesophagogastroduodenoscopy. No cardiorespiratory complications occurred during either technique. Majority of patients (87%) preferred transnasal oesophagogastroduodenoscopy. Examinations were completed in all cases, with comparable endoscopic patterns. All biopsy specimens were suitable for histology.

CONCLUSIONS

Transnasal oesophagogastroduodenoscopy without sedation provides good diagnostic accuracy, is safer and better accepted than conventional oesophagogastroduodenoscopy under sedation and, therefore, represents a valid alternative in routine diagnosis of upper digestive tract diseases.

Cerebral venous thrombosis: a retrospective multicentre study of 48 patients

The objective was to describe the clinical features and management of cerebral venous thrombosis (CVT) in non-selected centres. An observational study in 11 neurological departments in NW Italy was carried out from 1995 through 1999 on 38 female and 10 male patients. Mean age: 44.8 years, SD=14.3. Onset: acute in 21 patients (44%), subacute in 17 (35%) and chronic in 10 (21%). Most frequent onset: with focal deficits and/or seizures, followed by impaired consciousness or confusion, isolated headache, isolated intracranial hypertension and cavernous syndrome. No risk factor was found in 8 patients (17%). The superior sagittal sinus was involved in 27 patients (56%) and the transverse sinus in 29 (60%). Anticoagulants were used in 45 patients (94%). Rankin Scale score at discharge: 0 (27 patients), 1 (four), 2 (five), 3 (five), 4 (none), 5 (one) and six were dead. Thirteen patients had deep CVT: age, risk factors, neurological signs and outcome differed from cortical CVT (35 patients), although not significantly. Clinical features, risk factors and outcome of CVT patients from non-selected centres are similar to those from specialised centres.

New daily persistent headache: clinical and serological characteristics in a retrospective study

We present a retrospective clinical study of 18 cases of new daily persistent headache (NDPH), a rare chronic headache, included in the fourth chapter of the II IHS classification; the pathophysiology of NDPH is unknown but a link with viral infections (especially Epstein-Barr virus (EBV)) has been suggested. Comparing our series with the other two published until now, we did not find any particular difference, as regards to clinical aspects. However, our laboratory tests show a recent herpes simplex virus infection in 42% and cytomegalovirus in 11% of cases; moreover we could not find any EBV infection. Our data suggest that viruses other than EBV can play a role in NDPH.

4-Biphenylaldehyde and 9-anthraldehyde: two fluorescent substrates for determining P450 enzyme activities in rat and human

1. 4-Biphenylaldehyde (4-BA) and 9-anthraldehyde (9-AA) were examined as substrates for cytochrome P450 (CYPs) enzymes in rat and human. Both aldehydes were oxidized by CYPs to fluorescent carboxylic acids, which can be assayed with a high sensitivity by an easy fluorimetric method. 2. With liver microsomes from control and induced rats, the oxidation of both 9-AA and 4-BA followed simple Michaelis-Menten kinetics. Only microsomes from rats pretreated with phenobarbital (a strong inducer of P4502B1/2) could increase (about threefold) the oxidation rates (V(max)) of both aldehydes above the control values, which were 6.7+/-1.1 and 3.3+/-0.6 nmol min(-1) mg(-1) protein for 4-BA and 9-AA, respectively. On the other hand, the (K)(m)'s, which were similar for both aldehydes (about 25 micro M), did not change significantly with any inducer. The use of purified rat CYP1A1, 2E1, 2B1 and 2C11 in a reconstituted system showed that only 2B1 and 2C11 could oxidize both substrates with a high turnover. 3. In human liver microsomes, the oxidation rates of these aldehydes (1.6+/-0.2 and 0.42+/-0.1 nmol min(-1) mg(-1) protein for 4-BA and 9-AA, respectively) were lower than those of rat but with similar K(m)'s(20-26 microm). 4. The oxidation of these aldehydes was also determined with cDNA-expressed CYP1A1, 1A2, 2A6, 2B6, 2C9, 2D6, 2E1 and 3A4 and with a characterized bank of 14 human liver microsomes. In a reconstituted system, only CYP2B6, 2A6, 3A4 and with a lower turnover 2C9 oxidized both substrates. 5. Among the CYP marker activities of the 14 human samples, good correlations were only observed between CYP3A-dependent 6 beta-testosterone hydroxylase and the oxidation of 4-BA (r = 0.74) or 9-AA (r = 0.80) and between the oxidation of 4-BA versus 9-AA (r = 0.74). Weak correlations were also found between the 2B6-linked S-mephenytoin N- demethylase and the oxidation of 4-BA (r = 0.58) or 9-AA (r = 0.65). 6. Inhibition experiments revealed that the oxidation of these aldehydes was inhibited by ketoconazole, 8-methoxypsoralene and sulphophenazole, selective inhibitors for P4503A6, 2A6 and 2C9, respectively. 7. In summary, based on the use of cDNA-expressed CYPs, correlation analysis and chemical inhibition, the metabolism in human liver microsomes of these aldehydes appears primarily catalysed by CYP3A, although CYP2A6, 2B6 and 2C9 may play a role. 9-AA and particularly 4-BA, owing to the high rate of its metabolism, may be two novel useful fluorescent probe substrates for assaying CYP activities in various species.

Oxidation of N,N-dimethylformamide and N,N-diethylformamide by human liver microsomes and human recombinant P450s

N-N, dimethyl- (DMF) and N-N, diethyl-formamide (DEF) are two hepatotoxic solvents, whose metabolism has not been investigated in humans. To identify the P450 isoforms involved in the microsomal oxidation of these solvents we used (a) 12 human liver samples; (b) human recombinant P450 isoforms (1A1, 1A2, 2B6, 2C10, 2E1, 3A4); (c) chemical and immunological inhibitions. When correlation analyses were performed using enzymatic markers in human liver microsomes, the p-nitrophenol hydroxylation rate significantly correlated (r=0.87) with the dealkylation rate of DMF but not with that of DEF. Among the tested recombinant P450s only 2E1 oxidised DMF, while DEF was oxidised by 2E1, 2C10 and 3A4. 4-Methylpyrazole and anti human 2E1 IgG strongly inhibited the DMF demethylation but only partially the DEF deethylation. These findings indicate that, in the DMF metabolism, the role of 2E1 is crucial and its expression may be an important factor in determining the susceptibility of human to this solvent.

[The effects of eradication therapy in patients with chronic atrophic gastritis and seropositivity for anti-HP antibodies and histological negativity for Helicobacter pylori]

PURPOSE

The present study was undertaken to analyze both whether the elevated Helicobacter pylori levels in patients with atrophic gastritis without histologic evidence of Helicobacter pylori would be a sign of an ongoing infection and the effects of eradication on gastric atrophy.

PATIENTS AND METHODS

Twenty patients (10 M e 10 F; mean age 57.25 SD 12.19) with atrophic gastritis and elevated Helicobacter pylori titers without histological evidence for Helicobacter-like organisms were included in the study. Ten patients were randomized into eradication group (Group 1) (amoxicillin at 500 mg twice a day for 14 days, metronidazole at 500 mg twice a day for 10 days and omeprazole at 20 mg twice a day for 20 days) and 10 patients were randomized into the control group (Group 2). For all subjects, serum samples and duplicate biopsy specimens (obtained endoscopically) were collected prior the study period and approximately 6 months after the therapy or the follow-up for serum samples and 8 weeks for biopsy specimens.

RESULTS

In the Group 1, the Helicobacter pylori antibody titers dropped significantly in 73.39% of the patients (p < 0.0001), while in the Group 2, the antibody titers declined only in a patient who received antibiotics during the study period (p < 0.00006). In both groups, no significant improvement of atrophic gastritis was observed.

CONCLUSIONS

In conclusion, in patients with atrophic gastritis, the only histological evaluation of Helicobacter-like organisms colonization in gastric biopsy specimens, appeared in our study to underestimate the true prevalence of current HP infection and the importance of the bacterium in the pathogenesis and progression of such disease. Since HP infection is often associated with an increase of proliferative index, the eradication of HP could induce a mucosal protective effect against the other carcinogen factors, although it is extremely unlikely that it can promote the regeneration of a normal gastric mucosa.

Molecular Probe Data Base (MPDB)

In this paper, the current status of the Molecular Probe Data Base (http://www.biotech.ist.unige.it/interlab/ mpdb.html ) is briefly presented together with a short analysis of its activity during 1997. This has been performed by statistically evaluating the 'logs' of the Internet servers that are used for its distribution with reference to the geographical origin of the requests, the words that were utilized to carry out of the searches and the oligonucleotides that were retrieved. Planned enhancements of this database are also described. They include a revision of its data structure and, even more relevant, of its data management procedures.

Improvement of intestinal metaplasia six month after misoprostol treatment

PURPOSE

To establish whether misoprostol (a synthetic prostanoid) is effective in improving intestinal metaplasia of dyspeptic patients.

PATIENTS

Of the 206 dyspeptic patients without Helicobacter pylori, 18 (7.1%) had histological evidence of intestinal metaplasia (2 presented mild metaplasia, 9 moderate and 7 severe). They were treated with misoprostol 200 mg twice daily for six months and, after stopping the treatment, they all underwent endoscopic control.

RESULTS

There was a statistical significant improvement of intestinal metaplasia (p < 0.001) and of the activity of antral gastritis (p = 0.03). There were no significant changes in antral and body specimens during follow-up.

DISCUSSION

Though the small number of the patients and the lack of control group, our results suggest that misoprostol allows regression and/or improvement of histological IM (p < 0.001). It has proved to be effective in prevention of both gastric and duodenal ulcers induced by NSAID therapy, probably related largely to replacement of endogenous prostaglandins inhibited by the use of NSAID and it may also exerts its protective effects through inhibition of gastric acid secretion. Moreover, misoprostol showed to increase the rate of gastric blood flow, inducing a mucosal protective effect against the factors damaging gastric mucosa. It has been also documented that misoprostol regulates inflammatory cytokines and prolonged the survival of transplants, reflecting both its immunosuppressive and anti-inflammatory effect. In conclusion, since intestinal metaplasia increases the risk of gastric cancer, the use of misoprostol, in this pathology, would be of some interest.

ESWL experience in the therapy of difficult bile duct stones

In recent years, alternatives to surgery for difficult bile duct stones have been developed. Routine endoscopy fails in about 10% of patients. To verify the role of extracorporeal shock wave lithotripsy in residual CBD stones, we treated 32 patients by HM4 or MPL 9000 Dornier lithotripters. Ten (34.4%) patients needed two extracorporeal shock wave lithotripsy sessions, and 3 (10.3%) patients three. Complete clearance was achieved in 29 patients (90.6%) after one or more sessions either by endoscopic (20 pts) or percutaneous (9 pts) extraction of the debris; of the remaining 3 patients, in 2 a bilioduodenal stent was placed and in 1 electrohydraulic lithotripsy was performed. Eighteen and seven-tenths percent transient mild hemobilia, 12.5% microhematuria, and no mortality were observed. It is possible to state that in site- or size-related difficult biliary stones, extracorporeal shock wave lithotripsy is a rapid, safe, and highly effective treatment as an additional nonoperative option to resolve the failure of routine endoscopic measures.

[Echographic and ERCP-manometric study of gallbladder and Oddi's sphincter behavior in biliary colic in patients with cholelithiasis. Effects of cerulein]

In a previous study, we have shown that caerulein relieves biliary colic pain in gallstone patients. This study was initiated to determine gallbladder and sphincter of Oddi behaviour during biliary colic and their response to caerulein. In 10 gallstone patients gallbladder volume was measured by real-time ultrasonography during a biliary colic episode and 72 hours after cessation of pain, before and after caerulein administration. Basal sphincter of Oddi pressure was determined by CPRE manometry in 10 gallstone patients during biliary colic and three days after cessation of pain, before and after caerulein. The results of this study show that, during biliary colic, gallbladder volume is 8 times greater than in the post-colic state. Basal sphincter of Oddi pressure was also significantly higher during biliary colic than in the post-colic state. Caerulein relieved in all cases the biliary colic pain while reducing gallbladder volume and decreasing the sphincter of Oddi.

Effect of nizatidine versus ranitidine on gastric intraluminal prostaglandin release in duodenal ulcer patients

The role of prostaglandins in peptic ulcer disease and their relation to Helicobacter pylori infection remain controversial. This study sought to compare the effects of oral nizatidine and ranitidine on the gastric mucosal release of prostanoids in duodenal ulcer (DU) patients and to correlate prostanoid concentrations with H. pylori status. Twenty-eight patients with DUs were randomized to receive either nizatidine or ranitidine. Nizatidine 300 mg at night elevated intraluminal PGE2 concentrations; 6-keto-PGF1 alpha concentrations also rose, but did not reach statistical significance. Ranitidine induced non-significant falls in PGE2 and 6-keto-PGE1 alpha concentrations. Patients with H. pylori infection had lower PGE2 and 6-keto-PGF1 alpha concentrations than non-infected patients, but nizatidine was equally effective in increasing prostanoid levels in both groups. These findings may be considered as favourable side effects of nizatidine with uncertain clinical significance. Further studies are needed to elucidate the synergism between prostanoids, eradication of H. pylori and nizatidine in the treatment of DU.

[Rheumatic fever from 1960's to 1990's. Case records in 2 hospitals of the Lombardian area]

An epidemiological study of rheumatic fever (RF) has been done. Incidence and prevalence of RF observed in Monza Hospital from 1964 to 1990 and in Como Hospital from 1980 to 1990 both show a progressive reduction. An exception to this trend was observed in 1986 in Monza in 1985 in Como. The percentage of carditis in pediatric age is high (60-70%), often associated with arthritis and chorea. However carditis clinical picture seems nowadays less severe, probably because in the past the diagnosis was delayed. Sice 1980 no death were observed due to RF or related cardiac involvement. Relapses and residual valvulopathies are significantly reduced only when penicillin prophylaxis was correctly performed.

Single photon emission computed tomography with 99mTc HM-PAO in the study of focal epilepsy

We used 99mTc HM-PAO SPECT to study 50 patients with partial epilepsy: 47 interictally and 3 during a seizure. All 3 patients studied during a seizure presented an area of increased tracer uptake. Of those in whom recordings were taken during seizure-free intervals 35 (74%) showed perfusion asymmetries: 27 (57%) with decreased and 8 (17%) with increased uptake. We discuss the findings and compare them with those of similar studies using SPECT and positron emission tomography.

[Vasculitis in children]

Vasculitis is an inflammatory involvement with or without necrosis of blood vessels and the predominant feature of a large number of different diseases and syndromes in childhood. Vasculitis could be a primitive disease or it could participate with minor or mayor gravity to other diseases. Symptoms and prognosis vary accordingly to the size of vessels, type of inflammatory exudate and the organs involved. In pediatric age most frequent vasculitis are Schönlein-Henoch syndrome, Kawasaki syndrome and vasculitis associated with connective tissue diseases.

[Therapy of vasculitis in children]

Therapy of vasculitis syndromes varies considerably according to different forms and gravity. Mild cases often heal spontaneously. In other cases, when the causal factors are known, the removal of the offending antigen or the treatment of an underlying primary disease are sufficient to obtain remission. In the vasculitis syndromes, in which the causal factors are unknown, therapy is based on various associations of nonsteroidal antiinflammatory drugs, antiplatelet drugs, anticoagulants, corticosteroids and cytotoxic drugs, depending on the type, extention and gravity of disease. In most severe systemic necrotizing vasculitis, therapy with corticosteroids and cytotoxic drugs must be protracted for months, with inevitable side-effects, particularly severe in children. Pulse therapy with intravenous bolus of high doses of methylprednisolone seems to offer a new valid therapeutic approach, but is still under investigation. Plasmapheresis may be successful in acute and grave forms. High dose intravenous gammaglobulin therapy is indicated in the prevention of coronary involvement of Kawasaki disease. In this review these problems and therapeutic regimes suggested by different Authors are discussed, with particular attention to their application in childhood.

[Leukocytoclastic vasculitis]

Leukocytoclastic vasculitis is characterized by infiltration of polymorphonuclear leucocytes with leukocytoclastic (presence of nuclear pigments) and fibrinoid necrosis affecting the small vessels. Henoch-Schönlein purpura is characterized by non thrombocytopenic purpura, arthritis and arthralgia, abdominal pain and renal involvement. Hypocomplementemic urticarial vasculitis and cryoglobulinemia are exceptional in childhood.

[A case of stenosing ureteritis in Schoenlein-Henoch purpura]

A case of stenosing ureteritis in a 6 years old girl with Schönlein-Henoch purpura is described. In a careful review of the literature only a few cases results described. The authors discuss the problems concerning this rare and potentially serious complication of Schönlein-Henoch purpura.

[Our experience with a combination of rifampicin and minocycline in the therapy of brucellosis]

After a brief review of the literature on the treatment of brucellosis the results obtained with a new protocol (Rifampicin + Minocycline for 20 days) are reported. The combination was well-tolerated and undeniably effective producing a 94% cure rate.

[295 cases of brucellosis treated with minocycline]

295 cases of acute and subacute cases of brucellosis were treated with minocycline. It is concluded that because of its in vitro activity, its penetrability in macrophages and granulomas and its tolerance, minocycline is the antibiotic of choice for brucellosis.

[Intracranial hemorrhage caused by vitamin K deficiency in early infancy. Still a problem?]

A case of intracranial hemorrhage in a one month old infant is reported. A review of the prodromal symptoms presented by this infant seems useful to delineate a clinical picture that should allow a timely recognition of this problem in the population at risk. Furthermore, the relative frequency of this entity, due to vitamin K deficiency, in the first months of life in exclusively breast-fed infants, confirms the advisability of vitamin K supplementation at birth.

["Dense deposits" glomerulonephritis: description of a case]

The authors report a case of "dense deposits" glomerulonephritis in a girl who showed the first symptoms of asintomatic microhematuria at the age of 3 years during an ambulatorial examination which had been requested from her family doctor. After 1 year and 10 months the girl has been hospitalized and during her stay in the hospital it appeared that she still suffered of microhematuria with very low levels of serum complement. Being these results the same after the various check-ups made after her dismission from the hospital it has been decided to execute a renal biopsy, comprehending also the examination with an electronic microscopy which showed intramembranous "dense deposits" glomerulonephritis. In literature no similar cases under 4 years of age are reported.

[Plasma levels of anti-epileptic drugs. Evaluation of determinations carried out in the years 1978-1979]

The results of 701 determinations of antiepileptic drug plasma concentrations administered to 190 patients are described. It has been possible to reduce the number of prescribed drugs to 1.55 per patient, so that only 8.1% of subjects takes three or more drugs while 53% is on monotherapy. The use of the measurement of AEDs plasma concentrations resulted very useful: a) when Phenytoin (PHT) is prescribed; b) in epileptic children; c) when the patient takes two or more drugs; d) to evaluate the compliance. A significant increase (p less than 0.01) of the level/dose ratio of Phenobarbital (PB) when PHT is in, or over, the therapeutic range was observed, while at plasma concentrations of PHT below 10 micrograms/ml it does not influence the metabolism of PB.