Multiproxy bioarchaeological data reveals interplay between growth, diet and population dynamics across the transition to farming in the central Mediterranean

The transition to farming brought on a series of important changes in human society, lifestyle, diet and health. The human bioarchaeology of the agricultural transition has received much attention, however, relatively few studies have directly tested the interrelationship between individual lifestyle factors and their implications for understanding life history changes among the first farmers. We investigate the interplay between skeletal growth, diet, physical activity and population size across 30,000 years in the central Mediterranean through a 'big data' cross-analysis of osteological data related to stature (n = 361), body mass (n = 334) and long bone biomechanics (n = 481), carbon (δ13C) and nitrogen (δ15N) stable isotopes (n = 1986 human, n = 475 animal) and radiocarbon dates (n = 5263). We present the observed trends on a continuous timescale in order to avoid grouping our data into assigned 'time periods', thus achieving greater resolution and chronological control over our analysis. The results identify important changes in human life history strategies associated with the first farmers, but also highlight the long-term nature of these trends in the millennia either side of the agricultural transition. The integration of these different data is an important step towards disentangling the complex relationship between demography, diet and health, and reconstruct life history changes within a southern European context. We believe the methodological approach adopted here has broader global implications for bioarchaeological studies of human adaptation more generally.

Monitoring of indoor bioaerosol for the detection of SARS-CoV-2 in different hospital settings

Background

Spore Trap is an environmental detection technology, already used in the field of allergology to monitor the presence and composition of potentially inspirable airborne micronic bioparticulate. This device is potentially suitable for environmental monitoring of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in hospital, as well as in other high-risk closed environments. The aim of the present study is to investigate the accuracy of the Spore Trap system in detecting SARS-CoV-2 in indoor bioaerosol of hospital rooms.

Methods

The Spore Trap was placed in hospital rooms hosting patients with documented SARS-CoV-2 infection (n = 36) or, as a negative control, in rooms where patients with documented negativity to a Real-Time Polymerase Chain Reaction molecular test for SARS-CoV-2 were admitted (n = 10). The monitoring of the bioaerosol was carried on for 24 h. Collected samples were analyzed by real-time polymerase chain reaction.

Results

The estimated sensitivity of the Spore Trap device for detecting SARS-CoV-2 in an indoor environment is 69.4% (95% C.I. 54.3-84.4%), with a specificity of 100%.

Conclusion

The Spore Trap technology is effective in detecting airborne SARS-CoV-2 virus with excellent specificity and high sensitivity, when compared to previous reports. The SARS-CoV-2 pandemic scenario has suggested that indoor air quality control will be a priority in future public health management and will certainly need to include an environmental bio-investigation protocol.

Ultrasound screening for asymptomatic deep vein thrombosis in critically ill patients: a pilot trial

Deep vein thrombosis (DVT) in critically ill patients still represents a clinical challenge. The aim of the study was to investigate whether a systematic ultrasound (US) screening might improve the management of the antithrombotic therapy in intensive care unit (ICU). In this non-randomized diagnostic clinical trial, 100 patients consecutively admitted to ICU of the University Hospital of Perugia were allocated either in the screening group or in the control group. Subjects in the screening group underwent US examination of lower limbs 48 h after admission, and again after 5 days. Subjects in the control group underwent US examination according to the standard of care (SOC) of the enrolling institution. Retrospectively registered at ClinicalTrials.gov (NCT05019092) on 24.08.2021. Lower limb DVT was significantly more frequent in the screening group (p < 0.001), as well as the subsequent extension of a pre-existing DVT (p = 0.027). In the control group, DVT of large veins was more frequent (p = 0.038). Major bleedings were reported in 5 patients, 4 in the non-screening group and in 1 in the screening group. Patients in the screening group started the antithrombotic treatment later (p = 0.038), although the frequency, dose and duration of the treatment were not different between the two groups. The duration of stay in ICU was longer in the screening group (p = 0.007). Active screening for DVT is associated with an increased diagnosis of DVT. The screening could be associated with a reduced incidence of proximal DVT and a reduction in the bleeding risk.

P160 RIGHT SISTEMIC VENTRICLE AND PREGNANCY

Patient with complex congenital heart disease: situs inversus with dextrocardia and transposition of the great vessels (D–TGA), right aortic arch and inferior cava agenesis with azygos continuation; at 4 months Mustard atrial switch (intratrial baffle for redirection of the systemic venous circulation in the left subpulmonary left ventricle and of the pulmonary venous circulation in the right subaortic systemic ventricle). At 22 years, 1st pregnancy without complications, caesarean section, birth weight 2.2 kg. Two pregnancies spontaneously terminated in the firts trimester. At 29 years echocardiography: right systemic ventricle hypertrophic, dilated and slightly hypokinetic with tricuspid (systemic) valve with mild to moderate insufficiency; Mustard circuit normally functioning on the systemic side, mild stenosis of the pulmonary buffle (Gmax 6mmHg). At 33 years monochorionic biamniotic twins pregnancy; the risk linked to pregnancy for the patient on the basis of her heart disease was included in a WHO class III worsened by twinning. Because of the high probability of maternal and fetal complications related to the continuation of pregnancy, it was necessary to recommend a selective interruption of the pregnancy of the fetus affected by severe selective underdevelopment with signs of twin to twin transfusion at the 20th week of gestation. Maternal clinical and haemodynamic conditions have been stable during pregnancy. At the 24th week of gestation echocardiography: worsening of the systemic right function ventricle, moderate tricuspid insufficiency and increased gradients in the Mustard circuit (systemic Gmax 13mmHg and pulmonary venous Gmed 8mmHg). After the pregnancy team‘s discussion, a delivery plan was proposed to transfer the patient to a third level cardiac surgery center with experience in congenital heart disease adult between the 35th and 36th week. This was not possible because the patient at 32th week presented preterm labor with caesarean section without maternal and newborn complications (birth weight 1,650 kg). In the puerperium ehocardiography: hypertrophic, dilated and moderately hypokinetic systemic right ventricle with moderate tricuspid insufficiency; Mustard circuit: systemic baffle max gradient 16mmHg and pulmonary venous medium gradient 9mmHg. 7 years after this pregnancy at the last visit: stable clinical and echocardiographic situation with persistence of moderate dysfunction of the systemic right ventricle.

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P398 A CASE OF MIS–C: SARS–COV2 AND MYOCARDITIS IN PEDIATRIC AGE

A 12–year–old patient with paucisymptomatic SARS–COV2 infection in November 2020 with negative swab after 10 days. After 3 weeks access to pediatric emergency room for fever, maculo–papular rash on the trunk, conjunctivitis, nausea and abdominal pain: evidence of thrombocytopenia, increased CPK, LDH, AST and inflammation markers. She starts antibiotic therapy for suspected sepsis. After 24 hours asthenia, general illness, hypotension and tachycardia: echocardium with diffuse hypokinesia of the left ventricle (EF 35%); worsening of thrombocytopenia, D–Dimer, BNP and CPK increase, hyponatremia, troponin positivity, ATIII reduction; negative viral markers. On the basis of the most recent literature, the diagnosis of MIS–C is made, a post–infection SARS–COV2 multisystemic inflammatory syndrome. After discussion with the 3rd level SARS–COV2 Pediatric Center, the following therapy begins: iv diuretic, iv cortisone, sc heparin, iv immunoglobulins, Anakinra. For a progressive clinical worsening by cardiogenic shock with evolution to DIC, she is transferred by military plane to the pediatric intensive care of 3rd level SARS–COV2 Center. The patient is subjected to mechanical ventilation, therapy with inotropes (adrenaline and milrinone) and CRRT ultrafiltration in order to reduce the excessive levels of inflammatory mediators responsible for rapid multiorgan failure. After 4 days, haemodynamic parameters improvement (EF 50%); sartan and low dose diuretic have been started because of the presence of diastolic dysfunction. Discharge after 1 month of hospitalization with good clinical and haemodynamic stability. After 6 months from myocarditis onset with cardiogenic shock in MIS–C, cardiac MRI with evidence of EF 57% and small area of delayed enhancement on the anterior IVS with non–ischemic pattern, no longer present by imaging after 1 year by acute event. Currently the patient reports subjective well–being by the regular follow–up without arrhythmias by Holter monitoring. SARS–COV2 post–infection multisystemic inflammatory syndrome (MIS–C) represents a serious complication with possible myocardial involvement also following a paucysymptomatic infection as in the described case. What happened shows us that SARS–COV2 infection is still a devious clinical entity that needs close follow–up in the short and long term.

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Bioelectrical Impedance Vector Analysis (BIVA) for the monitoring of body composition in pregnancy

BACKGROUND/OBJECTIVES

During pregnancy, body composition alterations can be considered as markers of complications and in this context, a non-invasive and low-cost method such as Bioelectrical Impedance Vector Analysis (BIVA), can be employed to monitor such changes. This study aimed at identifying body compartments trend during physiological pregnancy.

SUBJECTS/METHODS

Classic and specific BIVA variables have been measured in a sample of 37 pregnant women approximately every 4 weeks of gestation and once postpartum. Researchers used both longitudinal and cross-sectional approach. The first case included data of women from the 11th to the 15th week along with data from the 28th to the 32nd week of gestation. The cross-sectional approach regarded two more specific moments (11th-12th weeks and 30th-31st weeks) and data within two months postpartum RESULTS: The longitudinal approach showed a significant decrease in classic BIVA variables (R/H, Xc/H, Z/H p < 0.001) and a shortening of the vector, pointing out that TBW and hydration increased significantly. Specific vector length increased significantly, indicating a physiological gain of FM% (p < 0.01). The cross-sectional approach showed lower values of R/H, Xc/H, Z/H between 12th-13th and 30th-31st weeks (p < 0.01), while in the postpartum period values tended to those registered at the beginning of pregnancy. No changes have been found for the phase angle in both approaches, indicating that ECW/ICW ratio remained constant CONCLUSIONS: Among physiological pregnancies, bioelectric values showed a coherent trend and these results represent a first contribution to support routine exams, leading to an early detection of anomalous values potentially correlated to pathologies.

The detrimental impact of elevated Ferritin to Iron ratio on in-hospital prognosis of patients with COVID-19

Background

Acute viral infections, including coronavirus disease 2019 (COVID-19), are characterized by the dysregulation of iron metabolism, resulting in high serum ferritin and low iron levels.

Research design and methods

This study aimed to evaluate the prospective impact of iron metabolism dysregulation, as expressed by serum Ferritin-to-Iron Ratio (FIR), on the in-hospital prognosis of patients with COVID-19. Serum levels of ferritin and iron, as well as other iron metabolism markers and recognized prognostic indicators of COVID-19 severity, were measured in 362 patients consecutively hospitalized for COVID-19. The prospective relationship between FIR and the risk of the composite outcome of intensive care unit (ICU) admission/in-hospital death was analyzed.

Results

In the population examined (mean age 74 ± 15 years, males 55%), the rates of radiographic signs of pneumonia, respiratory distress, and the need for noninvasive ventilation were higher in patients with high FIR (≥29.2, the 75^th percentile) than in those with low FIR (<29.2, the 75^th percentile) (p < 0.05 for all comparisons). High FIR was associated with a 1.7-fold (HR 1.709, 95% CI 1.017–2.871, p = 0.043) higher risk of ICU admission/in-hospital death.

Conclusions

Increasing FIR values significantly and independently predicts worse in-hospital prognosis in hospitalized patients with COVID-19.

Tumor induced osteomalacia: A single center experience on 17 patients

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome due to a phosphaturic tumor, which overproduces Fibroblast Growth Factor 23 (FGF-23), causing hyperphosphaturia, hypophosphatemia, low 1,25(OH)₂D and osteomalacia. Tumor localization is critical, diagnostic delay ranges from 2.5 to 28 years and to date surgical removal is considered effective treatment. We retrospectively evaluated patients with definite diagnosis of TIO referred to a tertiary Rheumatology Center between September 2000 and May 2020, investigating clinical management and disease outcome. We included 17 patients: 10 (58.8%) were females, mean age at diagnosis was 55.3 ± 13.9 years (mean ± standard deviation), with a diagnostic delay from symptoms onset to tumor detection of 6.6 ± 6.25 years. Biochemical data were: serum phosphorus 1.3 ± 0.4 mg/dL (Reference Range: 2.5-4.6), serum 1,25(OH)₂D 31.8 ± 22.9 ng/mL (RR: 25-86), intact FGF-23, 358.9 ± 677 pg/mL (RR: 25-45); 24 h-Urine Phosphorus was increased in only 2 patients, while tubular reabsorption of phosphate (TRP) was decreased in all patients confirming a renal phosphate wasting. In 2013 ⁶⁸Ga- DOTA-based PET/CT was introduced in routinely practice and diagnostic delay was consistently reduced (from 8.6 ± 7.9 to 4.3 ± 2.4 years). Thirteen patients underwent surgery, one patient underwent radiofrequency ablation; 3 patients, not eligible for surgery, were treated only with supplements of phosphorus and calcitriol. One was started on Burosumab after several unsuccessful surgical attempts. After surgery or ablation, 8 patients had complete remission, 3 TIO persistence, and 3 had overtime relapse. Relapses were observed only in patients who previously underwent closed biopsy. To our knowledge, this is the widest European cohort of TIO patients in the last two decades. We confirm a usual diagnostic delay and recommend a stepwise diagnostic approach. Tumor biopsy is not recommended due to the potential cell spilling. Surgery is generally considered a definitive treatment, even though other approaches have been successful in curing TIO. Active surveillance on possible recurrence is always needed. Burosumab appears a promising therapy.

Effects of structured home-based exercise training on circulating endothelial progenitor cells and endothelial function in patients with intermittent claudication

INTRODUCTION

Exercise training improves walking capacity in patients with intermittent claudication (IC). Endothelial progenitor cells (EPCs), endothelial microparticles (EMPs), and endothelial dysfunction could play a role in this process.

METHODS

We measured EPCs and EMPs in a group of 60 patients with IC, and in a control group of 20 individuals without IC, before a treadmill test and 2, 24, and 48 hours after the test. Thirty patients with IC were randomly assigned to perform a 12-week home-based exercise training program. The EPC count, flow-mediated dilation (FMD) of the brachial artery, pain-free walking time (PFWT), and maximum walking time (MWT) were measured at the baseline and after the exercise training program.

RESULTS

In patients with IC, EMPs significantly increased 2 hours after the treadmill test, whereas EPCs significantly increased after 24 hours. Among the subjects assigned to complete the training program, we observed a significant increase in the number of EPCs after 12 weeks, as well as an improvement in FMD, PFWT, and MWT. A significant correlation between the variation of EPCs, FMD, and MWT was found. The increase of EPCs and FMD were independent determinants of the walking capacity improvement, without significant interaction.

CONCLUSION

Our results suggest that EPCs mobilization contributes to the improvement of walking capacity in patients with IC undergoing structured physical training. A number of different, partly independent, mechanisms are involved in this process, and our results highlight the potential role of EMPs release and endothelial function improvement. ClinicalTrials.gov Identifier: NCT04302571.

The association between neutrophil to lymphocyte ratio and endothelial dysfunction in people living with HIV on stable antiretroviral therapy

BACKGROUND

Residual inflammation is thought to promote endothelial dysfunction and cardiovascular disease risk among people living with HIV (PLWH) receiving antiretroviral therapy (ART). Whether the neutrophil-to-lymphocyte ratio (NLR), a putative marker of systemic inflammation, may be associated with endothelial dysfunction has not been investigated in PLWH on stable ART.

RESEARCH DESIGN AND METHODS

In this cross-sectional study, 210 PLWH (mean age 49 years, 79% males, 88/7/5% Caucasians/Africans/Hispanics) on long-term ART (median ART duration 8 years) were enrolled among those who were afferent to an Infectious Diseases outpatient clinic. The association between NLR and brachial flow-mediated dilation (bFMD) was analysed.

RESULTS

A curvilinear association was observed between logarithmic-NLR and logarithmic-bFMD (R square = 0.034, p = 0.027), with logarithmic-bFMD decreasing significantly with increasing logarithmic-NLR only in PLWH with high NLR (≥1.47, median NLR) (r = -0.369, p < 0.001). However, NLR had a poor accuracy in the prediction of low bFMD (≤4.55, median bFMD) in PLWH with high NLR (55% sensitivity, 80% specificity, Youden index 0.35 for NLR 2.20).

CONCLUSIONS

Although there is an inverse association between NLR and bFMD among long-term ART-treated PLWH with high NLR, NLR has a low discriminatory ability toward endothelial dysfunction in this category of patients.

PCSK9 and cancer: Rethinking the link

BACKGROUND

Cancer is emerging as a major problem globally, as it accounts for the second cause of death despite medical advances. According to epidemiological and basic studies, cholesterol is involved in cancer progression and there are abnormalities in cholesterol metabolism of cancer cells including prostate, breast, and colorectal carcinomas. However, the importance of cholesterol in carcinogenesis and thereby the role of cholesterol homeostasis as a therapeutic target is still a debated area in cancer therapy. Proprotein convertase subtilisin/kexin type-9 (PCSK9), a serine protease, modulates cholesterol metabolism by attachment to the LDL receptor (LDLR) and reducing its recycling by targeting the receptor for lysosomal destruction. Published research has shown that PCSK9 is also involved in degradation of other LDLR family members namely very-low-density-lipoprotein receptor (VLDLR), lipoprotein receptor-related protein 1 (LRP-1), and apolipoprotein E receptor 2 (ApoER2). As a result, this protein represents an interesting therapeutic target for the treatment of hypercholesterolemia. Interestingly, clinical trials on PCSK9-specific monoclonal antibodies have reported promising results with high efficacy in lowering LDL-C and in turn reducing cardiovascular complications. It is important to note that PCSK9 mediates several other pathways apart from its role in lipid homeostasis, including antiviral activity, hepatic regeneration, neuronal apoptosis, and modulation of various signaling pathways. Furthermore, recent literature has illustrated that PCSK9 is closely associated with incidence and progression of several cancers. In a number of studies, PCSK9 siRNA was shown to effectively suppress the proliferation and invasion of the several studied tumor cells. Hence, a novel application of PCSK9 inhibitors/silencers in cancer/metastasis could be considered. However, due to poor data on effectiveness and safety of PCSK9 inhibitors in cancer, the impact of PCSK9 inhibition in these pathological conditions is still unknown.

SEARCH METHODS

A vast literature search was conducted to find intended studies from 1956 up to 2020, and inclusion criteria were original peer-reviewed publications.

PURPOSE OF REVIEW

To date, PCSK9 has been scantly investigated in cancer. The question that needs to be discussed is "How does PCSK9 act in cancer pathophysiology and what are the risks or benefits associated to its inhibition?". We reviewed the available publications highlighting the contribution of this proprotein convertase in pathways related to cancer, with focus on the potential implications of its long-term pharmacological inhibition in cancer therapy.

Time-related changes in sex distribution of COVID-19 incidence proportion in Italy

Background

Variable sex-disaggregated data on Coronavirus disease 2019 (COVID-19) incidence proportion (IP) have been reported in different datasets and studies. Factors explaining the inconsistent distribution of COVID-19 among sexes are still unclear.

Objectives

This study aimed to analyse time-related variation of sex-disaggregated COVID-19 IP in Italy since March 9^th to May 11^th 2020, and to test its association with the frequency of swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Study design

Sex-disaggregated data on COVID-19 cases were collected from Italian publicly accessible databases along with undisaggregated data on the number of reverse transcriptase–polymerase chain reaction (RT-PCR) SARS-CoV-2 tests. Crude and adjusted associations between the frequency of RT-PCR SARS-CoV-2 testing and male-to-female (M/F) ratio of COVID-19 IP were performed.

Results

COVID-19 IP increased progressively in both sexes. Sex prevalence of COVID-19 IP reversed over time, with the M/F ratio of COVID-19 IP having passed from 1,73 to 0,91. The mean number of daily swabs for RT-PCR SARS-CoV-2 test increased progressively until reaching a plateau in the last three weeks of the study period. The M/F ratio of COVID-19 IP inversely correlated with the number of daily swabs for RT-PCR SARS-CoV-2 test (r = -0,87, p < 0.001), even after adjusting for the median age of COVID-19 cases (β = -0,66, p < 0,001).

Conclusions

Time-related changes of sex distribution of COVID-19 IP in Italy are strongly influenced by the number of swabs testing for SARS-CoV-2. Whether gender-related disparities in the access to the diagnosis of COVID-19 may explain such a result need to be explored.

Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass

Osteoporosis is a health issue in postmenopausal women. Physical activity is recommended in these subjects, since it has positive effects on bone mass. Cellular mechanisms underlying this effect are still unclear. Osteogenic cells, released after physical exertion, could be a key factor in exercise-induced bone formation.

INTRODUCTION

The aim of our research was to explore if a weight-bearing and resistance exercise program could positively affect circulating osteogenic cells (OCs), markers of bone formation and quality of life (QoL) in osteopenic postmenopausal women.

METHODS

We recruited 33 postmenopausal women with a T-score at lumbar spine or femoral neck between - 1 and - 2.5 SD. Anthropometric and fitness parameters, bone-remodeling markers, OCs, and QoL were evaluated at the time of enrolment, after 1-month run-in period, and after 3 months of weight-bearing and resistance exercise.

RESULTS

After 3 months of training, the pro-collagen type 1 N-terminal peptide (P1NP) and the number of OCs were significantly increased, with no significant increase of the type 1 collagen cross-linked C-telopeptide (sCTX). We also observed a significant increase in body height, one-repetition maximum (1RM) on the pull-down lat machine and leg press, and mean VO₂max. The increase of immature circulating OCs was significantly correlated with the improvement of 1RM both of the upper and lower limbs. Moreover, QoL was significantly improved with regard to pain, physical function, mental function, and general QoL. The improvement in QoL, namely in the overall score and in the pain score, was significantly correlated with the increase in height.

CONCLUSIONS

The exercise program we trialed is able to increase the markers of bone formation and the commitment of immature OCs with no significant increase in the markers of bone resorption. Our results confirm that combined weight-bearing and resistance physical activity is an effective tool to improve QoL of postmenopausal women with low bone mass.

TRIAL REGISTRATION

NCT03195517.

Combined aerobic and resistance training improves microcirculation in metabolic syndrome

BACKGROUND

Exercise intervention improves macrovascular function in metabolic syndrome (MeS) patients, but few studies have evaluated the effect of exercise on microcirculatory dysfunction, which plays a key role in the development of MeS and its correlated organ damage. We carried out this intervention study to evaluate the influence of an aerobic and resistance training on skin microvascular reactivity in MeS patients.

METHODS

Postocclusive reactive hyperemia (PORH) of the forearm skin was evaluated, by laser-Doppler flowmetry, before and after a 12-week program of aerobic and resistance training in 15 MeS patients referring to our Lipid Metabolism Outpatients Clinic, together with anthropometric, fitness and metabolic parameters; 15 matched MeS patients who did not exercise, served as a control group. The exercise training consisted of 2 sessions/week of aerobic and resistant exercise.

RESULTS

Following exercise program, we observed a significant reduction in body weight, fat mass, fasting blood glucose, serum HbA1c and triglycerides, while HDL-cholesterol significantly increased. The exercise-treated group experienced a significant improvement in the area of hyperemia (AH) after PORH, and in all fitness parameters: VO2max, strength on the pulldown lat machine, chest press, leg press and leg extension. A significant correlation emerged between the increase in AH and the reduction in HbA1c and between increase in AH and strength at the chest press, and at the leg extension.

CONCLUSIONS

Our study showed that a short-term combined aerobic-resistance training positively affects microvascular reactivity in MeS patients. This improvement is correlated with the reduction of HbA1c and fitness parameters, and particularly with increased muscle strength at the upper and lower limbs.

Allanblackia floribunda Oliv.: An aphrodisiac plant with vasorelaxant properties

ETHNOPHARMACOLOGICAL RELEVANCE

Allanblackia floribunda Oliv. is one of the most commonly used medicinal plant in Cameroon. The stem bark of the plant is traditionally used for its aphrodisiac and antihypertensive properties.

AIM OF THE STUDY

To validate the traditional uses of Allanblackia floribunda stem bark ethanol extract through the evaluation of their aphrodisiac and vasorelaxant properties.

MATERIALS AND METHODS

The extract's ability to increase sexual desire and the frequencies of erection (mount), intromission and prolonged latency of ejaculation were studied on adult male rats. The vasodilator effect was investigated using isolated rat aorta rings. Tests were conducted using fractions obtained by reverse phase column-chromatography (CC), after the acquisition of the HPLC fingerprint of the ethanol extract, resulted the most active in previous studies.

RESULTS

The CC allowed the isolation of five fractions whose aphrodisiac and vasodilator activities were tested and compared with those of the whole extract. Four compounds were identified and characterized, three of them, Fukugiside, Morelloflavone and Volkensiflavone, are secondary metabolites known to be in Allanblackia floribunda; the fourth, Spicataside, is a biflavonoid glycoside known to be present in the genus Garcinia but never found neither in Allanblackia floribunda nor in Allanblackia genus. The crude ethanolic extract (CEE) induced a relaxation on aorta rings with EC₅₀=11±2μg/mL and Morelloflavone displayed a similar activity with EC₅₀=42±6μg/mL; for all the other compounds only the vasodilation % at the maximum concentration assessable (90μg/mL) was determined: 30±8 (Fukugiside), 24±6 (Spicataside), 33±4 (Morelloflavone+Volkensiflavone), 47±1 (Volkensiflavone). Regarding the activity on male sexual behaviour, only CEE and Fukugiside showed activity in the 9 parameters evaluated.

CONCLUSIONS

These results may support the traditional uses of Allanblackia floribunda as aphrodisiac plant with antihypertensive properties suggesting the phytocomplex as responsible for the claimed activity.

Increased Bone Resorption: A Possible Pathophysiological Link Between Hypovitaminosis D and Peripheral Arterial Disease

OBJECTIVE/BACKGROUND

Vitamin D deficiency has been associated with the prevalence and severity of peripheral arterial disease (PAD); nevertheless, data on bone turnover in patients with PAD is lacking. The present study investigates a possible relationship between the markers of bone turnover and the presence and severity of PAD.

METHODS

The study examined 143 patients, with a mean ± SD age of 75.3 ± 8.5 years (range 50.0-93.0 years), of both sexes, admitted to a department of internal medicine. All patients underwent ankle brachial index (ABI) assessment by Doppler velocimetry. Serum levels of 25(OH) vitamin D and two markers of bone turnover, C-terminal telopeptide of type I collagen (sCTX) and bone isoenzyme of alkaline phosphatase, were measured. The differences between patients with normal ABI and patients with PAD were analyzed. Pearson and Spearman correlation coefficients were calculated and independent predictors were identified through a stepwise linear regression analysis. Odds ratios were calculated with a logistic regression model.

RESULTS

Compared with patients with a normal ABI (≥0.90), patients with PAD (ABI < 0.90) presented with significantly lower levels of 25(OH) vitamin D (12.2 ± 9.6 ng/mL vs. 16.7 ± 8.7 ng/mL; p = .006) and a significantly higher concentration of sCTX (1.1 ± 0.7 ng/mL vs. 0.6 ± 0.4 ng/mL; p < .001). There was a positive correlation between ABI and serum concentration of 25 (OH) vitamin D (r = 0.3; p < .001), whereas ABI was inversely correlated with the concentration of sCTX (r = -0.358; p < .001). At logistic regression analysis, age, cigarette smoking, and both vitamin D and sCTX were independent predictors of an ABI < 0.90.

CONCLUSION

These results support the hypothesis that hypovitaminosis D and increased bone turnover are risk factors for the presence and severity of PAD. Furthermore, the presence of PAD, even if asymptomatic and diagnosed by a reduced ABI, could identify a population at risk for osteoporosis and osteomalacia.

Bioelectrical impedance vector analysis (BIVA) for the assessment of two-compartment body composition

This review is directed to define the efficacy of bioelectrical impedance vector analysis (BIVA) for assessing two-compartment body composition. A systematic literature review using MEDLINE database up to 12 February 2014 was performed. The list of papers citing the first description of BIVA, obtained from SCOPUS, and the reference lists of included studies were also searched. Selection criteria included studies comparing the results of BIVA with those of other techniques, and studies analyzing bioelectrical vectors of obese, athletic, cachectic and lean individuals. Thirty articles met the inclusion criteria. The ability of classic BIVA for assessing two-compartment body composition has been mainly evaluated by means of indirect techniques, such as anthropometry and bioelectrical impedance analysis (BIA). Classic BIVA showed a high agreement with body mass index, that can be interpreted in relation to the greater body mass of obese and athletic individuals, whereas the comparison with BIA showed less consistent results, especially in diseased individuals. When a reference method was used, classic BIVA failed to accurately recognize FM% variations, whereas specific BIVA furnished good results. Specific BIVA is a promising alternative to classic BIVA for assessing two-compartment body composition, with potential application in nutritional, sport and geriatric medicine.

The nutrition transition in the Venezuelan Amazonia: increased overweight and obesity with transculturation

OBJECTIVES

Amerindians have a particularly high propensity to overweight and obesity as they change lifestyle and experience a nutrition transition. The aim of this study was to evaluate the effects of transculturation on nutritional status in three Amazonian Amerindian villages.

METHODS

Nutritional status was assessed in 232 volunteers: 65 Yanomami from an isolated village and 167 Guahibo subjects from villages with intermediate and high levels of transculturation.

RESULTS

There was a significant pattern of decreasing stunting and increasing overweight and obesity across the gradient of transculturation. From the jungle Yanomami to the intermediate and transculturated Guahibo, stunting was respectively 72, 55, and 39%, and children /adult overweight was 0, 3/44, and 15/89%. These anthropometric-based patterns were confirmed by bioimpedance vector analysis.

CONCLUSIONS

Transculturation in these Amerindian populations is associated with an increase in overweight and obesity coexisting with undernourished children.

Is fibromyalgia a cause of failure in the treatment of a painful shoulder?

PURPOSE

This study aims to review the incidence of fibromyalgia in a cohort of patients who were treated for shoulder pain and address whether a concomitant fibromyalgia could have had detrimental effect on outcomes.

METHODS

The treatment of 286 consecutive patients for shoulder pain was reviewed.

RESULTS

Eighteen patients (6.3 %) were diagnosed as having fibromyalgia, but in 13 of them (72 %), the diagnosis was initially missed. Five patients received a total of 11 surgeries for treatment of the shoulder. At an average follow-up of 15 months (range 12-27), the average new Oxford shoulder score (OS score) was 49 % (range 6-87 %). The average physical component of the Short-Form-12 Healthy Survey (SF-12) was 36 (range 21-55), and the mental component 30 (range 15-46). The Summary Outcome Determination score (SOD score) was 1.3 (range-3 to 6).

CONCLUSIONS

Fibromyalgia occurs relatively frequently in patients who complain of shoulder pain and it can be a cause of failure in the treatment of concomitant painful shoulder conditions.

The removal of a malpositioned implant in the anterior mandible using piezosurgery

In oral, cranio, and maxillofacial surgery, a close relationship among the bone, nerves, and blood vessels can be regularly observed. Surgical procedures for the removal of dental implants have the potential to cause vascular injury and bleeding in the floor of the mouth and internal anterior region of the mandible. Furthermore, conventional osteotomy techniques always require extensive protection of adjacent soft tissue because cutting is not limited to bone and could easily affect other tissues when applied improperly. We report the removal by means of piezosurgery of a malpositioned osseointegrated implant that had previously caused a sublingual hematoma during its insertion. The postoperative course was uneventful, no bleeding, infection, or hematoma formation was noted and the patient reported 100% resolution of all symptoms.

Efficacy of specific bioelectrical impedance vector analysis (BIVA) for assessing body composition in the elderly

OBJECTIVES

This study aimed to ascertain the efficacy of bioelectrical impedance vector analysis (BIVA) in assessing body composition in the elderly by comparing findings with the results of dual-energy X-ray absorptiometry (DXA), and to test an analytical variant of the method (specific BIVA).

DESIGN

Cross-sectional study.

PARTICIPANTS

The sample comprised 207 free-living elderly individuals (75 men and 132 women) aged 65 to 93 years.

MEASUREMENTS

Anthropometric and bioelectrical measurements were taken according to standard criteria. BIVA was applied using the 'classic' procedure and correcting bioelectrical values for body geometry to obtain an estimate of the whole-body impedivity. DXA was used as a reference body composition assessment method. BIVA (classic and specific values) and DXA findings were compared using Student's t and Hotelling's T2 tests, and Pearson's correlation coefficient.

RESULTS

In both sexes, BIVA distinguished between individuals with different amounts of fat and fat-free mass (lean mass including bone mineral content), according to DXA, but not between those with different proportions of fat mass (FM%). Specific bioelectrical values detected changes in body composition.

CONCLUSION

BIVA should be used with caution for evaluating body composition in the elderly. Specific bioelectrical values proved effective, showing promise as a methodological variant of BIVA, suitable for identifying age-related changes in body fatness.

Nutritional and psycho-functional status in elderly patients with Alzheimer's disease

OBJECTIVES

Analysis of variations of nutritional status in relation to psycho-functional conditions in elderly patients with mild to moderate Alzheimer's disease (AD) by means of bioelectrical impedance vector analysis (BIVA).

DESIGN

Cross-sectional study.

SETTING

Alzheimer Center, SS. Trinità Hospital, Cagliari (Italy).

PARTICIPANTS

83 free-living patients (29 men, 54 women) with mild-moderate Alzheimer's disease, aged 66 to 96 years, and 91 age-matched controls (37 men and 54 women).

MEASUREMENTS

Nutritional status was evaluated by anthropometry (weight, height, waist and upper arm circumferences, triceps skinfold; body mass index, BMI; arm muscle area, AMA); Mini Nutritional Assessment, MNA®; bioelectrical impedance vector analysis, BIVA. Psycho-functional status was assessed by the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL).

RESULTS

Compared to the control groups, patients with Alzheimer's disease had a worse psycho-functional and nutritional status. BIVA detected lower body cell mass in Alzheimer's patients with respect to controls (men: T²= 23.4; women: T²=27.3; p<0.01), as well as in the female patients with lower levels of IADL and MMSE (respectively, T²= 8.0; T²=7.4; p<0.05). In patients with AD, a worse psycho-functional status was associated with obesity.

CONCLUSION

The psycho-functional decline of patients with AD is related to body composition variations, with a relative increase of fat mass with respect to the muscle component. The BIVA technique distinguished patients from controls and patients with different levels of cognitive decline. Therefore, it is a suitable tool for the screening and monitoring of nutritional status in Alzheimer's disease.

Bioelectrical impedance vector analysis detects low body cell mass and dehydration in patients with Alzheimer's disease

OBJECTIVES

This paper evaluates the nutritional status in patients with mild-moderate and severe Alzheimer's disease (AD) by bioelectrical impedance vector analysis (BIVA).

DESIGN

Cross-sectional study.

SETTING

Alzheimer Center, SS. Trinita Hospital, Cagliari, and "Monsignor Angioni" Nursing Home, Quartu Sant'Elena (Cagliari, Italy).

PARTICIPANTS

83 free-living patients with mild-moderate Alzheimer's disease (29 men, 54 women), 9 institutionalized women in the severe stage; 468 age-matched controls (202 men, 266 women).

MEASUREMENTS

Mini Nutritional Assessment (MNA), anthropometric (height, weight, BMI), bioelectrical (R, Xc) and biochemical variables (serum albumin) were assessed.

RESULTS

Bioelectrical characteristics were significantly different in the patients with mild-moderate AD with respect to controls, indicating low body cell mass (men, T2= 12.8; women, T2=34.9; p < 0.01). Women with severe AD showed low body cell mass and dehydration with respect to patients with mild-moderate AD (T2=17.1; p < 0.01). The phase angle, R/H and Z/H were significantly correlated (p < 0.05) with MNA (phase: r = 0.31; R/H: r =-0.37; Z/H: r =-0.37) and albumin (phase: r=0.47; R/H: r=-0.36; Z/H: r=-0.36).

CONCLUSION

Alzheimer's disease is characterized by a tendency to malnutrition, present even in the mild-moderate stages, and a tendency to dehydration that appears in the severe stage. The BIVA technique is a promising tool for the screening and monitoring of nutrition and hydration status in Alzheimer's disease.

Upward oriented sellar spine. MRI findings. A case report

The sellar spine is a rare congenital malformation due to the persistence of a notochord rest within the fetal sella turcica. We describe a unique case of a sellar spine vertically oriented displacing the pituitary stalk upwards and forwards. The MRI findings are briefly discussed.

Nutritional status in the healthy longeval population from Sardinia (Italy)

OBJECTIVES

The aim of this study was to evaluate sex- and age-related variations of the nutritional status in the aged population of central Sardinia, a geographical area with a high frequency of long-lived people, particularly men.

DESIGN

The sample consisted of 200 subjects over 70 years of age (men: N= 100, age= 81.0 +/- 7.0 years; women: N= 100, age= 81.5 +/- 7.3 years).

SETTING

Orroli (central Sardinia, Italy).

MEASUREMENTS

Mini nutritional assessment (MNA) and bioelectrical impedance vector analysis (BIVA) were used to evaluate nutritional status and body composition.

RESULTS

The indicators revealed a generally good nutritional status. The MNA results (men: 24.6 +/- 2.2; women: 23.4 +/- 2.5) showed that 64.1% of the subjects had a normal nutritional status and only a small proportion (1.2%) could be classified as malnourished. BIVA showed that most subjects (74.2%) were normal, while the prevalence of low body cell mass was 10.7% and that of dehydration 11.2%. According to the MNA, the nutritional status was significantly better in the men. Almost three-quarters of the men (73.1%) were well nourished vs. half of the women (50.6%). A worsening of the nutritional status with age was observed. The proportion of malnourished individuals, as assessed by MNA, increased from 0% to 9.1% from 70-79 to > 90 years.

CONCLUSIONS

With respect to their contemporaries from other regions, the elderly of Orroli presented a better nutritional status, a similar worsening with age and generally higher sexual dimorphism.

Small (Radiol Med 2009;114:1239-66. [PMID: 19697104 DOI: 10.1007/s11547-009-0439-x]

PURPOSE

We prospectively compared gadoliniumenhanced magnetic resonance imaging (dynamic MRI), superparamagnetic iron oxide (SPIO) (ferucarbotran) MRI and multidetector-row computed tomography (MDCT) and the combination of dynamic MRI plus MDCT vs. dynamic MRI plus SPIO-MRI (double-contrast MRI: DC-MRI) for the detection of small (

MATERIALS AND METHODS

Sixty-three patients with liver cirrhosis and suspicious nodules detected during ultrasound (US) surveillance underwent DC-MRI in the same imaging session and MDCT within 15 days. The final diagnosis was established at pathology on the explanted liver (n=10), resection (n=6) and biopsy (n=38) specimens or at 2-years' follow-up (n=9).

RESULTS

One hundred and twenty-three nodules were detected: 87 were confirmed HCCs in 54 patients. The accuracy of SPIO-MRI and dynamic MRI were similar, both being superior to MDCT. Dynamic MRI demonstrated the highest sensitivity (83.9%; p<0.001). especially for lesions <1 cm (90.6%) - coupled with a lower specificity (36.1%) than SPIO-MRI, particularly in subcentimeter lesions (28.6%). SPIO-MRI demonstrated the highest sensitivity for nodules >1 cm and the highest specificity (83.3%) superior to dynamic MRI (p<0.0001). In the per-lesion analysis, SPIO-MRI demonstrated a positive predictive value higher than dynamic MRI (p=0.0059) and than both the combinations dynamic MRI/MDCT and DC-MRI (p=0.0021 and p=0.0087, respectively). DC-MRI showed the highest sensitivity (97.7%) and accuracy (78.9%), detecting hypovascular and atypical HCCs >1 cm. Furthermore its per-patient negative predictive value was the highest (100%), and significantly higher than all the other methods.

CONCLUSIONS

DC-MRI is the most sensitive and accurate method and can be confidently used as a single-step procedure for the detection of small HCCs, with the exception of lesions <1 cm.

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Key Words Collapse

MESH Headings

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/diagnostic imaging
• Contrast Media
• Dextrans
• Female
• Ferrosoferric Oxide
• Follow-Up Studies
• Gadolinium DTPA
• Humans
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/diagnostic imaging
• Liver Neoplasms/diagnosis
• Liver Neoplasms/diagnostic imaging
• Magnetic Resonance Imaging
• Magnetite Nanoparticles
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Sensitivity and Specificity
• Tomography, X-Ray Computed

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Grants Collapse

Affiliation(s)

R Golfieri Radiologia Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Università di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
E Marini
A Bazzocchi
F Fusco
F Trevisani
C Sama
G Mazzella
S Cavuto
F Piscaglia
L Bolondi

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Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: a prospective, randomized, double-blind comparison between levobupivacaine 0.25%, and ropivacaine 0.25% or 0.4%

BACKGROUND AND OBJECTIVES

To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery.

METHODS

Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment.

RESULTS

No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups.

CONCLUSION

When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.

Variations of Somatotype in elderly Sardinians

Somatotyping is an effective technique for the study of anthropometric variations and body composition in elderly subjects, even though it has not often been used in this field. The present study was conducted on a sample of 280 healthy Sardinians (134 men and 146 women) of age 60-89 years, subdivided into three age classes (60-69 years; 70-79 years; and 80-89 years). Somatotypes were computed according to Carter and Heath (Somatotyping-Development and Applications. Cambridge, England: Cambridge University Press; 1990). The results show a dominance of the endo- and mesomorphic components in the elderly subjects, with less development of ectomorphy than in younger individuals. In a comparison with other populations, our sample shows strong development of endomorphy and especially of mesomorphy, while ectomorphy values are generally low. Age-related variations are significant in both sexes and consist in a progressive reduction of the endomorphic component, particularly in the 80-89-year class (endomorphy in the three age classes: 6.4, 6.1, and 5.3 in men; 8.1, 7.8, and 6.8 in women). The mesomorphic component is characterized by stability (age variations: 6.4, 6.4, and 5.9 in men; 6.3, 6.4, and 6.3 in women) and the ectomorphic component by a slight increase (age variations: 0.5, 0.6, and 0.8 in men; 0.4, 0.3, and 0.5 in women). Sex differences are significant and especially large for the endomorphic component, with generally higher values in women. The sexual dimorphism tends to decrease with age. The results are discussed with regard to the biology of aging, with emphasis on the potential application of somatotype to studies of the elderly population.

Corticotrophin-releasing activity of desmopressin in Cushing's disease: lack of correlation between in vivo and in vitro responsiveness

Desmopressin (DDAVP), an arginine vasopressin analogue, markedly stimulates ACTH secretion in patients with Cushing's disease, in contrast to its minimal effect in normal subjects. However, little is known about the mechanisms underlying this action and it appeared to be of interest to evaluate the effect of DDAVP on ACTH-secreting pituitary adenomas in vitro, in comparison with its effect in the same patients in vivo. Pituitary adenomas from 14 patients with Cushing's disease were incubated with DDAVP, corticotrophin-releasing hormone (CRH) and DDAVP together with vasopressin receptor antagonists or CRH. Incubation with DDAVP induced a modest dose-dependent increase in ACTH concentrations which appeared maximal at 10 nM. CRH stimulated ACTH to a greater extent compared with DDAVP and potentiated the effect of DDAVP alone. The DDAVP-induced ACTH increase appeared blunted by vasopressin V(2) and V(3) receptor antagonists. V(3) receptor gene expression was detected by RT-PCR in all adenoma samples except for two which were not responsive to DDAVP in vitro but responsive to the peptide in vivo. Surprisingly, no difference in the in vitro ACTH secretory response was observed between in vivo DDAVP-responsive (ACTH peak>150% baseline) and -unresponsive (ACTH peak<120% baseline) patients, suggesting that the pituitary adenoma is not the sole mediator of the ACTH-releasing effect of DDAVP. In conclusion, the marked stimulatory effect of DDAVP observed in patients with Cushing's disease appears to be mainly dependent on an extrapituitary action, possibly the inhibition of a corticotrophin release-inhibitory factor.

Polycyclic aromatic hydrocarbons air levels in Florence, Italy, and their correlation with other air pollutants

Benzo(a)pyrene [B(a)P] air levels were measured in Florence (Italy) in the period 1992-2001. For the period 1999-2000 seven polycyclic aromatic hydrocarbons (PAH) (benzo(a)anthracene, crysene, benzo(a)pyrene (B(a)P), benzo(b)fluoranthene (B(b)F), benzo(k)fluoranthene, dibenzo(a,h)anthracene (DBA) and benzo(g,h,i)perylene (BGP)), were measured in the air in four different sites (one with heavy traffic (A), one in a park (B), one in a residential area (C) and one in a hill area (D)). B(a)P levels were elevated in 1992-1998 (maximum average value of winter months: 5.8 ng/ m3) but a decreasing trend was observed in the following years, probably due to improvement in vehicle emissions. The sum of PAH in the air in the period 1999-2000 was about one order of magnitude lower in the hill site (D) relative to the urban sites, and residential areas (B and C) had values 2.5-3 times lower compared to site A with a heavy traffic. PAH concentrations decreased in the warmer seasons of 2000 in all sites. A negative correlation was found between PAH levels and ozone. A positive correlation with carbon monoxide (CO) (r = 0.862, P < 0.001) and low B(a)P/BGP ratios, ranging from 0.44 to 0.51, indicated that vehicular traffic was the major PAH source in all monitored sites. Using B(a)P(TEF) values (toxic equivalency factors) for evaluating the biological activity of PAH, we found that the highest PAH contributors in terms of potential air carcinogenic activity were B(a)P and DBA. Therefore, in addition to B(a)P, DBA concentration should be considered in the evaluation of air quality in terms of PAH contamination.

Variation in sexual dimorphism in relation to physical activity

The aim of this study was to examine variations in sexual dimorphism in relation to physical activity. A sample of 542 males and females (20-30 years), born and resident in Cagliari (Sardinia, Italy), was divided into two groups: active and inactive. Twenty-five anthropometric dimensions were taken (weight, lengths, breadths, circumferences, and skinfolds). The circumferences and skinfolds were adjusted for the effects of overall body size (represented by skeletal variables). Body composition parameters--fat-free mass (FFM), fat mass (FM), and arm muscular area (AMA)--were derived from the adjusted values. The D index (Bennett, 1981; Chakraborty and Majumder, 1982) was used to assess the degree of sexual dimorphism. The difference between the D values of active and inactive individuals was analyzed with the technique of Bennett (1981). Principal components analysis (PCA) was performed on groups of homogeneous variables (circumferences and skinfolds) in order to simplify the description of the original anthropometric data. The univariate and multivariate analyses indicate a greater sex difference in the group of individuals who are regularly active. The results agree with theoretical expectations, and suggest greater stability of women to environmental pressures (i.e., physical activity).

Univariate estimates of sexual dimorphism: the effects of intrasexual variability

The difference between male and female values of quantitative traits depends on the distribution of the variables within each sex, increasing with the rise in the difference between male and female average values and with the decrease of the dispersion of measurements in both sexes. This paper deals with the sensitivity of some widely used indices (relative difference between male and female mean values (MDI), Student's t, and the so-called Bennett-Chakraborty-Majumder D coefficient) with respect to intrasexual variability. The Kolmogorov-Smirnov distance (KS) is suggested here as a further index of dimorphism, although it is not usually utilized for this purpose. The theoretical approach is accompanied by the analysis of empirical data (metric variables obtained from a sample of present Sardinians) and by computer simulations under various assumptions. Indices based on the difference between male and female average values are not able to evaluate fully the various aspects of dimorphism. Student's t proved to be an adequate measure of whole sex differences, both in real and in simulated samples, as intrasexual variability is included in its formulation. The D index also proved to be a good measure of undivided sexual dimorphism, as it is the result of formal examination, and from application to empirical or to simulated cases. The Kolmogorov-Smirnov distance gave the best performance both in formal examination and in the whole simulation results, as it takes into account intrasexual variability, and is applicable to any kind of distribution. In simulated cases it was sensitive to variations of means and variances, and it was able to evaluate variance dimorphism. Since the last three indices measure the combined effect of size and variance dimorphism, the joint use of the MDI index is suggested in order to isolate the relative contribution of the difference between the means.

Correlation between computed tomography findings of leukoaraiosis and 24-hour blood pressure variability in elderly subjects

BACKGROUND AND PURPOSE

Leukoaraiosis (LA) has been defined as low attenuation areas involving only the periventricular white matter, in the mild form, and extending to the subcortical region in the severe form. This study evaluates, in elderly patients, if brain computed tomography (CT) evidence of LA significantly correlates with the findings of 24-hour, blood pressure monitoring.

METHODS

Sixtysix neurologically nondiseased elderly patients underwent CT examination of the brain and 24-hour ambulatory blood pressure monitoring. The patients were divided in two groups (patients with none-to-mild LA in group 1; patients with severe LA in group 2) based on CT findings evaluated at level of foramina of Monro, body of lateral ventricles, and frontoparietal white matter (centrum semiovale). CT findings were compared with main 24-hour ambulatory blood pressure monitoring results (systolic and diastolic blood pressure and heart rate values).

RESULTS

Patients with severe LA showed a wider variability both in blood pressure and heart rate; in particular, major oscillations were found during the nighttime period. No significant 24-hour blood pressure variability was found in group 1.

CONCLUSION

Increased blood pressure variability can play a role in the pathogenesis of LA.

Blood pressure rhythm and prevalence of vascular events in hypertensive subjects

OBJECTIVES

To evaluate the influence of age on the day-night blood pressure rhythm and on the prevalence of vascular events in those whose systolic blood pressure (SBP) fell by <10% overnight (non-dippers).

DESIGN

Cross-sectional observational cohort study.

SETTING

Outpatient hypertension clinic.

PARTICIPANTS

419 Hypertensive patients (214 male, 205 female).

METHODS

All subjects were submitted to ambulatory blood pressure monitoring (Spacelabs 90207). The nocturnal fall of SBP was calculated from (day SBP--night SBP)/day SBP, where 'day' values were recorded between 0600 h and 2200 h and 'night' values between 2200 h and 0600 h. Dippers and non-dippers were divided in two subgroups according to age (under or over 65 years). Information on gender, smoking, diabetes mellitus and body mass index was collected and cerebrovascular and cardiovascular events, evaluated by history and medical records, were registered.

RESULTS

The day-night difference in blood pressure significantly decreased with age and the prevalence of non-dippers was greater in elderly than in younger subjects (65.1% vs. 29.8%). No difference was found between groups for cerebrovascular events, irrespective of age. A relationship between non-dipping pattern and cardiovascular events was found only in younger hypertensive non-dippers (odds ratio, 2.0; 95% confidence interval, 1.20-3.21); in elderly people the prevalence of cardiovascular events was similar in dippers and non-dippers.

CONCLUSIONS

Cardiovascular risk is not increased in elderly non-dipper hypertensive subjects. This contrasts with results in younger populations.

[Multicenter study of Helicobacter pylori infection prevalence in patients with chronic gastroduodenal disease. Various epidemiologic features]

The aim of this study was to establish the prevalence of H. Pylori infection in patients with chronic gastroduodenal pathology, who were treated in the gastroenterology units of four hospitals located in the Federal Capital and its neighbouring areas. 398 patients were studied by means of clinical assessment and epidemiology data. Upper endoscopy was carried out two biopsies were taken of the gastric antrum for a quick ureasa test and histological assessment of the H. pylori state by means of giemsa's stain. The prevalence of infection on the total of the studied population was 75.6%. In patients with gastric ulcer was 70%; in patients with duodenal ulcer it was 77.2% and 78.5% in patients with chronic gastritis. The prevalence of H. Pylori infection on the population according to age groups was: 61.54% in patients between 21 and 40 years; 76.14% in patients between 41 and 60 years, and 68.22% in patients over 60 year. We have tried to obtain a correlation between the prevalence of the infection and some sanitary characteristic (Running water and sewers) on the studied population. It was seen that 225 patients who lived in dwellings with running water and sewers showed a prevalence of infection of 69.34% and in 129 patients who did not have running water or sewer the rate of prevalence of infection was 83.72; a difference which was statistically significant, (with P < 0.01) for the patients who lived in poor sanitary conditions. These data may be important when the design of therapeutic schemes for the eradication of the bacteria is made.

[Carcinogens in the urban environment of Italian cities: benzene and benzo(a)pyrenes]

In Italian urban areas air pollution from benzene and benzo(a)pyrene-B(a)P--is mostly caused by traffic. The concentration limits in the atmosphere fixed by Italian legislation up to December 31, 1998 expressed as annual means are 15 micrograms/m3 and 2.5 ng/m3 for benzene and B(a)P respectively and, starting from January 1, 1999, 10 micrograms/m3 and 1 ng/m3. In the city of Florence the concentrations detected and expressed as annual means of benzene and B(a)P in an area with heavy traffic (32.1 micrograms/m3 and 3.5 ng/m3), in a densely populated area (9.2 micrograms/m3 and 1.86 ng/m3), and in a city park (6.0 micrograms/m3 and 0.25 ng/m3), suggest a marked progressive reduction in the atmospheric levels of these chemicals with the distance from the main roads. The environmental data obtained from densely populated areas of a number of Italian cities (Firenze, Milano, Roma, Bologna, Bolzano, Pavia, Modena), the only ones that allow evaluation of the health risk, show benzene concentrations ranging from 6.0 to 11.3 micrograms/m3 and B(a)P levels, measured in heavy traffic areas, from 1.0 to 3.5 ng/m3 respectively (annual mean in 1996). The data obtained in the city of Florence show that the population is exposed weekly to average concentrations of 14.3 micrograms/m3 for benzene and 2.0 ng/m3 for B(a)P. These results suggest that, regarding benzene and B(a)P pollution, the situation in Florence is far from being critical but not such as to ensure that long-term exposure is without adverse effects.

Osteogenic response to hydroxyapatite-fibrin implants in maxillofacial bone defects

Bone formation in hydroxyapatite-fibrin implants has been reported several times. However, available studies refer to experimental animals, or are limited to short periods after implantation. We report the results of histological, histochemical and ultrastructural studies carried out 2.5-8 yr after implantation of non-resorbable, porous hydroxyapatite (HA) and fibrin glue in human maxillofacial bones. Prominent ossification was found in all cases, with the presence of normally structured spongy bone. HA granules were embedded in the calcified bone matrix. They had not elicited inflammatory reactions and did not induce bone resorption. Ossification was preceded by the appearance of alkaline phosphatase activity on fibroblast-like cells, and by the formation of dense collagenous layers, similar to osteoid borders, on the surface of HA granules. The early phases of the calcification process occurred in these borders, with the appearance of calcification nodules adjacent to alkaline phosphatase-positive osteoblast-like cells. A remodeling process similar to that occurring in normal bones was found in the newly formed bone. These results justify the conclusion that HA-fibrin implants lead to the formation of long-lasting bone that does not differ from that of the normal maxillofacial skeleton. Mixing the HA granules with fibrin has the advantage of creating an easily mouldable material which can be adapted to any skeletal surface and stays in place after surgery.

Long-term results of hydroxyapatite-fibrin glue implantation in plastic and reconstructive craniofacial surgery

The bone tissue formed in orthotopic or heterotopic implants of granular, porous hydroxyapatite and fibrin glue was examined several (2 1/2-8) years after implantation. The results showed distinct ossification in all cases and the functional situation and external appearance were also satisfactory. The reconstituted spongy and compact bone underwent a remodelling process similar to that of normal bone. Most of the hydroxyapatite granules were embedded in the bone tissue; a few were very close to the fibrillar connective tissue of the intertrabecular spaces and were either covered by osteoid-like collagenous borders or were in contact with osteoclast-like giant cells. Even if the results refer only to a few patients, and were obtained from a cross-sectional study, they allow the conclusion to be reached that the implantation of porous hydroxyapatite and fibrin glue leads to the formation of long-lasting bone whose hardness is equal to, or greater than, that of normal bone.

Silent lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation

It is still debated whether non valvular atrial fibrillation (NVAF) may be responsible for "silent" lacunar lesions. The aims of our study were to compare the prevalence of subcortical lacunar infarctions in highly selected elderly subjects with or without NVAF, and to investigate the positive relationship of such lesions to the impairment in cognitive and physical functions. Thirty-eight patients with NVAF (mean age 80.6 years) were compared with 40 patients in sinus rhythm (mean age 80.4 years). Exclusion criteria were previous stroke or transient ischemic attacks, significant lesions of extracranial arteries, and any previous disease leading to cognitive impairment or potentially interfering with cognitive functions. A cranial computed tomogram was performed in every case, and the number of lacunae was recorded. Cognitive status and mood were assessed by means of Mini Mental Status Examination and the Geriatric Depression Scale, respectively. The number of impaired basic and instrumental activities of daily living (BADL e IADL) was also recorded. A significantly higher percentage of patients with lacunar lesions was detected in the NVAF group. The MMS score was lower in these patients, but did not reach significant levels. In univariate analysis, the presence of lacunae was found to be significantly associated with age, systolic blood pressure and atrial fibrillation, but, in a multiple logistic regression model, only age and atrial fibrillation retained a significant association. Similarly, in univariate analysis, a low MMS score was found to be related to age, systolic blood pressure, leukoaraiosis and both the presence and the number of lacunar lesions. In multivariate analysis, only age and the number of lacunae were significantly associated with a low MMS. It is concluded that in elderly patients NVAF is associated with subcortical ischemic lesions which may contribute to the impairment of cognitive function.

Variability of the CD4 and F13A1 short tandem repeats in Corsicans, Sardinians and Piaroa Indians

This paper presents allele frequencies of two short tandem repeats (CD4 and F13A1) in three anthropologically defined populations: Sardinians (Italy), Corsicans (France) and Piaroa Indians (Venezuela). The comparison shows some relevant differences both in number and distribution of the CD4 and F13A1 alleles.