Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible?

Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy.

Thoracoscopic Management of Chylothorax by Application of a Fibrin Sealant Patch

Thoracic duct ligation is a demanding procedure when the chyle leak and/or the duct itself are not identified. This report is of a new procedure using thoracoscopic closure of the chyle leak by application of a fibrin sealant patch. This strategy was successfully applied for closing (i) a small fistula due to a postoperative lesion of the lymphatic tributary vessels in one case, and (ii) a large fistula due to idiopathic rupture of the thoracic duct in another case.

Modified blade: an interventional option in rigid bronchoscopy for non-resectable benign tracheal stenosis

INTRODUCTION

Benign tracheobronchial stenosis is a abnormal tracheal lumen narrowing that may incur progressive dyspnea and life-threatening hypoxemia. There is no consensus on which patients should be treated with endoscopic or surgical method. This study investigates the outcomes of bronchoscopic dilatation in the treatment of benign tracheal stenosis using a device equipped with a blade to cut the stenotic lesions with dense fibrosis.

MATERIALS AND METHODS

The procedure was carried out in an operating room under general anesthesia. All patients were intubated with a Rigid Bronchoscope (RB) placed just above the stenosis. Through Rigid Bronchoscopy combined modalities were used as needed: radial incisions of the mucosal stenosis with blade at the levels of 4, 8 and 12 o'clock, with back and forth movements, then the stenotic area was dilated more easily with a rigid bronchoscope. Dilatation was performed by passing the RB of increasing diameter through stenotic areas and then Balloon dilatation of increasing diameter. There were no complications during the procedure.

RESULT

We conducted an observational, retrospective, single-centre study in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2011 to September 2021. We included all consecutive patients with benign tracheal stenosis inoperable. During the study period, 113 patients were referred to our department with benign tracheal stenosis inoperable. 61 patients were treated with the blade. During the follow-up, a recurrence of the stenosis was observed in 8 patients in the first month and in 4 patients in the third month. Instead in the patients treated with the use of laser (52 patients), during the follow-up a recurrence was observed in 16 patients in the first month and in 6 patients in the third month; no patient relapsed after 6 months and after 1 year. Long term successful bronchoscopic management with blade was attained by 99% in simple and 93% in mixed stenosis and in complex type stenosis.

CONCLUSION

Our study underlines the importance of the use of the blade in bronchoscopic treatment as a valid conservative approach in the management of patients with inoperable benign tracheal stenosis as an alternative to the use of the laser, reducing the abnormal inflammatory reaction in order to limit recurrences.

Three-dimensional lung reconstructions for the localization of lung nodules to be resected during surgery

BACKGROUND

The localization of lung nodules is challenging during thoracoscopy. In this study, we evaluated the use of three-dimensional (3D) lung reconstruction for use in the operating room to guide the identification of lung nodules during thoracoscopy.

METHODS

This was a single-center retrospective study. All consecutive patients undergoing thoracoscopic resection of lung nodules were included in the study. Patients were retrospectively divided into two groups based upon whether the thoracoscopic resection was performed with the assistance (3D group) or not (standard group) of 3D lung reconstruction. The operative time (minutes) to detect lung nodules was statistically compared between the two study groups in relation to the characteristics of lung nodules as size, localization, and distance from the visceral pleura.

RESULTS

Our study population consisted of 170 patients: 85 in the 3D group and 85 in the standard group. No intergroup difference differences were found regarding the characteristics and histological diagnosis of lesions. The standard group compared to the 3D group was associated with a significantly longer operative time for the detection of lesions <10 mm (13.87 ± 2.59 vs. 5.52 ± 1.01, p < 0.001), lesions between 10 and 20 mm (5.05 ± 0.84 vs. 3.89 ± 0.92; p = 0.03), lesions localized in complex segments (7.49 ± 4.25 vs. 5.11 ± 0.97; p < 0.001), and deep lesions (9.58 ± 4.82 vs. 5.4 ± 1.01, p < 0.001).

CONCLUSIONS

Our 3D lung reconstruction model for use in the operating room may be an additional tool for thoracic surgeons to guide the detection of small and deep nodules during thoracoscopy. It is a noninvasive and cost saving procedure and may be widely used.

Intraoperative lung ultrasound improves subcentimetric pulmonary nodule localization during VATS: Results of a retrospective analysis

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) resection of deep-seated lung nodules smaller than 1 cm is extremely challenging. Several methods have been proposed to overcome this limitation but with not neglectable complications. Intraoperative lung ultrasound (ILU) is the latest minimally invasive proposed technique. The aim of the current study was to analyze the accuracy and efficacy of ILU associated with VATS to visualize solitary and deep-seated pulmonary nodules smaller than 1 cm.

METHODS

Patients with subcentimetric solitary and deep-seated pulmonary nodules were included in this retrospective study from November 2020 to December 2022. Patients who received VATS aided with ILU were considered as group A and patients who received conventional VATS as group B (control group). The rate of nodule identification and the time for localization with VATS alone and with VATS aided with ILU in each group were analyzed.

RESULTS

A total of 43 patients received VATS aided with ILU (group A) and 31 patients received conventional VATS (group B). Mean operative time was lower in group A (p < 0.05). In group A all the nodules were correctly identified, while in group B in one case the localization failed. The time to identify the lesion was lower in group A (7.1 ± 2.2 vs. 13.8 ± 4.6; p < 0.05). During hospitalization three patients (6.5%; p < 0.05) in group B presented air leaks that were conservatively managed.

CONCLUSION

Intracavitary VATS-US is a reliable, feasible, real-time and effective method of localization of parenchymal lung nodules during selected wedge resection procedures.

One-way endobronchial valves in the management of complex persistent air leaks in a soft tissue sarcoma patient

Complex persistent air leak (PAL) is a clinical condition which is difficult to treat. Herein, we report the clinical case of an 18-year-old woman with lung and bone metastases due an ultrarare sarcoma: "round cell sarcoma non-Ewing". She developed persistent air leaks due to an alveolopleural fistula which developed following two cycles of chemotherapy with doxorubicin. Chest drainage with suction failed to resolve the air leaks, while surgical treatment was unfeasible due to the poor clinical condition of the patient. Thus, she was reviewed for endoscopic treatment with one-way endobronchial valves. A small valve was sequentially inserted within each segment of the right upper bronchus to occlude the entire upper lobe. Two days after the procedure, resolution of the air leaks were obtained. Chest drainage was removed 5 days later and the patient was discharged. Chemotherapy was resumed. The patient died 7 months later because of disease progression.

Advances in Endoscopic Management of Endobronchial Carcinoid

INTRODUCTION

Bronchial carcinoid (BC) tumors represent between 1% and 5% of all lung cancers and about 20-30% of carcinoid tumors; they are classified into two groups: typical and atypical bronchial carcinoids. The aim of the present study was to review the results of endoscopic treatments as an alternative to surgical treatment in selected patients.

MATERIALS AND METHODS

The present study was a retrospective and multicentric study, in which all data were reviewed for patients with BC in the central airways, referred to the Thoracic Surgery Units of Luigi Vanvitelli University of Naples and Sant'Andrea Hospital in Rome between October 2012 and December 2022 Overall, 35 patients, 13 of whom were female, were included in the study (median age, 53 years; range, 29-75 years). All patients underwent rigid bronchoscopy combined with flexible bronchoscopy. Tumor clearance was mostly performed by use of Argon Plasma Coagulation or Thulep Laser, mechanical debridement and excision with the use of forceps and aspirator through the working channel of the 8.5 mm-sized rigid bronchoscope. There were no complications during the treatment.

RESULTS

Endobronchial treatment provided complete tumor eradication in all patients; two patients had controlled bleeding complications; however, bleeding was well controlled without patient desaturation, and only one patient died of renal failure during the follow-up period. We found two recurrences in the left and right main bronchus, in patients with atypical carcinoma during fiberoptic bronchoscopy follow-up. Only one patient died of renal failure. At the first analysis, there were no significant differences between the patients receiving endobronchial treatment and patients receiving surgical treatment in the present study (p-value > 0.05-it means statistically insignificant).

CONCLUSIONS

Endobronchial treatment is a valid and effective alternative for patients with BC unsuitable for surgery.

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

BACKGROUND

Intrathoracic neurogenic tumors (INTs) are derived from nerve tissue and grow within the chest. Preoperative diagnosis can be challenging and only complete surgical exeresis enables confirmation of the suspected diagnosis. Here, we analyzed our experience on management of paravertebral lesions with solid and cystic patterns.

METHODS

A monocentric retrospective study was conducted, which included 25 consecutive cases of ITNs in the period from 2010 to 2022. These cases had been surgically treated by thoracoscopic resection alone, or in combination with neurosurgery in the case of dumbbell tumors. The demographic and operative data along with complications were recorded and analyzed.

RESULTS

Twenty-five patients were diagnosed with a paravertebral lesion of which 19 (76%) had solid features and six (24%) had cystic features. The most common diagnosis was schwannoma (72%), followed by neurofibroma (20%) and malignant schwannoma (8%). In four cases (12%) the tumor showed an intraspinal extension. None of the patients had recurrence until 6 months of follow-up. Comparison between the VATS and thoracotomy procedures showed that outcome of discharge on the postoperative day, on average, was 2.61 ± 0.5 versus 3.51 ± 0.53, respectively (p-value <0.001).

CONCLUSION

The treatment of choice for INTs is complete resection which is tailored to tumor size, location, and extension. In our study, paravertebral tumors with cystic characteristics were not associated with an intraspinal extension and did not show a different behavior from solid tumors.

Intraoperative ventilatory leak: Real-time guidance for management of air leak in lung cancer patients undergoing VATS lobectomy

BACKGROUND

Persistent air leak (PAL) is a common complication after video-assisted thoracoscopic surgery (VATS) lobectomy. We aimed to evaluate whether the intraoperative quantitative measurement of air leaks using a mechanical ventilation test could predict PAL and identify those patients needing additional treatment for the prevention of PAL.

METHODS

This was an observational, retrospective, single-center study that included 82 patients who underwent VATS lobectomy with a mechanical ventilation test for VL. Only 2% of patients who underwent lobectomy surgery had persistent air leaks.

RESULTS

At the end of lobectomy performed in patients with non-small cell lung cancer, the lung was reinflated at a 25-30 mmH2O pressure and ventilatory leaks (VL) were calculated and in relation to the entity of the air leaks, we evaluated the most suitable intraoperative treatment to prevent persistent air leaks.

CONCLUSION

VL is an independent predictor of PAL after VATS lobectomy; it provides a real-time intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL.

Intraoperative ultrasound: "Alternative eye" in lymph nodal dissection in non-small cell lung cancer

INTRODUCTION

Staging of the mediastinum lymph nodes involvement in patients with non-small cell lung cancer (NSCLC) is an important prognostic factor determining the most appropriate multimodality treatment plan. The objective of this study is to assess ultrasound characteristics of mediastinal lymph nodes metastasis and effectiveness of intraoperative ultrasound-guided mediastinal nodal dissection in patients with resected NSCLC.

MATERIALS AND METHODS

All patients undergoing video-assisted thoracoscopic surgery lobectomy and pulmonary lymphadenectomy from November 2020 to March 2022 at the thoracic surgery department of the Vanvitelli University of Naples underwent intraoperative ultrasound-guided mediastinal lymph nodal dissection.

RESULTS

This study evaluates whether individual B-mode features and a compounding thereof can be used to accurately and reproducibly predict lymph node malignancy.

DISCUSSION

Intraoperative ultrasound, during systematic mediastinal lymph node dissection, is helpful in preventing lesion to mediastinal structures. Pathological nodal sonographic characteristics are round shape, short-axis diameter, echogenicity, margin, the absence or presence of coagulation necrosis sign, and the absence or presence of central hilar structure, increased color Doppler flow, the absence or presence of calcification, and nodal conglomeration. Operating time was not substantially prolonged. The procedure is simple, safe and highly accurate.

CONCLUSIONS

Ultrasonic techniques allow surgeons to detect the relationship between lymph nodes and surrounding large blood vessels during biopsy, improving the safety and simplicity of the operation, increasing the number of harvested lymph nodes, and reducing the risk of intraoperative injury; it is a fast, easily reproducible, and inexpensive method.

Application of ERAS Protocol after VATS Surgery for Chronic Empyema in Immunocompromised Patients

Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications.

Slow light nanocoatings for ultrashort pulse compression

Transparent materials do not absorb light but have profound influence on the phase evolution of transmitted radiation. One consequence is chromatic dispersion, i.e., light of different frequencies travels at different velocities, causing ultrashort laser pulses to elongate in time while propagating. Here we experimentally demonstrate ultrathin nanostructured coatings that resolve this challenge: we tailor the dispersion of silicon nanopillar arrays such that they temporally reshape pulses upon transmission using slow light effects and act as ultrashort laser pulse compressors. The coatings induce anomalous group delay dispersion in the visible to near-infrared spectral region around 800 nm wavelength over an 80 nm bandwidth. We characterize the arrays' performance in the spectral domain via white light interferometry and directly demonstrate the temporal compression of femtosecond laser pulses. Applying these coatings to conventional optics renders them ultrashort pulse compatible and suitable for a wide range of applications.

Unifying Frequency Combs in Active and Passive Cavities: Temporal Solitons in Externally Driven Ring Lasers

Frequency combs have become a prominent research area in optics. Of particular interest as integrated comb technology are chip-scale sources, such as semiconductor lasers and microresonators, which consist of resonators embedding a nonlinear medium either with or without population inversion. Such active and passive cavities were so far treated distinctly. Here we propose a formal unification by introducing a general equation that describes both types of cavities. The equation also captures the physics of a hybrid device-a semiconductor ring laser with an external optical drive-in which we show the existence of temporal solitons, previously identified only in microresonators, thanks to symmetry breaking and self-localization phenomena typical of spatially extended dissipative systems.

School-age dental screening: oral health and eating habits

AIM

the study has the purpose to evaluate the association between clinical data collected from dental screening carried out on children and their eating habits. Materials and methods: The dental screening was carried out on a sample of eight-year-old children attending the third grade of the elementary schools of Gaeta (Latina). Clinical data and periodontal status indexes were recorded. The descriptive statistics (mean, standard deviation, frequency) of all data were calculated and anova analysis and chi square test have been performed.

RESULTS

On the sample of 70 children the results showed an average of 1.4 decayed teeth per child (sd ± 2.3) with a slightly higher average in females. More than 68% of the sample had poor or insufficient oral hygiene conditions with plaque presence in 64% of cases. Moreover, 57% of children had class II malocclusion with increased overjet and oral breathing respectively in 37% and 30% of cases. Only 24% were breastfed in the first months of life and more than 40% maintained a bad habit for over two years of age. About eating habits, more than 80% of the sample consumed sweets or sweet drinks every day. The analysis of the data showed as children consume several snacks throughout the day, and 47% eat them watching TV.

CONCLUSIONS

The results of this study showed how prevention program carried out through the School is more effective on children for learning of content especially when the acquisition of knowledge follows the application and verification of theoretical and practical skills in terms of oral health.

Direct thermo-optical tuning of silicon microresonators for the mid-infrared

We use light from a visible laser diode to directly tune silicon-on-chip microresonators by thermo-optical effect. We show that this direct tuning is local, non invasive and has a much smaller time constant than global temperature tuning methods. Such an approach could prove to be highly effective for Kerr comb generation in microresonators pumped by quantum cascade lasers, which cannot be easily tuned to achieve comb generation and soliton-mode locked states.

Infant and Child Oral Health Risk Status Correlated to Behavioral Habits of Parents or Caregivers: A Survey in Central Italy

AIM

The aim of this survey was to evaluate the knowledge and awareness of parents and caregivers about potential oral health risk factors for their children in their first months of life (3-30 months).

MATERIALS AND METHODS

The participation to the survey was proposed to all parents or caregivers of children attending the public consulting service in Latina for mandatory vaccinations during the period of June to August 2014. A self-administered questionnaire was completed to obtain information regarding demographic variables, infant feeding practice, maternal oral health during and after pregnancy, children's oral hygiene habits and risk behaviors (e.g., sharing cutlery, tasting of baby food, nightly using of baby bottles with sugared beverages, or sugared pacifier), and knowledge about caries and its transmission. The analysis of the data was performed using SPSS 14.0 for Windows (SPSS Inc., Chicago, IL, USA). The variance analysis and chi-square test were used to investigate the relationship between the variables.

RESULTS

Overall, the parents of 304 children consented to fill the questionnaire. Data analysis showed that about 50% of respondents considered dental caries an infectious disease, however, 53.6% was not aware of the potential vertical transmissibility of cariogenic bacteria through contaminated saliva. It is a common trend in the early stages of weaning to taste the baby food (53%) and sharing cutlery (38.5%). With regard to children oral health care, parents reported no toothbrushing for 53.1% of the children in their first 3 years of life. The relationship between the two variables concerning caries transmissibility and tools sharing carried out on through Pearson chi-square test identified P = 0.32.

CONCLUSIONS

From this survey, the need for parental oral health promoting program emerged to control children oral health risk status.

Achromatic Metalens over 60 nm Bandwidth in the Visible and Metalens with Reverse Chromatic Dispersion

In this Letter, we experimentally report an achromatic metalens (AML) operating over a continuous bandwidth in the visible. This is accomplished via dispersion engineering of dielectric phase shifters: titanium dioxide nanopillars tiled on a dielectric spacer layer above a metallic mirror. The AML works in reflection mode with a focal length independent of wavelength from λ = 490 to 550 nm. We also design a metalens with reverse chromatic dispersion, where the focal length increases as the wavelength increases, contrary to conventional diffractive lenses. The ability to engineer the chromatic dispersion of metalenses at will enables a wide variety of applications that were not previously possible. In particular, for the AML design, we envision applications such as imaging under LED illumination, fluorescence, and photoluminescence spectroscopy.

Polarization-Insensitive Metalenses at Visible Wavelengths

In this Letter, we demonstrate highly efficient, polarization-insensitive planar lenses (metalenses) at red, green, and blue wavelengths (λ = 660, 532, and 405 nm). Metalenses with numerical apertures (NA) of 0.85 and 0.6 and corresponding efficiencies as high as 60% and 90% are achieved. These metalenses are less than 600 nm-thick and can focus incident light down to diffraction-limited spots as small as ∼0.64λ and provide high-resolution imaging. In addition, the focal spots are very symmetric with high Strehl ratios. The single step lithography and compatibility with large-scale fabrication processes make metalenses highly promising for widespread applications in imaging and spectroscopy.

Correlation among periodontal health status, maternal age and pre-term low birth weight

PURPOSE

To assess correlations between periodontal status, maternal age and adverse pregnancy outcomes, such as pre-term and low birth weight in a sample of pregnant women.

METHODS

Study population was represented by outpatient pregnant women, gestational age > 26 weeks. Medical history questionnaires were administered to all participants who underwent clinical evaluation; clinical obstetric outcome records were collected after delivery. A questionnaire was administered regarding personal information, socio-economic status, oral hygiene habits, and oral health conditions. A clinical oral examination was performed to collect Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Pregnancy outcome records included: delivery week, kind and causes of delivery, any relevant complications, and birth weight. Descriptive statistics were used to depict the data from the questionnaire while the relationship between delivery week, birth weight, maternal age and periodontal status was evaluated through multivariate tests of significance.

RESULTS

88 pregnant women were enrolled in the study. The results showed a statistically significant correlation (P< 0.001) among participants older than 40 years of age, between periodontal disease and adverse pregnancy outcomes. No statistical correlation was found among pre-term and low birth weight, smoking, ethnicity and educational level of mothers. The results highlight the importance of including a routine oral and periodontal health examination in pregnant women older than 40 years of age.

CLINICAL SIGNIFICANCE

The correlation between periodontal status and adverse pregnancy outcomes in older mothers indicates the need for routine oral health examination and periodontal status assessment and care in pregnant women older than 40 years of age.

Multispectral Chiral Imaging with a Metalens

The vast majority of biologically active compounds, ranging from amino acids to essential nutrients such as glucose, possess intrinsic handedness. This in turn gives rise to chiral optical properties that provide a basis for detecting and quantifying enantio-specific concentrations of these molecules. However, traditional chiroptical spectroscopy and imaging techniques require cascading of multiple optical components in sophisticated setups. Here, we present a planar lens with an engineered dispersive response, which simultaneously forms two images with opposite helicity of an object within the same field-of-view. In this way, chiroptical properties can be probed across the visible spectrum using only the lens and a camera without the addition of polarizers or dispersive optical devices. We map the circular dichroism of the exoskeleton of a chiral beetle, Chrysina gloriosa, which is known to exhibit high reflectivity of left-circularly polarized light, with high spatial resolution limited by the numerical aperture of the planar lens. Our results demonstrate the potential of metasurfaces in realizing a compact and multifunctional device with unprecedented imaging capabilities.

Super-Dispersive Off-Axis Meta-Lenses for Compact High Resolution Spectroscopy

Metasurfaces have opened a new frontier in the miniaturization of optical technology by allowing exceptional control over the wavefront. Here, we demonstrate off-axis meta-lenses that simultaneously focus and disperse light of different wavelengths with unprecedented spectral resolution. They are designed based on the geometric phase via rotated silicon nanofins and can focus light at angles as large as 80°. Due to the large angle focusing, these meta-lenses have superdispersive characteristics (0.27 nm/mrad) that make them capable of resolving wavelength differences as small as 200 pm in the telecom region. In addition, by stitching several meta-lenses together, we maintain a high spectral resolution for a wider wavelength range. The meta-lenses have measured efficiencies as high as 90% in the wavelength range of 1.1 to 1.6 μm. The planar and compact configuration together with high spectral resolution of these meta-lenses has significant potential for emerging portable/wearable optics technology.

A variable degree of autoimmunity in the pedigree of a patient with type 1 diabetes homozygous for the PTPN22 1858T variant

We investigated whether the PTPN22 C1858T polymorphism is associated with the autoimmune conditions present in the family of a child affected by type 1 diabetes (T1D) carrying the TT genotype (index patient) and the potential immunological effect of the variant. We found that nine family members carried the CT genotype and five suffered from autoimmunity. Interestingly, anti-ZnT8 antibodies were detected in T1D patients and in three healthy relatives. In the TT patient, we showed diminished T-cell proliferation and reduced interleukin-2 (IL-2) and interferon-gamma (IFN-γ) production. A marked reduction of IL-2 was also observed for all CT relatives with autoimmunity and a lack of IFN-γ production was observed for the younger brother of the index patient, heterozygous for the polymorphism. In this family, the C1858T variant might confer a high risk of autoimmunity. Moreover, our data confirm that impaired IL-2 production upon T-cell receptor stimulation is associated with autoimmunity in the carriers of the polymorphism. This study might prompt to extend the panel of risk markers in relatives of subjects affected by T1D.

Mycobacterium avium subsp. paratuberculosis in an Italian cohort of type 1 diabetes pediatric patients

Mycobacterium avium subsp. paratuberculosis (MAP) is the etiological agent of Johne's disease in ruminants. Recent studies have linked MAP to type 1 diabetes (T1D) in the Sardinian population. The aim of this study was to investigate the prevalence of MAP infection in a T1D cohort from continental Italy compared with healthy control subjects. 247 T1D subjects and 110 healthy controls were tested for the presence of MAP. MAP DNA was detected using IS900-specific polymerase chain reaction (PCR). The presence of antibodies towards a MAP antigen, heparin binding hemoagglutinin (HBHA), was detected by ELISA. We demonstrated a higher MAP DNA prevalence in plasma samples from T1D patients and a stronger immune response towards MAP HBHA, compared with healthy control subjects. Moreover, in the recent onset patients, we observed an association between anti-MAP antibodies and HLA DQ2 (DQA1 0201/DQB1 0202). These findings taken together support the hypothesis of MAP as an environmental risk factor for the development of T1D in genetically predisposed subjects, probably involving a mechanism of molecular mimicry between MAP antigens and pancreatic islet β-cells.

Cephalometric evaluation of the hyoid triangle before and after maxillary rapid expansion in patients with skeletal class II, mixed dentition, and infantile swallowing

BACKGROUND

Rocabado's hyoid triangle is the only cephalometric parameter that can assess the effects of orthodontic treatment on tongue posture.

AIM

To evaluate the restoration of tongue posture and function by conducting a cephalometric assessment of the hyoid triangle before and after rapid maxillary expansion.

METHODS

Sixty-four healthy patients aged 6-11 years with skeletal class II malocclusion, mixed dentition, and infantile swallowing took part in this study. They submitted to lateral cephalometric radiography before and after orthodontic maxillary rapid expansion, in order to assess the resulting changes in the proportions of the hyoid triangle (following Rocabado's parameters). The cephalometric findings were compared according to sex, age, and divergence using the chi-square McNemar test at the 5% significance level (p<0.05).

RESULTS

The orthodontic treatment resulted an improvement from skeletal class II malocclusion to class I, with elimination of infantile swallowing in 81.8% of male patients [95% confidence interval (CI)=61.5-92.7%], in 87.1% of patients aged 6-7 years (95% CI=71.1-94.9%).

CONCLUSIONS

This cephalometric analysis revealed that the hyoid triangle was modified by the orthodontic maxillary expansion, reconditioning of tongue posture and function particularly among male, aged 6-7 years old with skeletal class II malocclusion, mixed dentition, and infantile swallowing.

Prokinetic effect of a standardized yarrow (Achillea millefolium) extract and its constituent choline: studies in the mouse and human stomach

BACKGROUND

Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder characterized by alterations in gastric motility. Yarrow (Achillea millefolium L., Fam Asteraceae) preparations are traditional remedies used to treat dyspeptic complaints. Herein, we investigated the effect of a standardized dry water extract obtained from A. millefolium flowering tops (AME) on gastric motility.

METHODS

The effect of AME on motility was evaluated on the resting tone of the isolated gastric antrum and on gastric emptying in vivo (phenol red meal method) both in control mice and in the model of cancer chemotherapy (cisplatin)-induced gastric abnormalities.

KEY RESULTS

The AME contracted mouse and human gastric strips and this action was unaffected by hexamethonium and tetrodotoxin, but strongly reduced by atropine. Among various chemical ingredients in yarrow, choline, but not the flavonoids rutin and apigenin, mimicked the action of AME. Furthermore, AME deprived of choline did not exert a contractile effect. In vivo, AME stimulated gastric emptying both in control and in cisplatin-treated mice, being more active in pathological states.

CONCLUSIONS & INFERENCES

It is concluded that (i) AME exerts a direct spasmogenic effect on gastric antrum; (ii) choline is the chemical ingredient responsible of such effect; (iii) the prokinetic effect of AME observed in vivo could provide the pharmacological basis underlying its traditional use in the treatment of dyspepsia.

Early childhood caries underweight or overweight, that is the question

AIM

The purpose of this retrospective case study is to describe the body mass index in a group of children, from 3 to 6 years old with ECC and a similar group of caries-free children.

MATERIALS AND METHODS

This case-control analysis involves two groups of children: the first was of 244 healthy children, 3 to 6 year-old and caries-free; the second was of 586 otherwise healthy children, same age, with Early Childhood Caries divided into three subgroups according the AAPD definition. Demographics, dmft, number teeth with pulpal involvement, BMI percentile, weight at birth, weight and height of both parents were measured during the clinical evaluation. Statistical analyses were performed using standard statistical software (SPSS Version 13). BMI distribution of the subjects with caries was graphically compared with the use of confidence intervals to a similar caries-free sample.

RESULTS

Results are expressed as mean ± SD and frequencies (percentages), depending on the data type. The distribution of BMI percentiles of the ECC group was: underweight = 10%; normal weight = 55.90%; at risk of overweight = 22.22 %; overweight = 11.11%. Significantly, more children in the case group were underweight than in the control group (10% vs. 4.94%).

CONCLUSION

The ECC population does not have a typical weight distribution, and the underweight finding in a significant number of Severe ECC (S-ECC) children may be due to the chewing alteration related to the dental pain due to caries and to missing teeth after hard tissues breakdown.

Inhibitory effects of bromelain, a cysteine protease derived from pineapple stem (Ananas comosus), on intestinal motility in mice

BACKGROUND

Bromelain (BR) is a cysteine protease with inhibitory effects on intestinal secretion and inflammation. However, its effects on intestinal motility are largely unexplored. Thus, we investigated the effect of this plant-derived compound on intestinal contractility and transit in mice.

METHODS

Contractility in vitro was evaluated by stimulating the mouse isolated ileum, in an organ bath, with acetylcholine, barium chloride, or electrical field stimulation. Motility in vivo was measured by evaluating the distribution of an orally administered fluorescent marker along the small intestine. Transit was also evaluated in pathophysiologic states induced by the pro-inflammatory compound croton oil or by the diabetogenic agent streptozotocin.

KEY RESULTS

Bromelain inhibited the contractions induced by different spasmogenic compounds in the mouse ileum with similar potency. The antispasmodic effect was reduced or counteracted by the proteolytic enzyme inhibitor, gabexate (15 × 10(-6)  mol L(-1) ), protease-activated receptor-2 (PAR-2) antagonist, N(1) -3-methylbutyryl-N(4) -6-aminohexanoyl-piperazine (10(-4) mol L(-1) ), phospholipase C (PLC) inhibitor, neomycin (3 × 10(-3) mol L(-1) ), and phosphodiesterase 4 (PDE4) inhibitor, rolipram (10(-6)  mol L(-1) ). In vivo, BR preferentially inhibited motility in pathophysiologic states in a PAR-2-antagonist-sensitive manner.

CONCLUSIONS & INFERENCES

Our data suggest that BR inhibits intestinal motility - preferentially in pathophysiologic conditions - with a mechanism possibly involving membrane PAR-2 and PLC and PDE4 as intracellular signals. Bromelain could be a lead compound for the development of new drugs, able to normalize the intestinal motility in inflammation and diabetes.

PAF formation by human gastrointestinal mucosa/submucosa in-vitro: release by ricinoleic acid, and inhibition by 5-aminosalicylic acid

Human isolated gastrointestinal mucosa/submucosa incubated with ricinoleic acid (12·5–100 μg mL−1) or the calcium ionophore A23187 (10 μg mL−1) released platelet-activating factor (PAF) as determined by a scintillation proximity assay after extraction and purification. 5-Aminosalicylic acid (25–100 μg mL−1) inhibited PAF release by ricinoleic acid in a concentration-dependent manner, and 50 μg mL−1 reduced the effect of A23187. We suggest that PAF may play a role in the taxation and mucosal damage by ricinoleic acid released from castor oil.

Time Course of PAF Formation by Gastrointestinal Tissue in Rats After Castor Oil Challenge

When castor oil was administered by gavage to rats, the duodenum and jejunum, but not the stomach, produced large amounts of platelet activating factor 3–7 h after oil challenge with a peak at 3 h. Intraluminal release of acid phosphatase was also markedly increased in the duodenum and jejunum of castor oil-treated rats, especially 3–5 h after oil challenge. No increase was observed in the stomach. There was a correlation between elevated release of acid phosphatase and intestinal hyperaemia.

Effects of senna and its active compounds rhein and rhein-anthrone on PAF formation by rat colon

A single or a prolonged oral administration of senna (60 mg kg−1) to rats did not increase either colonic PAF (platelet activating factor) content or intraluminal release of acid phosphatase. A similar result was observed in the colonic tissue of rats perfused in-vitro with rhein (1–300 μg mL−1) or rhein-anthrone (1–300 μg mL−1). A single or prolonged administration of castor oil (2 mL) to rats increased both colonic PAF content and intraluminal release of acid phosphatase. Colonic tissue of rats perfused in-vitro with calcium ionophore A23187 (1 and 10 μg mL−1) formed large amounts of PAF and acid phosphatase. Since PAF can mediate intestinal damage and acid phosphatase is a marker of cellular injury, we conclude that senna and its derivatives, rhein and rheinanthrone, are well tolerated in rats.

[Oral health and pregnancy: promotion of oral health during the pre-natal training in the Latina province]

The aim of this study, conducted in the Province of Latina, was to verify knowledge, attitudes, and lifestyles in relation to oral health in a sample of pregnant women, assessing their subjective perception of oral health, and highlight prenatal dental prevention need specialist in the area and provide adequate information on the importance of good oral hygiene in order to achieve a better health level both of the mother and the child. The study was conducted on a sample of pregnant women between the 26th and 39th gestational week, in the period from June to October 2009, during the childbirth training courses in the Province of Latina. Each patient was administered a questionnaire for the assessment of oral habits during pregnancy and for the definition of specific knowledge on and perception of themselves and their own oral condition. The survey shows that more than one third of the sample reported visiting a dentist only in case of pain, over half (56.9%) did not undergo any dental visit during the gestational period, only 24 subjects (33.3%) having applied to a dental hygienist for professional oral hygiene and that only 7 out of 72 women had been prescribed a dental checkup by a gynecologist. The study showed that knowledge about dental problems that may arise during pregnancy is insufficient to guarantee a good threshold to oral health care for the mother hence the need to promote information programs, oral health and pregnancy prevention and training in the territory mainly directed to health-care specialists (gynecologists and obstetricians) and to pregnant women.

Genotypes of p53 codon 72 correlate with age at onset of type 1 diabetes in a sex-specific manner

In type 1 diabetes mellitus (T1D) p53 pathways are up-regulated and there is an increased susceptibility to apoptosis. The hypothesis is that p53 codon 72 polymorphism could be associated with T1D. A total of 286 children with T1D and a control sample of 730 subjects were studied. p53 codon 72 polymorphism was analysed by polymerase chain reaction. A large increase of p53 *Arg/*Arg was observed in T1D patients with age at onset < 6 years. A strong linear correlation between *Arg/*Arg genotype and age at onset was observed in females. The involvement of the *Arg/*Arg genotype in apoptosis suggests that during the autoimmune process leading to T1D, genetic factors that favor apoptosis may contribute to the onset of overt disease.

Band-gap engineering: from physics and materials to new semiconductor devices

Band-gap engineering is a powerful technique for the design of new semiconductor materials and devices. Heterojunctions and modern growth techniques, such as molecular beam epitaxy, allow band diagrams with nearly arbitrary and continuous band-gap variations to be made. The transport properties of electrons and holes can be independently and continuously tuned for a given application. A new generation of devices with unique capabilities, ranging from solid-state photomultipliers to resonant tunneling transistors, is emerging from this approach.

Quantum cascade laser

A semiconductor injection laser that differs in a fundamental way from diode lasers has been demonstrated. It is built out of quantum semiconductor structures that were grown by molecular beam epitaxy and designed by band structure engineering. Electrons streaming down a potential staircase sequentially emit photons at the steps. The steps consist of coupled quantum wells in which population inversion between discrete conduction band excited states is achieved by control of tunneling. A strong narrowing of the emission spectrum, above threshold, provides direct evidence of laser action at a wavelength of 4.2 micrometers with peak powers in excess of 8 milliwatts in pulsed operation. In quantum cascade lasers, the wavelength, entirely determined by quantum confinement, can be tailored from the mid-infrared to the submillimeter wave region in the same heterostructure material.

Dynamics of actively mode-locked Quantum Cascade Lasers

The impact of upper state lifetime and spatial hole burning on pulse shape and stability in actively mode locked QCLs is investigated by numerical simulations. It is shown that an extended upper state lifetime is necessary to achieve stable isolated pulse formation per roundtrip. Spatial hole burning helps to reduce the pulse duration by supporting broadband multimode lasing, but introduces pulse instabilities which eventually lead to strongly structured pulse shapes that further degrade with increased pumping. At high pumping levels gain saturation and recovery between pulses leads to suppression of mode locking. In the absence of spatial hole burning the laser approaches single-mode lasing, while in the presence of spatial hole burning the mode locking becomes unstable and the laser dynamics does not reach a steady state anymore.

Klinefelter syndrome: Case report

OBJECTIVES.: The aim of this work is to describe the problems of child dentistry affected by Klinefelter's syndrome. METHODOS.: Through the presentation of a clinical case that was followed by a Pediatric Dentistry, University Sapienza of Rome. RESULT.: Interceptive therapy aims to eliminate the functional interference that occurs during growth. CONCLUSION.: For this reason it's a must for the dentist to carefully monitor the oral health of the small patient immediately.

Epitaxial Catalyst-Free Growth of InN Nanorods on c-Plane Sapphire

We report observation of catalyst-free hydride vapor phase epitaxy growth of InN nanorods. Characterization of the nanorods with transmission electron microscopy, and X-ray diffraction show that the nanorods are stoichiometric 2H-InN single crystals growing in the [0001] orientation. The InN rods are uniform, showing very little variation in both diameter and length. Surprisingly, the rods show clear epitaxial relations with the c-plane sapphire substrate, despite about 29% of lattice mismatch. Comparing catalyst-free with Ni-catalyzed growth, the only difference observed is in the density of nucleation sites, suggesting that Ni does not work like the typical vapor-liquid-solid catalyst, but rather functions as a nucleation promoter by catalyzing the decomposition of ammonia. No conclusive photoluminescence was observed from single nanorods, while integrating over a large area showed weak wide emissions centered at 0.78 and at 1.9 eV.

Inhibitory effect of salvinorin A, from Salvia divinorum, on ileitis-induced hypermotility: cross-talk between kappa-opioid and cannabinoid CB(1) receptors

BACKGROUND AND PURPOSE

Salvinorin A, the active component of the hallucinogenic herb Salvia divinorum, inhibits intestinal motility through activation of kappa-opioid receptors (KORs). However, this compound may have target(s) other than the KORs in the inflamed gut. Because intestinal inflammation upregulates cannabinoid receptors and endogenous cannabinoids, in the present study we investigated the possible involvement of the endogenous cannabinoid system in salvinorin A-induced delay in motility in the inflamed gut.

EXPERIMENTAL APPROACH

Motility in vivo was measured by evaluating the distribution of a fluorescent marker along the small intestine; intestinal inflammation was induced by the irritant croton oil; direct or indirect activity at cannabinoid receptors was evaluated by means of binding, enzymic and cellular uptake assays.

KEY RESULTS

Salvinorin A as well as the KOR agonist U-50488 reduced motility in croton oil treated mice. The inhibitory effect of both salvinorin A and U-50488 was counteracted by the KOR antagonist nor-binaltorphimine and by the cannabinoid CB(1) receptor antagonist rimonabant. Rimonabant, however, did not counteract the inhibitory effect of salvinorin A on motility in control mice. Binding experiments showed very weak affinity of salvinorin A for cannabinoid CB(1) and CB(2) and no inhibitory effect on 2-arachidonoylglycerol and anandamide hydrolysis and cellular uptake.

CONCLUSIONS AND IMPLICATIONS

The inhibitory effect of salvinorin A on motility reveals a functional interaction between cannabinoid CB(1) receptors and KORs in the inflamed--but not in the normal--gut in vivo.

[Advances on the effects of the compounds of a phytotherapic agent (COLIMIL) on upper gastrointestinal transit in mice]

AIM

Phytotherapic agents, such as herbal formulations containing Matricariae recutita flowers (chamomile) extract, Foeniculum vulgare fruit (fennel) extract and Melissa officinalis aerial parts (lemon balm) extract have beneficial effects on gastrointestinal tract in colicky infants. However, the mechanism is largely unexplored and, particularly, it is not clear if it affects intestinal motility. The aim of this experimental study was to evaluate the effect of different herbal formulations containing Matricariae recutita extract, Foeniculum vulgare extract and Melissa officinalis extract on upper gastrointestinal transit in mice in vivo.

METHODS

Gastrointestinal transit was measured in male ICR mice and in croton oil-treated mice after the oral administration of herbal formulations containing chamomile, fennel and lemon balm (ColiMil) and chamomile and lemon balm (ColiMil experimental).

RESULTS

The herbal formulations tested (0.4-0.8 mL/mouse) dose-dependently and significantly inhibited gastrointestinal transit both in control and in croton oil-treated mice. Chamomile extract and lemon balm extract reduced significantly intestinal motility, but not fennel. At similar concentration ColiMil evoked a more consistent response than ColiMil experimental.

CONCLUSION

Our findings directly demonstrate in vivo the effect of a combination of herbal formulations on intestinal motility. The observed inhibitory effect might be studied with clinical studies to test the efficacy of these compounds in the treatment of colicky infants.

The hallucinogenic herb Salvia divinorum and its active ingredient salvinorin A reduce inflammation-induced hypermotility in mice

The hallucinogenic plant Salvia divinorum has been used for medical treatments of gastrointestinal disorders. Here, we evaluated the effect of a standardized extract from the leaves of Salvia divinorum (SDE) and of its active ingredient salvinorin A on motility in vivo, both in physiological states and during croton oil-induced intestinal inflammation. SDE (1-100 mg kg(-1)) significantly inhibited motility only in inflamed, but not in control, mice. In control mice, salvinorin A (0.01-10 mg kg(-1)) significantly inhibited motility only at the highest doses tested (3 and 10 mg kg(-1)) and this effect was not counteracted by naloxone or by the kappa-opioid receptor (KOR) antagonist nor-binaltorphimine. Inflammation significantly increased the potency of salvinorin A (but not of the KOR agonist U-50488) in reducing motility. The inhibitory effects of both salvinorin A and U-50488 in inflamed mice were counteracted by naloxone or by nor-binaltorphimine. We conclude that salvinorin A may reduce motility through activation of different targets. In physiological states, salvinorin A, at high doses, inhibited motility through a non-KOR mediated mechanism. Gut inflammation increased the potency of salvinorin A; this effect was mediated by KOR, but it was not shared by U-50488, thus suggesting that salvinorin A may have target(s) other than KOR in the inflamed gut.

The role of endocannabinoids in the regulation of gastric emptying: alterations in mice fed a high-fat diet

BACKGROUND AND PURPOSE

Endocannabinoids (via cannabinoid CB(1) receptor activation) are physiological regulators of intestinal motility and food intake. However, their role in the regulation of gastric emptying is largely unexplored. The purpose of the present study was to investigate the involvement of the endocannabinoid system in the regulation of gastric emptying in mice fed either a standard diet (STD) or a high-fat diet (HFD) for 14 weeks.

EXPERIMENTAL APPROACH

Gastric emptying was evaluated by measuring the amount of phenol red recovered in the stomach after oral challenge; CB(1) expression was analysed by quantitative reverse transcription-PCR; endocannabinoid (anandamide and 2-arachidonoyl glycerol) levels were measured by liquid chromatography-mass spectrometry.

KEY RESULTS

Gastric emptying was reduced by anandamide, an effect counteracted by the CB(1) receptor antagonist rimonabant, but not by the CB(2) receptor antagonist SR144528 or by the transient receptor potential vanilloid type 1 (TRPV1) antagonist 5'-iodoresiniferatoxin. The fatty acid amide hydrolase (FAAH) inhibitor N-arachidonoyl-5-hydroxytryptamine (but not the anandamide uptake inhibitor OMDM-2) reduced gastric emptying in a way partly reduced by rimonabant. Compared to STD mice, HFD mice exhibited significantly higher body weight and fasting glucose levels, delayed gastric emptying and lower anandamide and CB(1) mRNA levels. N-arachidonoylserotonin (but not rimonabant) affected gastric emptying more efficaciously in HFD than STD mice.

CONCLUSIONS AND IMPLICATIONS

Gastric emptying is physiologically regulated by the endocannabinoid system, which is downregulated following a HFD leading to overweight.

Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer

BACKGROUND

Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor progression. However, none of activation coagulation markers has any predictive value for the occurrence of the thrombotic events in one individual patient. Current clotting methods can't reveal the overall dynamic clot formation; in contrast thromboelastographic methods specifically assess overall coagulation kinetics and its strength in whole blood.

AIM

Objective of study was to evaluate if the activation of coagulation as eventually revealed by ROTEM thromboelastometry could assess an hypercoagulable state in surgical neoplastic patients.

PATIENTS AND METHODS

Fifty consecutive patients with carcinoma of the digestive tract in preoperative period (23 M, 27 F aging 61.5 (45-79 years) and 147 healthy subjects (71 M, 76 F) were studied. A recent thromboelastometric method based on thrombelastography after Hartert was employed. Measurements were performed on ROTEM Coagulation Analyzer. The continuous coagulation data from 50 min course were transformed into dynamic velocity profiles of WB clot formation.

RESULTS

Standard parameters (CT, CFT, MCF) of cancer patients were similar to controls. CT (in cancer patients): females 50 s (38.3-58.7), males 50 s (42-71.2) vs 51 s (42-59), p = 0.1210 / 53 s (42-74.8), p = 0.1975 (in controls). CFT (in cancer patients): females 72 s (32- 92.4), males 80 s (50.2- 128.7) vs 78 s (62-100), p = 0.0128 / 80 s (59-124.4), p = 0.9384 (in controls). MCF (in cancer patients): females 70 mm (59.9-82.5), males 63 mm (56-73.7) vs 69 mm (59-95.8), p = 0.9911 / 69 mm (53.6-90), p = 0.0135 (in controls). Females showed a higher MaxVel when compared to males. The MaxVel was increased in cancer patients: females 19 mm /100 s (14.3-49.5) males 18 mm / 100 s (11-27) vs 15 mm 100 s (11.8-22), p < 0.001 / 13 mm / 100 s (10-21.8), p < 0.001 in controls. The t-MaxVel was shortened in cancer patients: females 65s (48.6-112.8), males 81s (50.1-135.9) vs 115s (56.8-166), p < 0.001 / 115 s (59.8-180.8), p = 0.0002 in controls. The AUC was increased in cancer patients: females 6451 mm 100(5511-8148), males 5984 mm 100 (5119-6899) vs 5778 mm 100 (4998-6655), p < 0.001 / 5662 mm 100 (4704-6385), p = 0.0105.

CONCLUSION

Unlike other assays measuring variations in a single component during coagulation, the thrombelastographic method records a profile of real-time continuous WB clot formation, and may provide extensive informations on haemostasis in neoplastic patients before surgery.

The hallucinogenic herb Salvia divinorum and its active ingredient salvinorin A inhibit enteric cholinergic transmission in the guinea-pig ileum

Salvia divinorum is a widespread hallucinogenic herb traditionally employed for divination, as well as a medicament for several disorders including disturbances of gastrointestinal motility. In the present study we evaluated the effect of a standardized extract from the leaves of S. divinorum (SDE) on enteric cholinergic transmission in the guinea-pig ileum. SDE reduced electrically evoked contractions without modifying the contractions elicited by exogenous acetylcholine, thus suggesting a prejunctional site of action. The inhibitory effect of SDE on twitch response was abolished by the opioid receptor antagonist naloxone and by the kappa-opioid antagonist nor-binaltorphimine, but not by naltrindole (a delta-opioid receptor antagonist), CTOP (a mu-opioid receptor antagonist), thioperamide (a H(3) receptor antagonist), yohimbine (an alpha(2)-receptor antagonist), methysergide (a 5-hydroxytryptamine receptor antagonist), N(G)-nitro-L-arginine methyl ester (an inhibitor of NO synthase) or apamin (a blocker of Ca(2+)-activated K(+) channels). Salvinorin A, the main active ingredient of S. divinorum, inhibited in a nor-binaltorphimine- and naloxone-sensitive manner electrically induced contractions. It is concluded that SDE depressed enteric cholinergic transmission likely through activation of kappa-opioid receptors and this may provide the pharmacological basis underlying its traditional antidiarrhoeal use. Salvinorin A might be the chemical ingredient responsible for this activity.