Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis

A systematic review (SR) is a research method for synthesizing evidence on a specific topic. Among the various types of systematic reviews, there are SRs of guidelines (CPGs) and SRs of SRs. Traditionally, they are limited to just one type of secondary evidence. This paper introduces an innovative SR methodology that combines CPGs and SRs to improve evidence synthesis and overcome the limitations of isolated use. Essential steps that should always precede the actual research process include registering the research protocol, formulating research questions and setting inclusion/exclusion criteria. Using the PRISMA protocol for comprehensive database searches, it's crucial to combine keywords with boolean operators and remove duplicates. The eligibility of studies should be assessed by selecting potentially relevant articles through an initial screening of titles and abstracts, followed by a meticulous analysis of the full-texts. Rigorous evidence evaluation tools, such as AGREE II for CPGs and AMSTAR 2 for SRs, and the double reviewer approach ensure high-quality selections. Additionally, converting summarized results into percentages and applying statistical analyses facilitate interpretation and improve the reliability of rater assessments. A further characteristic of this methodology is its adaptability to the evolution of healthcare research.

Dysgeusia and Chronic Kidney Disease: a Scoping Review

BACKGROUND/AIM

Dysgeusia, a common altered taste perception in CKD patients, results in reduced taste acuity, impaired salt detection, and a metallic taste sensation, leading to nutritional alterations. The study aims to identify available treatments for educating, screening, and clinically managing dysgeusia in this population.

DESIGN/METHODS

A scoping review was conducted following the protocol of Arksey and O'Malley, incorporating the JBI methodology, and adhering to the PRISMA-ScR guidelines. The review protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RS2A6).

RESULTS

Among the 424 identified records, 13 studies were included. Screening methodologies included taste acuity tests, evaluation scales, and chemical tests integrated with cotton swab applicators and rinsing solutions. Furthermore, educational strategies, particularly a hospital-based program focusing on salt reduction, showed a significant improvement in dysgeusia (p < 0.001). The identified clinical treatments exclusively included oral zinc supplementation, with dosages ranging from 50 to 220 mg, reporting heterogeneous results not consistent across different studies.

CONCLUSION

The personalized management of dysgeusia associated with CKD is crucial, requiring targeted education and treatment protocols to prevent and address nutritional complications such as malnutrition. The heterogeneity of results emphasizes the need for further high-quality research to produce robust scientific evidence.

A methodological framework for rigorous systematic reviews: Tailoring comprehensive analyses to clinicians and healthcare professionals

Systematic reviews represent a fundamental study design, providing the highest level of evidence across diverse research inquiries, encompassing both public health and clinical research and practice. However, for healthcare professionals, the process of selecting, synthesizing, and interpreting evidence can be challenging, and requires specialized skills. Therefore, it is imperative to explore innovative solutions aimed at simplifying and making the traditional systematic review process more accessible while ensuring the validity and reliability of results. In this perspective, our research objective is to develop a systematic review framework that, while maintaining a rigorous methodological approach, streamlines the process for healthcare professionals. This study describes such approach in every phase, from the collection of evidence to the writing of the text, creating a guide for the healthcare professional who approaches this type of research. The qualitative and organizational analysis tools are also described, providing useful information for the use of non-paid programs. This systematic review aims to develop a framework with a rigorous methodological approach that allows simplify the process for clinicians and healthcare professionals. The implementation of this methodology in clinical practice offers new perspectives to ensure a thoughtful consideration and application of scientific evidence and opens the way to innovative and easily accessible solutions to facilitate the conduct of systematic reviews in the clinical care setting.

Non-pharmacological strategies to alleviate dysgeusia in patients undergoing chemotherapy: A systematic review

PURPOSE

Dysgeusia is a common side effect in oncology patients, significantly impacting their quality of life. This systematic review aims to evaluate the effectiveness of non-pharmacological strategies in treating dysgeusia in patients undergoing chemotherapy or radiotherapy.

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search across five databases: PubMed, Embase, Cochrane Library, CINAHL, and the British Nursing Database. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the quality of the included studies. A harvest plot was used to synthesise evidence about the differential effects of population-level interventions.

RESULTS

Nine studies of non-pharmacological strategies to manage dysgeusia were included. These studies encompassed a variety of interventions, including oral applications and supplements, instrumental techniques, and educational programs. The review identified promising interventions such as cryotherapy and Miraculine supplementation, which showed potential in mitigating taste alterations. Instrumental techniques like photobiomodulation therapy and complementary and integrative medicine approaches, including acupuncture and herbs, were also found to be beneficial. Educational and self-management strategies emerged as effective interventions for empowering patients to manage dysgeusia. Despite the diversity of interventions and the limitations of the included studies, such as small sample sizes and geographical differences, these findings underscore the potential of non-pharmacological strategies in managing dysgeusia.

CONCLUSION

The results support the integration of these strategies into clinical practice, highlighting the importance of multidisciplinary approaches to improve patient care. Further research should prioritize rigorous studies to enhance evidence and explore long-term effects.

The Italian Validation of the Healthcare Professional Humanization Scale for Nursing

Purpose: The Healthcare Professional Humanization Scale (HUMAS) is a measure of the evaluation of the humanization of care in nursing professions. Despite being validated for the Spanish language, there still needed validation in Italian, which seems essential considering the cultural differences. Aim: We aimed to test the validity and reliability of the HUMAS with an Italian sample of registered nurses. Methods: The present study used cross-sectional data from 300 nurses that completed the survey. The study's main phases were (a) construction of the Italian version; (b) testing and analyzing the psychometric properties of the scale. The exploratory factor analysis and the Content Validity Index (CVI) were performed. Cronbach's alpha and test-retest were used to determine the reliability. Findings: The final Italian version of HUMAS (HUMAS-I) comprised 19 items grouped into five correlated latent factors, accounting for 68.4% of the variance. Additionally, it exhibited a satisfactory Cronbach's alpha for each latent component and an average CVI for the entire scale of 0.68. Conclusions: The HUMAS-I shows acceptable psychometric proprieties as the original Spanish version. Therefore, it could be an advantageous instrument for use in nursing practice and research.

Utilization and effects of security technologies in mental health: A scoping review

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

Surface guided radiation therapy: An international survey on current clinical practice

Introduction

Surface Guided Radiation Therapy (SGRT) is being increasingly implemented into clinical practice across a number of techniques and irradiation-sites. This technology, which is provided by different vendors, can be used with most simulation- and delivery-systems. However, limited guidelines and the complexity of clinical settings have led to diverse patterns of operation. With the aim to understand current clinical practice a survey was designed focusing on specifics of the clinical implementation and usage.

Materials and methods

A 32-question survey covered: type and number of systems, quality assurance (QA), clinical workflows, and identification of strengths/limitations. Respondents from different professional groups and countries were invited to participate. The survey was distributed internationally via ESTRO-membership, social media and vendors.

Results

Of the 278 institutions responding, 172 had at least one SGRT-system and 136 use SGRT clinically. Implementation and QA were primarily based on the vendors' recommendations and phantoms. SGRT was mainly implemented in breast RT (116/136), with strong but diverse representation of other sites. Many (58/135) reported at least partial elimination of skin-marks and a third (43/126) used open-masks. The most common imaging protocol reported included the combination of radiographic imaging with SGRT. Patient positioning (115/136), motion management (104/136) and DIBH (99/136) were the main applications.Main barriers to broader application were cost, system integration issues and lack of demonstrated clinical value. A lack of guidelines in terms of QA of the system was highlighted.

Conclusions

This overview of the SGRT status has the potential to support users, vendors and organisations in the development of practices, products and guidelines.

Phenolic Substances in Foods: Health Effects as Anti-Inflammatory and Antimicrobial Agents

Background: The interest in phenolic compounds present in foods of vegetable origin has shown a notable increase in recent decades. This interest is due to the growing number of scientific studies concerning their beneficial role in human health. The interest in polyphenols has been supported by the current and growing awareness, and attention of consumers to food from a food safety viewpoint and also because of the beneficial effects ascribed to polyphenols. Objective: The aim of this article is to highlight antibacterial, antifungal, and anti-inflammatory activities of various phenolic compounds normally found in certain foods. Conclusions: Phenolic compounds exert different biological functions, such as antioxidant activity, modulation of detoxifying enzymes, stimulation of the immune system, reduction of platelet aggregation, modulation of hormonal metabolism, reduction of blood pressure, and anti-inflammatory, antibacterial, antiviral, and antifungal activities.

New approach in Auger elemental relative sensitive factor calculation by using TEM-EDS analysis based on bi-layers of pure elements

In fabrication of microelectronic devices two important steps are often recognized: i) all the processes performed on the wafer in order to build the active part of the devices and, ii) the assembly and packaging processes, typically performed on a chip, in order to fabricate interconnections between active part and exterior. The wafer back side is an active part of power devices and is normally coated with a stack of Ti-Ni-Au or Ti-Ni-Ag layers to ensure the best electrical contact with the frame on which the device is attached prior to the packaging. An important failure mechanism related to this particular process step is related to the diffusion of Ni to the surface of the stack that causes its oxidation on the back metal surface, inhibiting the correct connection to the metallic frame. Auger Electron Spectroscopy (AES) is a powerful analytical technique that can be used to detect this failure mechanism for its very high sensitivity in the characterization of surface layers. Unfortunately, its results are mainly qualitative. Quantitative extrapolations can be inaccurate using library Elemental Relative Sensitive Factor (ERSF) because they are mainly referred to a silicon substrate and could be not valid for a different matrix. A most accurate evaluation of the ERSF is based on the analysis, under identical experimental condition, of standard materials (with known concentration) that should be similar to the unknown sample and having the same matrix. However, the production of this kind of standard is not easy due to the mobility of Ni in Au and Ag. Another commonly used technique is the Energy Dispersive X-ray Spectrometry (EDS) which is less sensitive than the Auger and not sufficiently adequate for a quantitative analysis due to the limitation of the matrix correction methods. Recently, a new method to perform quantitative analysis by using Transmission Electron Microscopy (TEM) EDS was proposed, starting from bi-layers of pure elements. In this work we show how the use of TEM-EDS quantification of Ni in Ag could be a successful method for ERSF evaluation in order to overcome matrix effect in Auger quantification. For this purpose suitable foils of Ag/Al and Ni/Al were used. The validation of the method was performed on a sample with a tri-metal stack of Ti/Ni/Ag previously stimulated by means of a thermal budget to induce Ni migration on Ag surface. The quantitative analysis allowed us to use this characterized sample as AES standard for ERSF calculation.

Histochemical and morphological aspects of fresh frozen bone: a preliminary study

Bone graft are used in dentistry for the reconstruction of severely atrophic jaws. Fresh frozen bone has no osteogenic property but it has osteoconductive and osteoinductive properties because its matrix contains growth factors such as vascular endothelial growth factor. The purpose of the present study was to evaluate morphological and protein expression characteristics of fresh frozen bone before graft and after six months of graft in patients who needed maxillary reconstruction. After 6 month of graft we observed the presence of viable bone as evidenced by full osteocyte lacunae and by the presence of RANKR, osteocalcin positive cells and vascular endothelial growth factor. In conclusion, our findings show that the fresh frozen bone after six month of graft is for the most part viable bone, encouraging its use as an alternative to autogenous bone for reconstructing maxillary bone defects prior to implant.

Sarcoglycan complex in masseter and sternocleidomastoid muscles of baboons: an immunohistochemical study

The sarcoglycan complex consists of a group of single-pass transmembrane glycoproteins that are essential to maintain the integrity of muscle membranes. Any mutation in each sarcoglycan gene causes a series of recessive autosomal dystrophin-positive muscular dystrophies. Negative fibres for sarcoglycans have never been found in healthy humans and animals. In this study, we have investigated whether the social ranking has an influence on the expression of sarcoglycans in the skeletal muscles of healthy baboons. Biopsies of masseter and sternocleidomastoid muscles were processed for confocal immunohistochemical detection of sarcoglycans. Our findings showed that baboons from different social rankings exhibited different sarcoglycan expression profiles. While in dominant baboons almost all muscles were stained for sarcoglycans, only 55% of muscle fibres showed a significant staining. This different expression pattern is likely to be due to the living conditions of these primates. Sarcoglycans which play a key role in muscle activity by controlling contractile forces may influence the phenotype of muscle fibres, thus determining an adaptation to functional conditions. We hypothesize that this intraspecies variation reflects an epigenetic modification of the muscular protein network that allows baboons to adapt progressively to a different social status.

High-Dose Robotic Stereotactic Body Radiotherapy in the Treatment of Patients With Prostate Cancer: Preliminary Results in 26 Patients

BACKGROUND

Stereotactic body radiotherapy (SBRT) can emulate high dose rate brachytherapy (HDR-BRT) dose fractionation. We report our preliminary results using SBRT in monotherapy or pre-external-beam radiotherapy (EBRT) boost in patients with localized prostate cancer (LpC). The primary end point was the evaluation of both acute and late toxicities; secondary end point was the observation of prostate-specific antigen (PSA) nadir.

PATIENTS AND METHODS

Patients with LpC having prostate volume ≤90 cm(3) were enrolled in the present study. Patients were treated with SBRT alone or in combined modality (SBRT + EBRT). SBRT was performed using a CyberKnife System (Accuray Incorporated, Sunnyvale, California) and fiducial tracking system.

RESULTS

From February 2008 to July 2013, 21 patients for monotherapy (38 Gy/4 fractions) and 5 for combined modality (9.5 Gy/2 fractions plus 46 Gy/23 fractions EBRT) were enrolled. Androgen deprivation therapy (ADT) was administered in 16 of the 26 patients. The median pretreatment PSA was 9.4 (range, 4.5-14.3) ng/mL. All patients completed the planned therapy. Acute Grade 1 toxicity was observed in 18 patients, genitourinary (GU) in 12 / 26 patients, and gastrointestinal (GI) in 6 / 26 patients. Acute Grade 2 GU toxicity was reported in 1 / 26 patients, and Grade 2 GI toxicity was observed in 2 / 26 patients. The median PSA nadir was 0.15 (range, 0.02 = 1.4) ng/mL. Late toxicities were observed in 5 / 26 patients: Grade 1 GU (3 of 26), Grade 2 GU (1 of 26), and Grade 1 GI (1 of 26). Median follow-up was 21.5 (range, 8-65) months.

CONCLUSIONS

Our preliminary results of SBRT "simulating" HDR for LpC confirm a minimal toxicity and an optimal PSA response. The PSA nadirs appear comparable with HDR-BRT.

Sarcoglycan immunoreactivity is lacking in infantile hypertrophic pyloric stenosis. A confocal laser scanning microscopic study

OBJECTIVES

The Dystrophin-Glycoprotein Complex (DGC) is a large multisubunit complex that plays a crucial role in maintaining the structural integrity and physiology of muscle fibers. Dystrophin has been reported to be absent in the pyloric muscle of infantile hypertrophic pyloric stenosis (IHPS) patients. The present study was designed to investigate the other two patterns of DGC (dystroglycan and sarcoglycan complexes) in normal pyloric muscle and their possible modifications in IHPS patients.

METHODS

Ten pyloric muscle biopsies were obtained from babies operated for IHPS and five control pylorus biopsy taken at autopsy from cases without gastrointestinal disease. The DGC sub-complexes (beta-dystroglican and beta, delta- sarcoglycans) were localized immunohistochemically using specific monoclonal antibodies. The results were evaluated using a confocal laser scanning microscope.

RESULTS

Positive immunolocalization of the two DGC sub complexes was demonstrated in the smooth muscle cells (SMCs) of the pyloric region of control patients. Similarly, a positive immune expression of beta-dystroglican was observed in the pyloric SMCs of IHPS patients. On the other hand a negative immunoreaction for sarcoglycans was recorded within the full thickness of the pyloric SMCs of these patients.

CONCLUSIONS

The absence of sarcoglycans within the hypertrophied pyloric muscle may be a predisposing factor in the pathogenesis of IHPS since it could alter the normal physiology of SMCs through the modifications of structural integrity of sarcolemma and signaling between the extracellular and intracellular compartment.

Sarcoglycan subcomplex in normal and pathological human muscle fibers

Sarcoglycans are a sub-complex of transmembrane proteins which are part of the dystrophin-glycoprotein complex (DGC). They are expressed above all in the skeletal, cardiac and smooth muscle. Although numerous studies have been conducted on the sarcoglycan sub-complex in skeletal and cardiac muscle, the manner of distribution and localization of these proteins along the non-junctional sarcolemma is still not clear. Furthermore, there are unclear data about the actual role of sarcoglycans in human skeletal muscle affected by sarcoglycanopathies. In our studies on human skeletal muscle, normal and pathological, we determined the localization, distribution and interaction of these glycoproteins. Our results, on normal human skeletal muscle, showed that the sarcoglycans can be localized both in the region of the sarcolemma over the I band and over the A band, hypothesizing a correlation between regions of the sarcolemma occupied by costameres and the metabolic type of the fibers (slow and fast). Our data on skeletal muscle affected by sarcoglycanopathy confirmed the hypothesis of a bidirectional signaling between sarcoglycans and integrins and the interaction of filamin2 with both sarcoglycans and integrins. In addition, we have recently demonstrated, in smooth muscle, the presence of alpha-SG, in contrast with data of other Authors. Finally, we analyzed the association between contractile activity and quantitative correlation between alpha- and epsilon-SG, in order to better define the arrangement of sarcoglycan subcomplex.

Integrins, muscle agrin and sarcoglycans during muscular inactivity conditions: an immunohistochemical study

Sarcoglycans are transmembrane proteins that seem to be functionally and pathologically as important as dystrophin. Sarcoglycans cluster together to form a complex, which is localized in the cell membrane of skeletal, cardiac, and smooth muscle. It has been proposed that the dystrophin-glycoprotein complex (DGC) links the actin cytoskeleton with the extracellular matrix and the proper maintenance of this connection is thought to be crucial to the mechanical stability of the sarcolemma. The integrins are a family of heterodimeric cell surface receptors which play a crucial role in cell adhesion including cell-matrix and intracellular interactions and therefore are involved in various biological phenomena, including cell migration, and differentiation tissue repair. Sarcoglycans and integrins play a mechanical and signaling role stabilizing the systems during cycles of contraction and relaxation. Several studies suggested the possibility that integrins might play a role in muscle agrin signalling. On these basis, we performed an immunohistochemical analyzing sarcoglycans, integrins and agrin, on human skeletal muscle affected by sensitive-motor polyneuropathy, in order to better define the correlation between these proteins and neurogenic atrophy due to peripheral neuropathy. Our results showed the existence of a cascade mechanism which provoke a loss of regulatory effects of muscle activity on costameres, due to loss of muscle and neural agrin. This cascade mechanism could determine a quantitative modification of transmembrane receptors and loss of alpha7B could be replaced and reinforced by enhanced expression of the alpha7A integrin to restore muscle fiber viability. Second, it is possible that the reduced cycles of contraction and relaxation of muscle fibers, during muscular atrophy, provoke a loss of mechanical stresses transmitted over cell surface receptors that physically couple the cytoskeleton to extracellular matrix. Consequently, these mechanical changes could determine modifications of chemical signals through variations of pathway structural integrins, and alpha7A could replace alpha7B.

Non-invasive assessment of motor unit anatomy in jaw-elevator muscles

The estimation of fibre length in jaw-elevator muscles is important for modelling studies and clinical applications. The objective of this study was to identify, from multi-channel surface EMG recordings, the main innervation zone(s) of the superficial masseter and anterior temporalis muscles, and to estimate the fibre length of these muscles. Surface EMG signals were collected from 13 subjects with a 16-electrode linear array. The innervation zones of the masseter and anterior temporalis were identified and their variability intra- and inter-subject outlined. More than one main innervation zone location was identified in the masseter of all subjects and in the temporalis anterior of 12 subjects. Average estimated fibre lengths, for the right (left) side, were (mean+/-SD) 27.3+/-2.4 mm (27.0+/-1.7 mm) and 25.9+/-2.3 mm (26.6+/-1.6 mm), for the superficial masseter and temporalis anterior muscle, respectively. The range of innervation zone locations was up to approximately 50% of the fibre length, both within and between subjects. Fibre length estimates well matched with published data on cadavers. It was concluded that multi-channel surface EMG provides important and reliable information on the anatomy of single motor units in jaw-elevator muscles.

Pre-Surgical Finasteride Therapy in Patients Treated Endoscopically for Benign Prostatic Hyperplasia

INTRODUCTION

Transurethral resection of the prostate is considered the standard technique for patients with moderate or severe lower urinary tract symptoms related to benign prostatic hyperplasia (BPH). Pathologically BPH is characterized by an increased proliferation of stromal and acinar cells, sustained by increased vascularization (neoangiogenesis). Recent studies have also shown that finasteride reduces angiogenesis and prostatic bleeding associated with BPH. Reducing the volume as a final step in reducing neoangiogenesis could thus represent a fundamental advance in limiting intra- and postoperative bleeding in patients undergoing transurethral resection of the prostate (TURP).

MATERIALS AND METHODS

Our study included 60 patients undergoing TURP between January 2001 and January 2002. Of the patients, 30 received pretreatment with finasteride while 30 did not undergo any pretreatment (control group). In all the patients we evaluated the degree of peri-surgical bleeding, intended as a reduction in hemoglobin values in the 24 h following surgery.

RESULTS AND CONCLUSIONS

In the group of patients pretreated with finasteride, blood loss, evaluated as a reduction in hemoglobin values, was minimal, and none of the patients required blood transfusion. The average hemoglobin loss in the 24 h following surgery was 0.9%. In the control group (average age 67 years), 4 patients (12%) required blood transfusion. The loss of hemoglobin was 2.36%. Finasteride, therefore, seems to play a fundamental role in the pretreatment of TURP patients, since by reducing dihydrotestosterone synthesis, it interacts with endothelial growth factors, thus reducing angiogenesis and preventing bleeding.

Sarcoglycan and integrin localization in normal human skeletal muscle: a confocal laser scanning microscope study

Many studies have been performed on the sarcoglycan sub-complex and a7B and b1D integrins, but their distribution and localization patterns along the non-junctional sarcolemma are still not clear. We have carried out an indirect immunofluorescence study on surgical biopsies of normal human skeletal muscle, performing double localization reactions with antibodies to sarcoglycans, integrins and sarcomeric actin. Our results indicate that the tested proteins colocalize with each other. In a few cases, a-sarcoglycan does not colocalize with the other sarcoglycans and integrins. We also demonstrated, by employing antibodies to all the tested proteins, that these proteins can be localized to regions of the sarcolemma corresponding either to the I-band or A-band. Our results seem to confirm the hypothesis of a correlation between the region of the sarcolemma occupied by costameric proteins and the metabolic type (fast or slow) of muscle fibers. On this basis, we suggest that slow fibers are characterized by localization of costameric proteins to I-bands, while fast fibers are characterized by localization of costameric proteins to A-bands. The results open a new line of research in understanding interactions between the components of the DGC and vinculin-talin-integrin complexes in the context of different fiber types. Moreover, the same results may be extended to skeletal muscle fibers affected by neuromuscular diseases to detect possible structural alterations.

Lithiasic Obstructive Uropathy

OBJECTIVES

The purpose of this study was to evaluate the role of magnetic resonance (MR) pyelography in patients affected by hydronephrosis due to ureteric stones, in order to identify a pyonephrotic condition.

MATERIALS AND METHODS

In the last 3 years, 315 patients, who had originally been investigated by ultrasonography, were evaluated with MR pyelography in order to define the etiology of obstruction. In 67 patients hydronephrosis was referred as caused by lithiasis.

RESULTS

MR pyelography not only confirmed urinary tract dilatation in all patients, but also identified grade and site of obstruction, both in acute dilatation (25 patients) and in chronic obstructions (42 patients). In 7 patients, MR pyelography documented pyonephrosis that was obviously confirmed by nephrostomic drainage.

CONCLUSION

MR pyelography, made with ultrafast breath-hold sequences, has a great value in identifying hydronephrosis in patients with ureteric stones. Furthermore, it provides the chance to identify pyonephrosis requiring an immediate drainage of the kidney before major complications develop.

Distribution and Localization of Vinculin-Talin-Integrin System and Dystrophin-Glycoprotein Complex in Human Skeletal Muscle

The vinculin-talin-integrin system and the dystrophin-glycoprotein complex (DGC) are two protein systems with structural and signaling functions, allowing interaction between muscle fibers and extracellular matrix. Although numerous studies have been conducted on these systems, their localization and distribution patterns along the nonjunctional sarcolemma are not clear. On this basis, we carried out an indirect immunofluorescence study on the vastus lateralis muscle of human adults not affected by neuromuscular diseases to better define these patterns. Our results showed that all tested proteins of the two systems have a costameric distribution; all tested proteins of the two systems colocalize with each other (about 90-95% of the cases); only alpha-sarcoglycan in a few cases (about 6%) does not colocalize with other proteins; in about 9-10% of the cases, dystrophin and beta-dystroglycan colocalize partially with other proteins; all tested proteins can be localized in different fibers, both in the region of the sarcolemma over I or A bands. The colocalization between the vinculin-talin-integrin and DGC systems may imply their functional interaction involving the structural aspect, by providing a stronger adhesion between sarcolemma and extracellular matrix in well-defined regions of the muscle fiber. Besides, their colocalization may suggest the existence of a mechanism of mutual modulation of the transmitted signals. This reciprocal control may determine, in different conditions, the prevalence of one system over another with a consequent transmission of different messages to the sarcolemma-associated cytoskeleton.

Sarcoglycans in human skeletal muscle and human cardiac muscle: a confocal laser scanning microscope study

Sarcoglycans are a subcomplex of transmembrane proteins which are part of the dystrophin-glycoprotein complex. They are expressed in the skeletal, cardiac and smooth muscle. Although numerous studies have been conducted on the sarcoglycan subcomplex in skeletal and cardiac muscle, the manner of the distribution and localization of these proteins along the nonjunctional sarcolemma is not clear. We therefore carried out an indirect immunofluorescence study on surgical biopsies of normal human skeletal muscle and of healthy human atrial myocardium biopsies of patients affected by valvulopathy. Our results indicate that, in skeletal muscle, sarcoglycans have a costameric distribution and all colocalize with each other. Only in a few cases did the alpha-sarcoglycan not colocalize with other sarcoglycans. In addition, these glycoproteins can be localized in different fibers either in the regions of the sarcolemma over band I or band A. In cardiac muscle, our results show a costameric distribution of all proteins examined and, unlike in skeletal muscle, they show a constant colocalization of all sarcoglycans with each other, along with a consistent localization of these proteins in the region of the sarcolemma over band I. In our opinion, this situation seems to confirm the hypothesis of a correlation between the region of the sarcolemma occupied by costameric proteins and the metabolic type, fast or slow, of the muscular fibers. These data, besides opening a new line of research in understanding interactions between the sarcoglycans and other transmembrane proteins, could also be extended to skeletal and cardiac muscles affected by neuromuscular and cardiovascular pathologies to understand possible structural alterations.

Validation of a high-performance liquid chromatography method for the determination of oxytetracycline, tetracycline, chlortetracycline and doxycycline in bovine milk and muscle

High-performance liquid chromatography with diode-array detection (HPLC-DAD) was optimised and validated for the determination of tetracyclines in bovine milk and tissues. Milk and tissue samples were extracted and purified using a solid-phase extraction HLB Oasis cartridge and analysed using HPLC-DAD set at 365 nm. The analyses were carried out using the mobile phase of 0.01 M oxalic acid-acetonitrile-methanol (60:25:15, v/v/v) on a C8 column (250 x 4.6 mm I.D., 5 microm). Recoveries of tetracyclines from spiked samples at the three concentrations (0.5, 1 and 1.5) of the maximum residues limits (corresponding to 100 microg/kg for milk and the muscle) were higher than 81.1% in milk and 83.2% in muscle. The method was successfully validated for bovine milk and muscle in compliance with requirements set by draft SANCO/ 1805/ 2000 European Decision. The decision limit (CCalpha) was in the range 113.2-127.2 microg/kg and 107.7-129.9 micro/kg for all compounds in milk and muscle, respectively. The detection capability (CCbeta) was in the range 117.2-131.3 microg/kg and 114.9-133.1 microg/kg for all compounds in milk and muscle, respectively.

Actin-associated proteins in ameloblast differentiation

Focal contacts are systems of adherens junctions of the cell-extracellular matrix type, which allow the transfer of fundamental signals from the extracellular matrix to nuclear compartments, capable of regulating adhesion, proliferation, migration and differentiation of cells. Recently, many authors have concentrated their attention on epitheliomesenchymal interactions which guide organogenesis of dental germ, identifying numerous growth and differentiation factors and having the inner enamel epithelial cells of the enamel organ as a target. Given that the two cellular compartments in their tooth germ are separated by a basal membrane and by an extracellular matrix, which touches it, we wanted to evaluate the presence of focal contacts through the identification of talin and vinculin, proteins of the actin-associated protein complex. In this study we utilized the hemimandibles of young Wistar rats and we extracted the related odontogenic tooth organs present at their apical end. Specimens are processed with antibody against vinculin and talin. Results show that these junctional system proteins are present at the apical poles of both cellular compartments suggesting that putative epithelial-mesenchymal interactions, other than marker molecules, may use focal contacts as a system for transmission of signals.

AQP1 in red blood cells of uremic patients during hemodialytic treatment

Hemodialysis influences the transport of water through the erythrocytic membrane, and induces morphologic and functional modifications. Recently water channels, called aquaporins (AQP), have been identified on the membrane of red blood cells. The aim of the present study was, therefore, to evaluate any relationships between volumetric changes in erythrocytes (MCV), plasma osmolarity and membrane expression of AQP1 in 22 uremic patients during a hemodialysis session, and compare value with those in a control group of 22 healthy volunteers. Membranal AQP1 expression was evaluated using three methods: indirect immunofluorescence under confocal microscopy, immunoenzymatic method after membrane extraction, and immunoblotting. In uremic subjects, at baseline membrane AQP1 expression was significantly lower, whereas plasma osmolality was higher than in controls. At 1 and 2 h of replacement therapy, a progressive increase was observed in erythrocytic AQP1, values similar to those in controls being attained after 3.5 h. During the session osmolality values reduced progressively, becoming significantly lower than basal values. The mean erythrocytic corpuscular volume in patients with ESRD was significantly lower than in cntrols at baseline. This value increased during hemodialysis, attaining statistical significance with respect to the basal value at 3.5 h of dialysis. Close correlations were found between plasma osmolality and AQP1 values (r = -0.930; p < 0.05), and also between MCV and plasma osmolality trend (r = -0.909; p < 0.05). There was a linear correlation (r = 0.63, p < 0.05) between plasma AVP concentrations and plasma osmolality. The variations found in plasma osmolarity during hemodialysis, may induce AQP1 expression on the membrane of intact red blood cells.

[Usefulness of ultrasonography in the diagnosis of acute scrotal edema]

Ultrasonography has gained an important role for the diagnosis of acute and chronic scrotal lesions. We report our experience on 6 cases of acute scrotal edema. The etiology of edema was congestive cardiopathy (two patients), glomerulonephrosis (three patients) and lumboaortic lymphnode metastases from bladder transitional cell carcinoma (one patient). Ultrasound scan scrotal appearances were similar in all examined patients, and the only pathologic findings observed were "onion" like appearance and a thickened scrotal wall. Therefore, to define acute scrotal edema etiology, it isn't enough an ultrasound examination, but it's necessary to extend the ultrasound scan assessment to other organs.

[Validity of PSA density of the transition zone in the diagnosis of prostate cancer]

One hundred four patients (mean age 70.6 years) with prostatic specific antigen (PSA) values between 4 and 10 ng/ml (average 7.9 ng/ml), and with no suspects for neoplasia by digital rectal examination (DRE) and transrectal ultrasound (TRUS) were studied. In all patients PSA density for the entire prostate (PSAD) and PSA density for the transition zone (PSAT) were calculated. TRUS was performed using a 5 MHz probe. Prostate and transition zone volumes were obtained by ellipsoid formula. Aim of the study was to evaluate the PSAT predictivity for prostate cancer compared to the PSAD. Sixteen out of 104 patients (15.4%) had histologically confirmed prostate cancer, and 88 (84.6%) had benign prostatic hyperplasia. When cut-off for PSAD was 0.15 ng/ml/cc, specificity and sensitivity were respectively 75% and 68% with positive and negative predictive values of 54% and 17%; when cut-off for PSAT was 0.34% ng/ml/cc, sensitivity and specificity were respectively 100% and 68% with positive and negative predictive values of 60% and 18%. Our results, according to the literature data, suggest that PSAT seems to have a higher predictivity for prostate cancer than PSAD, providing an optimization for the employ of prostatic biopsy, especially for those patients with PSA values between 4 and 10 ng/ml.

Molecules that inhibit T-cell functions: cytochemical localization and shuttling

Adaptive immune responses to antigens are mediated by specific receptors expressed on B cells (BCR's) and T cells (TCR's). Effector cells and memory cells are produced following a proliferative wave that accounts for clonal expansion. If not down-regulated, clonal expansion might lead to uncontrolled lymphoproliferation that would be harmful for the organism. Several mechanisms that account for the down-sizing of activated lymphocyte clones are briefly reviewed here. We next consider in detail one such mechanism that deals with the functional characterization and the immunocytochemical localization of two T-cell inhibitory molecules, namely the Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) and the HP-F1 antigen, both present in all T lymphocytes. CTLA-4 and HP-F1 inhibit CD4+ T-helper cell proliferation and the lytic ability of CD8+ T-cytotoxic cells in non-specific and in antigen-specific cytolytic assays. Interestingly, a clonal distribution exists as for the ability of CTLA-4 and HP-F1 to inhibit T-cell functions. In resting and activated T cells, both molecules are largely confined in the endosomal compartment, as shown by immunofluorescence analyses. However, upon interaction of T cells with Antigen-Presenting Cells (APC's) or with target cells that must be killed, CTLA-4 molecules are transported to the plasma membrane, at the site of cell-to-cell contact where, following interaction with ligands, they trigger inhibitory signals.

Anatomy of the immune system: facts and problems

In the introductory section of this report, the anatomy of the immune system, from organs and tissues to molecules, will be reviewed briefly. Cell proliferation and differentiation in the central lymphoid organs (thymus and bone marrow) yield a repertoire of T- and B-cell clones that seed into peripheral lymphoid organs (spleen, lymph nodes and Mucosa-Associated Lymphoid Tissue, MALT), where humoral and cell-mediated antigen-specific immune responses occur. The stringent process of clonal selection in the central lymphoid organs implies deletion of inappropriate cells via apoptosis. In the peripheral lymphoid organs, the potential of unlimited activation and expansion of lymphocytes in response to antigens is primarily regulated by apoptosis and anergy. These events, on the one hand, are relevant to prevent autoimmunity and lymphoproliferative disorders; on the other hand, clonal deletion and anergy provide a detrimental escape to immune recognition of malignant cells. Two major inhibitory mechanisms of the immune response have emerged recently. One is linked to the existence of bona fide suppressor cells and cytokines; the other relies on the existence of inhibitory molecules expressed by T, B and NK cells, as well as by other leukocytes. In the studies herein reported, emphasis will be given to surface membrane molecules that down-regulate T-cell-mediated immune responses. These molecules control interactions between T cells and antigen presenting cells (APC's) or target (virus-infected or mutated) cells that have to be killed. Two sets of molecules exist that either upregulate (coactivation molecules) or down-regulate (inhibitory molecules) T-cell mediated responses. The latter aspect of the immune regulation, i.e. molecules that limit the expansion of T-cell clones following specific recognition of antigens will be considered in depth. Two inhibitory molecules, CD152 (CTLA-4) and CD85/LIR-1/ILT2 are expressed in all T cells, being largely confined within intracellular compartments of these lymphocytes when they are in a resting state, but ready to be shuttled to and from the plasma membrane when cells are activated following encounter with antigen. Membrane expression of the two inhibitory molecules is transient and is regulated by an internalization process directed to endosomal compartments and to receptor degradation and/or recycling. CTLA-4 and CD85/LIR-1/ILT2 play a pivotal role in T-cell homeostasis that follows any cell-mediated immune response; their localization and functional role will be thoroughly analyzed. In the last part of this study a major question will be faced, i.e. is the containment of the possibly unlimited expansion of the immune system due to a blockade of the cell cycle? Or, else, could be apoptosis the sole mechanism responsible? Experimental data in support of the latter contention will be provided.

The CD85/LIR-1/ILT2 inhibitory receptor is expressed by all human T lymphocytes and down-regulates their functions

The inhibitory molecule CD85/LIR-1/ILT2 has been detected previously on the surface of a small proportion of T lymphocytes. In this study, evidence is provided that, although only a fraction of CD3+ cells are stained by mAb specific for CD85/LIR-1/ILT2 on their surface, this inhibitory receptor is present in the cytoplasm of all T lymphocytes, and that it is detectable on the surface of all T cell clones by the M402 mAb. Biochemical analyses further demonstrate that CD85/LIR-1/ILT2 is present in all T clones analyzed, and that the protein is tyrosine-phosphorylated. Expression of mRNA coding for CD85/LIR-1/ILT2 has been assessed by RT-PCR. Notably, in the NKL cell line and in one T cell clone, amplification of the messenger required 30 cycles only, whereas, in other T cell clones, an amplification product was detected by increasing the number of cycles. CD85/LIR-1/ILT2 inhibits CD3/TCR-mediated activation in both CD4+ and CD8+ clones, and it down-regulates Ag recognition by CD8+ cells in a clonally distributed fashion. Addition of anti-ILT2 HP-F1 mAb in the cytolytic assay enhances target cell lysis mediated by Ag-specific CTL. This could be due to interference of the mAb with receptor/ligand interactions. In contrast, HP-F1 mAb cross-linking triggers inhibitory signals that reduce cytotoxicity. CD85/LIR-1/ILT2 also controls responses to recall Ags and, in low responders, its engagement sharply increases T cell proliferation. The inhibitory function of the molecule is also confirmed by its ability to reduce CD3/TCR-induced intracellular Ca2+ mobilization.

[Unusual case of calcified renal fibroma]

The renal fibroma is an extremely rare event that takes its origin from parenchima, from the peri-renal tissues or from the renal capsule. A case of renal fibroma of a rarely met medullary origin is described.

Ultrastructural and immunohistochemical study of basal lamina of the testis in adolescent varicocele

OBJECTIVE

To evaluate a possible involvement of the extracellular matrix (ECM) in the testes of adolescents with varicocele.

DESIGN

Cross-sectional study.

SETTING

University-based medical center.

PATIENT(S)

Twenty-four adolescents aged between 13 and 18 years underwent surgical treatment for repair of left idiopathic varicocele.

INTERVENTION

A testis biopsy was performed at time of surgery.

MAIN OUTCOME MEASURE(S)

Transmission electron microscopy study of basal lamina and immunofluorescence studies of collagen type IV and laminin, two major components of basal lamina.

RESULT(S)

Transmission electron microscopy observations showed an uneven profile of the basal lamina with a variable thickness. Immunofluorescence studies showed an irregular immunofluorescent line that appeared interrupted in some observations. Collagen type IV showed some areas of strong immunostaining with other areas with reduced immunoreactivity.

CONCLUSION(S)

Our ultrastructural and immunohistochemical observations highlight focal damage at the level of peritubular basal lamina, but this damage is not as severe as that described in adult varicocele. Initial involvement of basal lamina could represent one of the mechanisms responsible for varicocele-induced histologic alterations of the testes.

Ameloblast morphogenesis during amelogenesis. S.E.M. study

A study has been carried out on the S.E.M. on the enamel of an albino rat's inferior incisor. The observations concern almost the entire ameloblastic cycle, specifically, from the end of the cellular differentiation phase (pre-ameloblasts III) to the end of the modulation phase. The authors have pointed out some morphogenetical variations which during the depositing phase, are manifested on the distal extremity of the cells and are concentrated at this level in the differentiation of the Tomes' processes. Successively, during the transitional post-secretory and cellular modulation phases, the morphogenetical differences at the distal extremities also involve the lateral walls of the ameloblasts and their spatial relationships. Some morphological differences are correlated with different functional moments and revealed by an examination of the corresponding superficial areas of the enamel in the course of its formation. In this study, the constant orientation of the perpendicular is evident at the secretion plane in opposition with other studies that propose a 'pendulum movement' theory of these cells during the depositing phase of the prismatic layers. In addition, a morphological classification is proposed consisting of four types of modulative ameloblasts.

[Clinical and etiologic features of hepatocarcinoma in Sicily]

Hepatocellular carcinoma is a neoplasia with a high degree of malignancy and a quite unfavorable prognosis, and its frequency has tripled over the last 30 years. The aim of this study was to shed further light on some epidemiological and clinical aspects of hepatocellular carcinoma, on the basis of experience with a wide ranging patient population. We included 179 patients (127 males, 52 females, age range 31-86 years), diagnosed with hepatocellular carcinoma between January 1993 and December 1998. For each patient we recorded age, sex, coexistence and cause of cirrhosis, severity of cirrhosis, stage of hepatocellular carcinoma, serum markers of viral hepatitis (hepatitis B surface antigen and hepatitis C virus antibodies) and serum levels of alpha-fetoprotein. Hepatocellular carcinoma was associated with hepatitis C virus in 72% of patients, with hepatitis B virus in 10%, with combined infection in 3% and with negative viral markers in 15%. Mean age at diagnosis was significantly higher in the hepatitis C virus infection patients than in the combined infection patients (p < 0.04); the male/female ratio was 2.1:1 in the hepatitis C virus and 8:1 in the hepatitis B virus subjects. At hepatocellular carcinoma diagnosis, 175 out of 179 patients had liver cirrhosis with a significantly higher severity in patients with negative viral markers than in those with positive viral markers (p < 0.02). The stage of hepatocellular carcinoma at diagnosis was very advanced: in 103 out of 179 cases (58%) neoplasia was stage IV, with a stage I diagnosis in only 14 out of 179 (8%) cases. All the combined (hepatitis B and C virus) cases were diagnosed at stage IV, while hepatocellular carcinoma cases in patients with negative viral markers were diagnosed at earlier stages (66% stages I-II). Serum alpha-fetoprotein levels were above the normal limit (20 ng/mL) in 72% of patients; however, only 30% (54/179) had alpha-fetoprotein values > 400 ng/mL. These data confirm some previous epidemiological and clinical evidence concerning hepatocellular carcinoma (mean age at diagnosis, male/female ratio, severity of pre-existing liver disease, frequency of an associated hepatitis C and/or hepatitis B virus infection). Data based on such a large population, moreover, aid clarification of some still unresolved points such as the utilization of alpha-fetoprotein values in diagnosing hepatocellular carcinoma.

Role of sonography in diagnosing anterior urethral stenoses. Personal experience

Ultrasonography was used on 15 patients with clinical suspicion of urethral stenosis documented by retrograde urethrography. With respect to site, length and number of the stenoses, ultrasound gave the same results as the technique using contrast, with the advantage of not exposing the gonads to radiation. It also provided further data on the degree of infiltration of the spongeous body, which is a decisive factor in choosing the most rational therapeutic option and to predict recurrence.

The non-junctional sarcolemmal cytoskeleton: the costameres

In skeletal muscle fibers the costameres have been defined by Pardo et al. (1983) as transverse circumferential elements of the cytoskeleton associated to the sarcolemma. Since the first immunolocalization, carried out with purified antivinculin antibodies to the present day, about 10 proteins have been located in costameres, as well as some transmembrane proteins of the integrin superfamily. In particular the colocalization of vinculin and talin and the presence of the integrins confers to this system the description of the adherens junctions type cell-ECM, while the presence of dystrophin in correspondence to both A and I bands with Z line negative is important for the stabilization of the membrane of the skeletal muscle fiber. We are therefore of the opinion that costameres can be defined as a real proteic "machinery".

Comparative responses to three different types of interferon-alpha in patients with chronic hepatitis C

We investigated the efficacy and tolerability of three different types of interferon-alpha, administered with the same schedule to naive patients with chronic hepatitis C. One hundred and seven patients with histologically proven chronic hepatitis C were enrolled during a period of three years and randomly divided into three groups, to receive (a) leukocyte-interferon-alpha, 6 MU three times a week for 4 months, followed by 3 MU three times a week for 8 months (Group I); (b) recombinant-IFN-alpha-2a, with the same schedule (Group II); and (c) lymphoblastoid-IFN-alpha-N1, with the same schedule (Group III). All patients were followed-up for 6 months to evaluate the long-term response. The 'Complete Response' rates at the end of treatment were: 50%, 46.1% and 41.6%, in Groups I, II and III, respectively; most patients relapsed after the end of therapy, so that the 'sustained responders' were, after 6 months of follow-up, 18.7%, 23.1% and 19.4%, respectively. Analysis of pre-treatment variables showed that age, ALT and gamma GT serum levels, as well as the prevalence of liver cirrhosis, were lower in the 'sustained responder' group. Four patients were eliminated from the study because of severe adverse events: 1, 2 and 1, in Groups I, II and III, respectively. Our results indicate a similar response rate with the three different types of interferon-alpha, although at baseline, age, serum levels of gamma globulins and the number of patients with cirrhosis-possible negative-risk factors, were higher in Group I.

Immunolocalization of the costameres in human skeletal muscle fibers: confocal scanning laser microscope investigations

BACKGROUND

The costameres in skeletal muscle fibers were first described by Pardo et al. (1983a) and have been defined as transverse circumferential elements of the cytoskeleton associated to the sarcolemma. Specific immunostaining for vinculin shows that the costameres overlie I bands. However, an exact correlation between the costameres and the Z line is uncertain, although approximately 10 proteins so far have been localized in the costameres. To define the exact localization of costameres in human skeletal muscle fibers, we carried out an immunofluorescence study using confocal scanning laser microscopy on the fascia lata muscle of adult males.

METHODS

Samples were fixed in 3% paraformaldehyde; frozen sections were treated with antivinculin, antitalin, antidesmin, and anti-alpha-actinin, then immunostained with TRITC. For double localization, the TRITC-streptavidin, as a marker for vinculin and FITC-streptavidin a marker for desmin, were used.

RESULTS

The distance between two subsequent transverse lines of actininf indicated that muscle fibers were well stretched. Processing, with different software functions of the images obtained using CLSM, shows that vinculin and talin are only present in the sarcolemmal lattice. Immunostaining for vinculin and double immunostaining for vinculin and desmin demonstrate that costameres superimpose underlying I bands without interruption at the Z line. Immunostaining for talin showed that the protein is located in correspondence with the I band and M line.

CONCLUSIONS

We believe that costameres are "proteic machinery." The findings of the present study suggest that it is possible to determine the width and the period of each proteic component. In addition, we indicate that costameres are present in correspondence with M line.

[Procollagen III and laminin in chronic viral hepatopathies]

OBJECTIVES

We measured serum concentrations of the N-terminal peptide of type III procollagen (PIIIP) and laminin (Lam-P1) in patients with chronic viral liver disease in the various stages of the clinical course, to judge their value in assessing liver fibrogenesis, and also compared them with a number of liver function tests and histological scores of inflammation and fibrosis.

METHODS

Twenty-nine patients with chronic persistent hepatitis, 39 with chronic active hepatitis and 42 with liver cirrhosis were studied. The control group was composed of 45 healthy blood donors. Serum PIIIP and Lamp-P1 were determined by radioimmunoassay; hepatic function was measured by routine assay; liver fibrosis and inflammation were graded on a 0-3 score scale.

RESULTS

A significantly higher increase in serum levels of PIIIP and Lam-P1 was found in the liver cirrhosis group compared with the other groups (p < 0.05). Serum PIIIP correlated with transaminase levels in the chronic active hepatitis group and with gammaglobulin and total bilirubin in the liver cirrhosis group. A positive correlation was found only with gammaglobulin and total bilirubin in the cirrhosis group. A positive correlation was found between serum PIIIP levels and the rating scale of liver necrosis. In contrast, for Lam-P1 values, a correlation with the rating scale of necrosis and fibrosis was found.

CONCLUSION

Our findings confirmed the increase of PIIIP and Lamp-P1 in chronic viral liver disease, but because of the frequent overlap values, they cannot be used as substitutes for liver biopsy for diagnosis. The correlations with the histological findings indicate that these two markers can be used during the follow-up of patients receiving anti-inflammatory or anti-fibrotic treatment.

The shape of enamel crystals as seen with high resolution scanning electron microscope

The authors have carrie out a study on the shape of apatite enamel crystals by means of field emission S.E.M.; for this purpose the lower incisor enamel of albino rats and the enameloid of fossil remains of Odontaspis from the Cretaceus and Miocene ages were used. The analysis of the available literature showed two different models: according to the first model enamel crystals were elongated hexagonal rods; according to the second, the one of Warshawsky, the enamel crystals were flat ribbons, with a rectangular cross-section. In accordance to the synthetic apatite morphology and to the shape of the unit cell, the authors show that the single enamel crystal is a rod with an equilateral hexagon base.

Enamel fluorosis in rat's incisor: S.E.M. and T.E.M. investigation

Findings on the alterations taking place in the enamel have demonstrated that they are generally caused by a daily use of highly fluoridated drinking waters. According to that, the Authors have carried out an ultrastructural study on lower incisors of albino rats after administering for 60 days water with a fluorine concentration five times the normal one. The samples, studied under the S.E.M., showed a general slowing of both the deposition and the maturation phase as well as the presence of some hypomineralized areas even after eruption. All this suggested the possibility that the damages observed were not due to the direct effect of fluorine on the enamel, but to the interaction between fluorine and ameloblasts. The Authors have then carried out an ultrastructural study on the enamel organ using the S.E.M. The results showed the presence of a well-evident endoplasmic reticulum, the lack in dense granules during the secretion phase, the lack in ruffle ended webs during the modulation phase, and the mitochondrial damage in the ameloblast. All this could justify the slowing of the enamel mineralization caused by fluorine effect on the ameloblasts.

Atrophy of the soleus muscle in the albino rat induced by immobilization

The morphological changes in the soleus muscle, immobilized by means of a plaster cast applied to the posterior limb of albino rats was studied. The animals were sacrificed 20 and 30 days after immobilization. The Authors agree with the hypothesis put forth by Lazarides regarding the cytoskeleton model of striated muscle fiber: morphological changes of the sarcomeres and myofilaments are brought on by translateral and longitudinal bridge damage.

[Enamel mineralization in rats subjected to an excess fluoride diet: SEM study]

Aim of our present work is to investigate with the SEM the process of enamel mineralization in the lower incisors of albino rats submitted for 21 days (a single amelogenetic cycle) to an hyperfluoric diet (five folds more than the normal). Our observations were performed on specimens fractured 8, 12 and 16 mm from the cervical loop transversally along the major axis of the incisor. It was demonstrated that the three different phases of enamel maturation were slower, so that, when the incisor erupted, mineralization was not completed and localized areas of demineralization were present. The authors are of the opinion that all morphological changes are dependent on the effect of fluoride on ameloblasts, either during their secretory or modulatory phases. On the basis of our results attention is pointed on the possible lesions of the enamel dependent from an unwary fluoride administration, particularly when decidual teeth are still present.

[Use of synthetic resin cases for the scanning electron microscopic study of the kidney tubule system]

Aim of our present work was to investigate a new method to study the three-dimensional arrangement, the length and the diameter of the different parts of the renal tubules. The ureter was cannulated after blocking the urinary flow with a binding of the ureter itself at its intermediate third, and injected in it against flow a synthetic resin (Mercox) normally used for vascular corrosion casts. It was demonstrated that the binding maintained only for 24 hours is adequate for morphological studies of the urinary tracts from papillar ducts until the Henle's loop. On the contrary the binding maintained for 7 days induced marked changes in the tubular architecture similar to the first anatomo-pathological changes of the nephrosclerosis following a chronic obstructive nephropathy.

Scanning electron microscopy of histological relapse after gluten-challenge in coeliac disease

The steps of the morphological relapse occurring during gluten-challenge in coeliac children were for the first time investigated by scanning electron microscopy and compared with the morphological changes observed in untreated and treated coeliac patients, in pathological and normal controls. Some peculiar morphological changes, not reported up to now, were observed in treated and relapsed coeliac patients. No relationship was found among the degrees of mucosal atrophy observed by SEM and the duration of the challenge performed by an uncontrolled ingestion of gluten.