Valence tautomerism in a cobalt-dioxolene complex containing an imidazolic ancillary ligand

This work reports the synthesis, structural, spectroscopic and magnetic investigation of two complexes, [Co(bmimapy)(3,5-DTBCat)]PF₆·H₂O (1) and [Co(bmimapy)(TCCat)]PF₆·H₂O (2), where bmimapy is an imidazolic tetradentate ancillary ligand and 3,5-DTBCat and TCCat are the 3,5-di-tert-butyl-catecholate and tetrachlorocatecholate anions, respectively. Their structures have been elucidated using single crystal X-ray diffraction, showing a pseudo-octahedral cobalt ion bound to a chelating dioxolene ligand and the ancillary bmimapy ligand in a folded conformation. Magnetometry displayed an entropy-driven, incomplete, Valence Tautomeric (VT) process for 1 in the 300-380 K temperature range, while 2 displayed a temperature independent, diamagnetic low-spin cobalt(iii)-catecholate charge distribution. This behaviour was interpreted on the basis of the cyclic voltammetric analysis, allowing the estimation of the free energy difference associated with the VT interconversion of +8 and +96 kJ mol^-1 for 1 and 2, respectively. A DFT analysis of this free energy difference highlighted the ability of the methyl-imidazole pendant arm of bmimapy favouring the onset of the VT phenomenon. This work introduces the imidazolic bmimapy ligand to the scientific community working in the field of valence tautomerism, increasing the library of ancillary ligands to prepare temperature switchable molecular magnetic materials.

A bioinspired cobalt catalyst based on a tripodal imidazole/pyridine platform capable of water reduction and oxidation

The prototypical drug carrier [Co^II(L¹)Cl]PF₆ (1), where L¹ is a tripodal amine bound to pyridine and methyl-imidazoles, had its electrocatalytic water splitting activity studied under different pH conditions. This species contains a high-spin 3d⁷ Co^II metal center, and is capable of generating both H₂ from water reduction and O₂ from water oxidation_. Turnover numbers reach 390 after 3 h for water reduction. Initial water oxidation activity is molecular, with TONs of 71 at pH 7 and 103 at pH 11.5. The results reveal that species 1 can undergo several redox transformations, including reduction to the 3d⁸ Co^I species that precedes a ^LS3d⁶ hydride for water reduction, as well as nominal Co^IVO and Co^III-OOH species required for water oxidation. Post-catalytic analyses confirm the molecular nature of reduction and support initial molecular activity for oxidation.

Non-Compartment and compartmental pharmacokinetics, efficacy, and safety of Kedrion FIX concentrate

BACKGROUND

An open-label phase II, multicenter clinical trial was conducted at 11  Haemophilia Centres in  Italy, Romania, and Turkey, to evaluate the pharmacokinetics (PK), efficacy, and safety of high purity, plasma-derived, double virus inactivated and double nano-filtered factor IX (pd-FIX) concentrate (Kedrion FIX), EudraCT Number: 2005-006186-14.

MATERIAL AND METHODS

16 previously treated patients (PTPs) with severe or moderately severe haemophilia B were enrolled in the study. At enrolment, 14 underwent the first PK assessment (PK I), and the second PK (PK II) assessment was performed after six months of treatment (5 on-demand and nine prophylaxis) at the end of the study. PK parameters were evaluated by Non-Compartmental Analysis (NCA), One-Compartment model (OCM), and Two-Compartment Model (TCM). Efficacy of Kedrion FIX in all 16 patients was evaluated by the number of bleeding events, and clinical response following the infusions. Periodic FIX inhibitor assays and thrombogenicity tests were scheduled throughout the study to assess the safety of the drug.

RESULTS

As compared to the published data on PK of pdFIX, Kedrion FIX displayed a longer half-life (22.37-55.73 hrs), reduced clearance, and regular volume of distribution at PK I by both NCA and OCM. The comparison of outcomes of PK II with those of PK I by OCM,  also showed significant changes, particularly in patients on prophylaxis, who showed some improved parameters of PK. Due to two outlier values at the end of the trial, the NCA parameters of PK I were not compared to those of PK II. Breakthrough bleeds were successfully treated with 1 or 2 infusions. No significant adverse events were observed during the study.

DISCUSSION

During the six-month clinical study period, the use of Kedrion FIX resulted in a safe and effective pd-FIX concentrate with excellent PK characteristics.

An unusual partial occupancy of labile chloride and aqua ligands in cocrystallized isomers of a nickel(II) complex bearing a tripodal N4-donor ligand

A novel Ni²⁺ complex with the N₄-donor tripodal ligand bis[(1-methyl-1H-imidazol-2-yl)methyl][2-(pyridin-2-yl)ethyl]amine (L), namely, aqua{bis[(1-methyl-1H-imidazol-2-yl-κN³)methyl][2-(pyridin-2-yl-κN)ethyl]amine-κN}chloridonickel(II) perchlorate, [NiCl(C₁₇H₂₂N₆)(H₂O)]ClO₄ or [NiCl(H₂O)(L)Cl]ClO₄ (1), was synthesized and characterized by spectroscopic and spectrometric methods. The crystal structure of 1 reveals an interesting and unusual cocrystallization of isomeric complexes, which are crystallographically disordered with partial occupancy of the labile cis aqua and chloride ligands. The Ni²⁺ centre exhibits a distorted octahedral environment, with similar bond lengths for the two Ni-N(imidazole) bonds. The bond length increases for Ni-N(pyridine) and Ni-N(amine), which is in agreement with literature examples. The bond lengths of the disordered labile sites are also in the expected range and the Ni-Cl and Ni-O bond lengths are comparable with similar compounds. The electronic, redox and solution stability behaviour of 1 were also evaluated, and the data obtained suggest the maintenance of structural integrity, with no sign of demetalation or decomposition under the studied conditions.

Chlorido-(2,2'-{[2-(1-methyl-1H-imidazol-2-yl-κN 3)imidazolidine-1,3-diyl-κN]bis-(methyl-ene)}bis-(1-methyl-1H-imidazole-κN 3))copper(II) perchlorate

The mol­ecular and crystal structure of a novel copper(II) complex bearing a new tetra­dentate 1-methyl-imidazole-containing imidazolidine ligand is described.

In the crystal structure of the title complex, [CuCl(C₁₇H₂₄N₈)]ClO₄, the copper(II) metal exhibits an N₄Cl penta­coordinate environment in a distorted square-pyramidal geometry. Coordination to the metal centre occurs through the three 1-methyl­imidazole N atoms from the pendant groups, one amine N atom from the imidazolidine moiety and one chlorido anion. Inter­molecular inter­actions take place at two of the 1-methyl-­imidazole rings in the form of parallel-displaced π–π stacking inter­actions forming chains parallel to the a axis. Three O atoms of the perchlorate anion are rotationally disordered between two orientations with occupancies of 0.5.

trans-Bis(2,2′-bipyridine-4,4′-dicarboxylic acid-κ2 N,N′)dichloridoruthenium(III) perchlorate

In the crystal structure of the ruthenium(III) complex, trans-[RuIII(dcbpy)2Cl2]ClO4 (dcbpy = 2,2′-bipyridine-4,4′-dicarboxylic acid, C12H8N2O4), the RuIII atom lies on an inversion centre, showing a small distortion in its octahedral environment. The Ru—Cl bond lengths are shorter than those present in the analogous trans-ruthenium(II) compound containing the bipyridine ligand. The C—O distances in the two symmetry-independent carboxylic acid moieties of the ligand are similar in one group, but different in the other. This is probably due to the different intermolecular interactions they experience with neighbouring cationic complexes. The hydrogen-bonding interactions in which they are involved form a three-dimensional structure, similar to those found in coordination polymers.

Pulmonary Localization of Phosphate Bone Agents in a Case of Metastatic Breast Carcinoma

A case of breast carcinoma with bone and cartilaginous metaplasia is reported. Metastatic pulmonary localizations were revealed through routine bone scan. Histologic rarity but, above all, the uncommon bone scan findings are emphasized.

Investigation of cobalt(iii)-triazole systems as prototypes for hypoxia-activated drug delivery

A novel cobalt(iii)-triazole system was developed for hypoxia-activated drug delivery with an [O₂]-dependent reduction to cobalt(ii) followed by ligand dissociation.

Italian Society for Rheumatology recommendations for the management of hand osteoarthritis

Hand osteoarthritis (OA) is a common and potentially disabling disease, with different features from hip and knee OA so that a specific therapeutic approach is required. Evidence based recommendations for the management of hand OA were developed by the European League Against Rheumatism (EULAR) in 2006. The Italian Society for Rheumatology (SIR) aimed to update, adapt to national contest and disseminate the EULAR recommendations for the management of hand OA. The multidisciplinary group of experts included specialists involved in the management of patients with hand OA. In order to maintain consistency with EULAR recommendations, a similar methodology was utilized by the Italian group. The original propositions were reformulated in terms of a search query and for every recommendation a systematic search was conducted updating EULAR recommendations' review. The propositions were translated in Italian and reformulated basing on collected evidences and expert opinion. The strength of recommendation was measured for each proposition with the EULAR ordinal and visual analogue scales. The original 11 propositions of EULAR recommendations were translated and adapted to Italian context. Further evidences were collected about non-pharmacological therapies, local treatments, intra-articular injection with SYSADOA and corticosteroids, and surgery. The SIR has developed updated recommendations for the management of hand OA adapted to the Italian healthcare system. Their implementation in clinical practice is expected to improve the management of patients with hand OA.

Comparison of the Recent-Onset Arthritis Disability questionnaire with the Health Assessment Questionnaire disability index in patients with rheumatoid arthritis

BACKGROUND

Physical disability in patients with rheumatoid arthritis (RA) is often assessed by questionnaires. We compared the Recent-Onset Arthritis Disability (ROAD) questionnaire with the Health Assessment Questionnaire (HAQ) disability index (DI) in a cohort of RA patients. The aim of this study was to obtain information on several aspects of construct validity of these measures.

METHODS

A cross-sectional multicentre study was carried out among patients with RA who were attending hospital outpatient clinics. The patient group included 196 patients partially or not responding to disease modifying anti-rheumatic drugs. For the evaluation of the psychometric properties of the ROAD in comparison with HAQ-DI this population has been compared to another cohort of 247 outpatients with RA who were participating in a long-term observational study. All patients completed the ROAD and HAQ-DI. Additional comparator composite indices of disease activity were analysed. The ROAD structural validity was first assessed using exploratory factor analysis. Concurrent validity was analysed by Spearman's correlations and cross-tabulations. Discriminant validity to distinguish patients with active and non-active disease was assessed with receiver operating characteristic (ROC) curve analysis. For agreement analysis Bland and Altman plots were calculated.

RESULTS

Factor analysis yielded a two-factor ROAD score that accounted for 68.74% of the explained variance in the questionnaire. The first factor, namely upper extremity function/activity daily living and work (ROAD-upper) accounted for 55.6% of the explained variance. The second factor, namely lower extremity function (ROAD-lower) accounted for 13.1% of the explained variance. Significant correlations were found between the scores of the ROAD and the other clinical variables with a high ability to measure pain and disease activity, supporting the concept of convergent construct validity. The discriminatory power of both questionnaires to assess inactive and active RA patients was good, without significant difference.

CONCLUSIONS

ROAD is a good alternative to the HAQ-DI for the assessment of physical disability in RA. Use of the ROAD makes it easier and less costly to collect data and reduces the burden on RA patients and should be applied in both clinical trials and routine clinical care settings.

Psychometric properties of an index of three patient reported outcome (PRO) measures, termed the CLinical ARthritis Activity (PRO-CLARA) in patients with rheumatoid arthritis. The NEW INDICES study

OBJECTIVES

To evaluate the psychometric properties of an index based on 3 patient reported outcomes measures, termed PRO-CLinical ARthritis Activity (PRO-CLARA), in order to facilitate rapid and easy rheumatoid arthritis (RA) activity assessment in daily routine.

METHODS

196 patients partially or not responding to disease modifying anti-rheumatic drugs (DMARDs), consented to participate in a multicentre cross-sectional study. For the evaluation of the psychometric properties of the PRO-CLARA, this population has been compared to another cohort of 247 outpatients with RA who were participating in a long-term observational study and who satisfying minimal disease activity and remission definitions. All patients completed the PRO-CLARA, combining patient's physical function, self-administered tender joint count and perception of global health status into a single measure of disease activity. Additional comparator composite indices were analysed. Internal consistency was assessed with Cronbach's alpha coefficient. A confirmatory factor analysis was carried out to test factor structure. Concurrent validity was analyzed using Spearman's correlations and cross-tabulations. Discriminant validity to distinguish patients with active and non-active disease was assessed with receiver operating characteristic (ROC) curve analysis. For agreement analysis, kappa statistics were calculated.

RESULTS

In testing for internal consistency, we found that Cronbach's alpha for the PRO-CLARA was 0.893, indicating high reliability. PRO-CLARA proved to be significantly correlated to established RA activity assessment tools. The area under ROC curve of the PRO-CLARA gives identical results to those provided by other comparator indices.

CONCLUSIONS

The study showed satisfactory psychometric properties of the PRO-CLARA.

Synthesis, characterization and biological activities of mononuclear Co(III) complexes as potential bioreductively activated prodrugs

Aiming to investigate the use of tridentate ligands to develop new bireductively activated prodrugs, two N(2)O-donor ligands (HL1: [(2-hydroxybenzyl)(2-(imidazol-2-yl)ethyl)]amine; and HL2: [(2-hydroxybenzyl)(2-(pyridil-2-yl)ethyl]amine) were used to synthesize new Co(III) complexes, 1 and 2. Both complexes were characterized by X-ray crystallography, mass spectrometry, electrochemistry, IR, UV-visible and (1)H NMR spectroscopies. Electrochemical data in methanol revealed that the Co(III)-->Co(II) reduction of 1 (-0.84V vs. normal hydrogen electrode - NHE) is more positive than 2 (-1.13V vs. NHE), while it was expected to be more negative due to better sigma-donor ability of imidazole ring in HL1, compared to pyridine in HL2. Considering that reduction processes on Co(III) center may involve the lowest unoccupied molecular orbital (LUMO), it might play an important role on the electronic properties of the complexes, and could explain the observed redox potentials. Then, geometry optimizations of 1 and 2 were performed using the density functional theory (DFT), and different group participation in their LUMO is demonstrated. Using Saccharomyces cerevisiae cells as eukaryotic model, it is shown that in situ generated reduced species, 1(red) and 2(red), have high capacity to inhibit cellular growth, with IC50 (0.50mM for both complexes) lower than cisplatin IC50 (0.6mM) at the same time of exposure. Regarding to their ability to promote S. cerevisiae cells death, after 24 h, cells became susceptible only when exposed to 1(red) and 2(red): (i) at concentrations higher than 0.5mM in a non-dose dependence, and (ii) in anaerobic metabolism. These data reveal the potential of 1 and 2 as bioreductively activated prodrugs, since their oxidized forms do not present expressive activities when compared to their reduced forms.

Relationship between NK Cell Activation and Clinical Response in Rheumatoid Arthritis Treated with Rituximab

INTRODUCTION

We investigated the relationship between the anti CD20 therapy and the NK cell phenotype in patients with Rheumatoid Arthritis (RA).

METHODS

patients with seropositive RA according to the ACR criteria that was refractory to conventional and anti TNF alpha agents were studied. All patients were treated with Rituximab (1.0 g at days 1 and 15). At baseline and day 30 were collected: absolute counts of B cells (CD19+), total T cells (CD3+), helper (CD3+CD4+), cytotoxic (CD3+CD8+) and NK (CD16+CD56+). As NK activation marker was used CD54bright expression. Disease activity was primarily assessed using the the Clinical Disease Activity Index (CDAI); in addition, we calculated the Disease Activity Score 28-joint assessment (DAS28).

RESULTS

18 patients were enrolled (mean age ± SD 58.6 ± 2.8 years old). After the rituximab course, as expected CD19+ cells were not detectable, the cytotoxic lymphocytes and CD56+CD16+ cells downregulated (283 ± 34 and 85 ± 15 respectively), instead an up regulation of CD56+CD16+CD54bright was observed (187 ± 43). The dynamic of NK cells activation was significantly associated with clinical variables (r=0.811, p<0.001).

CONCLUSIONS

our data suggest a role of rituximab therapy in varying NK phenotype in patients with RA and show that NK cells activation correlates with clinical response.

Mononuclear Cu(II)-phenolate bioinspired complex is catalytically promiscuous: phosphodiester and peptide amide bond cleavage

In this work, the cleavage activity of the metal complex [Cu(C(21)H(21)N(3)O(2))(OH(2))(2)](2+) is demonstrated to occur toward double-stranded DNA, in addition to its previously described amide bond cleavage activity, thus suggesting catalytic promiscuity for this complex.

Modeling the resting state of oxalate oxidase and oxalate decarboxylase enzymes

In view of the biological and commercial interest in models for Oxalate Decarboxylases (OxDC) and Oxalate Oxidases (OxOx), we have synthesized and characterized three new Mn (II) complexes ( 1- 3) employing N3O-donor amino-carboxylate ligands (TCMA, 1,4,7-triazacyclononane- N-acetic acid; K (i) Pr 2TCMA, potassium 1,4-diisopropyl-1,4,7-triazacyclononane- N-acetate; and KBPZG, potassium N,N-bis(3,5-dimethylpyrazolyl methyl)glycinate). These complexes were characterized by several techniques including X-ray crystallographic analysis, X-band electron paramagnetic resonance (EPR), electrospray ionization mass spectrometry (ESI-MS), and cyclic voltammetry. The crystal structures of 1 and 3 revealed that both form infinite polymeric chains of Mn (II) complexes linked by the pendant carboxylate arms of the TCMA (-) and the BPZG (-) ligands in a syn-antipattern. Complex 2 crystallizes as a mononuclear Mn (II) cation, six-coordinate in a distorted octahedral geometry. Although complexes 1 and 3 crystallize as polymeric chains, all compounds present the same N3O-donor set atoms around the metal center as observed in the crystallographically characterized OxDC and OxOx. Moreover, complex 2 also contains two water molecules coordinated to the Mn center as observed in the active site of OxDC and OxOx. ESI-MS spectrometry, combined with EPR, were useful techniques to establish that complexes 1- 3 are present as mononuclear Mn (II) species in solution. Finally, complexes 1- 3 are able to model the resting state active sites, with special attention focused on complex 2 which provides the first exact first coordination sphere ligand structural model for the resting states of both OxDC and OxOx.

Heterometallic manganese/zinc-phytate complex as a model compound for metal storage in wheat grains

Myo-inositol-1,2,3,4,5,6-hexakisphosphate, also known as phytate, is a natural metal chelate present in cereals, an important feedstock worldwide. This article reports the characterization of three metal storage model complexes: the homometallic Mn(II) myo-inositol-1,2,3,4,5,6-hexakisphosphate (IP6), the heterometallic Zn(II), Mn(II) analogue Na4MnZn4(C6H6O24P6) x (NO3)2 x 8H2O (MnZn4IP6) and the homometallic Zn(II) metal complex Na3Zn5(C6H6O24P6)OH x 9H2O (Zn5IP6). The techniques of high-resolution 23Na, 13C and 31P NMR, electron paramagnetic resonance (EPR) and X-ray photoelectron spectroscopy (XPS) were applied in this study. The complexation of Zn(II) and Mn(II) by phosphate groups of IP6 is demonstrated by NMR and XPS results. 13C NMR results show a conformation for IP6 consisting of five equatorial phosphate groups to one axial group showing only one chemical environment for Zn and two for Mn, when characterized by XPS and EPR, in both Mn complexes. These results support, for the first time, a probable supramacromolecular structure for phytate complexes of transition metals. Based on the similarity between the EPR spectra of wheat seeds and that of the MnZn4IP6 compound, the manganese storage centers in wheat grains can be assigned to similar heterometallic phytate complexes.

Corroborative models of the cobalt(II) inhibited Fe/Mn superoxide dismutases

Attempting to model superoxide dismutase (SOD) enzymes, we designed two new N3O-donor ligands to provide the same set of donor atoms observed in the active site of these enzymes: K(i)Pr2TCMA (potassium 1,4-diisopropyl-1,4,7-triazacyclononane-N-acetate) and KBPZG (potassium N,N-bis(3,5-dimethylpyrazolylmethyl) glycinate). Five new Co(II) complexes (1-5) were obtained and characterized by X-ray crystallography, mass spectrometry, electrochemistry, magnetochemistry, UV-vis, and electron paramagnetic resonance (EPR) spectroscopies. The crystal structures of 1 and 3-5 revealed five-coordinate complexes, whereas complex 2 is six-coordinate. The EPR data of complexes 3 and 4 agree with those of the Co(II)-substituted SOD, which strongly support the proposition that the active site of the enzyme structurally resembles these models. The redox behavior of complexes 1-5 clearly demonstrates the stabilization of the Co(II) state in the ligand field provided by these ligands. The irreversibility displayed by all of the complexes is probably related to an electron-transfer process followed by a rearrangement of the geometry around the metal center for complexes 1 and 3-5 that probably changes from a trigonal bipyramidal (high spin, d7) to octahedral (low spin, d6) as Co(II) is oxidized to Co(III), which is also expected to be accompanied by a spin-state conversion. As the redox potentials to convert the Co(II) to Co(III) are high, it can be inferred that the redox potential of the Co(II)-substituted SOD may be outside the range required to convert the superoxide radical (O2*-) to hydrogen peroxide, and this is sufficient to explain the inactivity of the enzyme. Finally, the complexes reported here are the first corroborative structural models of the Co(II)-substituted SOD.

Hydrolytic Protein Cleavage Mediated by Unusual Mononuclear Copper(II) Complexes: X-ray Structures and Solution Studies

The crystal structures and redox and UV-vis/EPR spectroscopic properties of two new mononuclear copper(II) complexes, [Cu(HL1)Cl2] (1) and [Cu(L1)Cl] (2), prepared through the reaction between copper(II) chloride and the ligand 2-[(bis(pyridylmethyl)amino)methyl]-4-methyl-6-formylphenol (HL1) under distinct base conditions, are reported along with solution studies. Also, we demonstrate that these CuII complexes are able to cleave unactivated peptide bonds from bovine serum albumin (BSA) and the thermostable enzyme Taq DNA polymerase at micromolar concentration, under mild pH and temperature conditions. The cleavage activity seems to be specific with defined proteolytic fragments appearing after protein treatment. The location of the specific cleavage sites was tentatively assigned to solvent-accessible portions of the protein. These are two of the most active Cu(II) complexes described to date, since their cleavage activity is detected in minutes and evidence is here presented for a hydrolytic mechanism mediating protein cleavage by these complexes.

Phosphate Diester Hydrolysis and DNA Damage Promoted by New cis-Aqua/Hydroxy Copper(II) Complexes Containing Tridentate Imidazole-rich Ligands

The tridentate Schiff base [(2-(imidazol-4-yl)ethyl)(1-methylimidazol-2-yl)methyl)imine (HISMIMI) and its reduced form HISMIMA were synthesized and characterized, as well their mononuclear cis-dihalo copper(II) complexes 1 and 2, respectively. In addition, the dinuclear [CuII(mu-OH)2CuII](2+) complexes (3) and (4) obtained from complexes 1 and 2, respectively, were also isolated and characterized by several physicochemical techniques, including magnetochemistry, electrochemistry, and EPR and UV-vis spectroscopies. The crystal structures of 1 and 2 were determined by X-ray crystallography and revealed two neutral complexes with their tridentate chelate ligands meridionally coordinated. Completing the coordination spheres of the square-pyramidal structures, a chloride ion occupies the apical position and another is bonded in the basal plane. In addition, complexes 1 and 2 were investigated by infrared, electronic, and EPR spectroscopies, cyclic voltammetry, and potentiometric equilibrium studies. The hydrolytic activity on phosphate diester cleavage of 1 and 2 was investigated utilizing 2,4-BDNPP as substrate. These experiments were carried out at 50 degrees C, and the data treatment was based on the Michaelis-Menten approach, giving the following kinetic parameters (complex 1/complex 2): vmax (mol L(-1) s(-1))=16.4x10(-9)/7.02x10(-9); KM (mol L(-1))=17.3x10(-3)/3.03x10(-3); kcat (s(-1))=3.28x10(-4)/1.40x10(-4). Complex 1 effectively promoted the hydrolytic cleavage of double-strand plasmid DNA under anaerobic and aerobic conditions, with a rate constant of 0.28 h(-1) for the decrease of form I, which represents about a 10(7) rate increase compared with the estimated uncatalyzed rate of hydrolysis.

[2-(Imidazol-4-yl)ethylamine]-([2-(imidazol-4-yl)ethyl][(1-methyl-imidazol-2-yl)methyl]amine)copper(II) diperchlorate

In the title mononuclear complex, [Cu(C(5)H(9)N(3))(C(10)H(15)N(5))](ClO(4))(2), the Cu(II) centre is surrounded by two N-donor ligands, which impose a square-pyramidal environment on the metal. The new tridentate ligand [2-(imidazol-4-yl)ethyl][(1-methylimidazol-2-yl)methyl]amine (HISMIMA) lies in the basal plane, while the histamine ligand occupies the apical and one of the basal positions around the Cu(II) ion.

Paclitaxel efficacy and tolerability in second-line treatment of refractory and relapsed ovarian cancer patients

Nineteen patients with recurrent or refractory ovarian carcinoma after a first-line platinum-based chemotherapy were treated with a 3-hour i.v. infusion of paclitaxel 175 mg/m2 every 3 weeks from November 1992 to October 1996. The major hematologic toxicity was neutropenia (63.2%). No febrile neutropenia was observed. Other hematologic effects were leukopenia (47.4%) and anemia (47.4%). The main non-hematologic toxicities were as follows: neuropathy (52.6%), nausea and vomiting (36.8%), myalgia (36.8%), cardiac toxicity (15.8%) and mucositis (10.5%). Alopecia was observed in the majority of cases. The overall response rate was 47.4%, with 5 (26.3%) complete responses (CRs) and 4 (21.1%) partial responses (PRs). The median duration of response was 7 months (range: 3-19), with a median follow-up of 17 months (range: 3-61). Quality of life of responding patients was good. Our results confirm that paclitaxel as second-line therapy in relapsed and refractory ovarian cancer patients is an acceptable treatment with a good safety profile, and can be safely administered at the dose of 175 mg/m2. In our study paclitaxel was more active in relapsed than in refractory patients. Consequently, further studies are needed to identify more effective drugs for the refractory subset.

[A cytofluorimetric analysis of the DNA content and S phase in intraepithelial neoplasia of the cervix uteri]

The natural history of cervical intraepithelial neoplasia (CIN) evidenced in such pathologies a different biological behaviour due to the presence of similar morphological atypia with different potential development. To biologically characterize CIN lesions we valued by flow cytometry, the DNA content and the proliferative activity of 53 biopsies obtained by colposcopy. Aneuploid histograms were present in none of the histologically negative lesions, in 14% of the CIN I, in none CIN II, and in 40% of the CIN III. The mean value of S-phase was 2.7% in non dysplastic lesions, 5% in the CIN I, 2.5% in the CIN II and 6.1% in the CIN III. In this study the findings of aneuploid cells and the value of proliferative activities seems to be not correlated with the histological features. The clinical and instrumental follow up of the considered patients could establish the eventual prognostic significance of cytofluorimetric parameters in CIN lesions.

[Role of colposcopy in high-grade CIN (CIN II-III)]

We have considered the colpo-cytologic characteristic of 83 patients with CIN II-III histologic lesions over 900 colposcopic biopsies carried out at our Department from 1990-1992. In particular 38 cases were classified as CIN II of which 23 associated with HPV cytopathic feature, while 45 cases were, classified as CIN III, of which 13 associated with HPV c.f. 29% of CIN II were evident in women under 30 years of age; in this group the age decreased with the presence of HPV. 31% of CIN III were present in women under 35. A good correlation between cytologic and histological analysis on the same patient was observed particularly in CIN with the higher grade. Also a good correlation between colposcopy grading and CIN was observed. In CIN II, grade I images were present, while in CIN III, punctuation and white epithelium were the most common features. Our study shows also the impossibility of distinguishing between the images of simple viral infection and their related CIN morphologic patterns. Colposcopy represents a basic test for the definition of CIN, particularly for those with higher grade, and a complementary test for the definition of the topography of the lesions with the correct choice of the therapeutic treatment.

Etoposide, doxorubicin and cisplatin (EAP regimen) in advanced gastric cancer

The treatment of advanced gastric cancer is unsatisfactory. The response rates for single chemotherapy agents: 5-fluorouracil, mitomycin-c, methotrexate, cisplatin, adriamycin, nitrosoureas and etoposide are approximately 10-25% and response duration ranges from 3 to 6 months. Complete responses with single agents are rare. Combination chemotherapy produces higher response rates, but these responses are short. Recently the combination of etoposide, adriamycin and cisplatin (EAP regimen) has been reported to produce results superior to what have been previously reported with other regimens. Twenty-four consecutive patients with locally advanced or metastatic gastric cancer (stage III-IV) were treated between June 1990 and December 1992 with the EAP regimen at our Department. Twenty-two patients were evaluable for response and toxicity. Objective responses were observed in 8 of 22 patients (response rate 36%; 95% confidence interval 17% to 59%). No clinical complete response was found. The median duration of the response was 7 months (range 2 to 22). Myelosuppression represented the primary toxicity associated with the EAP regimen. Grade 4 leukopenia was observed in 4 patients (18%). Grade 3-4 thrombocytopenia was registered in two patients, and grade 3 anemia was detected in 4 patients (18%). The median survival for all patients was 8 months and 12 months for the 8 responding patients. The EAP regimen seems to be an effective chemotherapeutic regimen, but cannot be considered the standard therapy for patients with locally advanced or metastatic gastric cancer, because of the high incidence of moderate to severe myelotoxicity and a response rate and duration of survival similar, but not superior, to those obtained using a less toxic schedule.

Patterns of Pap smear use in the Rimini area: an analysis of women's attitudes to the test

The use of the Pap test is a method of the prevention of cervical cancer in our local division of the Sanitary Unit and has been studied with the help of a questionnaire which was completed by women who had adopted this test. The socioeconomic characteristics, level of education, occupation and general attitudes regarding the Pap test as well as how the women had acquired knowledge of the test, have all been examined. From an analysis of the answers, we have been able to trace a precise social, economic and cultural profile of the type of women who take advantage of this test. Principally, we are dealing with women aged 40-49 years, often with children, with a medium to low level of education, who are mainly housewives and white-collar workers. Very few elderly women present themselves for the Pap test. We have noticed that there is a direct decrease in the use of preventive methods, proportional to the increase in age. These results demonstrate that an erratic use of this preventive method, in the absence of an organized screening programme, seems only to involve women who are among those at less risk from cervical cancer.

[The role of colposcopy in the diagnosis of HPV infection]

Human papillomavirus (HPV) has been implicated as an important etiologic factor in cervical carcinoma. This study evaluates the efficacy of colposcopy in the detection of cervical lesions with koilocytosis features. Colposcopy, cervical smears and biopsy specimens from 217 women seen in our department between January-December 1991 were examined. The colposcopy examination detected 77.5% of the viral presence the histological diagnosis detected 85% of HPV, but the cytologic smears showed only 52% of infection. The data suggests that colposcopy is a good examination to evidence koilocytosis infection.

[Cervico-vaginal screening in some Local Sanitary Units of the Emilia-Romagna region]

Some Local Sanitary Units (USL) of the Emilia-Romagna region were contacted to define cervical screening variables, such as adequacy of smear technique, data collection and evaluation, laboratory quality control modalities of invitations to screening. Our data show there are a lot of deficiencies in the present management of the cervical program in Romagna. The most serious inadequacies concern data evaluation, follow-up, cytologic quality control, modalities of active invitations of women to screening. The survey has confirmed the need for launching organized programs of cervical screening to promote their efficacy of diagnosis and therapy.