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Maurer-Granofszky M, Schumich A, Buldini B, Gaipa G, Kappelmayer J, Mejstrikova E, Karawajew L, Rossi J, Suzan AÇ, Agriello E, Anastasiou-Grenzelia T, Barcala V, Barna G, Batinić D, Bourquin JP, Brüggemann M, Bukowska-Strakova K, Burnusuzov H, Carelli D, Deniz G, Dubravčić K, Feuerstein T, Gaillard MI, Galeano A, Giordano H, Gonzalez A, Groeneveld-Krentz S, Hevessy Z, Hrusak O, Iarossi MB, Jáksó P, Kloboves Prevodnik V, Kohlscheen S, Kreminska E, Maglia O, Malusardi C, Marinov N, Martin BM, Möller C, Nikulshin S, Palazzi J, Paterakis G, Popov A, Ratei R, Rodríguez C, Sajaroff EO, Sala S, Samardzija G, Sartor M, Scarparo P, Sędek Ł, Slavkovic B, Solari L, Svec P, Szczepanski T, Taparkou A, Torrebadell M, Tzanoudaki M, Varotto E, Vernitsky H, Attarbaschi A, Schrappe M, Conter V, Biondi A, Felice M, Campbell M, Kiss C, Basso G, Dworzak MN. An Extensive Quality Control and Quality Assurance (QC/QA) Program Significantly Improves Inter-Laboratory Concordance Rates of Flow-Cytometric Minimal Residual Disease Assessment in Acute Lymphoblastic Leukemia: An I-BFM-FLOW-Network Report. Cancers (Basel) 2021; 13:cancers13236148. [PMID: 34885257 PMCID: PMC8656726 DOI: 10.3390/cancers13236148] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Standardization of flow-cytometric assessment of minimal residual disease in acute lymphoid leukemia (ALL) is necessary to allow concordant multicentric application of the methodology. This is a prerequisite for internationally collaborative trials, such as the AIEOP-BFM-ALL and the ALL IC-BFM trial. We developed and applied a comprehensive training and quality control program involving a large number of international laboratories within the I-BFM consortium to complement standardization of the methodology with an educational component as well as with persistent quality control measures to allow large ALL treatment trials which use multi-laboratory FCM-MRD assessments for risk stratification of pediatric patients with ALL. Abstract Monitoring of minimal residual disease (MRD) by flow cytometry (FCM) is a powerful prognostic tool for predicting outcomes in acute lymphoblastic leukemia (ALL). To apply FCM-MRD in large, collaborative trials, dedicated laboratory staff must be educated to concordantly high levels of expertise and their performance quality should be continuously monitored. We sought to install a unique and comprehensive training and quality control (QC) program involving a large number of reference laboratories within the international Berlin-Frankfurt-Münster (I-BFM) consortium, in order to complement the standardization of the methodology with an educational component and persistent quality control measures. Our QC and quality assurance (QA) program is based on four major cornerstones: (i) a twinning maturation program, (ii) obligatory participation in external QA programs (spiked sample send around, United Kingdom National External Quality Assessment Service (UK NEQAS)), (iii) regular participation in list-mode-data (LMD) file ring trials (FCM data file send arounds), and (iv) surveys of independent data derived from trial results. We demonstrate that the training of laboratories using experienced twinning partners, along with continuous educational feedback significantly improves the performance of laboratories in detecting and quantifying MRD in pediatric ALL patients. Overall, our extensive education and quality control program improved inter-laboratory concordance rates of FCM-MRD assessments and ultimately led to a very high conformity of risk estimates in independent patient cohorts.
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Affiliation(s)
| | - Angela Schumich
- Children’s Cancer Research Institute, Medical University of Vienna, 1090 Vienna, Austria; (M.M.-G.); (A.S.)
| | - Barbara Buldini
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Giuseppe Gaipa
- M. Tettamanti Foundation Research Center, Department of Pediatrics, University of Milano-Bicocca, 20900 Monza, Italy; (G.G.); (O.M.); (S.S.)
| | - Janos Kappelmayer
- Department of Laboratory Medicine, University of Debrecen, 4032 Debrecen, Hungary; (J.K.); (Z.H.)
| | - Ester Mejstrikova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic; (E.M.); (O.H.)
| | - Leonid Karawajew
- Department of Pediatric Oncology and Hematology, Charité Berlin, 10117 Berlin, Germany; (L.K.); (S.G.-K.)
| | - Jorge Rossi
- Cellular Immunology Laboratory, Hospital de Pediatria “Dr. Juan P. Garrahan”, Buenos Aires C1245, Argentina; (J.R.); (E.O.S.)
| | - Adın Çınar Suzan
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, 34452 Istanbul, Turkey; (A.Ç.S.); (G.D.)
| | - Evangelina Agriello
- LEB Laboratorio, Servicio de Hematologia Hospital Penna, Bahia Blanca B8000, Argentina;
| | | | - Virna Barcala
- Laboratory—Flow Cytometry, Citomlab, Buenos Aires C1406AWK, Argentina;
| | - Gábor Barna
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary;
| | - Drago Batinić
- Division of Laboratory Immunology, Department of Laboratory Diagnostics, University Hospital Centre Zagreb & School of Medicine, 10000 Zagreb, Croatia; (D.B.); (K.D.)
| | - Jean-Pierre Bourquin
- Department of Oncology and Children’s Cancer Research Center, University Children’s Hospital, 8032 Zurich, Switzerland; (J.-P.B.); (C.M.)
| | - Monika Brüggemann
- Department of Hematology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.B.); (S.K.)
| | - Karolina Bukowska-Strakova
- Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Hasan Burnusuzov
- Center of Competence “PERIMED”, Department of Pediatrics, Department of Microbiology and Clinical Immunology, Medical University Plovdiv, 4002 Plovdiv, Bulgaria;
| | | | - Günnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, 34452 Istanbul, Turkey; (A.Ç.S.); (G.D.)
| | - Klara Dubravčić
- Division of Laboratory Immunology, Department of Laboratory Diagnostics, University Hospital Centre Zagreb & School of Medicine, 10000 Zagreb, Croatia; (D.B.); (K.D.)
| | - Tamar Feuerstein
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider’s Children’s Medical Center, Petah Tikva 4920235, Israel;
| | - Marie Isabel Gaillard
- Bioquimica, Inmunologia, Hospital de Ninos Rocardo Gutierrez, Buenos Aires C1425EFD, Argentina;
| | - Adriana Galeano
- Flow Cytometry Laboratory, FUNDALEU, Buenos Aires C1114, Argentina;
| | - Hugo Giordano
- Fundación Pérez Scremini, Pediatric Hematology-Oncology Service, Pereira Rossell Hospital, Montevideo 11600, Uruguay;
| | | | - Stefanie Groeneveld-Krentz
- Department of Pediatric Oncology and Hematology, Charité Berlin, 10117 Berlin, Germany; (L.K.); (S.G.-K.)
| | - Zsuzsanna Hevessy
- Department of Laboratory Medicine, University of Debrecen, 4032 Debrecen, Hungary; (J.K.); (Z.H.)
| | - Ondrej Hrusak
- Department of Paediatric Haematology and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic; (E.M.); (O.H.)
| | - Maria Belen Iarossi
- Flow Cytometry Laboratory, Provincial Histocompatibility Reference Centre, CUCAIBA, Buenos Aires C1114, Argentina;
| | - Pál Jáksó
- Flow Cytometry Laboratory, Department of Pathology, Clinical Centre, University of Pécs, 7622 Pécs, Hungary;
| | - Veronika Kloboves Prevodnik
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Saskia Kohlscheen
- Department of Hematology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.B.); (S.K.)
| | - Elena Kreminska
- Clinical Laboratory Diagnostics and Metrology of NCSH “OHMATDYT”, Ministry of Heath of Ukraine, 01601 Kiev, Ukraine;
| | - Oscar Maglia
- M. Tettamanti Foundation Research Center, Department of Pediatrics, University of Milano-Bicocca, 20900 Monza, Italy; (G.G.); (O.M.); (S.S.)
| | - Cecilia Malusardi
- Hospital de Clinica Jose de San Martin, Buenos Aires C1120, Argentina;
| | - Neda Marinov
- PINDA, Chilean National Pediatric Oncology Group, Hospital Roberto del Rio, Universidad de Chile, Santiago 8380418, Chile; (N.M.); (M.C.)
| | | | - Claudia Möller
- Department of Oncology and Children’s Cancer Research Center, University Children’s Hospital, 8032 Zurich, Switzerland; (J.-P.B.); (C.M.)
| | - Sergey Nikulshin
- Hematopathology and Flow Cytometry Division, Children’s Clinical University Hospital, LV-1004 Riga, Latvia;
| | | | | | - Alexander Popov
- Laboratory of Leukemia Immunophenotyping, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 117997 Moscow, Russia;
| | - Richard Ratei
- Clinic for Hematology and Tumor Immunology, HELIOS Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Cecilia Rodríguez
- Hospital Nacional de Clínicas, Universidad Nacional de Córdoba, Cordoba X5000HUA, Argentina;
| | - Elisa Olga Sajaroff
- Cellular Immunology Laboratory, Hospital de Pediatria “Dr. Juan P. Garrahan”, Buenos Aires C1245, Argentina; (J.R.); (E.O.S.)
| | - Simona Sala
- M. Tettamanti Foundation Research Center, Department of Pediatrics, University of Milano-Bicocca, 20900 Monza, Italy; (G.G.); (O.M.); (S.S.)
| | - Gordana Samardzija
- Laboratory for Flow Cytometry and Immunology, Institute for Health and Protection of Mother and Child of Serbia, 11070 Belgrade, Serbia; (G.S.); (B.S.)
| | - Mary Sartor
- The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia;
| | - Pamela Scarparo
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Łukasz Sędek
- Department of Microbiology and Immunology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Bojana Slavkovic
- Laboratory for Flow Cytometry and Immunology, Institute for Health and Protection of Mother and Child of Serbia, 11070 Belgrade, Serbia; (G.S.); (B.S.)
| | - Liliana Solari
- Servicio de Bioquimica, Hospital Posadas, Buenos Aires B1684, Argentina;
| | - Peter Svec
- National Institute of Children’s Diseases, 831 01 Bratislava, Slovakia;
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Anna Taparkou
- Department of Pediatric Oncology Hippokration General Hospital, 546 42 Thessaloniki, Greece;
| | | | - Marianna Tzanoudaki
- Department of Immunology & Histocompatibility, “Agia Sophia” Children’s Hospital, 115 27 Athens, Greece;
| | - Elena Varotto
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Helly Vernitsky
- Hematology Lab, Sheba Medical Center, Ramat Gan 52621, Israel;
| | - Andishe Attarbaschi
- St. Anna Children’s Hospital, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Martin Schrappe
- Department of Pediatrics, University Medical Center SchleswigHolstein, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany;
| | - Valentino Conter
- Clinica Pediatrica University degli Studi di Milano Biococca, Fondazione MBBM, 20900 Monza, Italy; (V.C.); (A.B.)
| | - Andrea Biondi
- Clinica Pediatrica University degli Studi di Milano Biococca, Fondazione MBBM, 20900 Monza, Italy; (V.C.); (A.B.)
| | - Marisa Felice
- Department of Hematology and Oncology, Hospital de Pediatria “Dr. Juan P. Garrahan”, Buenos Aires C1245, Argentina;
| | - Myriam Campbell
- PINDA, Chilean National Pediatric Oncology Group, Hospital Roberto del Rio, Universidad de Chile, Santiago 8380418, Chile; (N.M.); (M.C.)
| | - Csongor Kiss
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Giuseppe Basso
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Maternal and Child Health Department, University of Padova, 35122 Padova, Italy; (B.B.); (P.S.); (E.V.); (G.B.)
| | - Michael N. Dworzak
- Children’s Cancer Research Institute, Medical University of Vienna, 1090 Vienna, Austria; (M.M.-G.); (A.S.)
- St. Anna Children’s Hospital, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40470-4064
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Driessen EMC, de Lorenzo P, Campbell M, Felice M, Ferster A, Hann I, Vora A, Hovi L, Escherich G, Li CK, Mann G, Leblanc T, Locatelli F, Biondi A, Rubnitz J, Schrappe M, Silverman L, Stary J, Suppiah R, Szczepanski T, Valsecchi M, Pieters R. Outcome of relapsed infant acute lymphoblastic leukemia treated on the interfant-99 protocol. Leukemia 2016; 30:1184-7. [PMID: 26369984 DOI: 10.1038/leu.2015.246] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- E M C Driessen
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - P de Lorenzo
- Interfant-99 Trial Data Center, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy
| | - M Campbell
- Chilean National Pediatric Oncology Group, PINDA, Roberto del Rio Hospital, Universidad de Chile, Santiago, Chile
| | - M Felice
- Department of Pediatric Hematology/Oncology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - A Ferster
- Department of Hemato-Oncology, Hôpital Unviversitaire des Enfants Reine Fabiola (ULB), Brussels, Belgium
| | - I Hann
- UK Children's Cancer Study Group, Great Ormond Street Hospital for Children, London, UK
| | - A Vora
- Department of Paediatric Haematology, Sheffield Children's Hospital, Sheffield, UK
| | - L Hovi
- Nordic Society of Paediatric Haematology and Oncology, University of Helsinki, Helsinki, Finland
| | - G Escherich
- University Medical Center Hamburg-Eppendorf, Clinic of Pediatric Hematology and Oncology, Hamburg, Germany
| | - C K Li
- Hong Kong Paediatric Haematology and Oncology Study Group, Prince of Wales Hospital, Hong Kong, China
| | - G Mann
- St. Anna Children's Cancer Research Institute and St. Anna Children's Hospital, Department of Pediatrics, Medical University School, Vienna, Austria
| | - T Leblanc
- Departement of Pediatric Hematology, Hôpital Robert-Debré, Paris, fort he FRALLE group, Paris, France
| | - F Locatelli
- Associazione Italiana Ematologia Oncologia Pediatrica, Italy Bambino Gesù Children's Hospital, Rome, Italy
| | - A Biondi
- Associazione Italiana Ematologia Oncologia Pediatrica, Italy Bambino Gesù Children's Hospital, Rome, Italy
| | - J Rubnitz
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - M Schrappe
- Berlin-Frankfurt-Münster Study Group, Hannover, Germany
| | - L Silverman
- Dana-Farber Cancer Institute ALL Consortium, Boston, MA, USA
| | - J Stary
- Czech Pediatric Haematology, Prague, Czech Republic
| | - R Suppiah
- Australian and New Zealand Children's Haematology and Oncology Study Group, North Adelaide, Australia
| | - T Szczepanski
- Polish Pediatric Leukemia and Lymphoma Study Group, and Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - M Valsecchi
- Interfant-99 Trial Data Center, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy
| | - R Pieters
- Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Dutch Childhood Oncology Group, The Hague, the Netherlands
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Aráoz HV, D’Aloi K, Foncuberta ME, Sanchez La Rosa CG, Alonso CN, Chertkoff L, Felice M. Pharmacogenetic studies in children with acute lymphoblastic leukemia in Argentina. Leuk Lymphoma 2014; 56:1370-8. [DOI: 10.3109/10428194.2014.951844] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Gallo Llorente L, Luther H, Schneppenheim R, Zimmermann M, Felice M, Horstmann MA. Identification of novel NOTCH1 mutations: increasing our knowledge of the NOTCH signaling pathway. Pediatr Blood Cancer 2014; 61:788-96. [PMID: 24249312 DOI: 10.1002/pbc.24852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 10/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alterations in the NOTCH1 signaling pathway are found in about 60% of pediatric T-ALL, but its impact on prognosis remains unclear. PROCEDURE We extended the previously published CoALL cohort (n = 74) to a larger cohort (n = 127) and additionally included 38 Argentine patients from ALL IC-BFM to potentially identify novel mutations and decipher a stronger discriminatory effect on the genotype/phenotype relationship with regard to early treatment response and long-term outcome. RESULTS Overall, 101 out of 165 (61.2%) T-ALL samples revealed at least one NOTCH1 mutation, 28 of whom had combined NOTCH1 and FBXW7 mutations. Eight T-ALL samples (4.8%) exclusively revealed FBXW7 mutations. Fifty-six T-ALL (33.9%) exhibited a wild-type configuration of either gene. Four novel NOTCH1 mutations were identified localized in the C-terminal PEST domain, in the rarely affected LNR repeat domain and in the ankyrin domain. Novel LNR mutations may contribute to a better understanding of the structure of the NOTCH1 negative regulatory region (NRR) and the R1946 mutation in the ankyrin domain may represent an unusual loss-of-function mutation. CONCLUSIONS Overall, NOTCH1 pathway mutations did not affect the relapse rate and outcome of the extended T-ALL cohort uniformly treated according to CoALL protocols, although NOTCH1 mutations were associated with good response to induction therapy (P = 0.009). Individually, HD and PEST domain mutations might exert distinct functional effects on cellular homeostasis under treatment NOTCH1 pathway activity with prognostic implications.
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Affiliation(s)
- L Gallo Llorente
- Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Giaquinto C, Callegaro S, Andreola B, Bernuzzi M, Cantarutti L, D’Elia R, Drago S, De Marchi A, Falconi P, Felice M, Giancola G, Lista C, Manni C, Perin M, Pisetta F, Scamarcia A, Sidran MP, Largeron N, Trichard M, Da Dalt L. Costi della gastroenterite da rotavirus acquisita in comunità in età pediatrica a Padova in Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giaquinto C, Callegaro S, Andreola B, Bernuzzi M, Cantarutti L, D'Elia R, Drago S, De Marchi A, Falconi P, Felice M, Giancola G, Lista C, Manni C, Perin M, Pisetta F, Scamarcia A, Sidran MP, Da Dalt L. Prospective study of the burden of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years of age, in Padova, Italy. Infection 2008; 36:351-7. [PMID: 18633575 DOI: 10.1007/s15010-008-7200-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 01/08/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data on the burden of rotavirus gastroenteritis in Europe are needed to help understand the potential impact of introducing new rotavirus vaccines. MATERIALS AND METHODS As part of prospective observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study, REVEAL) conducted in 2004--2005 in seven European countries, we studied, the characteristics of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years in primary care, emergency room and hospital settings (Padova, Italy). RESULTS A total of 757 children with acute gastroenteritis were included and enzyme-linked immunoabsorbent assay (ELISA) results were available for 725 cases. The overall estimated annual incidence for rotavirus gastroenteritis was 4.7%. Overall, rotavirus gastroenteritis was estimated to account for 43.6% of acute gastroenteritis cases. Among children with acute gastroenteritis (AGE) aged 6-23 months, 61.2% were rotavirus positive. Rotavirus gastroenteritis (RVGE) was responsible for 68.8% of hospitalizations, 61% of emergency consultations, and 33% of primary care consultations. The most prevalent serotype was G9 (84.4%) followed by G1 (11.8%). The relative risk for rotavirus gastroenteritis of being referred to hospital after an initial consultation in primary care was 3.37 (95% CI: 1.77-6.43) and 3.38 (95% CI: 2.28-5.01) for emergency room referral. Children with rotavirus gastroenteritis generally had more severe disease than children with rotavirus-negative gastroenteritis. CONCLUSION Rotavirus accounts for a significant proportion of acute gastroenteritis cases in children less than 5 years in Italy, many of whom require frequent primary care consultations, or care in emergency room or hospital settings.
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Affiliation(s)
- C Giaquinto
- Dept. of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
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Abstract
Primary non-Hodgkin lymphoma of the central nervous system is rare in pediatric AIDS patients. We report a seven-year-old HIV-infected boy, in stage C3 of the disease, who developed non-Hodgkin lymphoma in the central nervous system with a leptomeningeal location. The patient started with signs and symptoms of increased intracranial pressure, impaired consciousness and then became blind. The diagnosis was based on brain biopsy, immunophenotypic studies of B cells, and Epstein-Barr virus serology of the cerebrospinal fluid. The boy was treated with intrathecal and systemic chemotherapy. Fifteen months after diagnosis he had clinically improved, but he then relapsed with a thalamic tumor. He was treated with radiotherapy and he died four months later. In the present article, we discuss diagnostic difficulties, evolution, treatment, and the association of this neoplasm with the Epstein-Barr virus.
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Affiliation(s)
- A Scrigni
- Hospital de Pediatría "Prof. Dr. J. P. Garrahan", Ciudad de Buenos Aires, Argentina
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Gilardi C, Felice M, Ferrari S, Riva S, Somaschini M. [Management of newborns with congenital malformations]. Pediatr Med Chir 2003; 25:197-200. [PMID: 14601239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- C Gilardi
- U.O. di Patologia Neonatale, A.O. Bolognini, Seriate
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Ceolotto G, Sartori M, Felice M, Clari G, Bordin L, Semplicini A. Effect of protein kinase C and insulin on Na+/H+ exchange in red blood cells of essential hypertensives. J Hum Hypertens 1999; 13:321-7. [PMID: 10376850 DOI: 10.1038/sj.jhh.1000804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The kinetic properties of sodium-proton exchange are abnormal in human red blood cells of hypertensive patients and it has been demonstrated that the transport protein undergoes post-translational modifications able to affect its kinetic properties. Protein kinase C (PKC) activation decreases the affinity constant for intracellular protons while insulin increases the maximal rate of proton translocation. The present study therefore aimed to examine the relationships among PKC activity, fasting insulin levels and the kinetic behaviour of sodium-proton exchange in red blood cells from 20 normotensives and 36 hypertensives. In comparison with normotensive subjects, hypertensive patients had higher body mass index (26.2 +/- 0.7 vs 23.6 +/- 0.6 kg/m2, P < 0.05), higher fasting insulin levels (93.2 +/- 10.8 vs 38.6 +/- 2.9 pmol/L), increased maximal velocity of proton translocation (37.9 +/- 2.7 vs 27.6 +/- 1.9 mmol/L per cell x h, P < 0.05), and reduced Hill's coefficient (1.6 +/- 0.1 vs 2.0 +/- 0.1, P < 0.01) of sodium-proton exchange. Basal PKC activity of the cytosol and membrane was similar in the study groups. However, after treatment with 1 micromol/L phorbol 12-myristate 13-acetate (PMA) for 10 min, membrane PKC activity was stimulated to a larger extent in hypertensives (to 181 +/- 8 pmol/min/mg protein) than in normotensives (to 136 +/- 6 pmol/min/mg protein, P < 0.01). The PMA stimulated PKC activity was positively correlated to fasting insulin levels (r = 0.59, P < 0.01). Stimulation of membrane PKC by PMA corrected the low Hill's coefficient for H(i)+ activation of sodium-proton exchange in the hypertensives, while the constant for half maximal activation for intracellular protons (ie, the affinity for intracellular protons) decreased to a similar extent in both groups. The maximal transport rate was unaffected by PMA. These results indicate that the abnormal proton activation of red blood cell sodium-proton exchange in hypertensives reflects an abnormal regulation of PKC translocation to the cell membrane, associated to hyperinsulinaemia and probably insulin resistance. Therefore, post-translational modifications of the transport protein(s) account for the altered kinetic behaviour of sodium-proton exchange in hypertensives.
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Affiliation(s)
- G Ceolotto
- Department of Clinical and Experimental Medicine, University of Padova Medical School, Italy
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Abstract
PURPOSE This study tested social skills training (SST), didactic training (DT), and no training (NT) on adolescents' social skills for resisting peer pressure to engage in acquired immunodeficiency syndrome (AIDS) and pregnancy risk behavior. METHODS A total of 307 Latino and Anglo youth ages 13-18 years were assigned at random to receive 18 h of SST, 18 h of DT, or NT. RESULTS Significantly (p < 0.05) greater increases in assertiveness followed SST compared to DT or NT for three trained skills: condom negotiation, asking a friend about their sex/drug history, and discussing a friend's risk of AIDS. Untrained negotiation skills (e.g., purchasing a condom) did not increase significantly. SST did not result in increased assertiveness for refusal skills. DT increased knowledge of AIDS significantly more than SST; both DT and SST increased knowledge significantly more than NT. CONCLUSIONS Social skills training can increase assertiveness for certain negotiation skills that may decrease risk of AIDS for Latino, Anglo, and male and female adolescents. Both DT and SST can increase knowledge of AIDS prevention. Differences between experimental groups were supported by differences between trained and untrained skills within the SST condition, adding to discriminant validity.
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Affiliation(s)
- M Hovell
- Graduate School of Public Health, San Diego State University, California 92182, USA
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Calò L, Felice M, Cantaro S, Ceolotto G, Monari A, Antonello A, Semplicini A. Inhibition of furosemide-sensitive cation transport and activation of sodium-lithium exchange by endogenous circulating factor(s) in Bartter's and Gitelman's syndromes. J Hypertens 1997; 15:1407-13. [PMID: 9431846 DOI: 10.1097/00004872-199715120-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The nature of the cellular abnormality causing hypokalemia, hypotension, and hypovolemia in Bartter's and Gitelman's syndromes is still being debated. In fact, despite the recent descriptions of an array of nonconservative missense or point mutations in some ion transporters and in K+ channel, the lack of detectable defects in some patients suggests that other abnormalities of cell ion homeostasis may be involved in the pathophysiology of these syndromes. The study of the activity of cell ion transporters in patients with these syndromes using red blood cells (RBC) as a cellular model never investigated the role of plasma factor(s) affecting ion transport. OBJECTIVE To evaluate the effect of plasma from patients with these syndromes on furosemide-sensitive lithium efflux (FSLE) from lithium (Li+)-loaded RBC of healthy subjects in vitro. METHODS RBC of healthy controls were loaded with Li+ in the presence of nystatin and FSLE was evaluated in the presence of various concentrations of plasma from controls and patients with the two syndromes. RESULTS Plasma from controls did not affect FSLE (0.08 +/- 0.02 mmol/l cells per h with 1:4 vol:vol and 0.07 +/- 0.02 mmol/l cells per h with 1:2 vol:vol plasma dilution). In contrast, doubling concentrations of plasma from patients with either syndrome in the efflux solution halved FSLE (from 0.10 +/- 0.0 mmol/l cells per h with 1:4 vol:vol to 0.05 +/- 0.01 mmol/l cells per h with 1:2 vol:vol plasma dilution, P < 0.05). Na+/Li+ exchange was significantly greater for RBC from patients with either syndrome than it was for RBC from controls (0.373 +/- 0.06 versus 0.257 +/- 0.01 mmol/l cells per h, P < 0.01), but the kinetic properties of furosemide-sensitive Na+-K+-2Cl- cotransport were similar. CONCLUSION These data provide evidence for the hypothesis that plasma factor(s) affect ion transport in patients with these two syndromes. Since FSLE estimates Na+-K+-2Cl- cotransport the data suggest that plasma factor(s) contribute(s) to K+ wasting, hypokalemia, and hypotension by inhibiting cotransport in patients with these syndromes. The increase of Na+/Li+ exchange is most likely a secondary phenomenon associated with the hypermineralocorticoid state.
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Affiliation(s)
- L Calò
- Institute of Internal Medicine, Division of Nephrology, University of Padova, Italy
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Dorella M, Giusto M, Da Tos V, Campagnolo M, Palatini P, Rossi G, Ceolotto G, Felice M, Semplicini A, Del Prato S. Improvement of insulin sensitivity by metformin treatment does not lower blood pressure of nonobese insulin-resistant hypertensive patients with normal glucose tolerance. J Clin Endocrinol Metab 1996; 81:1568-74. [PMID: 8636369 DOI: 10.1210/jcem.81.4.8636369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nine hypertensive patients with body mass indexes between 24-27 kg/m2 and normal glucose tolerance with at least a postchallenge plasma insulin level greater than 360 pmol/L were recruited for a double blind, cross-over study with metformin (850 mg, twice daily) and placebo. Each treatment lasted 1 month. Before and after each treatment, hormone and substrate concentrations were determined, blood pressure was monitored over 24 h, and insulin sensitivity was measured by a euglycemic (4.7 mmol/L) hyperinsulinemic (450 pmol/L) clamp study. Renal cation excretion and erythrocyte membrane cation heteroexchange were measured. Metformin, compared to placebo, did not affect body weight (70 +/- 7 vs. 70 +/- 7 kg), fasting plasma glucose (4.8 +/- 0.1 vs. 4.8 +/- 0.1 mmol/L), total cholesterol (5.38+/0.33 vs. 5.48 +/- 0.38 mmol/L), or triglycerides (1.73 +/- 0.72 vs. 1.91 0.89 mmol/L). Nevertheless, after metformin treatment, the plasma high density lipoprotein cholesterol concentration increased (1.42 +/- 0.18 vs. 1.34 0.16 mmol/L), and the plasma insulin level dropped (62 +/- 10 vs. 88+/- 12 pmol/L; both P < 0.05). Insulin-mediated glucose disposal was higher after metformin treatment (26.1 +/- 2.4 vs. 19.3 +/- 2.3 micromol/min x kg; P < 0.01), whereas hepatic glucose production was completely suppressed. These positive metformin-induced metabolic effects were not associated with a significant change in mean daily blood pressure levels (141 +/- 6/89 +/- 3 vs. 142 +/- 7/90 +/- 3 mm Hg). Compared to placebo, metformin increased the excretion of sodium, potassium, and lithium by enhancing their glomerular filtration rate. Na+/Li+ countertransport was not affected by metformin. However, the apparent affinity for H+ of Na+/H+ exchange was increased, and the Hill coefficient was decreased. In conclusion, 1 month of metformin administration to patients with essential hypertension and normal glucose tolerance 1) reduces the basal plasma insulin concentration, 2) improves whole body insulin-mediated glucose utilization, and 3) improves plasma high density lipoprotein cholesterol levels. Despite these positive effects, metformin did not reduce arterial blood pressure.
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Affiliation(s)
- M Dorella
- Institute of Clinical Medicine, University of Padova, Italy
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Selikson M, Felice M, Forrest R, Lodhi L, McCue J, Reilley J. A portable survey meter method for locating and quantifying removable contamination after 131I therapies. Health Phys 1996; 70:245-249. [PMID: 8567293 DOI: 10.1097/00004032-199602000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Identifying 131I surface contamination and decontaminating the removable fraction from rooms where patients have received iodine therapies is a common task at many hospitals. The current regulatory preferred method for this task is wipe testing for removable contamination. The purpose of this paper is to evaluate the suitability of a sensitive survey meter for this task. Both methods and their detection systems are evaluated in the laboratory as well as in a clinical environment. The results indicate that the portable survey meter method is better at both locating and quantifying removable contamination. An additional benefit of the survey meter method is the ability to clean rooms promptly for reoccupancy.
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Affiliation(s)
- M Selikson
- Radiation Safety Office, University of Pennsylvania, Phialdelphia 19104, USA
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Semplicini A, Ceolotto G, Felice M, Bordin L, Monari A, Clari G, Pessina AC. Posttranslational effects of protein kinase C and insulin on red cell membrane phosphorylation and cation heteroexchange in hypertension. Blood Press Suppl 1996; 1:55-8. [PMID: 9162439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the red blood cell membrane, sodium-proton exchange (NHE-1) exchanges intracellular H(+), Li(+), and Na(+) with extracellular Na(+). In hypertensives (HT), the maximal velocity of translocation (V max)of Na(+)/H(+) and of Na(+)/Li(+) exchange modes are higher, while apparent affinity for external Na(+) of Na(+)/Li(+) exchange and Hill's coefficient for H(+) activation of Na(+)/H(+) exchange are lower than in normotensive subjects (NT). We have therefore examined the effects of protein kinase C (PKC) and insulin on red blood cell membrane phosphorylation and on the kinetic properties of cation heteroexchange. In red cell from NT, PMA-induced activation of PKC reduced K(m) for H(+) of NHE but it did not affect V(max) and K(m) for Na(+). In red cell from HT, PMA-induced a greater PKC stimulation and membrane phosphorylation of band 3,4.1,4.9 than in NT and it did not significantly reduced K(m) for H(i). On the contrary, in HT PKC activation significantly increased Hill's coefficient of NHE. The larger activation of PKC in HT could be due to downregulation secondary to higher membrane calpain activity. Incubation of red cells with insulin decreases K(m) for external Na(+) and increases V(max) of Na(+)/Li(+) exchange. Therefore, we have examined the relationships between Na(+)-activation kinetics of Na(+)/Li(+) exchange and fasting insulin levels. Na(+)-stimulated Li(+) efflux was studied by raising Na(+)up to 300 mM isoosmotically to measure K(m) for Na(+) and V (max). Li(+) efflux saturated at 150 mM external Na(+)in NT but not in HT because in HT it exhibited a two fold higher Na(+) Km. V(max) was higher in HT than in NT. In hyperinsulinemic (fasting insulin > 10 mu U/ml) HT, V(max) and Na(+) Km were higher than in normoinsulinemic HT. In NT, hyperinsulinemia was not associated to abnormal kinetic properties of Na(+)/Li(+)exchange. Stepwise multiple regression analysis confirmed that the main determinants of a high Km were blood pressure and insulin. Our results show that posttranslational effects of PKC and insulin affect the kinetic properties of NHE-1 in red blood cells and suggest that the differences observed between hypertensives and normotensive subjects can be accounted for by PKC activation and insulin exposure.
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Affiliation(s)
- A Semplicini
- Institute of Clinical Medicine and Department of Biochemistry, University of Padua Medical School, Italy
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Semplicini A, Ceolotto G, Felice M, Reato S, Valle R, Gebbin A, Fontebasso A, Serena L, Pessina AC. Kinetic properties of erythrocyte Na+-Li+ and Na+-H+ exchange in hypertensive patients. J Hypertens 1995; 13:1566-70. [PMID: 8903610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To ascertain the relationships between the kinetic properties of erythrocyte Na+-H+ exchange [maximum kinetic energy (Vmax), Michaelis constant (Km) for internal H+ and Hill's coefficient], Na+-Li+ (Vmax and Km for external Na+), and metabolic parameters in normotensive controls and hypertensive subjects. MATERIALS AND METHODS Na+-H+ exchange was measured as the Na+ influx driven by intracellular H+, and Na+-Li+ exchange as the Li+ efflux driven by extracellular Na+, in erythrocytes from normotensive (n = 59) and hypertensive (n = 93) subjects. RESULTS In comparison with normotensives, the hypertensives had a higher Vmax for Na+-Li+ and Na+-H+ exchange, a higher Km for external Na+ for Na+-Li+ exchange and a lower reduced Hill's number for Na+-H+ exchange. Vmax values for Na+-Li+ and Na+-H+ exchange were significantly correlated, as were Km values for internal H+ for Na+-H+ exchange and Km for external Na+ for Na+-Li+ exchange. Insulin resistance and beta-cell function indices were higher in the hypertensives than the normotensives. Upon stepwise multiple regression analysis, Vmax for Na+-Li+ exchange was correlated significantly and independently with Km for external Na+ and with the insulin resistance index, while Km for external Na+ was correlated with Km for internal H+, Vmax for Na+-H+ exchange and mean blood pressure. Vmax and Hill's coefficient for Na+-H+ exchange were correlated only with mean blood pressure. CONCLUSIONS The demonstration of functional correlations between the kinetic properties of Na+-H+ and Na+-Li+ exchange provides further evidence that erythrocyte Na+-Li+ exchange is a functioning mode of Na+-H+ exchange, which is affected by insulin resistance.
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Affiliation(s)
- A Semplicini
- Institute of Clinical Medicine, University of Padua, Italy
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Abstract
It has been suggested that endogenous substances (known as ouabain-like factors, OLF), secreted from the central nervous system in response to salt and water retention, inhibit the cell membrane Na+/K+ pump in the renal tubules and reduce sodium reabsorption. However, by also acting upon vascular smooth muscle cells, they may induce cell Na+ and Ca++ accumulation, vasoconstriction and systemic hypertension. Recently, an endogenous Na+/K+ pump inhibitor was isolated from human plasma; this inhibitor is indistinguishable from the cardiac glycoside ouabain based on biochemical and immunological criteria. Its plasma concentration is close to the therapeutic range for ouabain (around 0.4 nmol/L). Since plant ouabain promotes natriuresis, vasoconstriction, and hypertension; endogenous ouabain may therefore control extracellular fluid volume and blood pressure. The highest plasma concentrations of endogenous ouabain and OLF were found in congestive heart failure, aldosterone producing adenoma, human and animal models of volume expanded hypertension (reduced renal mass and DOCA-salt hypertension), and in Milan hypertensive rats (MHS). Aldosterone antagonists (canrenone and canrenoate) exert both agonist and antagonist effects on the digitalis receptor site of the Na+/K+ pump. They are effective antihypertensive agents in animal models of hypertension sustained by OLF (reduced renal mass-Na+ and DOCA-salt hypertension in rats). Moreover, in a subgroup of essential hypertensives, 4 weeks of canrenoate administration reduced blood pressure, heightened red blood cell Na+/K+ pump activity, and antagonized ouabain-induced vasoconstriction. None of these effects was seen in the other hypertensives. These data suggest that aldosterone antagonists stimulate the Na+/K+ pump inhibited by endogenous ouabain and exert their antihypertensive action at least in part through this mechanism.
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Abstract
The physiology of the orbital arteries supplying the eye is currently under intensive investigation. However, while the anatomical distribution of these vessels in humans is well known, their normal histology and age-related or other pathologic alterations have hardly been studied. We obtained at autopsy 10 orbits from persons aged > or = 74 years, and two orbits from a person aged 47 years. Specimens were taken from 20 locations along the orbital arteries, from the internal carotid to the globe, and studied by light microscopy. We observed the following arteriosclerotic changes, in order of decreasing frequency: intimal hyperplasia, medial atrophy, atherosclerotic fibrous plaques, and calcifications of the internal elastic lamina. As a rule, the intensity of the changes decreased from proximal to distal. This study shows that aged human orbital arteries are readily subject to degenerative changes that may play an important role in ophthalmic vascular disease.
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Affiliation(s)
- E R Büchi
- University Eye Hospital, Basel, Switzerland
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Abstract
Teenage pregnancy is not an epidemic in the United States. Because this is an emotional topic that receives high-decibel publicity in the press and on television, we wish to present the most recent factual information available on the subject and a more balanced perspective of the problem for physicians and other health professionals who care for women at the youngest age of the reproductive spectrum. Pregnancy during adolescence is a multiethnic sociologic problem that crosses all socioeconomic, ethnic, cultural, and geographic boundaries. Pregnancies in teenagers are decreasing (except in teenagers under age 15), not accelerating. New approaches for premature adolescent pregnancy and childbearing focus on adolescent peer pressure for behavior modification, prevention of pregnancy at a younger age, continuation of secondary education, and job training for both adolescent fathers and mothers.
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Abstract
In order to investigate the main sites of action of phototherapy in the treatment of neonatal jaundice we studied (a) the in vivo and in vitro relationship between the hematocrit and the effectiveness of phototherapy, and (b) the effect of varying the skin area exposed to light. The results show that the hematocrit does not influence in vivo the efficacy of phototherapy, while they confirm that the total skin surface exposed to light is important in determining the effectiveness of light treatment. The authors have also studied the possible action of phototherapy on bilirubin solutions placed into the postmortem brain or the stomach. The results suggest that blue light does not penetrate strongly enough to photomodify the exposed pigment.
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Cozzani I, Jori G, Reddi E, Fortunato A, Granati B, Felice M, Tomio L, Zorat P. Distribution of endogenous and injected porphyrins at the subcellular level in rat hepatocytes and in ascites hepatoma. Chem Biol Interact 1981; 37:67-75. [PMID: 7285247 DOI: 10.1016/0009-2797(81)90166-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Different doses (0.5-20 mg/kg) of hematoporphyrin (HP) have been injected intraperitoneally into normal rats and rats affected by Yoshida ascites hepatoma. About 80% of HP reaching the liver was recovered in the extracellular compartment after liver perfusion, the ratio of extra- to intracellular HP being essentially independent of the administered dose. Similar data were obtained at different times after injection of 20 mg/kg HP. Intracellular HP largely accumulates in the mitochondria and in the membrane components of the nuclear fraction of isolated hepatocytes. Kinetic studies suggest that the cell receptors of highest affinity for HP are present in the external membrane. The latter result obtains for ascites hepatoma cells in an even more evident way, although the latter cells exhibit secondary HP binding sites probably constituted by cytoplasmatic proteins. Moreover, the clearance of intracellular HP from malignant cells occurs at a remarkably lower rate as compared with HP clearance from liver cells.
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Smith J, Felice M. Interviewing adolescent patients: some guidelines for the clinician. Pediatr Ann 1980; 9:238-43. [PMID: 7393665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Felice M, Grant J, Reynolds B, Gold S, Wyatt M, Heald FP. Follow-up observations of adolescent rape victims. "Rape may be one of the more serious afflictions of adolescence with respect to long-term psychosocial effects". Clin Pediatr (Phila) 1978; 17:311-5. [PMID: 639413 DOI: 10.1177/000992287801700401] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Felice M. [The dynamics of granulations of the neutrophil leukocytes found with supravital staining in fluorescence microscopy]. Fracastoro 1969; 62:275-81. [PMID: 4187760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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