P16.01.A Factors predicting cognitive impairment after intrathecal methotrexate treatment in patients with non-small cell lung cancer and leptomeningeal disease

Background

Leptomeningeal disease (LD) is a devastating cancer-related neurological complication. LD accounts for 4-15% of patients with non-small cell lung cancer (NSCLC). In this population, the median overall survival (OS) with intrathecal (IT) methotrexate (MTX) plus systemic therapy (ST) is 4-6 months (m). Until now, disease and treatment-related cognitive impairment (CI) has been poorly studied in this group.

Material and Methods

Patients with NSCLC and LD treated with IT MTX in our institution between 2010 and 2021 were retrospectively studied. LD was diagnosed based on positive cerebrospinal fluid cytology or radiological findings in the brain/spinal MRI plus suitable clinical signs/symptoms. IT MTX (12mg twice weekly for 4 weeks, then 12mg weekly for 4 weeks) was given in combination with ST. Patients’ clinical characteristics and patient-reported CI were assessed at baseline and at 3-months post IT MTX. A Kaplan-Meier survival analysis was performed. Primary endpoint: predictive factors of CI at 3m post IT MTX. Secondary endpoint: prognostic factors.

Results

Out of 55 patients included, 51% were male and median age at LD diagnosis was 59 years old (range 38-78). Most patients had an ECOG PS≤1 (76.4%) and adenocarcinoma histology (83.6%). 47% of patients harbored EGFR mutation. In 23.6% of patients LD was diagnosed synchronously with lung tumor and for patients without LD at tumor diagnosis, the median time to LD development was 8m (range 0-73). Clinical features at LD diagnosis were 43.7% infratentorial symptoms, 29% CI, 20% multiple symptoms and 7% asymptomatic. At LD diagnosis, 53% of patients had synchronous brain metastases (BM) and in 38% the systemic disease was not controlled. 85.5% of patients received ST concurrently with IT MTX (N=22 chemotherapy, N=22 TKIs and N=3 immunotherapy). 14.5% of patients did not receive ST.

Median OS from IT was 5m (95% CI 1.3-8.6). ECOG PS and ST administered concurrently with IT MTX was associated with longer OS (p<0.05). 23.6% of patients developed CI at 3m post IT therapy. Median OS for patients without and with CI post IT therapy was 6m (95% CI 0.7-11.3) vs 4m (95% CI 0.5-75) respectively (p=0.15). Patients with leukoencephalopathy at baseline (score≥2in the periventricular Fazekas’ score) (p=0.033), women (p<0.01) and those ≥60 years (p=0.04) were more likely to present CI 3m post IT MTX. The presence of cardiovascular risk factors, previous brain radiotherapy and concurrent BM was not statistically associated with CI.

Conclusion

In this cohort, 24% of patients with NSCLC and LD treated with IT MTX will develop CI 3m post treatment. Baseline leukoencephalopathy, female gender, elder than 60 years old were more likely to exhibit CI after IT MTX. A better characterization of these patients is warranted to develop new treatment strategies to prevent/reduce CI.

Effects of free-fatty-acid content and saturation degree of the dietary oil sources on lipid-class content and fatty-acid digestibility along the gastrointestinal tract in broilers from 22 to 37 days of age

The aim of the present study is to assess the effect of the free-fatty-acid (FFA) content and saturation degree of dietary fat (added at 6%) on the fatty-acid (FA) digestibility and lipid-class content along the gastrointestinal tract and excreta in broilers from 22 to 37 d of age. This is essential to determine the potential use of acid oils (refining by-products rich in FFA) in broiler diets as an alternative to crude oils. The study consisted of a 2 × 4 factorial arrangement, which included 2 fat sources (soybean oils – unsaturated, or palm oils – saturated) and 4 levels of FFA (5, 15, 35, and 50%). Samples of digestive content of the gizzard, duodenum, jejunum, ileum and of the excreta were obtained at 37 d of age. Irrespective of the dietary fat source, more than 80% of total FA (TFA) was absorbed in the jejunum. Broilers fed with unsaturated diets had a higher absorption efficiency of FA than did those fed with saturated diets. This conclusion is supported by the lower FFA content and the higher TFA and polyunsaturated FA (PUFA) digestibility coefficients in the ileum (P < 0.001) observed in the former group. The dietary FFA level did not affect the FA absorption process as much as the dietary fat source did. This was supported by the lack of statistical differences among the diets with a similar saturation degree but rather different levels of FFA, for TFA, saturated FA, and PUFA digestibility coefficients both in the jejunum and ileum. However, the interactions reported in the ileum for triacylglycerol and diacylglycerol contents (P < 0.001), as well as for monounsaturated FA digestibility coefficients (P < 0.05) show that the dietary FFA content affects the FA absorption process. The present results show that the inclusion of acid oils in grower-finisher broiler diets with FFA levels up to 35% does not have a negative impact on the FA absorption process.

Duloxetine against symptomatic chemotherapy-induced peripheral neurotoxicity in cancer survivors: a real world, open-label experience

The objective of this observational study was to evaluate the efficacy and safety of duloxetine in a cohort of 100 cancer survivors with chemotherapy-induced peripheral neurotoxicity (CIPN). CIPN was graded employing the TNSc and the NCI-CTCv4. The Patient Global Impression of Change (PGIC) scale measured the efficacy of duloxetine (1: no benefit; to 7: excellent response). A clinically meaningful response was considered a PGIC > 4. Median age was 62 (29-81) years and 42% were male. CIPN was graded as grades 1, 2 and 3 in 20, 66, and 14% of patients, respectively. Median time to duloxetine initiation was 6 (1-63) months after chemotherapy. Fifty-seven patients early dropped out from duloxetine, due to lack of efficacy (20%) or side effects (37%). Male patients more frequently discontinued duloxetine due to lack of efficacy (35.7 vs. 8.6% P = 0.001). PGIC scores were higher in female patients (4 vs. 1, P = 0.001), taxane-treated patients (4 vs. 1, P = 0.042) and with short-lasting (<6 months) CIPN (4 vs. 1, P = 0.008). Patients with long-lasting CIPN had a higher rate of adverse events (47 vs. 27%, P = 0.038) and discontinuation (54.8 vs. 45.1%, P = 0.023). In the multivariate analysis, female gender and short-lasting CIPN were independently associated with a favorable response to duloxetine. Low tolerability, male gender, and long-lasting CIPN significantly limited duloxetine use in daily practice setting. A minority of cancer survivors with CIPN treated with duloxetine had a meaningful CIPN improvement, and tolerability was overall low. Female gender and short-term CIPN were independently associated with a favorable response to duloxetine.

104 SOFaaci-HEPES or holding media can be used for embryo loading without changes in pregnancies per embryo transfer nor pregnancy loss in an invitro-produced embryo transfer program

Time elapsed between removal from culture and embryo transfer (ET) can have a profound effect on the success of an invitro-produced (IVP) ET program. The embryo culture medium provides the necessary nutrients for embryo development and the use of media with a different nutrient composition to load embryos into straws could negatively affect embryo viability. The objective of the present study was to evaluate the effect of type of media used for embryo loading on pregnancy establishment and maintenance. Holstein heifers (n=800) were synchronized using a modified 5-day CO-Synch + controlled internal drug release (CIDR) as follows: Day −8: CIDR inserted, Day −3: CIDR removed, prostaglandin F2α treatment (500μg cloprostenol sodium), Day 0: gonadotrophin-releasing hormone (GnRH; 100μg of gonadorelin acetate). Five days after GnRH, heifers were evaluated by ultrasonography to determine presence of a corpus luteum (CL). Embryos were removed from culture on Day 7 (Day 0=fertilization), placed into tubes containing SOFaaci, and transported in an incubator (LabMix, WTA) to the transfer facility within 1.5h. Upon arrival embryos were removed from transport tubes and randomly assigned to be loaded into 0.25-mL straws containing either holding media (Vigro Holding Plus) or SOFaaci-HEPES. After loading into straws, embryos were placed in an ET gun and AI gun warmers set at 35°C until transfer by 1 of 5 technicians. Heifers with a CL were randomised for transfer of a fresh IVP embryo loaded into a straw containing either holding media or SOFaaci-Hepes on Day 7±1. Interval from embryo loading to transfer ranged from 1 to 3h. Pregnancy was determined by ultrasonography on Days 32 and 60. Data were analysed by logistic regression and included the fixed effects of loading media, embryo stage, embryo quality, interval between GnRH and ET, and biologically relevant interactions. Pregnancies per ET (P/ET) on Day 32 were not different between the groups in which embryos were loaded using holding media and those which used SOFaaci-Hepes, nor there were interactions between loading medium and embryo stage, embryo quality, or interval from GnRH to ET (P&gt;0.10; Table 1). Pregnancies per ET (P/ET) on Day 60 were not different between the loading media groups, nor were there interactions between loading medium, embryo stage, and embryo quality, or interval from GnRH to ET (P&gt;0.10). Pregnancy loss between Days 32 and 60 was not different between groups, nor there were interactions between loading media groups and any other factor (P&gt;0.10). In conclusion, the use of either holding medium or SOFaaci-HEPES for fresh IVP embryo loading does not affect fertility; thus, both are suitable alternatives for loading of embryos into transfer straws. Table 1.Pregnancies per embryo transfer (P/ET) and pregnancy loss in recipient heifers transferred with fresh invitro-produced embryos, using either holding medium or SOFaaci-HEPES medium for loading Item P/ET Day 32 (n) P/ET Day 60 (n) Pregnancy loss (n) Loading medium Holding 47.0% (186/396) 41.3% (163/395) 11.9% (22/185) SOFaaci-HEPES 48.8% (197/404) 43.1% (174/404) 11.7% (23/197) P-value 0.77 0.22 0.84

109 Effect of ruminal infusion with propylene glycol on the invitro embryo production of Holstein (Bos taurus) prepubertal heifers and pregnancy rate of the embryo transfer

The aim of this study was to evaluate the effect of ruminal infusion with propylene glycol (PG) on the invitro embryo production (IVEP) of Holstein (Bos taurus) prepubertal heifers (7 to 8 months). For this study, 16 prepubertal heifers were distributed into two groups: Propylene Glycol Group (PGG; n=8) and Control Group (CG; n=7). Additionally, 8 pubertal heifers were used for the positive control group (PUB). All animals (n=23) underwent an ovum pickup (OPU) for follicular ablation on Day 0, followed by an FSH protocol treatment (160mg performed in 4 injections twice a day in decreasing doses, designated as D2PM, D3AM, D3PM, and D4AM). Animals from PGG received a ruminal infusion with 250mL of PG twice a day on Days 0, 1, 2, 3, and 4, using a drench. Animals from CG and PUB did not receive any additional treatment. On Day 5 all animals underwent another OPU, and oocytes were used for the IVEP (Sexing Technologies commercial laboratory). The produced embryos were transferred fresh to Holstein heifer recipients. Additionally, blood sampling was performed on D4PM (M1) and on the day of OPU (D5AM, M2) for insulin-like growth factor (IGF-1, via radioimmunoassay) and glucose (hexokinase) analysis. Data were analysed using the GLIMMIX procedure of SAS. No difference was observed between groups for number of recovered oocytes (CG: 14.28±1.9; PGG: 14.87±3.9; PUB: 10.50±2.2; P=0.24), number of viable oocytes (CG: 10.71±2.5; PGG: 10.75±2.7; PUB: 9.50±2.0; P=0.80), cleaved oocytes (CG: 7.71±1.5; PGG: 9.50±2.1; PUB: 6.25±1.4; P=0.14), cleavage rate (CG: 54.2% (7.7 out of 14.2); PGG: 64.1% (9.5 of 14.8); PUB: 59.0% (6.2 of 10.5); P=0.35) and number of blastocysts (CG: 1.71±0.5; PGG: 2.00±0.6; PUB: 3.12±1.0; P=0.71). Pubertal heifers had higher blastocyst rates compared with prepubertal heifers, regardless of PG treatment (CG: 11.9% (1.7 of 14.2); PGG: 13.5% (2 of 14.8); PUB: 29.5% (3.1 of 10.5); P=0.01). No difference was observed between groups for 30-day (CG: 41.7% (5 of 12); PGG: 46.7% (7 of 15); PUB: 42.9% (6 of 14); P=0.96) or 60-day pregnancy rates (CG: 41.7% (5 of 12); PGG: 33.3% (5 of 15); PUB: 42.9% (6 of 14); P=0.86). In addition, no difference was observed for pregnancy loss between 30 and 60 days (CG: 0.0% (0 of 12); PGG: 13.3% (2 of 15); PUB: 0.0% (0 of 14); P=0.99). Regarding metabolic blood analysis, no difference was observed for IGF-1 (ngmL−1) between groups (P=0.38), moment of sample collection (P=0.06), and interaction of group×moment (P=0.87; CG/M1: 263.36±15.2; CG/M2: 297.71±18.7; PGG/M1: 304.25±26.9; PGG/M2: 332.61±31.6; PUB/M1: 309.16±19.9; PUB/M2: 311.07±18.8). Glucose (mg dL−1) was higher (P=0.0001) for pubertal heifers (91.63±1.4) compared with the other groups (CG: 102.25±1.1; PGG: 107.71±3.5); however, no difference was observed for moment of sample collection (P=0.35) or interaction of group×moment (P=0.36). These data show that treatment with PG was not efficient to improve the IVEP of prepubertal Holstein heifers, embryos from prepubertal heifers treated with PG did not have increased pregnancy rate, and treatment did not increase IGF-1 or glucose blood levels.

176 Synchronisation of follicle wave emergence prior to superstimulation with purified FSH for ovum pickup affects blastocyst rate in pregnant Holstein heifers

The timing of initiation of superstimulatory treatments relative to follicle wave emergence has been shown to affect ovulatory response and invivo embryo production. The significant increase of invitro embryo production (IVP) and the possibility of using pregnant animals as oocyte donors has created the need to optimise superstimulatory treatments for IVP in pregnant cattle. Thus, the objective of the present study was to evaluate the effect of synchronisation of follicle wave emergence before superstimulation for ovum pickup (OPU) and IVP in pregnant heifers. Pregnant (47-62 days of gestation) Holstein heifers (n=28) 19.5±0.3 months of age were assigned in a completely randomised design to one of two groups: synchronisation of follicular wave emergence by dominant follicle removal (DFR; all follicles &gt;6mm) or untreated control (no DFR). Superstimulatory treatments were initiated 36h after DFR or at random stages of the follicular wave in the no-DFR group and consisted of the administration of 160mg of purified FSH (Folltropin-V, Vetoquinol) over four injections 12h apart as follows: 48.0, 42.7, 37.3, and 32.0mg. Ovum pickup was performed in all heifers 40h after the last purified FSH injection. Heifers were subjected to OPU for oocyte recovery, and the number of follicles was determined. Recovered oocytes were processed in groups by treatment, and IVP was performed. Differences between treatment groups were evaluated using generalised linear mixed models. Results are presented in Table 1 and are expressed as means±s.e.m. for data collected at the time of OPU or as proportions for embryo production results. The number of small follicles (&lt;6mm) at the time of OPU was greater in the no-DFR group than in the DFR group (P=0.04). Conversely, there were no differences between treatments in the number of medium follicles (6-10 mm; P=0.17), large follicles (&gt;10 mm; P=0.11), total follicles (P=0.93), total number of recovered oocytes (P=0.4), or number of viable oocytes (P=0.53). The mean oocyte percentage recovery rate was not different between heifers in the DFR (53.6±4.7%) and no-DFR (56.5±4.7%) groups (P=0.52). Both cleavage and blastocyst rate were greater (P&lt;0.008) in the DFR group than in the no-DFR group; as a result, the number of transferable embryos per animal was 5.6 in the DFR group and 2.8 in the no-DFR group. In summary, initiation of superstimulatory treatments at the time of follicle wave emergence improves cleavage and blastocyst rates, thus leading to greater embryo production. Table 1.Ovarian response and embryo production in pregnant heifers superstimulated with or without synchronisation of follicle wave emergence Variable DFR No DFR Small follicles, n 8.1±1.2A 12.1±1.8B Medium follicles, n 18.3±1.3 13.7±2.0 Large follicles, n 2.4±0.6 1.4±0.4 Total follicles, n 28.8±1.4 27.2±2.2 Total oocytes, n 15.4±1.5 16.0±1.9 Viable oocytes, n 13.7±1.5 13.4±1.8 Cleavage rate,% (n) 77.1 (192)A 64.4 (188)B Blastocyst rate,% (n) 40.6 (192)A 20.7 (188)B A,BMeans within a row with different superscripts differ (P&lt;0.05).

105 Optimization of a five-day fixed-time embryo transfer program in dairy heifers: Use of gonadotrophin-releasing hormone at initiation of the protocol

Optimized fixed-time embryo transfer (FTET) protocols for synchronization of recipients have the potential to improve the overall efficiency and profitability of embryo transfer (ET) programs. The objective of the present study was to evaluate the effect of dose of gonadotrophin-releasing hormone (GnRH) at initiation of a 5-day synchronization protocol for FTET. Holstein heifers (n=2689) at two locations were synchronized using a 5-day CO-Synch protocol as follows: Day 0: CIDR inserted, Day 5: CIDR removed, prostaglandin (PG)F2α treatment (500μg cloprostenol), Day 6: PGF2α treatment, Day 8: GnRH (100μg of gonadorelin). On Day 0, at the time of CIDR insertion, heifers were assigned in a completely randomised design to the following groups: Single (a single dose of GnRH; 100μg of gonadorelin), Double (200μg of gonadorelin) or No GnRH (control). All heifers received an Estrotect patch placed on Day 5 and evaluated for signs of oestrus on Day 8. At location A, heifers were evaluated by ultrasonography 5 days after GnRH to determine presence and size of corpus luteum (CL), whereas at location B presence and location of CL were determined by transrectal palpation at the time of transfer. Heifers with a CL received an embryo 7±1 days after GnRH administration, and pregnancy was determined by ultrasonography 41 and 63 days after GnRH. Data were analysed by generalized linear mixed models. Oestrus expression was greater in heifers that received Single and Double GnRH than in the No GnRH group (P=0.001). Similarly, utilisation rate (number transferred per number treated) was greater for heifers in the Single and Double GnRH group than for those in the No GnRH group (P=0.02). Pregnancy data were analysed for a subset of recipients using data from Day 41 (n=2267) and Day 63 (n=2042). The analysis of fertility outcomes included as covariates the type of embryo (invitro fresh or frozen and invivo fresh or frozen), embryo stage, embryo quality, interval from GnRH to transfer, and oestrus expression. Pregnancies per embryo transfer (P/ET) at Days 41 and 63 were not different between treatment groups (P=0.86), and there was no interaction between type of embryo and treatment (P&gt;0.15). Pregnancy loss between Days 41 and 63 was not different (P=0.49) between treatments groups. In conclusion, the removal of the initial GnRH from a 5-day FTET protocol resulted in a slight but significant reduction in the utilisation rate and the percentage of heifers showing oestrus. However, there was no detrimental effect on fertility. As a result, the overall cost of the FTET program can be reduced by eliminating the need for the initial GnRH treatment without compromising fertility. Table 1.Reproductive performance in recipients receiving different doses of gonadotrophin-releasing hormone (GnRH) at initiation of the synchronization protocol Treatment Oestrus (n) Utilisation rate (n) P/ET1 D41 (n) P/ET D63 (n) Pregnancy loss (n) No GnRH 69.2%B (621/898) 85.0%B (763/898) 41.6% (308/740) 39.9% (268/672) 4.3% (12/280) Single GnRH 76.1%A (685/900) 88.8%A (799/900) 42.7% (329/770) 39.5% (272/689) 6.5% (19/291) Double GnRH 75.3%A (671/891) 88.7%A (790/891) 41.5% (314/757) 38.9% (265/681) 5.4% (15/280) A,BValues with different superscripts within a column differ (P&lt;0.05). 1P/ET=pregnancies per embryo transfer.

Effects of dietary free fatty-acid content and saturation degree on lipid-class composition and fatty-acid digestibility along the gastrointestinal tract in broiler starter chickens

The aim of the present study is to assess the effect of the dietary free fatty acid (FFA) content and dietary fat saturation degree on the fatty-acid (FA) digestibility and lipid-class content along the gastrointestinal tract and excreta in broiler chickens. The 8 experimental diets resulted from replacing crude soybean oil with soybean acid oil from chemical refining, or crude palm oil with palm FA distillate from physical refining. Thus, there were 4 soybean and 4 palm diets with 6% added fat varying in their FFA% (5, 15, 35, and 50%). Samples of digestive content (gizzard, duodenum, jejunum, and ileum) and excreta were collected at 14 D for the determination of the FA digestibility and lipid-class content. The total FA digestibility coefficients reported for the chickens fed S diets in the jejunum, ileum, and excreta were higher than for those fed P diets (P ≤ 0.02). The general greater digestibility of the unsaturated diets was mainly explained by a higher contribution of the ileum to the absorption of saturated FA. The dietary FFA content mainly affected the FA absorption process. The diets with 50% FFA presented lower saturated FA digestibility coefficients in the jejunum and ileum (P ≤ 0.03), and higher content of FFA in the ileum and excreta (P ≤ 0.014), in comparison to the diets with 5% FFA. The 15% FFA diets were not different from the 5% FFA diets, regarding the saturated FA digestibility in the jejunum and excreta, and the FFA content in the ileum and excreta. It was concluded that unsaturated diets with moderate content of dietary FFA (up to 15%) could be used in broiler-chicken starter diets, as they led to similar FA absorption and performance results to the diets with the lowest dietary FFA content. From the present study, it has also been concluded that dietary saturated FA content has a greater impact on FA absorption than the dietary FFA content has.

Absorption and diffusion of a 645 nm diode laser beam in the bone. An ex vivo study

The present preliminary ex vivo study aims to assess the possible interaction between complex biological systems and laser light, through irradiation of different hard tissue samples. A 645 nm wavelength diode laser was adopted to perform the present evaluation. Due to known similarities to human tissues, swine tissue samples were used. Two samples of cortical bone measuring 4.4 mm and 4.7 mm of thickness and 2 samples of spongeous bone measuring 2.45 mm and 2.9 mm were harvested for the analysis of hard tissues. Mean absorption values were as follows: 128.82 mW standard deviation 8.74 for 2.45 mm spongeous bone sample; 132.34 mW standard deviation 7.66 for 2.9 mm spongeous bone sample; 140.59 mW standard deviation 5.97 for 4.4 mm cortical bone sample and 152.20 mW standard deviation 3.36 for 4.7 mm mucosa and cortical bone sample. Red-light laser with 645nm wavelength has the ability to reach cells in each layer of measured tissues.

Effects of zoledronic acid and dexamethasone on early phases of socket healing after tooth extraction in rats: A preliminary macroscopic and microscopic quantitative study

Background

The exact pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) is still unknown. The aim of this paper was to investigate the effects of zoledronic acid and dexamethasone on the early phases of socket healing in rats subjected to tooth extractions.

Material and Methods

Thirty male Sprague-Dawley rats were divided into 2 groups: pharmacologically treated group (T, n=20) and non-pharmacologically treated group (C, n=10). T group rats received 0.1 mg/Kg of zoledronic acid (ZOL) and 1 mg/Kg of dexamethasone (DEX) three times a week for 10 consecutive weeks. C group rats were infused with vehicle. After 9 weeks from the first infusion, first maxillary molars were extracted in each of the rats. Quantitative macroscopic and microscopic analysis was performed to evaluate socket healing 8 days after extraction.

Results

Pharmacologically treated rats showed significant inhibition of bone remodeling. Connective tissue/alveolar bone ratio, osteoclast number and woven bone deposition were significantly reduced in group T compared to group C. Conversely, the proportion of necrotic bone was higher in group T compared to group C (0.8% and 0.3%, respectively. P=0.031). ZOL plus DEX do not cause gross effects on socket healing at a macroscopic level.

Conclusions

Our findings confirmed that exposure to ZOL plus DEX impairs alveolar wound repair. Inhibition of osteoclastic resorption of socket walls after tooth extraction and the inability to dispose of the necrotic bone may be considered the initial steps of MRONJ onset.

Key words:Medication-related osteonecrosis of the jaw, zoledronic acid, dexamethasone, tooth extraction, rat.

New Localization Technique for Breast Cancer Biopsy: Mammotome Guidance with Imaging Probe

Aims and Background

The “Imaging probe” (IP) is a small, portable, high-resolution gamma camera to be used in radioguided surgery. The present work discusses a special prototype designed for guiding biopsies. The IP was mounted to a Fischer digital X-ray stereotactic core biopsy system in such a way that biopsy could be guided simultaneously by X-ray stereotaxis and 99mTc-Sestamibi (MIBI) images from IP.

Methods

The IP field of view was 22.8 × 22.8 mm2, with a spatial resolution of approx. 2.5 mm. We used off-line software for image fusion on a dedicated Pentium III portable PC. It was matched with a Fischer digital X-ray stereotactic biopsy system dedicated to direct the mammotome towards breast opacities. The operator was allowed to slightly correct the direction of the mammotome needle taking into account stereotactic X-ray, scintigraphic and fused images. Biopsy samples were counted by IP before they were sent to the pathologist.

Results

High-resolution IP scintigraphy showed substantial, though not exact, matching between MIBI hot spots and X-ray opacities. More than one hot spot was detected even in the smallest (0.6 cm) lesion. Post-biopsy scintigraphy showed absence of significant hot spots in two patients, whereas in the third patient one of the three hot spots was still partially present. All lesions showed cancer on histological examination.

Conclusions

Measurement of radioactivity in biopsy specimens confirmed the heterogeneous distribution of radioactivity within cancers that IP had detected before biopsy.

New magnetostratigraphic evidence for the age of Acheulean tools at the archaeo-palaeontological site "Solana del Zamborino" (Guadix - Baza Basin, S Spain)

The sedimentary record in the Guadix-Baza Basin (southern Spain) has proved to be a great source of information for the Miocene through the Pleistocene periods, due to the abundant faunal remains preserved, in some cases associated with lithic tools. The Solana del Zamborino (SZ) section has been the subject of controversy ever since a magnetostratigraphic analysis resulted in an age of 750–770 Kyr for Acheulean tools, a chronology significantly older than the ~600 Kyr established chronology for the first Acheulean record in Europe. Although recent findings at the “Barranc de la Boella” site (north-east of the Iberian Peninsula) seem to indicate that an earlier introduction of such technique in Europe around 0.96–0.781 Ma is possible, the precise age of the classical site at SZ is still controversial. The aim of this paper is to constrain the chronology of the site by developing a longer magnetostratigraphic record. For this purpose, we carried out an exhaustive sampling in a new succession at SZ. Our results provide a ~65 m magnetostratigraphic record in which 4 magnetozones of normal polarity are found. Our new magnetostratigraphic data suggest an age range between 300–480 Kyr for the lithic tools, closer to the age of traditional Acheulean sites in Europe.

Stanozolol-soaked grafts enhance new bone formation in rat calvarial critical-size defects

Androgen hormones play a significant role in regulating bone morphogenesis and in maintaining bone homeostasis throughout life. This study aimed to investigate the local effects of the non-aromatizable androgen stanozolol (ST) on bone regeneration in rats. Bilateral critical-size defects were created in the parietal bone of 26 male Wistar rats: the defect on one side was filled with a deproteinized bovine bone scaffold (DBB) soaked in ST solution (test) and the contralateral with DBB alone (control). Samples were collected at one month and three months. Histomorphometry revealed a significantly higher new bone formation (NB) (24.41% ± 4.14% versus 15.01% ± 2.43%, p < 0.05) and mineral apposition rate (MAR) (9.20 μm/day ± 0.37 versus 6.50 μm/day ± 1.09, p < 0.05) in the test versus control group at one month. Accordingly, real time-polymerase chain reaction revealed a consistently higher Runx2 expression in test samples (fold change test/control: 4.50 ± 1.17, p ≤ 0.05). No morphometrical differences between groups were detected at three months (p > 0.05). However, test samples were characterized by an increase in blood capillary density from one month (11.43 n mm^-2 ± 2.01) to three months (28.26 n mm^-2 ± 5.62), providing evidence of a vital remodeling tissue. Control samples presented a decrease of anti-Osterix (SP7)/anti-osteocalcin (BGLAP) (3.9 n mm^-2 ± 0.32 versus 1.01 n mm^-2 ± 0.20) and alkaline phosphatase (ALP) (12.14 n mm^-2 ± 6.29 versus 6.29 n mm^-2 ± 2.73) immunohistochemical-positive elements, which was suggestive of a stabilized healing phase. Based on these observations, local ST administration boosted bone regeneration in rat calvarial critical-size defects at one month. This study showed the potential of local steroid delivery in bone regeneration.

Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents

BACKGROUND

To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents.

METHODS

As part of the EU project 'Suicidality: Treatment Occurring in Paediatrics' (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTracker^TM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTracker^TM, allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS.

RESULTS

The STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children's version. Good internal consistency was found for adolescents (Cronbach's alpha: 0.965), children (Cronbach's alpha: 0.922), parents (Cronbach's alpha: 0.951) and clinicians (Cronbach's alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians' (0.917), adolescents' (0.834) and parents' (0.756) versions but only fair (0.683) for children's version.

CONCLUSIONS

The STOP-SAS is a comprehensive, web-based PROM developed on the HealthTracker^TM platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.

Nurses and Requests for Female Genital Mutilation: cultural rights versus human rights

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.

An innovative protocol for schwann cells extracellular matrix proteins extraction

The evidence that extracellular matrix (ECM) components could represent new targets for drugs designed to approach degenerative disease, requires their analysis. Before the analysis, proteins should be extracted from ECM and solubilized. Currently, few protocols for ECM proteins extraction and solubilization are available in literature, and most of them are based mainly on the use of proteolytic enzymes, such as trypsin, which often lead to proteins damage. Moreover, no methods have been so far proposed to solubilize Schwann Cell ECM, which may represent an important target for the therapy of neurodegenerative disorders. In our study, we propose to solubilize SC ECM through the use of surfactants and urea. We compared our method of solubilization, with one of that proposed in literature for a general ECM, mainly based on the use of enzymes. We want to highlight the benefit of solubilizing SC ECM, avoiding the use of proteolytic enzymes. To compare the amount of proteins extracted with both methods, MicroBCA assay was used, while the quality of the proteins extracted was observed through the SDS-PAGE. The results obtained confirm a better solubilization of SC ECM proteins with the proposed protocol, both quantitatively and qualitatively, showing a higher concentration of proteins extracted and a better enrichment of protein fractions, if compared to the enzyme-based protocol. Our results show that SC ECM could be efficiently solubilized through the use of surfactant and urea, avoiding the use of enzyme-base methods. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 3175-3180, 2016.

Urticarial vasculitis and urticarial autoinflammatory syndromes

Urticaria is a frequent disorder classified as acute and chronic forms, which presents with wheals that can be associated with angioedema. Several entities may manifest with urticarial skin lesions, encompassing a heterogeneous group of conditions that have to be differentiated from ordinary urticaria. This review is focused on two of these urticarial syndromes: urticarial vasculitis (UV), which represents the most important differential diagnosis with common urticaria, and autoinflammatory diseases such as cryopyrin-associated periodic syndromes (CAPS) and Schnitzler's Syndrome, both rare multisystem forms that may masquerade as common urticaria. UV is a small-vessel vasculitis with predominant skin involvement, characterized by wheals persisting for more than 24 hours, burning rather than itching and resolving with hyperpigmentation as well as by other cutaneous manifestations including purpura, papules, vesicles, bullae and necrotic-ulcerative lesions. Histology shows a classic pattern of leukocytoclastic vasculitis, with possible presence of upper dermal edema. CAPS are classified as three distinct entities: familial cold autoinflammatory syndrome, Muckle-Wells Syndrome and chronic infantile neurological cutaneous and articular syndrome, which represent a spectrum of disorders caused by different mutations in a single gene, NLRP3 (NOD-like receptor 3). This gene encodes for cryopyrin, an inflammasome protein that activates interleukin-1β, leading to an overproduction of this pivotal proinflammatory cytokine. Histologically, urticarial lesions are generally characterized by a perivascular neutrophilic infiltrate. Unlike urticaria, neither UV nor urticarial autoinflammatory syndromes do respond to antihistamines: thus, it is important not to misdiagnose such conditions in order to give the patients specific treatments, potentially preventing serious systemic complications.

Relapsed actinic keratosis evaluation: an observational Italian multicenter prospective study. Does gender have a role?

AIM

Relapsed actinic keratoses evaluation study (RAKE) was performed in nine Italian centers of dermatology in order to observe the outcome of the treatments of these common skin neoplasms.

METHODS

A total of 182 patients were enrolled in 2 cohorts: the first included 144/182 patients (79.1%) evaluated after 6 months from clinical remission, and the second 116/182 (63.7%) evaluated for at least 12 months after clinical remission. Patients were previously treated with topical diclofenac 3% in hyaluronic acid, cryotherapy, photodynamic, curettage or imiquimod cream.

RESULTS

Subjects with history of malignant skin diseases showed an increased number of new lesions at 16 months from baseline (12 months from remission) compared to patients without history of cancers (mean 1.58 versus 1.17). Hyperkeratotic lesions healed more rapidly but relapsed at 6 months more frequently than non-hyperkeratotic ones (32.9% versus 20.7%). The results showed gender-related differences: male patients recovered better and independently from the treatment used; in contrast, men showed a higher recurrence (32% at 6 months and 6.6% between 6 and 12 months versus 16% at 6 months and 5.9% between 6 and 12 months for females) and a higher average number of new lesions after 12 months from remission (1.6 versus 0.88 for females).

CONCLUSION

The results may suggest a lower adherence to photoprotection in male patients. Hyperkeratotic lesions recurred mostly at 6 months in comparison to non-hyperkeratotic lesions.

Emerging roles for sodium dependent amino acid transport in mesenchymal cells

The functional aspects of sodium dependent amino acid transport in mesenchymal cells are the subject of this contribution. In a survey of the cross-talk existing among the various transport mechanisms, particular attention is devoted to the role played by substrates shared by several transport systems, such as L-glutamine. Intracellular levels of glutamine are determined by the activity of System A, the main transducer of ion gradients built on by Na,K-ATPase into neutral amino acid gradients. Changes in the activity of the System are employed to regulate intracellular amino acid pool and, hence, cell volume. System A activity has been found increased in hypertonically shrunken cells and in proliferating cells. Under both these conditions cells have to increase their volume; therefore, System A can be employed as a convenient mechanism to increase cell volume both under hypertonic and isotonic conditions. Although less well characterized, the uptake of anionic amino acids performed by System X(-) AG may be involved in the maintenance of intracellular amino acid pool under conditions of limited availability of neutral amino acids substrates of System A.

Reflectance confocal microscopy allows in vivo real-time noninvasive assessment of the outcome of methyl aminolaevulinate photodynamic therapy of basal cell carcinoma

BACKGROUND

Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an approved noninvasive treatment option for basal cell carcinoma (BCC). In vivo reflectance confocal microscopy (RCM) is a noninvasive imaging technique that has proved useful for in vivo real-time cytomorphological analysis of BCC cells infiltrating the epidermis.

OBJECTIVES

  To investigate the use of in vivo RCM to assess the persistence of BCC cells surviving MAL-PDT.

METHODS

In vivo  RCM images of 20 biopsy-proven BCCs were taken before patients underwent a treatment cycle with MAL-PDT. Follow-up after 3months was performed using clinical examination, RCM and conventional dermoscopy. Treated areas also underwent a targeted 3-mm punch biopsy for standard haematoxylin and eosin histology stain to establish the clinical and instrumental correlation of the treatment outcome.

RESULTS

  Three months after PDT, clinical examination established that two out of 20 BCCs were persistent; dermoscopy found three out of 20 residual BCCs, but RCM showed that one of these lesions was a false positive, and showed persistent BCC foci in five out of 20 lesions. Histological analysis of targeted biopsies confirmed these results.

CONCLUSIONS

  RCM provided noninvasive, early detection of incipient recurrences of BCC after MAL-PDT. RCM findings steered targeted biopsies and surgical removal, or a new MAL-PDT, of these subclinical recurrences with minimal invasiveness.

Photobiology, photodermatology and sunscreens: a comprehensive overview. Part 1: damage from acute and chronic solar exposure

Sun exposure of the skin triggers several inflammatory pathways via a multitude of photochemical and photobiological effects. Furthermore, local and systemic immune suppression develops. The main clinical effects of UV exposure can be classified schematically into immediate, including sunburn, tanning, vitamin D production and exacerbation of inherited and acquired photosensitive skin disorders and long-term, including solar ageing and skin cancer. The protection against solar radiation is afforded by a healthy behavior of reasonable sun avoidance and the use of topical sunscreens as well as topical and oral antioxidants. However, users of sunscreen products should be able to choose correctly the more convenient product according to their needs. In Europe, the sun protection factor (SPF) and the UVA-protection factor (UVA-PF) are labeled to indicate the degree of protection against UVB and UVA, respectively. However, dermatologists must be aware that the present knowledge of UV effects on human skin needs to be clarified and several regulatory issues of photo-protection remain to be clarified and standardized. Finally, much work is needed to improve water resistance, spreadability, transparency and homogeneity of the sunscreen agents.

Photobiology, photodermatology and sunscreens: a comprehensive overview. Part 2: topical and systemic photoprotection

Sun exposure of the skin triggers several inflammatory pathways via a multitude of photochemical and photobiological effects. Furthermore, local and systemic immune suppression develops. The main clinical effects of UV exposure can be classified schematically into immediate, including sunburn, tanning, vitamin D production and exacerbation of inherited and acquired photosensitive skin disorders and long-term, including solar ageing and skin cancer. The protection against solar radiation is afforded by a healthy behavior of reasonable sun avoidance and the use of topical sunscreens as well as topical and oral antioxidants. However, users of sunscreen products should be able to choose correctly the most convenient product according to their needs. In Europe, the sun protection factor (SPF) and the UVA-protection factor (UVA-PF) are labeled to indicate the degree of protection against UVB and UVA, respectively. However, dermatologists must be aware that the present knowledge of UV effects on human skin needs to be clarified and several regulatory issues of photo-protection remain to be clarified and standardized. Finally, much work is needed to improve water resistance, spreadability, transparency and homogeneity of the sunscreen agents.

The separate daily application of tacalcitol 4 µg/g ointment and budesonide 0.25 mg/g cream is more effective than the single daily application of a two compound ointment containing calcipotriol 50 µg/g and betamethasone dipropionate 0.5 mg/g

AIM

This pilot randomized intra-patient side to side trial was designed to assess the antipsoriatic efficacy, safety and tolerability of once daily versus the separate application of a vitamin D3 analogue and a powerful corticosteroid.

METHODS

Twenty patients with plaque type psoriasis were enrolled. Two similar symmetrical lesions were randomized to be treated with an application of an ointment containing calcipotriol 50 µg/g plus betamethasone dipropionate 0.5 mg/g once daily or the application of budesonide 0.25 mg/g cream in the morning and tacalcitol 4 µg/g ointment in the evening.

RESULTS

Eighteen patients completed the study. Both treatments proved to be effective but budesonide cream and tacalcitol ointment gave a faster improvement of lesions and itching relief at t1 and were better tolerated.

CONCLUSION

The separate daily regimen may represent a suitable treatment option for patients who need a faster improvement and a better moisturizing activity. Further studies which compare the efficacy and safety of these regimens need to be developed.

C-reactive protein and markers for thrombophilia in patients with chronic plaque psoriasis

Chronic plaque psoriasis is associated to an increased risk of cardiovascular events. The aim of our study is to test patients with psoriasis for common markers of acquired and inherited thrombophilia. A cross-sectional study on 172 patients with psoriasis and 198 controls was carried out. The plasma levels of coagulation protein C, coagulation protein S, homocysteine, folic acid, C-reactive protein (CRP) and fibrinogen as well as activated protein C resistance and antithrombin III activity, were measured. CRP and homocysteine levels were higher in patients with psoriasis than in controls (5.9 ± 7.1 vs 3.1 ± 2.4 mg/L, p=0.0003 and 16.3 ± 12.8 vs 10.4 ± 4.6 umol/L, p=0.0001; mean ± SD) whereas folic acid was lower in psoriatic patients compared to controls (4.3 ± 7.2 vs 12.6 ± 7.9 p=0.006). Levels of coagulation protein C, coagulation protein S, fibrinogen as well as activated protein C resistance, antithrombin III activity were within normal ranges both in cases and controls. In a multivariate regression analysis, psoriasis severity was an independent predictor of higher CRP. In conclusion, high levels of serum CRP and homocysteine were found in patients with psoriasis, related to the severity of the disease. These data suggest that the increased risk of thrombotic cardiovascular events observed in psoriasis patients should be ascribed to an acquired rather than inherited thrombophilic status.

Effects of extra feeding in mid-pregnancy for three successive parities on lean sows’ productive performance and longevity

The aim of this study was to investigate the long-term effects of increasing feeding allowance during mid-pregnancy in sows. A total of 103 PIC pregnant sows (mixed parity) were allocated to two treatments: control (C, n = 49) were fed 2.5-3.0 kg d-1 (12.1 MJ ME kg-1) and extra-fed (E, n = 54) received +2.0 kg d-1 of the same feed from day 45 to 85 of gestation over three consecutive cycles. Body weight, backfat thickness (BF) and loin depth were measured on days 45 and 85 of gestation, farrowing and weaning. Litter and sows performance were recorded during lactation and post-weaning. Overall culling rates were 61 and 67% for C and E groups, respectively. After three cycles, E sows showed a positive BF balance in contrast to C sows (E = +1.46 mm and C= -1.81 mm, P < 0.05). In cycle 3, E sows presented greater piglet birth weights than C sows, being mainly evident in sows that were nulliparous at the onset of the experiment (P < 0.05). Extra-fed sows showed a greater incidence of mastitis-metritis-agalactia syndrome than C sows (P = 0.003). Thus, increasing feeding allowance during mid-pregnancy positively affected BF balance and birth weight in nulliparous, but impaired the sows’ ability to produce milk in the long-term.

Treatment of lupus skin involvement with quinacrine and hydroxychloroquine

To evaluate the efficacy of hydroxychloroquine (HCQ) and quinacrine (Qn) association, at two different dosages, in treatment of lupus skin lesions not responding to HCQ alone. Thirty-four patients, affected by cutaneous and systemic lupus erythematosus, were retrospectively analysed. They were treated by HCQ (5 mg/Kg/qd) and Qn with two regimens: 100 mg/qd (29 cases) and 50 mg/qd (5 cases). Discoid lupus erythematosus (19 cases), acute malar rash (6 cases), chilblain lupus (4 cases) showed a significant improvement with combination therapy (P = 0.009, P = 0.019, and P = 0.04, respectively). Ten patients with subacute cutaneous lupus showed a partial response, whereas lupus profundus didn't improve. The same overall response rate was recorded comparing two Qn regimens, but subjects taking 100 mg/qd improved more rapidly than the others (P = 0.001). Ten patients developed side effects, mainly represented by skin yellowish discolouration. Depression and severe headache with nausea, which were globally recorded in two cases, led to drug withdrawal. One additional case of hepatitis was recorded in a patient with preexisting Hepatitis C virus (HCV) infection. Combination of HCQ and Qn is rapidly effective at 100 mg/qd and well tolerated in the treatment of lupus skin lesions unresponsive to HCQ alone.

Increased sow nutrition during midgestation affects muscle fiber development and meat quality, with no consequences on growth performance

Pregnant sow nutrition has potential effects on the muscle fiber development of progeny in utero. A total of 199 Landrace x Large White sows from parities 0 to 6 and their offspring were used to evaluate the effects of increasing the feeding amount during midpregnancy on the muscle tissue, growth performance, and meat quality of the progeny. The experiment was divided into 2 study replicates, and in each replicate, sows were assigned to 1 of the 2 treatments: 1) sows in the control group (C sows) were fed 2.5 to 3.0 kg/d (feed: 12.1 MJ of ME/kg and 0.62% lysine) throughout gestation; and 2) sows in the high group (H sows) received an extra feed allowance of 1.5 kg/d for gilts and 2.0 kg/d for multiparous sows above the C amount from d 45 to 85 of gestation (period of secondary muscle fiber formation). Sow backfat was recorded on d 40 and 85 of gestation. Sow performance (litter size and piglet BW) at farrowing and on d 18 of lactation was measured. At weaning, pigs were divided into 5 BW groups/treatment, and progeny growth performance was measured during the nursery (n = 958) and the growing-finishing (n = 636) periods. At slaughter, carcass and meat quality traits (lean content, main cut weight, pH, Minolta color, and drip loss) were recorded from the second lightest group at weaning (BW group 4; n = 90), and samples from the longissimus thoracis muscle were taken to study muscle fiber characteristics (n = 70). The extra nutrition from d 45 to 85 of gestation did not lead to differences in litter size or piglet BW at farrowing and on d 18 of lactation. Pigs born to H mothers had fewer muscle fibers and fewer estimated primary and secondary fibers than did pigs born to C mothers (P < 0.05). However, postnatal growth performance was not consistently affected by the maternal treatment. The smaller number of muscle fibers found in the H group of pigs was associated with fewer type IIB fibers (P < 0.05) with greater cross-sectional areas (P < 0.10), which might be related to the significantly greater meat pH at 24 h postmortem and the smaller L* (lightness) values recorded in the H group of pigs. Results from the present study confirm the existence of effects of maternal nutrition on fetal development, at least in terms of muscle tissue development and meat quality, although with no beneficial effects were found for the postnatal growth performance of the progeny.

A EuroPrevall review of factors affecting incidence of peanut allergy: priorities for research and policy

Peanuts are extensively cultivated around the world, providing a foodstuff that is both cheap to produce and nutritious. However, allergy to peanuts is of growing global concern, particularly given the severity of peanut-allergic reactions, which can include anaphylaxis and death. Consequently, it is important to understand the factors related to the prevalence of peanut allergy in order to inform efforts to ameliorate or pre-empt the condition. In this article we review evidence for the relevance of factors hypothesized to have some association with allergy prevalence, including both genetic and environmental factors. Although our analysis does indicate some empirical support for the importance of a number of factors, the key finding is that there are significant data gaps in the literature that undermine our ability to provide firm conclusions. We highlight these gaps, indicating questions that need to be addressed by future research.

Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial

BACKGROUND

Vitiligo is an acquired depigmenting disease with uncertain aetiopathogenesis, possibly associated with oxidative stress. Narrowband ultraviolet B phototherapy (NB-UVB) is the most widely used and effective treatment.

AIM

To evaluate the clinical effectiveness of NB-UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool (AP).

METHODS

Patients (n = 35) with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. The area and number of lesions, as well as some parameters of the oxidation-reduction (redox) status of the peripheral blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months, and at the end of the trial.

RESULTS

In total, 28 patients completed the study. After 2 months of AP supplementation, the catalase activity and the production of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05 and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs. 18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P < 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs. placebo) of the basal value was observed in PBMCs. Finally, the AP intake maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 : 3.1; P < 0.05), counteracting phototherapy-induced saturation.

CONCLUSIONS

Oral supplementation with AP containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated oxidative stress.

Sperm DNA fragmentation in a random sample of the Spanish boar livestock

A collection of 180 chilled boar semen samples, randomly chosen from stocks currently used for routine characterization of standard seminal quality, were studied for DNA fragmentation status using the sperm chromatin dispersion test and the DNA fragmentation index (DFI: percent of abnormal cell versus normal cells for DNA fragmentation) was determined. Values for sperm motility, acrosome status, coiled tails and abnormal head morphology, including presence and position of cytoplasmic droplets were also obtained. The DFI in the whole sample presented a wide range of variation with values oscillating between practically 0% and 47.95% and do not fit to a normal distribution. The most frequent classes (83.3%) presented a DFI lower than a 5%. Significant correlations between sperm DNA fragmentation and sperm motility, acrosome status, frequency of distal droplets, coiled tails and abnormal head morphology, were not observed. However, the presence of proximal cytoplasmic droplets showed a significant correlation with the level of DNA fragmentation observed in the ejaculated spermatozoa.

Photodynamic therapy: update 2006. Part 1: Photochemistry and photobiology

Photodynamic therapy (PDT) is a two-step therapeutic technique in which the topical or systemic delivery of photosensitizing drugs is followed by irradiation with visible light. Activated photosensitizers transfer energy to molecular oxygen, generating reactive oxygen species (ROS). The subsequent oxidation of lipids, amino acids and proteins induces cell necrosis and apoptosis. In addition, ROS indirectly stimulate the transcription and release of inflammatory mediators. The photosensitizers are selective, in that they penetrate and accumulate in tumour cells or in the endothelium of newly formed vessels while generally avoiding the surrounding healthy tissue. The mechanisms of penetration through the cell membrane and the pattern of subcellular localization strongly influence the type of cellular effect. The photobiology and photoimmunology of the haematoporphyrin (Hp) derivative and its purified, lyophilized and concentrated form porfimer sodium have been investigated over the past 30 years. However, interest in PDT in dermatology was not raised until the 1990s with the availability of a simple and effective technique, the topical application of aminolaevulinic acid (ALA) and its methyl ester (methyl aminolaevulinate, MAL) followed by irradiation with broadband red light. At the same time, several new 'second-generation' synthetic sensitizers (e.g. benzoporphyrin derivatives, phthalocyanines, chlorins and porphycenes) became available. These compounds are chemically pure, highly efficient, selective and safe, while offering the advantage that the generalized skin photosensitivity they produce lasts for only a short time. They are currently under clinical evaluation but have not yet been approved for clinical use. This paper provides an overview of the chemistry of the photosensitizers, the photobiology and photoimmunology of the photodynamic reaction as well as the photophysical characteristics of the light sources available for PDT.

Photodynamic therapy: update 2006. Part 2: Clinical results

In several randomized, controlled studies, the application of a standard preparation containing methyl-aminolevulinate (MAL; Metvix, Galderma, F), followed by red light irradiation proved effective and well tolerated in the treatment of actinic keratosis and basal cell carcinoma, and has now been approved for clinical use in European countries. A brand name aminolevulinic acid (ALA) solution (Levulan Kerastick, Dusa Pharmaceuticals Inc., Wilmington, MA) plus blue light exposure has been approved for the treatment of actinic keratosis in the USA. Randomized and controlled studies have shown that MAL as well as ALA are also effective in the treatment of Bowen's disease. In addition, a large and growing number of open studies or case reports have evaluated its use in the treatment of a broad range of other neoplastic, inflammatory and infectious skin diseases. However, efficacy and definite advantages over standard therapies remain to be clarified because the experimental design of these studies was often poor, the number of enrolled patients was generally low, and the follow-up was shorter than 12 months. However, these studies have suggested a few possible clinical applications worthy of further investigation. A growing number of laboratory and clinical findings suggest that several new synthetic sensitizers, besides ALA and MAL, may be helpful in the treatment of non-melanoma skin cancers, melanoma metastasis, and selected inflammatory and infective skin diseases. These compounds are deliverable intravenously, have short half-lives both in the blood and skin, and are highly efficient. However, they are as of yet not approved for clinical use.