Albendazole metabolites excretion in human saliva as a biomarker to assess treatment compliance in mass drug administration (MDA) anthelmintic programs

Soil-transmitted-helminth (STH) infections continue to be a persistent global public health problem. Control strategies for STH have been based on the use of mass drug administration (MDA). Coverage and compliance assessment is critical to understanding the true effectiveness of albendazole (ABZ) in those MDA programs. The aims of this work were to characterize the pattern of albendazole and metabolites excretion in human saliva, and to develop a saliva-based biomarker (HPLC drug/metabolite detection) useful to accurately estimate the coverage/compliance in MDA campaigns. The study subjects were 12 healthy volunteers treated with a single oral dose of ABZ (400 mg). Saliva and blood (dried blood spot, DBS) samples were taken previously and between 2 and 72 h post-treatment. The samples were analyzed by HPLC with UV detection, C18 reversed-phase column. ABZ sulphoxide was the main analyte recovered up to 72 h p.t. in blood and saliva. The concentration profiles measured in the blood (DBS samples) were higher (P < 0.05) than those in saliva, however, this ABZ-metabolite was recovered longer in saliva. The in vivo measurement of drugs/metabolites in saliva samples from ABZ-treated volunteers offers strong scientific evidence to support the use of saliva as a valid biological sample for assessing compliance in MDA programs.

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

X-Ray induced desorption and photochemistry in CO ice

We report an investigation of X-ray induced desorption of neutrals, cations and anions from CO ice. The desorption of neutral CO, by far the most abundant, is quantified and discussed within the context of its application to astrochemistry. The desorption of many different cations, including large cations up to the mass limit of the spectrometer, is observed. In contrast, the only desorbing anions detected are O- and C-. The desorption mechanisms of all these species are discussed with the aid of their photodesorption spectrum. The evolution of the X-ray absorption spectrum shows significant chemical modifications of the ice upon irradiation, which along with the desorption of large cations gives a new insight into X-ray induced photochemistry in CO ice.

Mechanism of Indirect Photon-Induced Desorption at the Water Ice Surface

Electronic excitations near the surface of water ice lead to the desorption of adsorbed molecules, through a so far debated mechanism. A systematic study of photon-induced indirect desorption, revealed by the spectral dependence of the desorption (7-13 eV), is conducted for Ar, Kr, N_{2}, and CO adsorbed on H_{2}O or D_{2}O amorphous ices. The mass and isotopic dependence and the increase of intrinsic desorption efficiency with photon energy all point to a mechanism of desorption induced by collisions between adsorbates and energetic H/D atoms, produced by photodissociation of water. This constitutes a direct and unambiguous experimental demonstration of the mechanism of indirect desorption of weakly adsorbed species on water ice, and sheds new light on the possibility of this mechanism in other systems. It also has implications for the description of photon-induced desorption in astrochemical models.

Influence of individual or group housing of newborn calves on rotavirus and coronavirus infection during the first 2 months of life

Bovine rotavirus A (RVA) and bovine coronavirus (CoV) are the two main viral enteropathogens associated with neonatal calf diarrhea. The aim of the present work was to study the impact of group and individual housing systems in the epidemiology of RVA and CoV infection. Eleven calves reared in individual housing (FA) and nine calves in group housing (FB) were monitored during the first 7 weeks of life. Stool and serum samples were screened for RVA and CoV antigens by ELISA. IgG1 antibodies (Ab) to both antigens were also measured. From the 160 fecal samples collected, the proportion of positive samples to RVA and CoV was significantly higher in FB (23.6%) than in FA (9%) (p = 0.03). The geometric mean of colostral IgG1 Ab titers to CoV and RVA in FA (IgG1 anti-CoV 1024 and anti-RVA 1782.9) was lower than in FB (IgG1 anti-CoV 10,321.2 and anti-RVA 4096) at birth. Calves less than 2 weeks of life from FB had a higher risk of being infected by RVA (OR = 4.9; p = 0.01) and CoV (OR = 17.15; p = 0.01) than calves from FA. The obtained results showed that there was higher RVA and CoV shedding in group-housed calves than in individual-housed animals.

A spectroscopic and molecular dynamics study on the aggregation process of a long-acting lipidated therapeutic peptide: the case of semaglutide

The aggregation properties of semaglutide, a lipidated peptide drug agonist of the Glucagon-like peptide 1 receptor recently approved for the treatment of type 2 diabetes, have been investigated by spectroscopic techniques (UV-Vis absorption, steady-state and time-resolved fluorescence, and electronic circular dichroism) and molecular dynamics simulations. We show that in the micromolar concentration region, in aqueous solution, semaglutide is present as monomeric and dimeric species, with a characteristic monomer-to-dimer transition occurring at around 20 μM. The lipid chain stabilizes a globular morphology of the monomer and dimer species, giving rise to a locally well-defined polar outer surface where the lipid and peptide portions are packed to each other. At very long times, these peptide clusters nucleate the growth of larger aggregates characterized by blue luminescence and a β-sheet arrangement of the peptide chains. The understanding of the oligomerization and aggregation potential of peptide candidates is key for the development of long acting and stable drugs.

Desorption of neutrals, cations, and anions from core-excited amorphous solid water

Core-excitation of water ice releases many different molecules and ions in the gas phase. Studying these desorbed species and the underlying desorption mechanisms can provide useful information on the effects of x-ray irradiation in ice. We report a detailed study of the x-ray induced desorption of a number of neutral, cationic, and anionic species from amorphous solid water. We discuss the desorption mechanisms and the relative contributions of Auger and secondary electrons (x-ray induced electron stimulated desorption) and initial excitation (direct desorption) as well as the role of photochemistry. Anions are shown to desorb not just through processes linked with secondary electrons but also through direct dissociation of the core-excited molecule. The desorption spectra of oxygen ions (O⁺, OH⁺, H₂O⁺, O^-, and OH^-) give a new perspective on their previously reported very low desorption yields for most types of irradiations of water, showing that they mostly originate from the dissociation of photoproducts such as H₂O₂.

Transrenal DNA-based diagnosis of Strongyloides stercoralis (Grassi, 1879) infection: Bayesian latent class modeling of test accuracy

For epidemiological work with soil transmitted helminths the recommended diagnostic approaches are to examine fecal samples for microscopic evidence of the parasite. In addition to several logistical and processing issues, traditional diagnostic approaches have been shown to lack the sensitivity required to reliably identify patients harboring low-level infections such as those associated with effective mass drug intervention programs. In this context, there is a need to rethink the approaches used for helminth diagnostics. Serological methods are now in use, however these tests are indirect and depend on individual immune responses, exposure patterns and the nature of the antigen. However, it has been demonstrated that cell-free DNA from pathogens and cancers can be readily detected in patient’s urine which can be collected in the field, filtered in situ and processed later for analysis. In the work presented here, we employ three diagnostic procedures—stool examination, serology (NIE-ELISA) and PCR-based amplification of parasite transrenal DNA from urine–to determine their relative utility in the diagnosis of S. stercoralis infections from 359 field samples from an endemic area of Argentina. Bayesian Latent Class analysis was used to assess the relative performance of the three diagnostic procedures. The results underscore the low sensitivity of stool examination and support the idea that the use of serology combined with parasite transrenal DNA detection may be a useful strategy for sensitive and specific detection of low-level strongyloidiasis.

As international bodies focus efforts on control of the world’s neglected tropical diseases, the critical importance of accurate and sensitive diagnosis becomes a key factor. The problem arises when the infection load in a community is reduced to a level where the standard diagnostic methodologies are insufficiently sensitive to detect the residual infection in the community. There is a need to develop improved diagnostic strategies for many parasitic diseases. One of the more difficult to diagnose helminth parasites is the nematode Strongyloides stercoralis. We have introduced a new approach that detects parasite-specific cell free DNA in urine as a sensitive measure of parasite presence. In the work presented here, we compare the performance of parasitological, serological and urine/DNA-based diagnosis of S. stercoralis infection. Using a Bayesian Latent Class Analysis approach, we provide evidence for the enhanced utility of using both urine and blood for the diagnosis of this parasite.

Microcirculation as a Novel Marker of Membrane Biocompatibility

Background

It is possible to consider microcirculation as a kind of “witness” of the complex biological reactions triggered by the dialytic treatment. The reactivity of microcirculation to the dialytic stress may represent a measure of the overall biocompatibility of the membrane. In this study we tested the hypothesis that different synthetic membranes may have different biological effects, particularly related to microcirculation.

Subjects and Methods

In this crossover study, we observed 16 chronically hemodialyzed patients. All patients were treated with the EVAL membrane; we recorded the TcPO2 during the second treatment of the week. All patients were then switched to the hf-PS membrane. During the study observation we did not change the dialytic prescription or the pharmacologic treatment.

Results

From the beginning of the session until 90', the behavior of TcPO2 is similar for both the membranes. From 120' to the end of the treatment in sessions with the EVAL membrane, the TcPO2 values come back to the starting level, whereas in the treatments with hf-PS the TcPO2, the values remain at a lower level; there was a significant difference between EVAL and hf-PS in the values recorded. Arterial blood gas values of paO2 and paCO2 are quite similar in the treatments with both the membranes, without any significant difference.

Conclusions

The analysis of microcirculation by means of TcPO2 measurement is a useful tool to obtain a “clinical” measure of biocompatibility of the dialytic treatment and different membranes may have different impacts on TcPO2.

Potential Remedies for the High Synchrotron-Radiation-Induced Heat Load for Future Highest-Energy-Proton Circular Colliders

We propose a new method for handling the high synchrotron radiation (SR) induced heat load of future circular hadron colliders (like FCC-hh). FCC-hh are dominated by the production of SR, which causes a significant heat load on the accelerator walls. Removal of such a heat load in the cold part of the machine, as done in the Large Hadron Collider, will require more than 100 MW of electrical power and a major cooling system. We studied a totally different approach, identifying an accelerator beam screen whose illuminated surface is able to forward reflect most of the photons impinging onto it. Such a reflecting beam screen will transport a significant part of this heat load outside the cold dipoles. Then, in room temperature sections, it could be more efficiently dissipated. Here we will analyze the proposed solution and address its full compatibility with all other aspects an accelerator beam screen must fulfill to keep under control beam instabilities as caused by electron cloud formation, impedance, dynamic vacuum issues, etc. If experimentally fully validated, a highly reflecting beam screen surface will provide a viable and solid solution to be eligible as a baseline design in FCC-hh projects to come, rendering them more cost effective and sustainable.

Mini-FLOTAC, Kato-Katz and McMaster: three methods, one goal; highlights from north Argentina

Background

Copro-parasitological diagnosis is still a challenge in management of helminth infections at individual and community levels in resource-limited settings.

The aim of our study was to compare the performance of three quantitative techniques: Kato-Katz, McMaster and Mini-FLOTAC methids. The study was carried out in Oran, Northern Argentina.

Methods

200 schoolchildren were enrolled to provide a single stool sample, which was tested for helminth infections with Kato-Katz, McMaster and Mini-FLOTAC methods. The Mini-FLOTAC was performed with two flotation solutions (FS2 saturated saline and FS7 zinc sulphate). Preparation and reading time for each of the three methods was calculated both when processing single and multiple samples.

Results

Out of 193 schoolchildren examined, 40% were positive for any helminth infection by any method; the most prevalent was Hymenolepis nana (23%) followed by Ascaris lumbricoides (17%) and a third group of less prevalent helminths: Enterobius vermicularis, Trichuris trichiura and hookworms (11% all together). Mini-FLOTAC FS2 was more sensitive than FS7 for H. nana (93% vs 78%) and for other helminths (85% vs 80%), whereas FS7 was more sensitive for A. lumbricoides (87% vs 61%). Kato-Katz method was more sensitive than McMaster method for A. lumbricoides (84% vs 48%) and for other helminths (48% vs 43%) except for H. nana (49% vs 61%). As for egg counts, Mini-FLOTAC FS2 reported 904 eggs per gram of faeces (EPG) for H. nana (vs 457 with McMaster and 111 with Kato-Katz) and 1177 EPG for A. lumbricoides (vs 1315 with Kato-Katz and 995 with McMaster); FS2 detected the highest EPG for both H.nana and A.lumbricoides (904 vs 568 and 1177 vs 643 respectively), the differences were not statistically significant. The technique feasibility was calculated: Kato-Katz mean time was 48 minutes/sample, Mini-FLOTAC 13 minutes/sample and McMaster 7 minutes/sample. However, especially for Kato-Katz and Mini-FLOTAC, the mean time (min/sample) decreased significantly when processing multiple samples.

Conclusions

Mini-FLOTAC is a promising technique for helminth diagnosis, it is more sensitive than Kato-Katz and McMaster for H. nana and as sensitive as Kato-Katz and more sensitive than McMaster for A. lumbricoides identification. Egg counts differences although relevant, did not reach statistical significance.

A public health response against Strongyloides stercoralis: time to look at soil-transmitted helminthiasis in full

Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann's and Koga's agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control.

Nature of the decrease of the secondary-electron yield by electron bombardment and its energy dependence

We performed a combined secondary electron yield (SEY) and x-ray photoelectron spectroscopy study as a function of the electron dose and energy on a Cu technical surface representative of the LHC accelerator walls. The electron bombardment is accompanied by a clear chemical modification, indicating an increased graphitization as the SEY decreases. The decrease in the SEY is also found to depend significantly on the kinetic energy of the primary electrons. When low-energy primary electrons are employed (E≤20 eV), the reduction of the SEY is slower and smaller in magnitude than when higher-energy electrons are used. Consequences of this observation are discussed mainly for their relevance on the commissioning scenario for the LHC in operation at CERN (Geneva), but are expected to be of interest for other research fields.

Oromandibular dystonia and hormonal factors: twelve years follow-up of a case report

Oromandibular dystonia (OMD) is a focal neurological movement disorder characterized by involuntary sustained and often painful muscle contraction, usually producing repetitive movements or abnormal positions of the mouth, jaw and/or tongue. We report on a 30-year-old woman affected with OMD with a 12-year follow-up. Focal dystonia involved an involuntary activity of the lateral pterygoid muscles causing forceful jaw displacement in the maximal protrusive position. These episodes initially occurred during jaw function and increased up to an open-lock with bilateral pre-auricular pain. Dystonic spasms were absent during sleep and were reduced temporarily by sensory tricks. Treatment with botulinum toxin type A (BTX) was performed during three different sessions over a 1-year period. Electromyographic-guided BTX injections into the lateral pterygoid muscles were given with cannula electrodes. Botox reduced the involuntary activity of the muscles. Recurrence and exacerbation of dystonic symptoms occurred during the two pregnancies and completely disappeared immediately after both deliveries with prolonged symptom-free periods. During the last 8 years, the patient had a slight relapse of symptoms during flu attacks, periods of stress and during menses. The temporal pattern of these symptoms indicates a possible relationship between OMD and hormonal factors.

Effects of orthognathic surgery for class III malocclusion on signs and symptoms of temporomandibular disorders and on pressure pain thresholds of the jaw muscles

The aim of this longitudinal study was to determine the effects of orthognathic surgery on signs and symptoms of temporomandibular disorders (TMD) and on pressure pain thresholds (PPTs) of the jaw muscles. Fourteen consecutive class III patients undergoing pre-surgical orthodontic treatment were treated by combined Le Fort I osteotomy and bilateral sagittal ramus osteotomy. The clinical examination included the assessment of signs and symptoms of TMD and the assessment of PPTs of the masseter and temporalis muscles. Anamnestic, clinical and algometric data were collected during five sessions over a 1-year period. Seven out of 14 patients presented with disc displacement with reduction at baseline, whereas four patients (two of them were new cases) did so at the end of follow up (p>0.05). None of the patients were diagnosed with myofascial pain of the jaw muscles at the beginning or end of follow up. PPTs of the masseter and temporalis muscles did not change significantly from baseline values throughout the whole study period. The occurrence of signs and symptoms of TMD fluctuates with an unpredictable pattern after orthognathic surgery for class III malocclusions.

Experimental observation of optical rotation generated in vacuum by a magnetic field

We report the experimental observation of a light polarization rotation in vacuum in the presence of a transverse magnetic field. Assuming that data distribution is Gaussian, the average measured rotation is (3.9 +/- 0.5) x 10(-12) rad/pass, at 5 T with 44 000 passes through a 1 m long magnet, with lambda = 1064 nm. The relevance of this result in terms of the existence of a light, neutral, spin-zero particle is discussed.

Electronic and magnetic structures of Sr(2)FeMoO(6)

We have investigated the electronic and magnetic structures of Sr(2)FeMoO(6) employing site-specific direct probes, namely x-ray absorption spectroscopy with linearly and circularly polarized photons. In contrast to some previous suggestions, the results clearly establish that Fe is in the formal trivalent state in this compound. With the help of circularly polarized light, it is unambiguously shown that the moment at the Mo sites is below the limit of detection (<0.25 mu(B)), resolving a previous controversy. We also show that the decrease of the observed moment in magnetization measurements from the theoretically expected value is driven by the presence of mis-site disorder between Fe and Mo sites.

Skeletal changes of Herbst appliance therapy investigated with more conventional cephalometrics and European norms

We measured the skeletal effects of Herbst appliance treatment in a retrospective sample of 25 boys (aged 10.7-14.5 years) and 25 girls (aged 10.7-14.3 years). Selection criteria were (1) a pretreatment full Class II molar relationship (ANB angle: average, 6.7 degrees; range, 2.5-10.5 degrees) and (2) a posttreatment full Class I or overcorrected Class I molar relationship within 6-8 months. A first t-test was used to evaluate variations between pre- and posttreatment cephalometric measures. Then, compared with the appropriate age- and sex-matched European norm, every pre- and posttreatment value was transformed into a z-score on the distribution of the norm value and a second t-test was performed. The second t-test was to study variations between pre- and posttreatment z-scores in order to neutralize the effect of natural growth. Posttreatment, the mandible showed a remarkable forward repositioning without opening of the gonial angle, particularly in males. Only ANB and Xi-CF-PTV angles were significantly different when the effect of normal growth was excluded. In males, ramus height and mandibular basal length were significantly increased when total variation was considered (ie, not excluding the effect of normal growth). In females, only the mandibular ramus height was significantly increased. In conclusion, even short-term Herbst therapy can be efficacious, with the most frequent effect being mandibular forward repositioning followed by mandibular ramus elongation. The statistical procedure used counteracts the effect of growth and sex on the results. Moreover, z-scores are adimensional measures with which any kind of parameter may be compared and scaled to each other in the perspective of a more reliable mutivariated interpretation of cephalometric variables.

Does the ovarian cycle influence the pressure-pain threshold of the masticatory muscles in symptom-free women?

AIMS

To test the hypothesis that the ovarian cycle influences the pressure-pain threshold of the masticatory muscles.

METHODS

Eighteen healthy women with a regular menstrual cycle (28 +/- 2 days), ranging in age from 18 to 35 years, participated in the study. For each subject, pressure-pain thresholds (PPTs) of the masseter and temporalis muscles were assessed at 4 muscular sites by means of an electronic algometer. Measurements were taken at 4 separate sessions across the menstrual cycle corresponding to the following phases: menstrual, follicular, periovulatory, and luteal. Menstrual cycle phases were determined by a pelvic ultrasonographic screening. The study was carried out in a single-blind design, and the initial session was randomly determined for each individual. Data collected were analyzed by repeated-measures analysis of variance.

RESULTS

The findings suggest that the PPTs of several masticatory muscles (2 of 4) are influenced by the ovarian cycle, but to a minor extent (P < 0.05), and the influence is of limited clinical relevance.

CONCLUSION

In healthy subjects, there is a link between mechanical sensitivity of the masticatory muscles and fluctuation of the ovarian hormones. The relationship between PPTs of the masticatory muscles and the ovarian cycle should be also investigated in patients with temporomandibular disorders and/or orofacial pain conditions.

Changes in pressure-pain thresholds of the jaw muscles during a natural stressful condition in a group of symptom-free subjects

AIMS

To investigate the effects of a natural emotional stressor on pressure-pain thresholds (PPTs) of the masticatory muscles of symptom-free subjects.

METHODS

Sixteen healthy dental students were selected before they undertook an academic examination. Sixteen gender-matched students who were not exposed to an examination served as controls. The 2 groups of students were monitored in parallel on 5 separate days over a 1-month period: 2 days before the examination (T1), on the day of the examination (T2), 2 days after (T3), 1 month after (T4), and again after another 2 days (T5). On the day of the examination (T2), the control students were only required to complete a brief, non-demanding questionnaire. On each day, the following parameters were assessed: PPTs of the masseter, the anterior temporalis, and the Achilles tendon; state anxiety; and present stress (measured on a visual analog scale [VAS]). Furthermore, in the students undergoing the examination, venous blood samples for assessment of beta-endorphin levels were obtained at T2 and T5.

RESULTS

In the stressed students, the PPTs of the masticatory muscles and the Achilles tendon were significantly lower (analysis of variance [ANOVA], P < or = 0.02) on the day of the examination (T2) and on the days nearest the exam (T1, T3), and state anxiety and present stress were significantly higher (ANOVA, P < or = 0.003). No significant change was found in beta-endorphin plasma levels (P > 0.05). In the control group, PPTs, state anxiety, and present stress did not change significantly (ANOVA, P > 0.05).

CONCLUSION

The results support a relationship between psychologic stress and pressure-pain sensitivity of the masticatory muscles.

[Epidemiologic study of patients with craniomandibular disorders. Report of data and clinical findings]

BACKGROUND

The purpose of this retrospective study was to identify the subjective and objective characteristics of a population referred to a clinic for diagnosis and treatment of orofacial pain and/or temporomandibular disorders.

METHODS

Beginning in 1993, 825 patients, consecutively referred to the University of Naples Federico II , were examined and their records entered into a database. These data were collected by trained clinicians. Diagnostic subgroups were identified following the Research Diagnostic Criteria for temporomandibular disorders (RDC).

RESULTS

Seventy-nine percent of patients were female, the mean age of the sample was 31.3+/-13 years (range: 5 to 74 years), most of patients were between 15 and 39 years of age. Based on diagnostic subgroups, patients were divided into: patients affected with myogenous pain (59%), arthrogenous pain (13%), arthrogenous and myogenous pain (16%) and fibromyalgia (4%). Sixty-three percent of the sample reported recent headaches, 53% reported parafunction, and 28% reported a previous trauma. Eighty-one percent reported spontaneous pain, which was chronic in 83% of them. The majority of patients (78%) presented a relatively high cultural BACKGROUND.

CONCLUSIONS

These data appear to agree with other epidemiologic studies and depict the TMD treatment-seeking population as a predominantly female population during child-bearing years with multiple chronic pain complaints.

[Muscular physiotherapy in patients with temporomandibular disorders. Controlled clinical trial]

BACKGROUND

The purpose of the present study is to evaluate the short term effects of physiotherapy and counseling in the treatment of myofascial pain of the jaw muscles.

METHODS

Forty consecutive myogenous TMD patients, were assigned to two treatment groups with a balanced-block randomization. The first group received only counseling, the second group received counseling supplemented by physiotherapy. The patients were followed for a period of three months. Data were collected on two different occasions: T0 = baseline and T1 = three months after the start of treatment. Treatment success was decided on the basis of an index called treatment contrast (Tc). It allowed a subjective, an objective and a total evaluation of the effects of the two therapeutic protocols.

RESULTS

There was no significant difference between groups in the outcome measures except for the subjective evaluation of treatment success: physiotherapy seems to be slightly more effective than counseling.

CONCLUSIONS

Elective therapy for the treatment of TMD patients remains the conservative one. Success of this therapy depend on a good patient--clinician relation, which improves patient's compliance.

The diagnostic value of pressure algometry in myofascial pain of the jaw muscles

Recent evidence suggests that evaluation of muscle tenderness in temporomandibular disorders (TMDs) patients might be improved by the use of pressure algometry; nevertheless, the evaluation of the diagnostic value of this tool has received little attention. The aim of this study was to assess the diagnostic value of pressure algometry in myofascial pain of the jaw muscles, by calculation of sensitivity (Se), specificity (Sp) and positive predictive values (PPV). Pressure pain thresholds (PPTs) of masseter and anterior temporalis muscles were assessed in 40 female myogenous TMD patients and 40 age-matched female controls. PPTs were significantly lower (P<0.001) in TMD patients than in control subjects for both masseter and temporalis muscles, being 40-50% of the control values. Setting a cutoff value 1 s.d. below the mean PPT values of control subject, sensitivity and specificity were 0.67 and 0.85, respectively, for the masseter muscle and 0.77 and 0.87, respectively, for the temporalis muscle. When taking into account the prevalences of myofascial pain in the general population and in TMD clinics, the PPV ranged from 0.5 to 0.7. As a result of the low PPV, pressure algometry has strong limitations when used as a solitary diagnostic tool.

In vitro exposure of acute promyelocytic leukemia cells to arsenic trioxide (As2O3) induces the solitary expression of CD66c (NCA-50/90), a member of the CEA family

Arsenic trioxide (As2O3) is a useful drug for the treatment of acute promyelocytic leukemia (APL), acting through a complex mechanism involving the induction of apoptosis. We investigated by flow cytometry whether in vitro treatment of APL leukemic cells with As2O3 determined specific surface membrane changes. Twelve APL bone marrow aspirates were analyzed following 7 days of in vitro treatment with As2O3 (0.25, 0.5 and 2.5 microM) with regard to the expression of a series of differentiation antigens. Twelve acute myeloid leukemia (AML) samples of non-APL morphotype were analyzed as controls. Exposure of APL as well as non-APL samples to any concentration of As2O3 did not affect the expression of beta2 integrins (CD11a and CD11b), CD45 isoforms (RA, RB and R0), CD44/H-CAM, CD33 and the CEA-related antigen family members CD66ade and CD66b, thus failing to disclose any maturating effect. Of interest, in all APL samples (but not in AML) every tested dose of As2O3 determined a dramatic upregulation of CD66c display; intermediate concentration (0.5 microM) of As2O3 increased the median percentage of CD66c+ cells from 5% in control cultures (25th-75th percentile 2-12%) to 80% in drug-exposed cultures (25th-75th percentile 58-90%) (P<0.001). The induction of solitary expression of CD66c is a new finding which demonstrates As2O3 capability of generating phenotypic changes absolutely restricted to APL cells Moreover, these results provide experimental basis for considering the involvement of the newly described CD66 signalling pathway in As2O3-driven programmed cell death.

Comparison of clinical and psychologic features of fibromyalgia and masticatory myofascial pain

The aim of this study was to investigate common symptoms and divergent features in fibromyalgia (FS) and masticatory myofascial pain (MFP) in patients affected by craniomandibular disorders. Twenty-three women with MFP and 23 women with FS were studied. All patients were examined by a dentist and by a rheumatologist. Craniomandibular disorders were assessed with a subjective symptoms questionnaire, detailed history interview, joint function examination, and manual palpation of masticatory and cervical muscles. The Middlesex Hospital Questionnaire was used to obtain personality profiles of the patients. The craniomandibular disorders questionnaire revealed various similarities in the two groups, the most striking of which were pain during mandibular function, articular noises, and headache. Both groups had muscle pain upon palpation; the mean scores (on a 0 to 4 scale) did not differ significantly between the two groups and ranged between 1.39 (SD 1.2) and 2.86 (SD 0.75). The mean value of active mouth opening was 40.9 mm (SD 9.1) in MFP patients and 44.6 mm (SD 7.2) in FS patients, while the mean value of passive opening was 49.6 mm (SD 6.0) in MFP patients and 49.8 mm (SD 3.5) in FS patients. These values did not differ significantly between the two groups, but did differ from the normal population, similar to the trend of the psychologic profile. The authors conclude that the physician should be alert to the need to conduct interdisciplinary evaluations in the diagnosis and management of FS and of MFP.

[Polydistrectual atherosclerosis in the elderly. Ischemic cardiopathy and obliterative peripheral arteriopathy of the lower limbs]

BACKGROUND

Numerous epidemiological studies have recently drawn attention to the polydistrict nature of atherosclerotic disease. In particular, it has been made clear the frequent association between coronary heart disease and peripheral arterial disease of the lower limbs. We have therefore evaluated the frequency of peripheral arterial disease in a consecutive unselected series of patients affected by coronary heart disease, over 65 and under 65. We have besides evaluated the frequency of some factors of risk for atherosclerotic disease on the subjects affected by coronary heart disease alone and in those with associated peripheral arterial disease.

METHODS

We have studied 502 patients (280 males and 222 females) with coronary heart disease admitted to the II Division of General Medicine of Pugliese-Ciaccio Hospital of Catanzaro. Of the 502 patients examined, 367 (72.7%) over 65 and 137 (27.3%) under 65. Factors of risk considered were familiarity, cigarette smoking, diabetes mellitus, dyslipidosis, arterial hypertension.

RESULTS AND CONCLUSIONS

Peripheral arterial disease was present in 37% of the subjects examined. In the elderly group there was a frequency of 87.6%, while in subjects under 65 the frequency was 12.4%. Symptoms of claudicatio were present in 100% of the subjects under 65 and 58.6% of the elderly subjects. Risk factors that apply with greater frequency were diabetes mellitus, arterial hypertension and smoking. The results of our study show the importance of searching for stenosis even if asymptomatic in patients with coronary heart disease, above all if elderly.

Neutrophilic-chronic myeloid leukemia: a distinct disease with a specific molecular marker (BCR/ABL with C3/A2 junction)

Neutrophilic-chronic myeloid leukemia (CML-N) is a rare myeloproliferative disorder that runs a much more benign course than chronic myeloid leukemia, and for which no specific underlying molecular lesion has been described so far. We have analyzed the genomic DNA by Southern blotting and the BCR/ABL hybrid gene transcripts by reverse transcriptase-polymerase chain reaction in three patients with clinical findings of CML-N, who did have a t(9;22) chromosomal translocation. In all patients we have found a rare type of BCR/ABL rearrangement, with a breakpoint between exons c3 and c4 of the BCR gene (corresponding to BCR exons 19 and 20). This was confirmed by hybridization with an oligonucleotide probe spanning the c3/a2 region. This type of junction causes almost the entire BCR gene to fuse with ABL. The junction is in frame and it gives rise to a fusion protein of predicted 230 kD. Our data now provide a molecular diagnostic marker for CML-N, and they are consistent with the notion that the inclusion or exclusion of BCR exons in the fusion protein affects dramatically its capacity to derange myeloid proliferation and differentiation, leading to the appearance of different disease phenotypes.

Coagulation activation and fibrinolytic imbalance in subjects with idiopathic antiphospholipid antibodies--a crucial role for acquired free protein S deficiency

To explore the coagulation/fibrinolytic balance and its relation with free protein S (f-PS) in subjects with antiphospholipid antibodies (aPLs) outside the setting of autoimmune inflammatory disorders, we carried out a cross-sectional study on 18 thrombotic patients with primary antiphospholipid syndrome and 18 apparently healthy subjects with persistence of idiopathic aPLs. Prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT) and D-Dimer (D-D) were taken as markers of thrombin generation and fibrin turnover. Mean F1 + 2 levels were higher in thrombotic (p = 0.006) and non-thrombotic subjects (p = 0.0001) than in controls as were those of D-D (p < 0.0001 and p = 0.003 respectively). TAT levels did not differ. Lower mean levels of f-PS were found in thrombotic (p = 0.0006) and non-thrombotic subjects (p = 0.002) than in controls. Within both groups, mean F1 + 2 levels were higher in subjects who had low f-PS levels compared to those with normal f-PS levels (p = 0.01). Gender analysed data revealed blunted tPA release (venous occlusion test) in thrombotic females (from 16.80 +/- 0.79 to 21.3 +/- 3.9 ng/nl, NS) but not in thrombotic males (from 18.2 +/- 2.0 to 33.7 +/- 4.9 ng/ml, p=0.01) nor in asymptomatic subjects of either sex. Also, in both patient groups females had higher mean PAI than males (p < 0.0002) and than control females (p < 0.02). Low free protein S was found in 100% of non-thrombotic and in 90% of thrombotic patients with defective fibrinolysis. These data are consistent with increased thrombin generation, accelerated fibrin turnover and fibrinolysis abnormalities also in asymptomatic carriers of aPLs and highlight a central role for acquired f-PS deficiency in the thrombotic tendency of the antiphospholipid syndrome.

Recombinant human erythropoietin in transfusion-dependent anemic patients with multiple myeloma and non-Hodgkin's lymphoma--a randomized multicenter study. The European Study Group of Erythropoietin (Epoetin Beta) Treatment in Multiple Myeloma and Non-Hodgkin's Lymphoma

One hundred twenty-one anemic, transfusion-dependent patients with multiple myeloma (MM) or low-grade non-Hodgkin's lymphoma (NHL) were randomly allocated to receive (a) recombinant human erythropoietin (rhEPO) 10,000 U/d subcutaneously 7 days a week (fixed dose group) (n = 38), or (b) rhEPO 2,000 U/d subcutaneously for 8 weeks followed by step-wise escalation of the rhEPO dose (titration group) (n = 44), or (c) no rhEPO therapy (control group) (n = 39). The total treatment period was 24 weeks. There were no differences between the three groups with regard to baseline clinical, demographic, or health status measures. The cumulative response frequency, defined as elimination of the transfusion need in combination with an increase in the hemoglobin concentration by >20 g/L, was 60% in both rhEPO treatment groups and 24% in the control group (P = .01 and .02, respectively, log rank test). For patients in the titration group the response rate on the first dose level (2,000 U/d) was only 14%. Cox's univariate regression analysis revealed that an inadequately low endogenous erythropoietin concentration in relation to the degree of anemia and a baseline platelet concentration > or = 100 x 10(9)/L were significant predictors for response to rhEPO therapy (P < .01). Multivariate regression analysis showed that relative erythropoietin concentration was the most important factor and the platelet count had no additional influence on response. Treatment with rhEPO was well tolerated. We conclude that treatment with rhEPO may be indicated in anemic MM and NHL patients with a relative erythropoietin deficiency. An initial dose of 5,000 U/d subcutaneously may be recommended.

Recombinant human erythropoietin in the anemia associated with multiple myeloma or non-Hodgkin's lymphoma: dose finding and identification of predictors of response

Previous phase I-II clinical trials have shown that recombinant human erythropoietin (rHuEpo) can ameliorate anemia in a portion of patients with multiple myeloma (MM) and non-Hodgkin's lymphoma (NHL). Therefore, we performed a randomized controlled multicenter study to define the optimal initial dosage and to identify predictors of response to rHuEpo. A total of 146 patients who had hemoglobin (Hb) levels < or = 11 g/dL and who had no need for transfusion at the time of enrollment entered this trial. Patients were randomized to receive 1,000 U (n = 31), 2,000 U (n = 29), 5,000 U (n = 31), or 10,000 U (n = 26) of rHuEpo daily subcutaneously for 8 weeks or to receive no therapy (n = 29). Of the patients, 84 suffered from MM and 62 from low- to intermediate-grade NHL, including chronic lymphocytic leukemia; 116 of 146 (79%) received chemotherapy during the study. The mean baseline Hb level was 9.4 +/- 1.0 g/dL. The median serum Epo level was 32 mU/mL, and endogenous Epo production was found to be defective in 77% of the patients, as judged by a value for the ratio of observed-to-predicted serum Epo levels (O/P ratio) of < or = 0.9. An intention-to-treat analysis was performed to evaluate treatment efficacy. The median average increase in Hb levels per week was 0.04 g/dL in the control group and -0.04 (P = .57), 0.22 (P = .05), 0.43 (P = .01), and 0.58 (P = .0001) g/dL in the 1,000 U, 2,000 U, 5,000 U, and 10,000 U groups, respectively (P values versus control). The probability of response (delta Hb > or = 2 g/dL) increased steadily and, after 8 weeks, reached 31% (2,000 U), 61% (5,000 U), and 62% (10,000 U), respectively. Regression analysis using Cox's proportional hazard model and classification and regression tree analysis showed that serum Epo levels and the O/P ratio were the most important factors predicting response in patients receiving 5,000 or 10,000 U. Approximately three quarters of patients presenting with Epo levels inappropriately low for the degree of anemia responded to rHuEpo, whereas only one quarter of those with adequate Epo levels did so. Classification and regression tree analysis also showed that doses of 2,000 U daily were effective in patients with an average platelet count greater than 150 x 10(9)/L. About 50% of these patients are expected to respond to rHuEpo. Thus, rHuEpo was safe and effective in ameliorating the anemia of MM and NHL patients who showed defective endogenous Epo production. From a practical point of view, we conclude that the decision to use rHuEpo in an individual anemic patient with MM or NHL should be based on serum Epo levels, whereas the choice of the initial dosage should be based on residual marrow function.

Simultaneous occurrence of tetrasomy 21 and trisomy 8 in a patient with early blastic metamorphosis of chronic myeloproliferative disorder

We report an unusual hyperdiploid karyotype characterized by the simultaneous occurrence of tetrasomy 21 and trisomy 8 detected during early blastic evolution of a BCR-ABL-negative chronic myeloproliferative disorder. Blast cells from this patient showed a striking response to all-trans-retinoic acid (ATRA)-induced differentiation as evaluated by CD15 expression following in vitro exposure to this inducer. Our report represents the first description of such a composite karyotype in human hematologic malignancies.

Trisomy 13 in a case of myelofibrosis with myeloid metaplasia with early blastic transformation

We describe a case of early myeloid blastic transformation in a 64-year-old man suffering from myelofibrosis with myeloid metaplasia. Both chronic and blastic phase cytogenetic analysis showed trisomy 13 to be the sole chromosome aberration. A potential role for this rare abnormality in determining such an unusually poor clinical outcome is discussed.

Lactate versus bicarbonate on-line hemofiltration: a comparative study

In this study, 6 chronic anuric uremic patients underwent lactate hemofiltration (HF) with a substitution fluid, prepared in bags, for 3 months and bicarbonate HF, with continuous on-line preparation of the substitution fluid, for 3 months. We determined Na+, Cl-, K+, total calcium (Ca), ionized calcium (Ca2+), phosphate, intact parathormone (I-PTH), pH, PCO2, PO2, and HCO3- in plasma before, during, and after the treatment, as well as Ca, Ca2+, phosphate, and I-PTH in the ultrafiltrate. Moreover, heart rate (HR) and mean arterial pressure (MAP) were continually recorded during the procedure. Furthermore, the patients underwent echocardiographic study before and after the session. In comparison with lactate, bicarbonate HF caused a significant increase in HCO3- and a decrease in K+ plasma concentrations. This was detectable, with lower significance, even 44 h after the end of the treatment. At the end of the long interdialytic period (68 h after the end of the treatment), no significant difference was detectable. pH and PCO2 showed a significant but transient increase during HF. The other parameters investigated did not differ significantly between the two methods.

Early blastic transformation of a myeloproliferative disorder with t(8;21) and progressive aberrations of chromosome 8

We describe a case of a patient affected by a chronic myeloproliferative disorder with t(8;21)(q22;q22) and trisomy 8 at diagnosis. At the time of blastic metamorphosis, 2 months later, trisomy 8 metaphases were significantly reduced, while a predominance of t(8;21) was present. Finally, in the phase of leukemic regrowth following chemotherapy administration, monosomy 8 associated with der(21)t(8;21) was the predominant cytogenetic abnormality.

Recombinant interferon alpha-2b as treatment of essential thrombocythaemia

We report the disease characteristics and therapeutic results for 25 patients suffering from essential thrombocythaemia (ET), treated with recombinant interferon-alpha-2b (IFN-alpha 2b). ET was diagnosed according to the criteria of the Polycythaemia Vera Study Group. All patients were programmed to receive a subcutaneous induction treatment consisting of 3 MU of IFN-alpha 2b daily for 6 months. In responding patients, treatment was continued for a further 6 months with 3 MU of IFN-alpha 2b three times a week. Complete response was achieved in 13 of 25 patients, partial response in 10 of 25. In 2 cases, therapy was unsuccessful. Side effects were usually mild, consisting of flu-like symptoms in most cases, and were easily controlled by paracetamol. After a median follow-up of 14 months after discontinuation of the treatment, most patients retained the therapeutic response in the absence of toxicity.

Recombinant interferon alpha-2b in the treatment of polycythemia vera

We studied the effects of recombinant alpha 2-b interferon (alpha 2-b IFN) in a dose of 3 x 10(6)U intramuscularly three times a week for 1 year in 13 patients affected by polycythemia vera (PV) previously treated with phlebotomy only. Response to treatment was evaluated by reduction of the number of phlebotomies required to retain normal hematocrit value. Ten out of 13 patients (77%) responded to treatment; in 4 of them the exigency of phlebotomy was completely eliminated. In all responders a concomitant decrease of platelet count and splenomegaly was obtained. Treatment was well tolerated and side effects were easily controlled. We conclude that alpha-IFN may represent an attractive therapeutic option in the management of the proliferative stages of PV.