Attenuation of renal ischemia-reperfusion injury in inducible nitric oxide synthase knockout mice

Renal ischemia-reperfusion (I/R) injury was investigated in inducible nitric oxide synthase (iNOS) knockout mice. After a 26-min bilateral renal pedicle clamp, serum creatinine concentrations (in mg/dl) in wild-type mice after a 24-h reperfusion were 0.25 +/- 0.03 in sham-operated controls and 2.3 +/- 0.38 in ischemic mice (P < 0. 01); after 48 h, concentrations (in mg/dl) were 0.25 +/- 0.03 in controls and 2.0 +/- 0.18 in ischemic mice (P < 0.01). iNOS knockout mice demonstrated an attenuation of serum creatinine concentration after renal I/R injury. Serum creatinine concentrations (mg/dl) after a 24-h reperfusion were 2.3 +/- 0.22 in wild-type ischemic and 1.21 +/- 0.25 in iNOS knockout ischemic mice (P < 0.05); after 48 h, concentrations were 2.0 +/- 0.18 in wild-type ischemic and 0.96 +/- 0.25 in iNOS knockout ischemic mice (P < 0.01). Histological scoring of acute tubular necrosis in iNOS knockout mice was decreased compared with that in wild-type controls (0.88 +/- 0.2 vs. 3.3 +/- 0. 3, P < 0.05). iNOS protein in the renal cortex of wild-type mice subjected to renal I/R injury was undetectable up to 48 h. However, a strong upregulation of heat shock protein 72 expression was observed in renal cortex of iNOS knockout mice under basal conditions. In conclusion, kidneys of iNOS knockout mice were protected against ischemic acute renal failure. This protective effect may be related to a compensatory upregulation of heat shock protein 72.

Renal osteopontin expression in experimental urolithiasis

Although osteopontin (Opn) is a strong inhibitor of calcium oxalate crystallization in vitro, its role in stone formation in vivo is unknown. We investigated the renal expression of Opn in normal, ethylene glycol (EG), and EG + ammonium chloride-treated rats. Male Sprague-Dawley rats were divided into three groups. Group 1 (N = 5) was the control. Animals in Group 2 (N = 6) received 4 weeks of treatment with 0.75% EG, and Group 3 animals (N = 6) were given 1 week of treatment with 0.75% EG and 1.0% NH4Cl. The kidneys were then examined for crystal deposition and Opn localization. In normal rats, staining for Opn was evident in the proximal tubules (PT; S3 > S2 > S1), distal tubules (DT), and the thick ascending limbs of Henle (TAL) and a few collecting ducts (CD). All rats in Group 3 had significant crystal deposition throughout their kidneys. In Group 2 rats, Opn staining increased in all segments of the PT, DT, and TAL. Staining in these tubular segments was even greater in Group 3 rats, including the CD and the papillary surface epithelium. In addition, Opn was present within all crystal deposits. Renal Opn expression in experimental urolithiasis becomes stronger and more diffuse as the severity of the lithiasis-inducing treatment increases. These results are consistent with the hypothesis that renal epithelial cells produce larger amounts of osteopontin to combat the development of kidney stones.

State-of-the-Art and Upcoming Innovations in Pancreatic Cancer Care: A Step Forward to Precision Medicine

Pancreatic cancer remains a social and medical burden despite the tremendous advances that medicine has made in the last two decades. The incidence of pancreatic cancer is increasing, and it continues to be associated with high mortality and morbidity rates. The difficulty of early diagnosis (the lack of specific symptoms and biomarkers at early stages), the aggressiveness of the disease, and its resistance to systemic therapies are the main factors for the poor prognosis of pancreatic cancer. The only curative treatment for pancreatic cancer is surgery, but the vast majority of patients with pancreatic cancer have advanced disease at the time of diagnosis. Pancreatic surgery is among the most challenging surgical procedures, but recent improvements in surgical techniques, careful patient selection, and the availability of minimally invasive techniques (e.g., robotic surgery) have dramatically reduced the morbidity and mortality associated with pancreatic surgery. Patients who are not candidates for surgery may benefit from locoregional and systemic therapy. In some cases (e.g., patients for whom marginal resection is feasible), systemic therapy may be considered a bridge to surgery to allow downstaging of the cancer; in other cases (e.g., metastatic disease), systemic therapy is considered the standard approach with the goal of prolonging patient survival. The complexity of patients with pancreatic cancer requires a personalized and multidisciplinary approach to choose the best treatment for each clinical situation. The aim of this article is to provide a literature review of the available treatments for the different stages of pancreatic cancer.

Autoimmune Pancreatitis: From Pathogenesis to Treatment

Autoimmune pancreatitis (AIP) is a rare disease. The diagnosis of AIP is difficult and should be made by a comprehensive evaluation of clinical, radiological, serological, and pathological findings. Two different types of AIP have been identified: autoimmune pancreatitis type 1 (AIP-1), which is considered a pancreatic manifestation of multiorgan disease related to IgG4, and autoimmune pancreatitis type 2 (AIP-2), which is considered a pancreas-specific disease not related to IgG4. Although the pathophysiological conditions seem to differ between type 1 and type 2 pancreatitis, both respond well to steroid medications. In this review, we focused on the pathogenesis of the disease to develop a tool that could facilitate diagnosis and lead to the discovery of new therapeutic strategies to combat autoimmune pancreatitis and its relapses. The standard therapy for AIP is oral administration of corticosteroids. Rituximab (RTX) has also been proposed for induction of remission and maintenance therapy in relapsing AIP-1. In selected patients, immunomodulators such as azathioprine are used to maintain remission. The strength of this review, compared with previous studies, is that it focuses on the clear difference between the two types of autoimmune pancreatitis with a clearly delineated and separate pathogenesis. In addition, the review also considers various therapeutic options, including biologic drugs, such as anti-tumor necrosis factor (TNF) therapy, a well-tolerated and effective second-line therapy for AIP type 2 relapses or steroid dependence. Other biologic therapies are also being explored that could provide a useful therapeutic alternative to corticosteroids and immunosuppressants, which are poorly tolerated due to significant side effects.

Gut dysbiosis-related thrombosis in inflammatory bowel disease: Potential disease mechanisms and emerging therapeutic strategies

Patients with inflammatory bowel disease (IBD) have an increased risk of developing venous thromboembolic events, which have a considerable impact on morbidity and mortality. Chronic inflammation plays a crucial role in the pathogenesis of thrombotic events in patients with IBD. However, many unresolved questions remain, particularly regarding the mechanisms that determine the persistent inflammatory state independent of disease activity. This review explored the role of gut microbiota dysbiosis and intestinal barrier dysfunction, which are considered distinctive features of IBD, in determining pro-thrombotic tendencies. Gut-derived endotoxemia due to the translocation of bacterial lipopolysaccharides (LPS) from the intestine to the bloodstream and the bacterial metabolite trimethylamine-N-oxide (TMAO) are the most important molecules involved in gut dysbiosis-related thrombosis. The pathogenic prothrombotic pathways linked to LPS and TMAO have been discussed. Finally, we present emerging therapeutic approaches that can help reduce LPS-mediated endotoxemia and TMAO, such as restoring intestinal eubiosis, normalizing intestinal barrier function, and counterbalancing the effects of LPS and TMAO.

Effects of sequential stimuli on Halobacterium salinarium photobehavior

We analyzed the motor photoresponses of Halobacterium salinarium to different test stimuli applied after a first photophobic response produced by a step-down of red-orange light (prestimulus). We observed that pulses given with a suitable delay after the prestimulus produced unusual responses. Pulses of blue, green, or red-orange light, each eliciting no response when applied alone, produced a secondary photophobic response when applied several seconds after the prestimulus; the same occurred with a negative blue pulse (rapid shut-off and turning on of a blue light). Conversely, no secondary photophobic response was observed when the test stimulus was a step (a step-up for red-orange light, a step-down for blue light) of the same wavelength and intensity. When the delay was varied, different results were obtained with different wavelengths; red-orange pulses were typically effective in producing a secondary photophobic response, even with a delay of 2 s, whereas the response to a blue pulse was suppressed when the test stimulus was applied within 5 s after the prestimulus. The secondary photophobic response to pulses was abolished by reducing the intensity of the prestimulus without affecting the primary photophobic response. These results, some of which were previously reported in the literature as inverse effects, must be produced by a facilitating mechanism depending on the prestimulus itself, the occurrence of reversals being per se ineffective. The fact that red-orange test stimuli are facilitated even at the shortest delay, whereas those of different wavelengths become effective only after several seconds, suggests that the putative mechanism of the facilitating effect is specific for different signaling pathways.

Clinical Implications of Helicobacter pylori Antibiotic Resistance in Italy: A Review of the Literature

Helicobacter pylori (H. pylori) resistance to antibiotics has increased worldwide in recent decades, especially to clarithromycin. As a result, the World Health Organization (WHO) identified clarithromycin-resistant H. pylori as a "high priority" pathogen in 2017. As international guidelines recommend empirical therapy as first-line treatment, it is crucial to know local resistance rates and history of antibiotic use to determine the most appropriate first-line antibiotic treatment. Italy is one of the European countries with the highest prevalence of H. pylori infection and the highest percentage of antibiotic-resistant H. pylori. The aim of this review is to summarize all data on H. pylori antibiotic resistance in Italy in order to quantify the current rate and determine the most effective therapeutic approach. The study confirms an elevated level of resistance to clarithromycin, metronidazole, and levofloxacin in Italy. In addition, our results show a satisfactory eradication rate for a bismuth-based regimen when used as first- or second-line treatment. Naive patients are also successfully treated with clarithromycin-based quadruple therapies. Considering the good results of bismuth-based therapy as recovery therapy, this argues for the potential use of clarithromycin quadruple therapy as a first-line treatment.

Photoresponses of Halobacterium salinarum to repetitive pulse stimuli

Halobacterium salinarum cells from 3-day-old cultures have been stimulated with different patterns of repetitive pulse stimuli. A short train of 0.6-s orange light pulses with a 4-s period resulted in reversal peaks of increasing intensity. The reverse occurred when blue light pulses were delivered as a finite train: with a 3-s period, the response declined in sequence from the first to the last pulse. To evaluate the response of the system under steady-state conditions of stimulation, continuous trains of pulses were also applied; whereas blue light always produced a sharply peaked response immediately after each pulse, orange pulses resulted in a declining peak of reversals that lasted until the subsequent pulse. An attempt to account for these results in terms of current excitation/adaptation models shows that additional mechanisms appear to be at work in this transduction chain.

Impact of COVID-19 in individuals with and without pre-existent digestive disorders with a particular focus on elderly patients

Coronavirus disease 2019 (COVID-19) has several extrapulmonary symptoms. Gastrointestinal (GI) symptoms are among the most frequent clinical manifestations of COVID-19, with severe consequences reported in elderly patients. Furthermore, the impact of COVID-19 on patients with pre-existing digestive diseases still needs to be fully elucidated, particularly in the older population. This review aimed to investigate the impact of COVID-19 on the GI tract, liver, and pancreas in individuals with and without previous digestive diseases, with a particular focus on the elderly, highlighting the distinctive characteristics observed in this population. Finally, the effectiveness and adverse events of the anti-COVID-19 vaccination in patients with digestive disorders and the peculiarities found in the elderly are discussed.

Photobehavior of Halobacterium halobium: sinusoidal stimulation and a suppression effect of responses to flashes

Sequences of reversals recorded by single-cell observation of Halobacterium halobium are analyzed. Autocorrelation functions of spontaneous and stimulated reversals are computed; the results show that the only periodicity present in our data is that of the stimulus. Several different patterns of light stimuli were used. Responses to repetitive linear ramps of different slopes and to sinusoidal lights with different mean values and/or modulation depths are reported, showing that the modulation depth is the stimulus parameter most effective in eliciting photoresponses. Responses to more complex stimuli obtained by superimposing flashes to sinusoidal stimuli are also reported; a suppression effect depending on the phase of the sinusoidal stimulation is shown in responses to complex stimuli. A model which accounts for this effect is proposed.

Competition-integration of blue and orange stimuli in Halobacterium salinarum cannot occur solely in SRI photoreceptor

Experiments on the integration of blue and orange stimuli in Halobacterium salinarum were performed by using different combinations of blue and orange steps. The results show that the prevalence of the blue stimulus over the orange one depends on both the blue and the orange light intensities. A quantitative analysis of the current hypotheses on the phototransduction of orange and UV-blue light stimuli is presented, showing that the balancing between the two antagonistic stimuli should depend only on the intensity of the blue stimulus and not on that of the orange one, provided that the combination of the two stimuli occurs linearly at the photoreceptor stage. We conclude that blue and orange stimuli elicit distinct intracellular signals whose integration occurs downstream of the photoreceptor.

Photosensory transduction in Halobacterium salinarium: evidence for a non-linear network of cross-talking pathways

Transduction of light stimuli in Halobacterium salinarium is studied by behavioural experiments. Selected patterns of sequential stimuli (impinging on couples of the signalling states of its photoreceptors) show that a simple model integrating different stimuli is inadequate and that non linear interactions between different pathways occur through a network with several connections. The experiments reported herein yield rough but clear-cut information on the level of such interactions and shed new light on earlier findings.

Motor responses of Halobacterium halobrium to sinusodial light stimuli

Sinusoidal light stimuli have been used to elicit photoresponses in Halobacterium halobium at various periods of the stimulus. Cycle histograms and histograms of the times between consecutive reversals are used to illustrate the responses, and the method used to obtain sinusoidally modulated intense light (with periods up to 1 s) is described.

Nutrition in Acute Pancreatitis: From the Old Paradigm to the New Evidence

The nutritional management of acute pancreatitis (AP) patients has widely changed over time. The "pancreatic rest" was the cornerstone of the old paradigm, and nutritional support was not even included in AP management. Traditional management of AP was based on intestinal rest, with or without complete parenteral feeding. Recently, evidence-based data underlined the superiority of early oral or enteral feeding with significantly decreased multiple-organ failure, systemic infections, surgery need, and mortality rate. Despite the current recommendations, experts still debate the best route for enteral nutritional support and the best enteral formula. The aim of this work is to collect and analyze evidence over the nutritional aspects of AP management to investigate its impact. Moreover, the role of immunonutrition and probiotics in modulating inflammatory response and gut dysbiosis during AP was extensively studied. However, we have no significant data for their use in clinical practice. This is the first work to move beyond the mere opposition between the old and the new paradigm, including an analysis of several topics still under debate in order to provide a comprehensive overview of nutritional management of AP.

Drug-Induced Acute Pancreatitis in Adults: Focus on Antimicrobial and Antiviral Drugs, a Narrative Review

Acute pancreatitis (AP) is an acute inflammation of the pancreas caused by the activation of digestive enzymes in the pancreatic tissue. The main causes of AP are cholelithiasis and alcohol abuse; less commonly, it can be caused by drugs, with a prevalence of up to 5%. Causal associations between drugs and pancreatitis are largely based on case reports or case series with limited evidence. We reviewed the available data on drug-induced AP, focusing on antimicrobial drugs and antivirals, and discussed the current evidence in relation to the classification systems available in the literature. We found 51 suspected associations between antimicrobial and antiviral drugs and AP. The drugs with the most evidence of correlation are didanosine, protease inhibitors, and metronidazole. In addition, other drugs have been described in case reports demonstrating positive rechallenge. However, there are major differences between the various classifications available, where the same drug being assigned to different probability classes. It is likely that the presence in multiple case reports of an association between acute pancreatitis and a drug should serve as a basis for conducting prospective randomized controlled trials to improve the quality of the evidence.

Altered GIP/GLP-1 Secretion Ratio is Associated With Impaired β Cell Function in Humans

INTRODUCTION

The entero-insular axis, mediated by the incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), is fundamental to maintaining glucose homeostasis. Dysregulation of these hormones' biology contributes to the pathogenesis of type 2 diabetes (T2D), but the existence of a dysfunctional secretory pattern of incretins toward deterioration of glucose tolerance is still debated. In this study, we evaluate possible impairments in the overall incretin secretion from normal glucose tolerance to overt diabetes, as well as their association with impaired insulin secretion.

METHODS

Sixty subjects with an unknown history of T2D who were not on antidiabetic treatments were divided into 3 groups according to oral glucose tolerance test-derived glucose tolerance: normal glucose tolerance (NGT) (n = 23), impaired glucose tolerance (IGT) (n = 16), and diabetes mellitus (DM) (n = 21). All subjects underwent deep metabolic evaluation with a mixed meal test (MMT) and euglycemic hyperinsulinemic clamp. During the MMT, we calculated the GIP/GLP-1 secretion ratio (SR) and the GIP/GLP-1 SR areas under the curve. Parameters of β cell function were obtained by mathematical modeling.

RESULTS

Linear mixed model analysis revealed similar GIP and GLP-1 responses to MMT among the 3 groups, while GIP/GLP-1 SR was reduced in DM subjects compared to NGT and IGT. Further, multiple regression analysis showed a predictive role of GIP/GLP-1 SR on rate sensitivity and standardized insulin secretion at 5 mmol/L.

CONCLUSION

Our findings demonstrate that, despite similar GIP and GLP-1 secretion, the GIP/GLP-1 SR declines as glucose tolerance deteriorates, reflecting an imbalance in incretin dynamics rather than absolute hormone secretion. This imbalance may indicate early β cell dysfunction and chronic incretin resistance.

Prediction regions based on dissimilarity functions

This paper presents a new methodology to obtain prediction regions of the output of a dynamical system. The proposed approach uses stored past outputs of the system and it is entirely data-based. Only two hyperparameters are necessary to apply the proposed methodology. These scalars are chosen so that the size of the obtained regions is minimized while fulfilling the desired empirical probability in a validation set. In this paper, methods to optimally estimate both hyperparameters are provided. The provided prediction regions are convex and checking if a given point belongs to a computed prediction region amounts to solving a convex optimization problem. Also, approximation methods to build ellipsoidal prediction regions are provided. These approximations are useful when explicit descriptions of the regions are necessary. Finally, some numerical examples and comparisons for the case of a non-linear uncertain kite system are provided to prove the effectiveness of the proposed methodology.

Identification and purification of overlapping cosmid clones of the region Xq24-qter of human X chromosome using HPLC

The assembly of a large physical map of genomes requires simultaneous analysis of many cosmid clones for overlapping regions. The search for overlapping regions may be achieved by various means. High-performance liquid chromatography (HPLC) provides an alternative to gel electrophoresis since microgram amounts of each DNA fragment may be collected into individual test tubes for further analysis. HPLC has been used to identify overlapping cosmid clones from a pool of cosmid DNA containing the terminal portion of the long arm of the human X chromosome (Xq24-qter). Among 400 cosmids analyzed, 3 were shown to overlap.

Photoreceptor sensitivity and the shot noise of chemical processes

The general modeling of dose-response curves to very low stimuli in a photosensory-effector system is critically reshaped starting from basic assumptions on the fluctuations of chemical signals inside the receptor cell, which add to those of the stimulus itself, both arising from their granular (or quantal) structure. We have shown, both through the analytical treatment of a simple kinetic scheme and by means of Monte Carlo simulations of the same, that shot noise arising from chemical transduction ("chemical shot noise") contributes considerably to the output noise of the receptor-effector system, thus affecting both the shape and the abscissa shift of dose-response curves under these conditions; the latter phenomenon has indeed been reported in Halobacterium halobium. After evaluating the general properties of a single-step amplifying mechanism, the effects of introducing several low-amplifying steps in cascade were investigated briefly. The results obtained were qualitatively and quantitatively at variance from those of earlier models on the same phenomenon, and the discrepancies are discussed in order to highlight the fundamental contribution of chemical shot noise to the response of any kind of sensory system to very low stimuli.

Sarcopenia in critically ill patients: the new pandemia

Alteration of muscle mass and function is often observed in critically ill patients and its etiology is multifactorial. Besides the effects of acute disease on muscle metabolism, intensive care stay may per se contribute to muscle derangements. Recently, the concept of sarcopenia has been completely revisited, and indicates the loss of muscle mass and function. Although sarcopenia is generally observed and diagnosed in older adults it may be present in different clinical settings, including critical illness. Sarcopenia in the intensive care unit (ICU) negatively impacts on patients' outcomes and may determine a negative long-term impact on ICU survivors. Additionally, sarcopenia may promote functional disability in the long-term after hospital discharge. Limited data are available on the prevalence of sarcopenia at ICU admission. Considering the growing population of older adults with multiple comorbidities, modern intensive care medicine should pay attention to the prevention of ICU-related sarcopenia and also to the routine screening for sarcopenia at ICU admission.

Color-specific conditioning effects due to both orange and blue stimuli are observed in a Halobacterium salinarum strain devoid of putative methylatable sites on HtrI

Behavioral responses of Halobacterium salinarum appear as changes in the frequency of motion reversals. Turning on orange light decreases the reversal frequency, whereas blue light induces reversals. Light pulses normally induce the same response as step-up stimuli. However, anomalous behavioral reactions, including inverse responses, are seen when stimuli are applied in sequence. The occurrence of a prior stimulus is conditioning for successive stimulation on a time scale of the same order of adaptational processes. These prolonged conditioning effects are color-specific. The only adaptation process identified so far is methylation of the transducers, and this could be somehow color-specific. Therefore we tested for the behavioral anomalies in a mutant in which all methylation sites on the transducer have been eliminated. The results show that behavioral anomalies are unaffected by the absence of methylation processes on the transducer.

Exploring the Role of Gut Microbiota and Probiotics in Acute Pancreatitis: A Comprehensive Review

Acute pancreatitis (AP) is a common and potentially severe gastrointestinal condition characterized by acute inflammation of the pancreas. The pathophysiology of AP is multifactorial and intricate, involving a cascade of events that lead to pancreatic injury and systemic inflammation. The progression of AP is influenced by many factors, including genetic predispositions, environmental triggers, and immune dysregulation. Recent studies showed a critical involvement of the gut microbiota in shaping the immune response and modulating inflammatory processes during AP. This review aims to provide a comprehensive overview of the emerging role of gut microbiota and probiotics in AP. We analyzed the implication of gut microbiota in pathogenesis of AP and the modification during an acute attack. The primary goals of microbiome-based therapies, which include probiotics, prebiotics, antibiotics, fecal microbiota transplantation, and enteral nutrition, are to alter the composition of the gut microbial community and the amount of metabolites derived from the microbiota. By resetting the entire flora or supplementing it with certain beneficial organisms and their byproducts, these therapeutic approaches aim to eradicate harmful microorganisms, reducing inflammation and avoiding bacterial translocation and the potential microbiota-based therapeutic target for AP from nutrition to pre- and probiotic supplementation to fecal transplantation.