Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients

The costotransverse joints (CTJs) are small arthrodial joints which articulate with the costal tuberosity on the transverse process of the thoracic vertebrae. CTJs are composed of oval-shaped facets with a major axis, vertical at the upper vertebrae and almost horizontal at the lower vertebrae. This position explains the different movements of the ribs: the cranial ribs move on the sagittal plane and the caudal ribs on the transverse plane. Movements in directions other than these usual CTJ spatial planes can cause inflammation resulting in a stinging pain in the space between the scapula and thoracic spine. We studied 15 subjects with paravertebral pain compatible with CTJ pathology. Mean age was 29 years, 11 females/4 males. In 12 patients, the non-dominant limb was affected. US imaging was carried out using linear 12 MHz and 9 MHz probes. Scanning was performed following the long axis of the rib (transverse plane) and the short axis (sagittal plane). Sagittal scanning is the method of choice for detection of possible joint effusion and comparison with undamaged joints above and below. US identified joint effusion correlating with the site of pain in all patients. Thickening of the posterior costotransverse capsular ligament was detected in six patients mainly affecting the first thoracic vertebrae. Power Doppler showed intraarticular hypervascularization in four patients. US imaging should be performed as a first-line examination in the evaluation of patients with stinging pain in the paravertebral region. US evidence of effusion within the joints is a sure sign of involvement of these structures.

Selected isolates of Trichoderma gamsii induce different pathways of systemic resistance in maize upon Fusarium verticillioides challenge

The pink ear rot is one of the most damaging maize diseases, caused by the mycotoxigenic fungal pathogen, Fusarium verticillioides. The application of biological control agents, like antagonistic and/or resistance inducer microorganisms, is an option to reduce fungal infection and kernel contamination in a sustainable and environmentally friendly way. It is well known that Trichoderma species are non-pathogenic fungi able to antagonize plant pathogens and to induce systemic resistance in plants. The present work aimed to verify if Trichoderma spp., applied to maize kernels, affect the plant growth and induce systemic responses to F. verticillioides. Besides, the capability to reduce fumonisin concentration in liquid cultures was investigated. Two T. gamsii (IMO5 and B21), and one T. afroharzianum (B75) isolates, selected both for antagonism and for the ability to reduce root infections, significantly reduced the endophytic development of the stem-inoculated pathogen, compared to the control. The mechanisms of action appeared to be strain-specific, with IMO5 enhancing transcript levels of marker genes of Induced Systemic Resistance (ZmLOX10, ZmAOS, and ZmHPL) while B21 enhancing marker genes of Systemic Acquired Resistance (ZmPR1 and ZmPR5), as evinced by measuring their expression profiles in the leaves. Moreover, IMO5 promoted plant growth, while B21 was able to significantly reduce the fumonisin content in a liquid medium. The results of this work give new evidence that the seed application of T. gamsii is a promising tool for controlling F. verticillioides to be integrated with breeding and the adoption of good agricultural practices.

Mantle cell lymphoma: from ultrasound examination to histological diagnosis

We report the case of a 42-year-old patient referred to our department for the examination of two large, symmetrical inguinal lumps. The ultrasound examination of the swollen lymph node demonstrated a cortical echogenicity greater than the medullary echogenicity, and the vascularization stop around the cortical zone suggested a pathological pattern of mantle cell lymphoma. In this type of lymphoma, lymphocytes are localized in a mantle zone, inducing a thickening of the lumps. Therefore, for the first time, ultrasound examination detected sonographic vascular features of mantle cell lymphoma, allowing the identification of the disease and suggesting the specific histological diagnosis.

Pattern of drug use among preterm neonates: results from an Italian neonatal intensive care unit

BACKGROUND

Drug use in preterm neonates admitted to Neonatal Intensive Care Unit (NICU) has been investigated, so far, in terms of unauthorized or off-label use; very little is known on the use of combinations of different active substances, which is frequently required in this population (prophylaxis of infections, treatment of concomitant diseases). The aim of this study was to describe the most common patterns of drug use in an Italian NICU, focusing on those with nephrotoxic potential.

METHODS

Medical records of preterm neonates (<37 weeks of gestational age) weighing less than 1,500 g at birth and admitted to an Italian NICU were scrutinized in a 3-year retrospective investigation. Analysis included drug exposure, duration of therapies, co-administration of drugs with potential renal side effects; also daily protein supplement was calculated from parenteral nutrition.

RESULTS

A cohort of 159 preterm neonates was selected; 68 were born weighing less than 1,000 g (extremely low birth weight infants, ELBW, Group A), 91 weighed between 1,000 and 1,500 g at birth (Group B). Compared to Group B, neonates of Group A were more likely to receive pharmacological treatments: the most used drugs were antibiotics (especially ampicillin and amikacin, p = .07 and p < .001, respectively), antifungals (especially fluconazole, p < .001), and diuretics (especially furosemide, p < .001). Analysis of co-administration of drugs with potential nephrotoxicity showed ampicillin and amikacin as the most reported combination (94.1% of Group A and 31.9% of Group B), the combination of furosemide with antibacterials (ampicillin or amikacin) was also frequently reported, with average period of combination shorter than 2 days.

CONCLUSIONS

ELBW infants were exposed to a higher number of drugs compared to other neonates and were more likely to receive associations of drugs with nephrotoxic potential (e.g. furosemide and amikacin), though only for short cycles. Further studies should evaluate the safety profile (especially potential renal side effects) related to most commonly used combinations.

lncRNA profiling in early-stage chronic lymphocytic leukemia identifies transcriptional fingerprints with relevance in clinical outcome

Long non-coding RNAs (lncRNAs) represent a novel class of functional RNA molecules with an important emerging role in cancer. To elucidate their potential pathogenetic role in chronic lymphocytic leukemia (CLL), a biologically and clinically heterogeneous neoplasia, we investigated lncRNAs expression in a prospective series of 217 early-stage Binet A CLL patients and 26 different subpopulations of normal B-cells, through a custom annotation pipeline of microarray data. Our study identified a 24-lncRNA-signature specifically deregulated in CLL compared with the normal B-cell counterpart. Importantly, this classifier was validated on an independent data set of CLL samples. Belonging to the lncRNA signature characterizing distinct molecular CLL subgroups, we identified lncRNAs recurrently associated with adverse prognostic markers, such as unmutated IGHV status, CD38 expression, 11q and 17p deletions, and NOTCH1 mutations. In addition, correlation analyses predicted a putative lncRNAs interplay with genes and miRNAs expression. Finally, we generated a 2-lncRNA independent risk model, based on lnc-IRF2-3 and lnc-KIAA1755-4 expression, able to distinguish three different prognostic groups in our series of early-stage patients. Overall, our study provides an important resource for future studies on the functions of lncRNAs in CLL, and contributes to the discovery of novel molecular markers with clinical relevance associated with the disease.

Silymarin and lycopene administration in periparturient dairy cows: effects on milk production and oxidative status

AIMS

To establish during late gestation and early lactation the effects of supplementing silymarin, a natural hepatoprotective substance, combined with a powerful antioxidant, lycopene, on milk production and on serum biomarkers of oxidative status.

METHODS

Italian Friesian dairy cows were given individually a supplement containing a mixture of silymarin (7.77 g/day/cow) and lycopene (1.27 g/day/cow) (n=10) or no supplement (control; n=10). Treatment was administered from 7 days before the expected calving date to the first 14 days in milk. At 7 days before the expected calving date, at calving, and 7 days postpartum, body condition score (BCS) and concentrations in serum of reactive oxygen metabolites (ROM), total antioxidant capacity (OXY) and thiobarbituric acid reactive substances (TBARS) were evaluated. Bodyweight, milk production, and somatic cell count (SCC) were determined at 7, 14 and 21 days postpartum.

RESULTS

The mean time of treatment prior to calving was 6.3 (min 4, max 11) days. Compared with control cows, treatment increased energy corrected milk yield (33.3 vs. 37.8 (SEM 1.10) kg/day; p=0.006) and milk fat yield (1.14 vs. 1.32 (SEM 0.06) kg/day; p=0.05) over the first 21 days of lactation. Treated cows had lower mean log10 SCC compared to control cows (4.9 vs. 5.24 (SEM 0.11) log10 cells/mL) and had lower overall concentration of TBARS (1.47 vs. 1.59 (SEM 0.016) nM/mL; p<0.001), but similar concentrations of ROM and OXY in serum. However there was a treatment by time interaction (p=0.09) for OXY, and at calving mean OXY was higher in treated cows compared with pre-calving values (p<0.001).

CONCLUSIONS

Despite the acknowledged limitation of the study, i.e. the small number of animals, our results suggest that silymarin and lycopene, as health-beneficial feed supplements, may help dairy cows in metabolic adaptation during the first stages of lactation.

CLINICAL RELEVANCE

During the peripartum period dairy cows suffer moderate-to-severe fatty liver and from an overproduction of free radicals. The supplementation of a mixture of silymarin and lycopene during these stressful days may be useful to mitigate these metabolic disorders with beneficial effects on the subsequent lactation.

Isatis canescens is a rich source of glucobrassicin and other health-promoting compounds

BACKGROUND

Glucobrassicin (GBS), a glucosinolate contained in many brassica vegetables, is the precursor of chemopreventive compounds such as indole-3-carbinol. Large amounts of GBS would be needed to perform studies aimed at elucidating its role in the diet. This study was mainly undertaken to evaluate the flower buds of Isatis canescens as a source for GBS purification. In order to investigate the health-promoting potential of this species, glucosinolate, phenol and flavonoid content as well as the whole antioxidant capacity were also determined. Flower bud samples were collected in four localities around Mount Etna in Sicily, Italy, where I. canescens is widespread, as they are locally traditionally eaten.

RESULTS

I. canescens flower buds displayed high GBS concentrations, up to 60 µmol g(-1) dry weight. The purification method consisted of two chromatographic steps, which made it possible to obtain GBS with a purity of 92-95%, with a yield of 21 g kg(-1) . The total glucosinolates, phenols, flavonoids and antioxidant activity were considerable, with the southern locality showing the highest concentrations for all the phytochemicals.

CONCLUSION

I. canescens flower buds represent a naturally rich source of GBS, at a level suitable for its purification. Furthermore, flower bud consumption could provide an intake of health-promoting compounds, with possible antioxidant and chemopreventive properties.

PubMed search strings for the study of agricultural workers' diseases

BACKGROUND

Several optimized search strategies have been developed in Medicine, and more recently in Occupational Medicine. The aim of this study was to identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of agricultural workers' diseases.

METHODS

We selected the Medical Subjects Heading (MeSH) term agricultural workers' diseases and six MeSH terms describing farm work (agriculture, agrochemicals NOT pesticides, animal husbandry, pesticides, rural health, rural population) alongside 61 other promising terms. We estimated proportions of articles containing potentially pertinent information regarding occupational etiology to formulate two search strategies (one "more specific," one "more sensitive"). We applied these strategies to retrieve information on the possible occupational etiology among agricultural workers of kidney cancer, knee osteoarthritis, and multiple sclerosis. We evaluated the number of needed to read (NNR) abstracts to identify one potentially pertinent article in the context of these pathologies.

RESULTS

The "more specific" search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The "more sensitive" string was based on use of broader search fields and additional coverage provided by other search terms under study. Using the "more specific" string, the NNR to find one potentially pertinent article were: 1.1 for kidney cancer; 1.4 for knee osteoarthritis; 1.2 for multiple sclerosis. Using the sensitive strategy, the NNR were 1.4, 3.6, and 6.3, respectively.

CONCLUSION

The proposed strings could help health care professionals explore putative occupational etiology for agricultural workers' diseases (even if not generally thought to be work related).

Ultrasound-guided thoracenthesis: the V-point as a site for optimal drainage positioning

INTRODUCTION

In the latest years the use of lung ultrasound is increasing in the evaluation of pleural effusions, because it makes follow-up easier and drainage more efficient by providing guidance on the most appropriate sampling site. However, no standardized approach for ultrasound-guided thoracenthesis is actually available.

AIM

To evaluate our usual ultrasonographic landmark as a possible standard site to perform thoracenthesis by assessing its value in terms of safety and efficiency (success at first attempt, drainage as complete as possible).

MATERIALS AND METHODS

Hospitalized patients with non organized pleural effusion underwent thoracenthesis after ultrasound evaluation. The point showing on ultrasound the maximum thickness of the effusion ("V-point") was chosen for drainage.

RESULTS

45 ultrasound guided thoracenthesis were performed in 12 months. In 22 cases there were no complications; 16 cases of cough, 2 cases of mild dyspnea without desaturation, 4 cases of mild pain; 2 cases of complications requiring medical intervention occurred. No case of pneumothorax related to the procedure was detected. In all cases drainage was successful on the first attempt. The collected values of maximum thickness at V-point (min 3.4 cm - max 15.3 cm) and drained fluid volume (min 70 ml - max 2000 ml) showed a significative correlation (p < 0.0001). When the thickness was greater or equal to 9.9 cm, drained volume was always more than 1000 ml.

CONCLUSIONS

The measure of the maximum thickness at V-point provides high efficiency to ultrasound guided thoracentesis and allows to estimate the amount of fluid in the pleural cavity. It is also an easy parameter that makes the proposed method quick to learn and apply.  

The role of imaging for the surgeon in primary malignant bone tumors of the chest wall

Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections.

The frequency of apneas in very preterm infants is increased after non-acid gastro-esophageal reflux

BACKGROUND

To evaluate whether physical and/or chemical features of gastro-esophageal reflux (GER) influence its relationship with apnea of prematurity (AOP).

METHODS

Fifty-eight preterm newborns (GA ≤ 33 weeks) with recurrent apneas were studied by simultaneous polysomnography and combined impedance and pH monitoring, to analyze whether the correlation between GER and AOP varies according to the acidity, duration and height of GERs.

KEY RESULTS

The frequency of apnea (number apnea/min) occurring after-GER [median (range) 0.07 (0-0.25)] was higher than the one detected in GER-free period [0.06 (0.04-0.13), P = 0.015], and also than the one detected before-GER [0 (0-0.8), P = 0.000]. The frequency of apneas detected in the 30'' after pH-GER [median (range), 0 min(-1) (0-1.09)] was higher than the frequency detected in the 30'' before [0 (0-0.91), P = 0.04]; even more, the frequency of apneas detected after non-acid MII-GER episodes [0 (0-2)] was significantly higher than the one detected before [0 (0-1), P = 0.000], whereas the frequency of apneas detected before acid MII-GER episodes [0 (0-0.67)] did not differ from the one detected after [0 (0-2), P = 0.137]. The frequency of pathological apneas detected in the 30'' after-GER (0 min(-1), range 0-0.55) was higher than the frequency detected before (0, range 0-0.09; P = 0.001). No difference in mean height or in mean duration was found between GERs correlated and those non-correlated to apnea.

CONCLUSIONS & INFERENCES

Non-acid GER is responsible for a variable amount of AOP detected after-GER: this novel finding must be taken into consideration when a therapeutic strategy for this common problem is planned.

A novel microplate-based screening strategy to assess the cellulolytic potential of Trichoderma strains

Bioconversion of lignocellulosic biomass to fuel requires a hydrolysis step to obtain fermentable sugars, generally accomplished by fungal enzymes. An assorted library of cellulolytic microbial strains should facilitate the development of optimal enzyme cocktails specific for locally available feedstocks. Only a limited number of strains can be simultaneously assayed in screening based on large volume cultivation methods, as in shake flasks. This study describes a miniaturization strategy aimed at allowing parallel assessment of large numbers of fungal strains. Trichoderma strains were cultivated stationary on microcrystalline cellulose using flat bottom 24-well plates containing an agarized medium. Supernatants obtained by a rapid centrifugation step of the whole culture plates were evaluated for extracellular total cellulase activity, measured as filter paper activity, using a microplate-based assay. The results obtained were consistent with those observed in shake-flask experiments and more than 300 Trichoderma strains were accordingly characterized for cellulase production. Five strains, displaying on shake-flasks at least 80% of the activity shown by the hyper-cellulolytic mutant Trichoderma Rut-C30, were correctly recognized by the screening on 24-well plates, demonstrating the feasibility of this approach. Cellulase activity distribution for the entire Trichoderma collection is also reported. One strain (T. harzianum Ba8/86) displayed the closest profile to the reference strain Rut-C30 in time course experiments. The method is scalable and addresses a major bottleneck in screening programs, allowing small-scale parallel cultivation and rapid supernatant extraction. It can also be easily integrated with high-throughput enzyme assays and could be suitable for automation.

Ultrasound-detected synovitis with power Doppler signal is associated with severe radiographic damage and reduced cartilage thickness in hand osteoarthritis

OBJECTIVES

To examine ultrasound (US) features of synovitis in hand osteoarthritis (OA) joints, and to evaluate their relationship with radiological damage severity and US-detected cartilage thickness.

METHODS

US examination was carried out on 14 joints of both hands of 25 patients with symptomatic hand OA (HOA) and 10 age- and sex-matched control subjects. US-detected features were: synovial hypertrophy, effusion, power Doppler signal (PDS), cartilage thickness. Conventional hand radiographs were scored utilizing the Kellgren-Lawrence and Kallman systems. HOA patients were divided into two subsets: non-erosive and erosive.

RESULTS

Among the three groups of subjects studied, erosive OA showed the highest values of radiological scores and the highest prevalence of US-detected synovitis. Joints positive for US synovitis features (above all PDS) had higher radiological scores and lower cartilage thickness, while joints with X-ray detected central erosions [the hallmark of erosive HOA were more likely to present PDS positivity. US measured cartilage thickness inversely correlated with radiological damage scores.

CONCLUSIONS

US-detected synovitis is present in about 10% of HOA finger joints and is associated with more severe radiological damage and reduced cartilage thickness. PDS and cartilage thickness (mm) may represent two innovative additional information tools provided by ultrasonography in HOA evaluation.

Validation of growth as measurand for bacterial adhesion to food and feed ingredients

AIMS

A miniaturized adhesion test was designed to study the binding capacity of food and feed ingredients for bacterial cells.

METHODS AND RESULTS

Bacteria were allowed to adhere to different fibrous materials supplied as well coatings in microtitration plates. The amount of bacteria retained on the materials was determined in an automated way as growth after addition of liquid medium. The test principle was based on an inverse relationship between initial cell densities and the appearance of growth: The higher adhering cell numbers are, the shorter are the detection times of growth. The growth curves obtained were fitted by nonlinear regression analysis employing a sigmoidal curve model. Growth parameters as (i) the time after incubation at which half of the maximum growth yield was reached; (ii) the time-coordinate of the point of inflection; (iii) the detection time calculated as x-axis intercept of the maximum specific growth rate in the point of inflection; and (iv) the time-coordinate of a growth detection threshold at OD = 0.05 were highly separating for the binding capacity of different food and feed ingredients for bacteria.

SIGNIFICANCE AND IMPACT OF THE STUDY

With growth as measurand for adhesion, a simple, high-throughput method was developed for the screening of huge numbers of different binding matrices and bacteria.

Delineating v-Src downstream effector pathways in transformed myoblasts

In this study, we delineate the intracellular signalling pathways modulated by a conditional v-Src tyrosine kinase that lead to unrestrained proliferation and block of differentiation of primary avian myoblasts. By inhibiting Ras-MAPK kinase and phosphatidylinositol 3-kinase with different means, we find that both pathways play crucial roles in controlling v-Src-sustained growth factor and anchorage independence for proliferation. The Ras-MAPK kinase pathway also contributes to block of differentiation independently of cell proliferation since inhibition of this pathway both in proliferating and growth-arrested v-Src-transformed myoblasts induces expression of muscle-specific genes, fusion into multinucleated myotubes and assembly of specialized contractile structures. Importantly, we find that the p38 MAPK pathway is inhibited by v-Src in myoblasts and its forced activation results in growth inhibition and expression of differentiation, indicating p38 MAPK as a critical target of v-Src in growth transformation and myogenic differentiation. Furthermore, we show that downregulation of p38 MAPK activation may occur via Ras-MAPK kinase, thus highlighting a cross-regulation between the two pathways. Finally, we report that the simultaneous inhibition of MAPK kinase and calpain, combined to activation of p38 MAPK, are sufficient to reconstitute largely the differentiation potential of v-Src-transformed myoblasts.

The role of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors

Soft-tissue tumors are not very common, but their diagnosis can be very difficult. In the final analysis, their diagnosis requires a biopsy, which must furnish a sufficient amount of material to allow a reliable histological diagnosis. The authors evaluated the diagnostic efficacy of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors of the musculoskeletal system. The aim of the study was to optimize the biopsy procedure, with particular emphasis on the choice of the biopsy needle (large-gauge manual versus semiautomatic) based on the characteristics of the neoplastic mass (consistency, depth, size, location). The results of the study showed that appropriate needle selection significantly reduced the frequency of biopsies that were insufficient for histological diagnosis. The method proved to be highly reliable for diagnosis of soft-tissue tumors but strongly related to the proper selection of the needle to be used.

Ultrasonography detection of early bone erosions in the metacarpophalangeal joints of patients with rheumatoid arthritis

OBJECTIVE

To compare ultrasonography (US) and magnetic resonance imaging (MRI) in their capability to detect bone erosions in early-advanced rheumatoid arthritis, where no erosion was evident on conventional radiography (X-ray).

METHODS

Metacarpophalangeal (MCP), radiocarpal and ulnocarpal joints of 13 patients with rheumatoid arthritis, with bone erosion that was not detected by conventional X-ray, were examined by US and MRI. Ten controls underwent examination of the same joints by US.

RESULTS

None of the controls showed bone erosions at US examination. No significant difference between US and MRI in detecting bone erosion was observed in wrist joints, whereas a significantly higher number of erosions was detected by US in MCP joints.

CONCLUSION

US is at least as sensitive as MRI in detecting bone erosions in MCP and wrist joints. Since US examination is a more easily available and less expensive procedure than MRI, our findings justify its use as a diagnostic tool for early arthritis. In addition US may also be utilized in the follow up of patients with an established diagnosis of inflammatory arthritis.

Efficacy of silymarin-phospholipid complex in reducing the toxicity of aflatoxin B1 in broiler chicks

Silymarin, the standardized extract of Silybum marianum, is used as a hepatoprotector in man, and is a potent antihepatotoxic agent. This study focused on the effects of a silymarin-phospholipid complex in reducing the toxic effects of aflatoxin B1 (AFB1) in broiler chickens. Twenty-one 14-d-old male commercial broilers were randomly allotted to 3 groups and treated as follows: basal diet alone [Group C (Control)]; AFB1 at 0.8 mg/kg of feed [Group B1]; AFB1 at 0.8 mg/kg of feed plus silymarin phytosome, a silymarin complexed form with phospholipids from soy, at 600 mg/kg of BW [Group B1+Sil]. Considering the whole growth cycle, BW gain and feed intake were lower in AFB1-treated birds with respect to controls (P < 0.05). In the B1+Sil group, BW gain and feed intake were higher with respect to birds receiving AFB1 alone (P < 0.05), and not different from the control birds. Serum biochemistry showed no difference among groups, except for a decrease of alanine amino transferase (ALT) in chicks treated only with AFB1. Alanine amino transferase activity in AFB1 plus silymarin phytosome treated birds was not different from the controls. No treatment differences were noted on liver weight. In conclusion, our results suggest that silymarin phytosome can provide protection against the negative effects of AFB1 on performance of broiler chicks.

The echo-guided treatment of calcific tendinitis of the shoulder

The authors report the results of percutaneous mini-invasive treatment of chronic calcific tendinitis of the rotator cuffs. A total of 39 patients have been treated by echo-guided injection under local anaesthesia since June 2000 with a follow-up of about 2 years. Considerable reduction in symptoms was obtained in 34 patients within a few days of treatment; improvement was moderate in 5 cases, there were no complications in any of the cases. Complete regression of calcification was observed in 21 patients, there was a more than 60% reduction in calcific deposits in 11 patients, there was little reduction in 5, and the calcification remained unchanged in 2. The method, based on our experience, proved to be simple to execute, low-cost and easily repeatable, offering good results from a symptomatological point of view as well. It is the purpose of this study to determine and maximize mini-invasive treatment that will allow for the elimination or reduction of calcifications by means of percutaneous and echo-guided access.

Effects of Silymarin, a Natural Hepatoprotector, in Periparturient Dairy Cows

Silymarin, a natural acknowledged hepatoprotector used in humans to treat liver diseases, has been tested in dairy cows during peripartum, a period during which animals are subject to subclinical fatty liver. Ten grams of silymarin (76% pure extract consisting in flavonolignans, taxifolin, and other trace compounds) per day, was administered as a water suspension by an oral drench to 15 cows from d 10 before expected calving to 15 d after calving. Milk production was measured, and colostrum, milk, and blood samples were analyzed during the experimental period. Treated animals showed the peak of milk production at 55 +/- 1.85 d after calving, 1 wk before the control group (62 +/- 3.27 d); the average peak production was 41.6 +/- 1.05 kg for the treated group vs. 39.1 +/- 1.44 kg for the control; the treated animals maintained a greater milk production than control cows throughout lactation (9922.1 +/- 215.7 vs. 9597.8 +/- 225.4 kg). Milk composition was unaffected by treatment. No silymarin residues were detected in colostrum and all milk samples. After calving, body condition score (BCS) decrease was greater for control compared with treated cows. Glucose, urea, triglycerides (TG), total cholesterol, beta-hydroxibutyrate (BHBA), and gamma-glutamyl transferase (GGT) in plasma were unaffected by treatment. Plasma nonesterified fatty acids (NEFA) on d-7 were higher in treated cows compared with the control group (741 vs. 181 micromol/L). From this evidence, it is possible to conclude that silymarin beneficially affected lactation performances and body condition of treated animals. Blood and milk parameters do not indicate any adverse effects of feeding this natural compound.

Silymarin, a possible hepatoprotector in dairy cows: biochemical and histological observations

Silymarin, a standardized extract from Silybum marianum seed, is a natural hepatoprotector used for the treatment of liver diseases in man. The aim of this study was to investigate its safety and efficacy in periparturient dairy cows. Ten treated and 10 control pregnant dairy cows were paired by parity, body condition score (BCS), health condition and previous milk production. Treatment consisted of daily 10 g per animal of silymarin extract administered as oral drenches, from 10 days prior to the calving date to 15 days after calving. Blood samples and liver biopsies were taken from each animal at 7 and 30 days after calving. Hepatic functions were evaluated by assay of plasma beta-hydroxybutyrate (BHBA), total cholesterol, high-density lipoproteins, low-density lipoproteins, triglyceride and total bilirubin. The histological aspect of the liver was assessed in biopsies. Clinical chemistry values were similar for both groups and effects at different times (day 7 versus day 30; P < 0.05) were attributed to physiological variations in periparturient cows. Histology showed fat accumulation in the liver of both groups, as it is expected in periparturient dairy cows. In treated cows, fat-rich hepatocytes were observed near the central vein. These observations suggest that, at the used dosage, S. marianum extract has no adverse effect on the liver of lactating cows, and presents no objective evidence for a hepatoprotective effect in this species.

Determination of methylmercury in environmental samples using static headspace gas chromatography and atomic fluorescence detection after aqueous phase ethylation

A rapid and automated method for the determination of monomethylmercury (MMHg) in environmental samples was developed using headspace gas chromatography with atomic fluorescence detection in combination with aqueous phase ethylation. Sample preparation steps were optimized for sediments, biological samples, and water samples using certified reference materials and real samples with a broad range of MMHg concentrations. Different extraction procedures were compared for both sediments and biological samples. The methods were applied in the intercomparison exercises for the certification of MMHg in sediments (IAEA 405) and in Oyster tissue (BCR 710) and the results were accepted for certification. The detection limits for MMHg are 0.002 ng Hg/g for sediments and biological samples and 0.01 ng Hg/L for water samples. The method was tested for methylation artifacts; no artifact was observed in the sediment samples and CRMs tested.

Neoadjuvant chemotherapy for osteosarcoma of the extremities with metastases at presentation: recent experience at the Rizzoli Institute in 57 patients treated with cisplatin, doxorubicin, and a high dose of methotrexate and ifosfamide

BACKGROUND

Effective adjuvant or neoadjuvant regimens of chemotherapy have dramatically improved the prognosis of patients with high-grade osteosarcoma of the extremity, localized at diagnosis. Currently, little is known about patients with metastatic disease at presentation.

PATIENTS AND METHODS

From May 1995 to May 2000, 57 patients with osteosarcoma of the extremity, metastatic at presentation, were treated according to the following scheme: primary chemotherapy, restaging, simultaneous resection of primary tumor and metastatic lesions, and maintenance chemotherapy.

RESULTS

Thirty-five patients achieved remission. At a follow-up ranging from 2 to 7 years, seven remained continuously free of disease, one died of chemotherapy-related toxicity and 27 patients relapsed. Twenty-one of the 22 patients who never achieved remission died as a result of the tumor, as well as 20 of the 27 who achieved remission but then relapsed. Of the remaining seven relapsing patients, six are alive with uncontrolled disease, while one is alive and free of disease 24 months after the last post-relapse treatment. Two-year event-free survival (EFS) and overall survival (OS) were 21% and 55%, respectively. These results are significantly poorer than those achieved in 128 contemporary patients with non-metastatic disease at presentation, treated with the same chemotherapy protocol (2-year EFS and OS of 75% and 94%, respectively).

CONCLUSIONS

The results of our study confirm that the prognosis of patients with osteosarcoma of the extremity, metastatic at presentation, remains poor, despite the use of aggressive treatments.

Current trends in chest wall malignant tumor

Surgery used to treat chest wall sarcomas requires preoperative evaluation in order to document their margins, and to reveal any nodules of recurrence. Because of its considerable sensitivity and specificity ultrasound was associated with routine imaging techniques. The results obtained are useful in defining superficial and lateral tumor margins, but particularly in determining micro-nodules of recurrence which would otherwise go unrecognized. Based on the data obtained using routine methods of diagnosis and ultrasound, we submitted patients to excision that each and every time proved to be wide on histological examination. A particular surgical method was used for reconstruction, involving a polypropylene mesh fixed to one or two mouldable plates. This method exploits the elasticity of polypropylene, which is indispensable for the correct respiratory dynamics of the rib cage, thus avoiding paradoxical or harmful movement. Oncological and functional results were satisfactory.

Gamma-linolenic acid and tocopherol contents in the seed oil of 47 accessions from several Ribes species

Gamma-linolenic acid is an essential fatty acid for humans with delta-6-desaturase deficiency; it is a precursor of prostaglandins, prostacyclins, and tromboxanes; and it has antiinflammatory and antitumoral effects. Tocopherols are natural antioxidants with biological activity, heart/vascular, and cancer protective properties. The oil, gamma-linolenic acid, and tocopherol contents, as well as tocopherol composition, were investigated in the seed oil of a collection of 47 accessions belonging to various species of the genus Ribes. Differences for oil content among species were not significant. The highest total tocopherol content was found in R. nigrum (mean, 1716 mg kg(-1) oil), followed by R. rubrum (mean, 1442 mg kg(-1) oil). R. grossularia showed the lowest values for this trait (mean, 786 mg kg(-1) oil). The three species also differed strongly for tocopherol composition. R. rubrumwas distinguished by a higher concentration of delta-tocopherol (mean, 20.2%); R. grossularia displayed the highest percentage of gamma-tocopherol (mean, 70.0%), and R. nigrum showed the highest concentration for alpha-tocopherol (mean, 34.8%), the most biologically active among the four tocopherols. Regarding gamma-linolenic acid, the highest content was found in R. nigrum, which exhibited up to 15.8% of this essential fatty acid in the oil. R. grossularia and R. rubrum showed mean gamma-linolenic acid contents of 8% and 6.2%, respectively. The present study indicated that seeds of Ribes species, especially R. nigrum, could be used as sources of gamma-linolenic acid and natural vitamin E.

Preparation and biological activity of four epiprogoitrin myrosinase-derived products

(5R)-5-Vinyl-1,3-oxazolidine-2-thione, (2S)-1-cyano-2-hydroxy-3-butene, and two diastereoisomeric erythro-(2S)- and threo-(2S)-1-cyano-2-hydroxy-3,4-epithiobutanes were prepared in pure form starting from (2S)-2-hydroxybut-3-enyl glucosinolate (epiprogoitrin). This glucosinolate was isolated in almost pure form using ripe seeds of Crambe abyssinica and then hydrolyzed under different conditions. The hydrolysis was carried out using either myrosinase immobilized on nylon, to produce (5R)-5-vinyl-1,3-oxazolidine-2-thione, or the endogenous myrosinase contained in defatted crambe meals, to produce the other epiprogoitrin-derived products. After purification and physicochemical characterization, all four myrosinase degradation products were tested for their biological activity. A bioassay on Lactuca sativa was chosen as a simple test to determine their apparent action on living tissues. (5R)-5-Vinyl-1,3-oxazolidine-2-thione negatively affected mainly root growth, whereas (2S)-1-cyano-2-hydroxy-3-butene affected the early phase of germination, and both (2S)-1-cyano-2-hydroxy-3,4-epithiobutane diastereoisomers appeared to negatively affect both germination and root growth at doses 5-10 times lower than those of (2S)-1-cyano-2-hydroxy-3-butene or (5R)-5-vinyl-1,3-oxazolidine-2-thione.

Haplo-diploid gene expression and pollen selection for tolerance to acetochlor in maize

The objectives of this research were to determine if genes controlling the reaction to the herbicide acetochlor in maize (Zea mays L.) are active during both the haploid and the diploid phases of the life cycle and if pollen selection can be utilized for improving sporophytic resistance. Pollen of eight inbred lines, previously characterized through sporophytic analysis for the level of tolerance to acetochlor, showed a differential reaction to the herbicide forin vitro tube length; moreover, such pollen reactions proved to be significantly correlated (r =0.786(*),df=6) with those of the sporophytes producing the pollen. Pollen analysis of two inbred lines (i.e. Mo17, tolerant, and B79, susceptible) and their single cross showed that thein vitro pollen-tube length reaction of the hybrid was intermediate between those of two parents. An experiment on pollen selection was then performed by growing tassels of Mo17xB79 in the presence of the herbicide. Pollen obtained from treated tassels showed a greater tolerance to acetochlor, assessed asin vitro tube length reaction, than pollen obtained from control tassels. Moreover, the backcross [B79 (Mo17xB79)] sporophytic population obtained using pollen from the treated tassels was more tolerant (as indicated by the fresh weight of plants grown in the presence of the herbicide) than was the control backcross population. The two populations did not differ when grown without the herbicide. These findings indicate that genes controlling the reaction to acetochlor in maize have haplodiploid expression; consequently, pollen selection can be applied for improving plant tolerance.

Patellar resurfacing in tumor endoprosthesis: a study in regard to power transmission

Relation between quadriceps muscle mass and knee extension strength was investigated after resection of malignant bone tumor and endoprosthetic replacement of the distal femur in 19 patients with patellar resurfacing (Group A) and 16 patients without resurfacing (Group B). In all cases, a modular cementless, hinged prosthesis had been used. Age and follow-up period were comparable in the 2 groups. Muscle mass was measured ultrasonographically and strength was evaluated isokinetically. All the data on the operated side are given as percentage of the non-operated side. There was a positive correlation between muscle mass and strength in both groups. By linear regression analysis, a slightly lower value of strength was predicted in the unresurfaced group than in the resurfaced group. Analysis of covariance revealed that the influence of patellar resurfacing on strength was significant. This factor should also be considered in making a decision about patellar resurfacing with a tumor endoprosthesis.

Intraoperative ultrasonography imaging in spinal surgery (technique and indications)

Intraoperative ultrasonography was conducted in 20 patients; the technique of intraoperative ultrasonography for use in spinal surgery is described. The authors emphasize that this non-invasive method obtains real time images of considerable diagnostic importance, allowing for a significantly minor use of image intensifier, with a consequent reduction in doses for both the patient and the staff.

[Angiographic evaluation of the response of osteosarcoma to neoadjuvant chemotherapy]

Modern therapeutic osteosarcoma protocols, including both pre- and post-operative cycles of chemotherapy, have helped improving the quality of the prognosis and marking the local control of the neoplasm more reliable, with a subsequent increase in conservative surgery. Angiographic results of the chemotherapeutic response in 76 patients with primitive high-grade bone osteosarcoma are reported. The need to repeat angiographic controls under the same technical conditions is emphasized. The comparison of the above findings with data from the histological evaluation of the specimen, shows that angiography is a reliable means of evaluating the response to chemotherapy. Angiography is thus emphasized as a valid method in an early evaluation of the efficacy of chemotherapy.

Neoadjuvant chemotherapy in the treatment of osteosarcoma of the extremities: preliminary results in 131 cases treated preoperatively with methotrexate and cisdiamminoplatinum

The results of 131 cases of classic non-metastatic osteosarcoma of the extremities treated with preoperative chemotherapy, surgery and postoperative chemotherapy are reported. Preoperatively, the patients were given Methotrexate (MTX) intravenously (high and average doses) and Cisplatinum (CDP) intraarterially. For postoperative chemotherapy, the drugs and treatment protocols were based on the degree of necrosis observed (good, fair, poor). Conservative surgery was performed in 73% of the cases and amputation in 27%. At an average 30 month follow-up (9-48 months) 59.5% of the patients had remained disease-free, 37.5% had developed metastases, and 3% had developed local recurrence. The percentage of disease-free patients was higher for those treated with high doses of MTX (68% vs. 51%) and for those in whom preoperative chemotherapy had induced good necrosis (75% vs. 44%). Neither the age or sex of the patients, nor the site of the tumor or type of surgery performed influenced prognosis.