The construction of a Project in adolescent maternity: an experience report

This article reports on the experience of a group of nursing faculty on the development of a project aimed at adolescent maternity with a view to prevent unwanted pregnancies. An additional proposal of the referred project is guiding adolescent mothers in terms of self-care, care with their babies, and encouraging exclusive breastfeeding. This would reduce the difficulties that those young mothers experience and, therefore, contribute with the maternal-child area.     

Impact of lower extremity strengthening exercises and mobility on fall rates in hospitalized adults

Preventing falls in acute care hospitals is a major challenge, and achieving positive outcomes has remained elusive. The purpose of this study was to examine the impact of lower extremity strengthening exercises and mobility on fall rates and fall rates with injury. A nonequivalent control group design was used. Subjects on the intervention unit received targeted lower extremity strengthening exercises and ambulation using a nurse-driven mobility protocol; subjects on the control unit received ambulation alone. One assisted fall occurred on the intervention unit.     

Chronic Idiopathic Thrombocytopenic Purpura in children: predictive factors and outcome

Idiopathic thrombocytopenic purpura (ITP) is the most common cause of acquired thrombocytopenia in children. In 20% of cases, this condition is classified as chronic when the thrombocytopenia is persistent 6 months after diagnosis. The aim of the present study is to identify the potential factors correlating with a favorable outcome in patients with chronic ITP. Some 71 patients affected by ITP were retrospectively analyzed. Results show a higher rate of spontaneous recovery that is statistically significant for patients with platelet count at diagnosis <20,000/??L. These observations suggest the possibility to delay or avoid aggressive surgical treatment for these patients.     

How to manage vaccinations in children with cancer

The optimal use of routine childhood immunizations in children with malignancy is still a matter of debate. Despite their higher risk of contracting vaccine preventable diseases and of suffering important complications, there is little understanding of the magnitude of the possible benefit of administering active immunization in this population due to a paucity of clinical trial data. Our review focuses on the management of children with cancer and offers some suggestions regarding their vaccination schedules.     

Tyrosine isomers mediate the classical phenomenon of concomitant tumor resistance

Concomitant tumor resistance (CR) is a phenomenon originally described in 1906 in which a tumor-bearing host is resistant to the growth of secondary tumor implants and metastasis. Although recent studies have indicated that T-cell-dependent processes mediate CR in hosts bearing immunogenic small tumors, manifestations of CR induced by immunogenic and nonimmunogenic large tumors have been associated with an elusive serum factor. In this study, we identify this serum factor as tyrosine in its meta and ortho isoforms. In three different murine models of cancer that generate CR, both meta-tyrosine and ortho-tyrosine inhibited tumor growth. In addition, we showed that both isoforms of tyrosine blocked metastasis in a fourth model that does not generate CR but is sensitive to CR induced by other tumors. Mechanistic studies showed that the antitumor effects of the tyrosine isoforms were mediated, in part, by early inhibition of mitogen-activated protein/extracellular signal-regulated kinase pathway and inactivation of STAT3, potentially driving tumor cells into a state of dormancy. By revealing a molecular basis for the classical phenomenon of CR, our findings may stimulate new generalized approaches to limit the development of metastases that arise after resection of primary tumors, an issue of pivotal importance to oncologists and their patients.     

Feasibility study of 21-day-on/7-day-off temozolomide in children with brain tumors

Temozolomide (TMZ) is an oral alkylating agent with proven antitumoral activity in preclinical and clinical studies in adults with high-grade glioma (HGG). However, only limited efficacy has been reported in children with HGG using the 5-day schedule. This study investigated the safety of administering TMZ to children and adolescents with brain tumors over an extended period. Extended schedules have been proven to overcome chemoresistance without any major toxicity. The toxicity of TMZ, administered at 70 mg/m²/day orally for 21 consecutive days every 28 days, was assessed in children with brain tumors. A total of 156 courses of TMZ were given to 17 patients (median age 12.5 years, range 1–17 years), who were recruited into the study. Eleven patients had progressive or relapsing disease, and six patients were newly diagnosed. In this cohort no cases of toxic death or nonhematological toxicity were reported. In comparison with the 5-day schedule, thrombocytopenia and neutropenia were noted to be less frequent. Grades 3 and 4 lymphopenia occurred in 10.8 and 22.4% of courses, respectively; among the lymphopenic patients there was one case of disseminated zoster (meningoencephalitis and cutaneous involvement), one case of rotavirus gastroenteritis, and two cases of herpetic stomatitis reported. The objective response rate was 11.8%. Overall, 82.3% of patients showed stable disease. The prolonged TMZ schedule appeared to be well tolerated, with few cases of neutropenia or thrombocytopenia recorded. Nevertheless, prolonged exposure to TMZ was associated with lymphopenia and may lead to a higher rate of viral infections.     

Sortase A Confers Protection against Streptococcus pneumoniae in Mice

Streptococcus pneumoniae sortase A (SrtA) is a transpeptidase that is highly conserved among pneumococcal strains, whose involvement in adhesion/colonization has been reported. We found that intraperitoneal immunization with recombinant SrtA conferred to mice protection against S. pneumoniae intraperitoneal challenge and that the passive transfer of immune serum before intraperitoneal challenge was also protective. Moreover, by using the intranasal challenge model, we observed a significant reduction of bacteremia when mice were intraperitoneally immunized with SrtA, while a moderate decrease of lung infection was achieved by intranasal immunization, even though no influence on nasopharynx colonization was seen. Taken together, our results suggest that SrtA is a good candidate for inclusion in a multicomponent, protein-based, pneumococcal vaccine.Streptococcus pneumoniae colonizes the nasopharynx of humans and represents a leading cause of severe diseases, such as otitis media, pneumonia, and meningitis. S. pneumoniae is one of the major causes of bacterial pneumonia in developing countries (19). It is estimated that each year, nearly 1 million children worldwide die because of pneumococcal diseases (10). Besides children, groups at high risk of pneumococcal infection are immunocompromised subjects and the elderly, for whom a high case fatality rate is also observed. The last decades have seen an increase in investigations of protein antigens, and several protein candidates have been proposed for a vaccine for S. pneumoniae (2) to overcome the problems inherent to the currently available polysaccharide-based vaccines. In fact, the 23-valent polysaccharide pneumococcal vaccine is not effective in children under 2 years of age, whose immune systems are unable to mount a T-independent response to polysaccharides. On the other hand, the 7-valent polysaccharide conjugate vaccine, although efficacious, induces serotype replacement (5, 20). Moreover, while more than 90 S. pneumoniae serotypes are presently known, both polysaccharide pneumococcal vaccines and polysaccharide conjugate vaccines are effective only against the serotypes included in the vaccine. Efforts to identify new S. pneumoniae factors that play a role in colonization and pathogenesis may contribute to the indication of possible targets of either new therapeutic agents or vaccines.Sortase A (SrtA) is a membrane-anchored transpeptidase expressed by gram-positive bacteria (12). The role of SrtA in the processing of sorting signals at the LPXTG motif to anchor surface proteins to the cell wall envelope was first described for Staphylococcus aureus (21), in which an isogenic SrtA mutation resulted in a strongly reduced ability to infect animals (13, 23). SrtA has been shown to participate in the colonization and/or pathogenesis of several Streptococcus species (1, 6, 8, 22, 24).S. pneumoniae SrtA has been described as playing a role in adhesion to human pharyngeal cells in vitro (7), in nasopharyngeal colonization in chinchilla (3), and in pneumonia, bacteremia, and nasopharyngeal colonization in murine models (15). Although SrtA seems to be dispensable in pilus biogenesis, its possible role in repressing pilus islet expression has been very recently proposed (9). SrtA has been found to be widely expressed among S. pneumoniae isolates and highly conserved, with a DNA identity of 99 to 100% (15). Although all of these findings suggest that pneumococcal SrtA might be useful as a protein vaccine, to the best of our knowledge no data have been provided so far on the protective efficacy afforded by SrtA immunization in animal models. Thus, we investigated the protective role of SrtA in murine models of S. pneumoniae infection.     

Decreased hemoglobin levels are associated with higher plasma level of fibrinogen, irrespective of age

BACKGROUND: Increased plasma levels of fibrinogen are been associated with an increased risk of cardiovascular accident. We aimed at verifying whether the changes of fibrinogen levels are associated with red blood cell (and/or hemoglobin) concentration. METHODS: A group of 381 carefully selected healthy volunteers (219 male and 162 female), aged from 18 to 101 years, were enrolled in this study. Fasting blood samples were taken and all measurements (fibrinogen plasma level, whole blood viscosity, hemoglobin concentration, hematocrit value, red blood cell and white blood cell count, platelet count, glucose, total cholesterol and triglycerides plasma concentration, and C-reactive protein level) were obtained with standardized methodology using appropriate equipment, procedures, and controls. RESULTS AND CONCLUSIONS: In the male but not in the female group, plasma fibrinogen concentration inversely correlated with hemoglobin (P < 0.0001) and hematocrit value (P < 0.01). In a post hoc analysis, plasma fibrinogen level inversely correlated with hemoglobin in the subgroup of the 93 premenopausal women and directly correlated with age and inversely correlated with platelet count in the subgroup of the 69 postmenopausal women. Results of multiple regression analysis revealed that in all the subjects, except in the postmenopausal women, hemoglobin level is an independent predictor of fibrinogen plasma level. Considering the physiopathologic role of increased plasma fibrinogen concentration and the scarcity of pharmacologic approaches to decrease its level, these findings could be important in designing a preventive therapy of cardiovascular disease.