Islet cell transplantation: the future?

BACKGROUND: Islet of Langerhans' cell transplantation is a promising strategy for the treatment of type-1 diabetes mellitus. Results of this procedure have yet to match those of whole organ pancreas transplantation, but are rapidly improving, as witnessed by increasing rates of insulin independence and graft function (i.e., C-peptide production) after islet transplantation. DISCUSSION: Identification of obstacles to the success of islet transplantation, such as primary nonfunction, immunosuppression-related metabolic workload, or recurrence of autoimmunity, will allow the development of new strategies tailored to overcome them. In particular, novel immunosuppressive protocols, with or without the aim of inducing tolerance, and immunoisolation devices are reaching the stage of clinical applicability. Finally, several strategies, such as utilization of porcine xenogeneic islets or genetically engineered beta-cell lines, or in vitro expansion of cultured beta-cells could theoretically expand indefinitely the pool of islet tissue for transplantation.     

Epidemiology of migraine

One-year migraine prevalence rates in the general population for Western countries vary from 4% to 9% in men and from 11% to 25% in women. Non-Western countries report lower figures. Incidence rates for people under 30 years of age vary from 1.5 to 6 per 1000 person-years in men and from 3 to 24 per 1000 person-years in women. Data on the prevalence of migraine in general, on the gender ratio and on the variations in prevalence in the different age ranges are fairly comparable and can be regarded as very close to reality. On the contrary, data on the incidence of migraine, on the prevalence of different migraine subtypes, such as migraine with aura and the so-called migrainous disorder, and on the frequency of migraine attacks show a striking discordance that somewhat undermines their reliability. The main critical points in prevalence and incidence studies are migraine definition and the methodological approaches used for case screening. Even if International Headache Society (IHS) classification is certainly an improvement over previous tools used in epidemiological studies, the diagnostic criteria for migraine without aura are quite scanty and not easily remembered by subjects belonging to the general population, and those for migraine with aura appear not only difficult to translate for use in a questionnaire or an interview, but also too loose. In particular, the lack of any low-end limit for aura duration may cause an overestimation of migraine with aura prevalence.     

Effect of photobiomodulation therapy on oxidative stress markers of gastrocnemius muscle of diabetic rats subjected to high-intensity exercise

This study aimed to determine whether photobiomodulation therapy (PBMT) in diabetic rats subjected to high-intensity exercise interferes with the expression of the oxidative stress marker in the gastrocnemius muscle. Twenty-four male Wistar rats were included in this study comprising 16 diabetic and eight control rats. The animals were allocated into three groups—control, diabetic fatigue, and diabetic PBMT fatigue groups. Diabetes was induced via the intraperitoneal administration of streptozotocin (50 mg/kg). We subsequently assessed blood lactate levels and PBMT. The animals of the diabetic fatigue group PBMT were irradiated before the beginning of the exercises, with dose of 4 J and 808 nm, were submitted to treadmill running with speed and gradual slope until exhaustion, as observed by the maximum volume of oxygen and lactate level. The animals were euthanized and muscle tissue was removed for analysis of SOD markers, including catalase (CAT), glutathione peroxidase (GPx), and 2-thiobarbituric acid (TBARS) reactive substances. CAT, SOD, and GPx activities were significantly higher in the diabetic PBMT fatigue group (p?<?0.05) than in the diabetic fatigue group. Outcomes for the diabetic PBMT fatigue group were similar to those of the control group (p?>?0.05), while their antioxidant enzymes were significantly higher than those of the diabetic fatigue group. PBMT mitigated the TBARS concentration (p?>?0.05). PBMT may reduce oxidative stress and be an alternative method of maintaining physical fitness when subjects are unable to perform exercise. However, this finding requires further testing in clinical studies.     

The problem of infections in acute leukemias

Summary This report is based on experience over the last 5 years in the diagnosis and treatment of infections in 200 acute leukemic patients hospitalized in the Institute of Haematology, University of Rome. The relevant clinical and laboratory findings are discussed in relation to the diagnosis of secondary infections. Most of the febrile episodes were associated with infection. The frequently rapid development of the infections in these patients requires empirical antibiotic treatment. The best results were obtained when the combinations carbenicillin-cephalothin-gentamicin (success rate of 65 %), and carbenicillin-cephalothin-gentamicin-lyncomycin-methicillin (success rate of 62 %), were used as empirical therapy.     

Intraoperative radiotherapy during radical prostatectomy for intermediate‐risk to locally advanced prostate cancer: treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy,in a matched‐pair analysis

OBJECTIVE

To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression‐free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue.

PATIENTS AND METHODS

Between June 2005 and October 2007, 33 consecutive patients with intermediate‐risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio‐ or hormone therapy could be administered. The median follow‐up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched‐pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared.

RESULTS

The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow‐up were the major limitations.

CONCLUSIONS

IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.