The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the 1999-2003 period.

AIM: The innovations for disease management need to be thoroughly evaluated so that their benefits and potential downsides can be compared with the already existing approaches. Endovascular laser (EVL) treatment for varicose veins offers today several advantages over surgical standard stripping. The Italian Endovenous-laser Working Group (IEWG) is a homogeneous group of surgeons and phlebologists who have been using EVL since 1999 and has undertaken to examine EVL in a multicenter study starting from a well defined rationale, with the benefit of a single protocol to use. METHODS: In a cooperative, multicenter, clinical study, 1076 limbs in 1050 patients, mean age of 54.5 years, 241 males and 809 females affected by chronic venous insufficiency (CVI) were considered eligible for surgery and stratified by CEAP classification in a four-year period (January 1999 December 2003). Inclusion criteria were insufficiency of the great and/or small saphenous vein at various levels, beyond those accessory saphenous trunks with incompetence in the saphenofemoral junction. In all cases truncular reflux apparead up on duplex scan examination, with or without associated varicosities. All the patients underwent a surgery on the basis of the clinical assessment. All the centres involved performed treatment in conformity with the Food and Drug Administration (FDA) validated procedure, using an endo-laser venous system kit with a 810-980 nm diode. Duplex scan was performed in all patients after 36 months with very few lost to follow-up cases. RESULTS: In the immediate postoperative period the results have been impressive, with a very effective closure of incompetent great saphenous vein and the other treated varicose veins (the early occlusion rate has been 99%). Major complications have not been detected: in particular, no deep venous thrombosis (DVT) evaluated duplex ultrasound. The patients' acceptability and satisfaction regarding the procedure, have been measured by means of a questionnaire on the quality of life, and the result was 96.7%. After 36 months, the total occusion rate of saphenous trunks has been 97%. CONCLUSIONS: The first important Italian experience with EVL based on preoperative, perioperative and postoperative duplex control and which is also based on the patients' satisfaction at mid/long-term has indicated some advantages over the standard treatment with the stripping method. In terms of reduced postoperative pain, shorter sick leave, a faster resumption of the normal activities, and, in particular, the total absence of DVT, we can conclude that EVL is a good solution for all patients with anatomic and hemodinamic patterns for saphenous vein surgery.     

A comparative trial of anti-glycoconjugate antibody assays: IgM antibodies to GM1

IgM class antibodies against the ganglioside GM1 have been found in a subgroup of patients with lower motor neuron syndromes and multifocal motor neuropathies (MMN). The pathogenic relevance of these antibodies is still unclear, but some MMN patients with IgM antibodies against GM1 seem to profit from immunosuppressive therapy. A reliable test for IgM antibodies against GMl may be useful for identifying these patients. We have assessed the comparability of the ELISA tests used for the determination of IgM against GM1 by sending coded serum samples to nine laboratories. In three samples high-titre IgM antibodies against GM1 were detected by all laboratories. This result was confirmed by dot blot immunodetection and thin-layer chromatography immuno-overlay. Seven samples were read as negative by nearly all laboratories. Major discrepancies between laboratories were noted in the analysis of one sample with results ranging from negative to high titre. Participating laboratories: N. Baumann and A. Ben Younes-Chennoufi, Neurobiologie cellulaire moleculaire et clinique, INSERM U134, Hôpital de la Sâpetrière, Paris, France; P. Fredman and L. Svennerholm, Department of Psychiatry and Neurochemistry, Goteborg University, Sweden; N. Gregson and R. A. C. Hughes, Department of Neurology, Guy's and St. Thomas's Medical and Dental School, London, UK; A. A. Ilyas, Department of Neurosciences, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark, N. J., USA; A. Pestronk, Division of Neuromuscular Diseases, Washington University School of Medicine, St. Louis, Mo., USA; A. J. Steck, Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (current address: Department of Neurology, University of Basle); H. Willison, Department of Neurology, University of Glasgow, Glasgow, UK     

Exercise Dependence in Amateur Competitors and Non-Competitor Recreational Exercisers

Research has demonstrated that exercising has health promoting effects. However, if habitual sporting activities become uncontrollable, detrimental health consequences can occur among a minority of individuals. Furthermore, such obligatory exercise can cause serious decline in school/work productivity, as well as financial problems, relationship problems, and poor psychological and physical wellbeing. The aim of the present study was to compare characteristics related to exercise dependence (ED) between recreational exercisers and amateur competitors. A total of 1439 participants (41.4 % male; mean age = 32 years) completed a battery of measures including the Exercise Dependence Scale (EDS), SCOFF, Well-Being Questionnaire, and Rosenberg’s Self-Esteem Scale. Results showed that 6.5 % of participants identified themselves as amateur competitive exercisers. Amateur competitors exercised significantly more (6.4 h) than non-competitor recreational exercisers (4.6 h). Amateur competitors also scored significantly higher on the EDS. Significant effects were found between competing and self-esteem concerning ED. Results showed that both features had a strong effect on ED. The study highlights the connection between ED symptoms and lower self-esteem and/or lower levels of subjective wellbeing. These influential factors are worth considering when planning preventive interventions addressing ED for both amateur competitors and non-competitive recreational athletes as well as when promoting sport as a healthy activity.     

Variability of haptoglobin and alpha 2-macroglobulin in Albino Oxford and Dark Augustin inbred strains of rats before and after trauma

Increased synthesis of acute-phase proteins (APP) in the liver represents the most prominent aspect of acute phase reaction (APR). Haptoglobin (Hp) and alpha 2-macroglobulin (alpha 2-M) are among the most important APP in rats. In this study AO (Albino Oxford) and DA (Dark Augustin) inbred strains of rats, with different resistance to trauma, were used to compare concentrations of Hp, alpha 2-M, IL-1, IL-6 and TNF, before and after tourniquet trauma. Cytokines IL-1, IL-6 and TNF have an important role in APP gene expression. Our results showed that before trauma, more resistant AO rats had higher concentrations of Hp and alpha 2-M compared to DA rats. The influence of genetic elements of these differences is significant. Tourniquet trauma caused an early increase of IL-1, IL-6 and TNF activities in the serum which preceded the increase in the Hp and alpha 2-M concentrations but differences between strains were not found.     

Breast milk oligosaccharides: effects of 2′-fucosyllactose and 6′-sialyllactose on the adhesion of Escherichia coli and Salmonella fyris to Caco-2 cells

Background: It is well known that human milk oligosaccharides play an important role as prebiotics, anti-inflammatory, and anti-infective agents. In the last few years, several studies have been performed using specific oligosaccharides, such as 2′-fucosyllactose and 6′-sialylactose, to evaluate their biological functions.

Objectives: The aim of the present study is to evaluate the anti-adhesive effect of the above oligosaccharides on Escherichia coli and Salmonella fyris.

Methods: Adhesion experiments were performed in the presence of 2′-fucosyllactose and 6′-sialyllactose as potential inhibitors of Escherichia coli and Salmonella fyris adhesion to Caco-2 cells. The oligosaccharides were used at different concentrations and the adhesion experiments were performed in triplicate and repeated at least three times.

Results: A significant reduction of Escherichia coli adhesion was observed in the presence of 2′-fucosyllactose and 6′-sialyllactose at the human milk concentration. On the contrary, no positive effects were observed in both oligosaccharides on Salmonella firis.

Conclusions: Our results suggest that the supplementation in infant formulas of 2′-fucosyllactose and 6′-sialyllactose, actually commercially available and absent in cow milk, could play positive effects in artificially fed infants.