Palpebral dirofilariasis in man: a case in Sardinia

Human palpebral dirofilariasis: a case in Sardinia. One case of human palpebral dirofilariasis, in Sardinia, is described. The nematode, Dirofilaria repens, during its permanence in the host caused local signs of an allergic type and migrated in the subcutaneous tissues from the left lower eyelid to the neck, the axillary region, the abdominal wall, reappearing in the right lower eyelid, from where it was removed.     

Effect of exercise on tissue anti-oxidant capacity and heart electrical properties in male and female rats

We studied the changes in the anti-oxidant capacity of tissues, such as heart, liver, and blood in male and female rats, as a parameter for evaluating oxidative stress after either a prolonged (210 min) or an exhausting bout of swimming. Furthermore, we also investigated exercise-induced changes in the electrophysiological properties, measured in vitro, of papillary muscle fibres. Small decreases of anti-oxidant capacities after prolonged exercise [0.10 (SEM 0.04) in heart, 0.43 (SEM 0.19) in liver, 0.22 (SEM 0.05) in blood] and greater decreases after exhausting exercise [0.23 (SEM 0.04) in heart, 0.90 (SEM 0.29) in liver, 0.34 (SEM 0.04) in blood] were found in tissues from the male rats. For the female rats, similar changes were found only in the blood [0.11 (SEM 0.07) and 0.35 (SEM 0.06) for prolonged and exhausting exercise, respectively]. Liver and heart anti-oxidant capacity remained unchanged after prolonged exercise, while after exhausting swimming it underwent a decrease almost the same as found in the male rats, though the swimming time to exhaustion (endurance capacity) was much greater [706 (SEM 10) min and 444 (SEM 32) min for the females and males, respectively]. The duration of the action potential, recorded from papillary muscle fibres, underwent changes related to the decreases in heart anti-oxidant capacity. In fact, the action potential duration (APD) was shorter only in preparations from the male rats after prolonged exercise, but in all preparations after exhausting exercise. After such exercise, the APD was similar for the male and female rats [37.1 (SEM 3.4) ms and 37.0 (SEM 3.6) ms, respectively]. Such a pattern was independent of stimulation frequency, since it was found substantially unchanged when the frequency was increased from 1 to 5 Hz. We concluded that the different susceptibilities to the effects of physical exercise, exhibited by tissues from these male and female rats might have been related to different capacities to oppose oxidative stress effectively.     

Sarcopenia and Appendicular Muscle Mass as Predictors of Impaired Fasting Glucose/Type 2 Diabetes in Elderly Women

Elderly women exhibit a high risk of type 2 diabetes (T2D), but no definitive data exist about the possible role of postmenopausal increases in visceral adiposity, the loss of lean body mass, or decreases in the sum of the lean mass of arms and legs (appendicular skeletal muscle mass (ASMM)). This retrospective, longitudinal study investigated whether body composition (bioelectrical impedance analysis) predicted the development of impaired fasting glucose (IFG) or T2D in a cohort of 159 elderly women (age: 71 ± 5 years, follow-up: 94 months) from southern Italy (Clinical Nutrition and Geriatric Units of the “Mater Domini” University Hospital in Catanzaro, Calabria region, and the “P. Giaccone ”University Hospital in Palermo, Sicily region). Sarcopenia was defined in a subgroup of 128 women according to the EWGSOP criteria as the presence of low muscle strength (handgrip strength <16 kg) plus low muscle mass (reported as appendicular skeletal muscle mass <15 kg). Participants with a low ASMM had a higher IFG/T2D incidence than those with a normal ASMM (17% vs. 6%, p-adjusted = 0.044); this finding was independent of BMI, fat mass, waist circumference, and habitual fat intake (OR = 3.81, p = 0.034). A higher incidence of IFG/T2D was observed in the subgroup with sarcopenia than those without sarcopenia (33% vs. 7%, p-adjusted = 0.005) independent of BMI and fat mass (OR = 6.75, p = 0.007). In conclusion, this study demonstrates that elderly women with low ASMM had a higher probability of developing IFG/T2D. Further studies are needed to confirm these results in men and in other age groups.     

Prospective study of the meaning of indeterminate results of the Recombinant Immunoblot Assay for hepatitis C virus in blood donors

Background

The interpretation of “indeterminate” results of the recombinant immunoblot assay (RIBA) is a particularly sensitive issue for Transfusion Services, and donors with such a serological condition require long-term follow-up.

Materials and methods

In the Immunohaematology and Transfusion Medicine Division of Umberto I University Hospital (Rome, Italy), 102,979 donor blood units were screened for hepatitis C virus (HCV) antibodies by enzyme-linked immunosorbent assay (ELISA) over a 5-year period (01.01.2000 – 31.12.2004). Since 24.10.2001, HCV -RNA testing was added. All samples repeatedly reactive by ELISA were then submitted to a HCV confirmatory assay (RIBA).

Results

Among the 102,979 donors we found 271 positive to HCV ELISA testing. The results of the RIBA assay for these donors were negative in 178 (65.7%) cases, positive in 28 (10.3%) and indeterminate in 65 (24.0 %).Of the 65 subjects with an indeterminate pattern, 24 completed a sufficient follow-up (median 25 months; range, 6 – 52), during which some (n=8; 33%) converted to a negative status, some (n=16; 67%) maintained their reactivity pattern, but none became seropositive for HCV.

Conclusions

The HCV-RIBA indeterminate status may indicate either a non-specific reaction (false positive) or a real pre-existing or initial infection and does not, therefore, enable a prediction of outcome. The use of HCV genomic assays (nucleic acid amplification testing), which are more specific than antibody-based assays (ELISA, RIBA), therefore improves HCV blood donor testing by allowing an accurate interpretation of such primary assays.     

Predictive biomarkers for the treatment of resectable esophageal and esophago-gastric junction adenocarcinoma: from hypothesis generation to clinical validation

Introduction: Esophageal and esophago-gastric junction (EGJ) adenocarcinomas remain a major health problem worldwide with a worryingly increasing incidence. Recent trials indicate survivals benefit for preoperative or perioperative chemoradiotherapy compared to surgery alone. Beside standard chemoradiotherapy regimens, new therapeutic approaches with targeted therapies have been proposed for the treatment of resectable disease. However, clinical outcomes remain extremely poor due to drug resistance phenomena. The failure of these approaches could be partially ascribed to their incorrect application in patients. Therefore, the identification of strong biomarkers for optimal patient management is urgently needed.

Areas covered: This review aims to summarize and critically discuss the most relevant findings regarding predictive biomarker development for neoadjuvant treatment of resectable esophageal and esophago-gastric junction adenocarcinoma patients.

Expert commentary: Optimizing the currently available therapeutic modalities through a more accurate selection of patients may avoid the use of ineffective and potentially toxic treatments. During the last decade, the advent of high-throughput ‘-omics’ technologies has set the basis for a new biomarker discovery approach from ‘molecule by molecule’ screening towards a large-scale systematic screening process with exponential increases in putative biomarkers, which often failed to provide adequate clinical validation.     

Detecting familial hypercholesterolemia by serum lipid profile screening in a hospital setting: Clinical,genetic and atherosclerotic burden profile

Background and aims

Familial hypercholesterolemia (FH) is underdiagnosed and public cholesterol screening may be useful to find new subjects. In this study, we aim to investigate the prevalence of FH patients in a hospital screening program and evaluate their atherosclerotic burden using intima-media thickness (IMT).

Separate impact of metabolic syndrome and altered glucose tolerance on early markers of vascular injuries

ObjectiveWe investigated the separate impact of metabolic syndrome (MS) and altered glucose tolerance on early markers of vascular injuries.MethodsIntima-media thickness (IMT) and Pulse Wave Analysis (PWA), were evaluated in 132 overweight or obese subjects, with (MS⁺) or without (MS^?) MS; subjects were further classified as normotolerant (NT) or with altered glucose tolerance (AGT) according to a 2 h oral glucose tolerance test (OGTT).ResultsIn MS⁺ patients, IMT was higher than in the MS^? group, and PWA revealed higher Augmentation Pressure (Aug, the contribution that wave reflection makes to systolic arterial pressure) and lower subendocardial viability ratio (SEVR, an estimate of myocardial perfusion). When analyzed according to glucose tolerance, IMT was higher in MS⁺NT subjects and AGT patients with and without MS, vs. MS^?NT subjects. Logistic regression modeling showed that both AGT and MS were independently associated with increased IMT. However, only MS remained associated with IMT after adjustment for age. SEVR was reduced only in MS⁺ patients, independently of glucose tolerance. In both groups, Aug and AugI were higher in the AGT group, but the correlation with 2 h-plasma glucose disappeared when corrected for age.ConclusionBoth MS and AGT altered IMT, but the effect of AGT disappears when age is added to the multiple regression model. In contrast, arterial stiffness was affected differently in the two categories: in subjects with MS, the subendocardial viability ratio (an estimate of myocardial perfusion) was impaired, while in subjects with AGT, both Aug and AugI were increased. These data suggest that applying the definition of MS might help to better characterize cardiovascular risk in subjects with altered glucose tolerance or obesity.