Official controls regarding artisanal ice cream shops: public health policies and consumer protection in the Italian and European legislative frameworks.

Ice cream is a widely enjoyed food that is especially popular during summer. To ensure it is safe and ready-to-eat for consumers, legislation imposes a series of obligations for food business operators, and for competent authorities that have to carry out official controls, including official sampling. This article reviews the general and specific requirements applicable to the premises where ice cream is produced, concerning aspects related to health notification obligations and to implementing and maintaining procedures based on the principles of the Hazard Analysis and Critical Control Point system. The review extends to results stemming from the most recent official control activities conducted in Italy, and to future perspectives on control methods that will have to be compliant with the provisions of the new EU Regulation 625/2017 applicable from 2019.

[Evaluation of outpatient referral to the nephrologist]. / Valutazione del Referral nefrologico ambulatoriale.

BACKGROUND: Late referral to the nephrologist has been mainly examined to assess its causes and effects in patients with chronic renal failure. It has not been analyzed as a phenomenon in itself, to identify its features and allow more effective prevention plans. This study proposes a methodological approach to the study of outpatient referral to the nephrologist (ORN) by defining a number of evaluation tools. METHODS: Patients referred to an outpatient nephrology department represent a cohort of selected subjects on the basis of patient-related factors (clinical, social and cultural) and care-related factors. The incidence and prevalence of kidney disease in this population cannot be considered as a measure of the frequency in the general population. They may represent a first-level approach to the study of ORN by providing an indication of its pattern but not of its actual size in the catchment area. For this purpose we implemented a "referral index", calculated as the percent ratio between the number of affected subjects attending our outpatient department and the number of affected subjects within the whole catchment area. RESULTS: The number of subjects attending our outpatient department showed a progressive increase, especially among diabetics, in the last 8 years, in concomitance with a collaborative prevention project involving general practitioners. The referral index of the most frequent chronic kidney diseases in 2005 never exceeded 4.9%, accounting for the steady increase in outpatients following our ORN promotion policy. Prevalence on the one hand and referral index on the other provide different types of information about the same subgroup of outpatients: among patients with chronic kidney diseases, prevalence shows a different graduation of ORN than the referral index. Finally, the frequency distribution of chronic kidney disease stages calculated with the referral index moved toward the fourth and fifth stages rather than the second and third stages, as shown by the prevalence. CONCLUSIONS: The incidence and prevalence of renal diseases among outpatients are measures of ORN and they are useful for a qualitative analysis, such as to assess its pattern. The referral index provides a quantitative evaluation of ORN with respect to the general population of the catchment area.

Developmental and hormonal regulation of rat theca-cell differentiation factor secretion in ovarian follicles.

We have recently presented data demonstrating that preantral follicles secrete a peptide (or family of peptides) that stimulates ovarian theca-interstitial cell (TIC) androgen production by an LH-independent mechanism. The purpose of the study reported here was to study the gonadotropin and developmental regulation of this thecal differentiating factor(s) (TDF) and to determine whether follicle-conditioned medium (FCM) containing TDF bioactivity could stimulate LH receptor and steroidogenic enzyme mRNA expression in TIC. Preantral follicles devoid of theca were obtained by limited enzymatic dispersal of 26-day-old rat ovaries. Follicles were cultured (5 follicles/well) in 96-well plates containing serum-free medium to generate FCM containing bioactive TDF. To bioassay for TDF activity, isolated TIC were cultured (2 days) with 50% FCM; then androsterone production was measured by RIA. Recombinant FSH (rFSH, 0.3-100 mlU/ml) increased TDF bioactivity in a dose-dependent fashion, stimulating maximum androsterone production (20 ng/ml) at 30 mlU/ml. To determine the time course of the production of TDF bioactivity, FCM was collected from follicle cultures treated with and without rFSH at 1, 6, 12, 18, 24, 30, 36, 42, and 48 h. FCM from follicles cultured without rFSH caused a progressive increase in androsterone production to a peak (8 ng/ml) at 18 h followed by a decline to baseline by 48 h. A similar time course was observed for the first 18 h with the rFSH-treated FCM, but androsterone production continued to increase to a level twice that of the untreated FCM (18 ng/ml) at 36 h of culture. In the presence of 100 mlU/ml of rFSH, TDF bioactivity was produced by preantral follicles with > or = 2 layers of granulosa cells but not by small antral follicles, preovulatory follicles, or corpora lutea, demonstrating that production of TDF bioactivity is developmentally regulated. To determine whether FCM could stimulate mRNA expression in TIC, LH receptor, cholesterol side-chain cleavage (P450scc), 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD), and 17 alpha-hydroxylase (P450(17) alpha) mRNAs were measured by reverse transcription polymerase chain reaction assays. FCM stimulated LH-receptor, P450scc, 3 beta-HSD, and P450(17) alpha mRNAs above controls. Our data demonstrate that the production of TDF bioactivity is increased by FSH during a specific stage in follicular development when the theca interna is rapidly differentiating, but its production stops when the follicle develops an antrum. Treatment of TIC with FCM stimulates the expression of the mRNAs coding for LH receptors and the steroidogenic enzymes P450scc, 3 beta-HSD, and P450(17) alpha, mimicking the events that occur during normal thecal differentiation. Thus, it seems likely that TDF is involved in the regulation of initial thecal differentiation in preantral follicles.

Discrimination between chronological and ovarian age in infertile women aged 35 years and older: predicting pregnancy using basal follicle stimulating hormone, age and number of ovulation induction/intra-uterine insemination cycles.

A marked decline in fertility rates has been demonstrated in women > 35 years of age. We have previously demonstrated the importance of basal follicle stimulating hormone (FSH) concentrations plus chronological age to predict pregnancies in women aged >/=40 years undergoing ovulation induction therapy. The purpose of the current study was to extend our previous study and determine the impact of age, basal FSH concentrations and ovulation induction/inter-uterine insemination (IUI) treatment cycles on pregnancy rates in infertile women age >/=35 years. This prospective observational study was performed at a tertiary university fertility centre. Assessments of basal hormonal status and ovulation induction protocols were performed. The main outcome measured was clinical pregnancies. A total of 770 treatment cycles in 179 women aged >/=35 years were analysed. The impact of basal FSH concentrations on treatment outcomes could be bifurcated into a favourable group (FSH /= mIU/ml). A multivariate logistic regression model was generated which accurately predicted pregnancies. There was a high degree of correlation between predicted pregnancies and observed pregnancies (r = 0.86). We conclude that age, number of treatment cycles and the interaction term basal FSH x age are useful and significant predictors of pregnancies in patients aged >/=35 years undergoing ovulation induction/IUI therapy.

Transvaginal probe ultrasonography. Diagnostic or outcome advantages in women with molar pregnancies.

This study attempted to determine whether patients with molar pregnancy initially evaluated by transvaginal ultrasound had earlier diagnoses and superior outcomes than did similar patients initially evaluated by only transabdominal scans. The medical records of 71 patients with molar pregnancy evacuated at the University of California at Los Angeles and affiliate hospital Olive View Medical Center between 1975 and 1988 were reviewed. Eight patients did not have ultrasound imaging prior to evacuation, and three had missing films. The remaining 60 patients were divided into two cohorts: 19 had transvaginal scans, while 41 had transabdominal scans only. The groups were compared retrospectively. Transvaginal pelvic ultrasound did not appear superior to the less expensive and less invasive transabdominal approach in identifying patients with molar pregnancy. These patients generally present with uteri over 10 weeks in size and often much larger; the gestation can be well visualized abdominally through the bladder window. Our study demonstrated no differences in outcome between patients from the two imaging groups.

Preantral follicles stimulate luteinizing hormone independent differentiation of ovarian theca-interstitial cells by an intrafollicular paracrine mechanism.

Ovarian thecal cells are thought to differentiate from fibroblast-like precursor cells in the stroma adjacent to developing follicles. Since the precursor cells do not contain LH receptors, a regulator other than LH must initiate thecal differentiation. These studies were designed to test the hypothesis that preantral follicles secrete substances that can stimulate thecal differentiation. Preantral follicles devoid of theca were obtained by limited enzymatic dispersal of 26-day old rat ovaries. Follicles were cultured (5 follicles/well) in 96-well plates containing serum-free medium to generate follicle-conditioned medium (FCM). Isolated theca-interstitial cells (TIC) were cultured (2 days) in 50% FCM, to bioassay for androgen-stimulating activity. Androsterone production was measured by RIA. FCM from follicles of increasing size with 1, 2, 3, 4 or 5 layers of granulosa cells (GC) stimulated increasing amounts of androsterone suggesting that secretion of androgen-stimulating activity is developmentally regulated in preantral follicles. The androgen-stimulating activity of 7.5-fold concentrated FCM was markedly increased above control levels or the levels stimulated by insulin-like growth factor-I (100 ng/ ml), transforming growth factor-α (100 ng/ml), transforming growth-factor-ß1 (10 ng/ml), inhibin A (300 ng/ml), activin A (100 ng/ml), or Müllerian inhibiting substance (MIS; 300 ng/ml) suggesting that the bioactive substances were distinct from these intrafollicular growth factors. rFSH stimulated a > 10-fold increase in androgenstimulating activity demonstrating that the bioactivity is hormonally regulated. The bioactivity was sensitive to trypsin digestion but was not inhibited by indomethacin (10 µm) suggesting that it is peptide not prostaglandin in nature. Gel filtration chromatography indicated that the M of the bioactive peptides in FCM ranged from 19 500 to 23 600. Taken together our results demonstrate that preantral follicles secrete thecal differentiating factors (TDFs) that are developmentally and hormonally regulated by FSH. The properties of the TDFs are markedly different from known intrafollicular growth factors and may represent a new paracrine regulator in the ovary that can stimulate LH-independent thecal differentiation.

Fetal umbilical artery Doppler response to graded maternal aerobic exercise and subsequent maternal mean arterial blood pressure: predictive value for pregnancy-induced hypertension.

Predictive tests for the identification of women at high risk of the development of preeclampsia are critical to allow the most appropriate preventive measures. Preeclampsia is a vasospastic condition of pregnancy characterized by early and enhanced vascular reactivity to endogenous pressor agents. Exercise tolerance testing with cycle ergometry to induce hemodynamic response measured with duplex Doppler A/B ratio of the umbilical artery could unmask latent vascular pressor hypersensitivity. Our prospective cohort study was designed to test the efficacy of the American College of Obstetricians and Gynecologists exercise in pregnancy guidelines for the low-risk athletic, physically active, or sedentary patient. The pattern of fetal response to material exercise testing at 28 weeks' gestation was compared with subsequent maternal mean arterial blood pressure and the development of pregnancy-induced hypertension and preeclampsia. Doppler A/B ratio during the recovery period was assessed as below baseline (18) or elevated above resting baseline values (12). Third-trimester blood pressure pattern was assessed to be elevated in 11 patients, 10 of whom had elevated recovery A/B ratios. The Fisher exact test results were (p = 0.00002) positive predictive value, 83%; negative predictive value, 94%; sensitivity, 91%; and specificity, 89%. Preeclampsia developed in four patients; all had elevated recovery A/B ratios. Fisher exact test results were (p = 0.01806) positive predictive value, 33%; negative predictive value, 100%; sensitivity, 100%; and specificity, 69%.

Ascorbic acid-dependent collagen formation in penaeid shrimp.

1. This study tested the hypothesis that black death, the ascorbic acid (AsA) related disease of penaeid shrimp, is related to collagen underhydroxylation. 2. Collagen measured as hydroxyproline (HYP) in healthy Penaeus californiensis (Holmes) and P. stylirostris (Stimpson) of a wide range of masses were determined. The results revealed a logarithmic relationship between total body collagen HYP and body weight fitting the equation y = 90x1.18 where y = total collagenous HYP (microgram) and x = body weight (g). 3. Shrimp tissues most subject to mechanical trauma (subcutis, hindgut and gills) had the highest collagenous HYP levels and were most consistently and severely affected by an ascorbic acid (AsA) deficiency disease. 4. Prolyl hydroxylase (PH) activity was demonstrated in tissues of P. californiensis and P. stylirostris by hydroxylation of [3,4-3H]proline. 5. AsA was required for shrimp PH activity using a chicken embryo substrate. 6. Nutritional trials revealed that dietary AsA was required for proline hydroxylation in collagen formation in P. californiensis.