Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study.

PURPOSE: Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery. RESULTS: 123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery. CONCLUSION: We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.

Nitrogen dioxide pollution increases vulnerability to COVID-19 through altered immune function.

Previous ecological studies suggest the existence of possible interplays between the exposure to air pollutants and SARS-CoV-2 infection. Confirmations at individual level, however, are lacking. To explore the relationships between previous exposure to particulate matter < 10 µm (PM10) and nitrogen dioxide (NO2), the clinical outcome following hospital admittance, and lymphocyte subsets in COVID-19 patients with pneumonia. In 147 geocoded patients, we assessed the individual exposure to PM10 and NO2 in the 2 weeks before hospital admittance. We divided subjects according to the clinical outcome (i.e., discharge at home vs in-hospital death), and explored the lymphocyte-related immune function as an index possibly affecting individual vulnerability to the infection. As compared with discharged subjects, patients who underwent in-hospital death presented neutrophilia, lymphopenia, lower number of T CD45, CD3, CD4, CD16/56 + CD3 + , and B CD19 + cells, and higher previous exposure to NO2, but not PM10. Age and previous NO2 exposure were independent predictors for mortality. NO2 concentrations were also negatively related with the number of CD45, CD3, and CD4 cells. Previous NO2 exposure is a co-factor independently affecting the mortality risk in infected individuals, through negative immune effects. Lymphopenia and altered lymphocyte subsets might precede viral infection due to nonmodifiable (i.e., age) and external (i.e., air pollution) factors. Thus, decreasing the burden of air pollutants should be a valuable primary prevention measure to reduce individual susceptibility to SARS-CoV-2 infection and mortality.

Coronary angiography and percutaneous transluminal coronary angioplasty procedures: Evaluation of patients' maximum skin dose using Gafchromic films and a comparison of local levels with reference levels proposed in the literature.

The aim of this study was to evaluate the maximum skin dose (MSD) in patients undergoing interventional cardiology procedures, obtaining local reference levels and comparing these with the reference levels proposed in the literature. The patients' MSD was measured using Gafchromic XR type R films. In order to evaluate reference levels, the number of images acquired, the fluoroscopy times and the KAP(TOTAL) were recorded for each procedure. For the evaluation of the MSD, 8 coronary angiography (CA) and 16 percutaneous transluminal coronary angioplasty (PTCA) procedures, carried out in the period from May to June 2008, were analyzed. For the CA procedures the MSD values were below 0.5 Gy. For the PTCA procedures, we found a fairly good correlation between fluoroscopy time and MSD (r = 0.80, p = 0.0002) and between MSD and WFP (r = 0.863, p < 0.0001); there was a strong correlation between KAP(TOTAL) and MSD (r = 0.904, p <0.0001). Since the correlation between KAP(TOTAL) and MSD is more striking than that with fluoroscopic time and the WFP, KAP measurements are suitable for online skin dosimetry and may, therefore, be used to avoid radiation-induced skin injuries. A MSD greater than 3 Gy occurred in only one procedure. For calculus of the local reference levels, we extended the data-gathering to 30 procedure CA and to 40 PTCA: we compared local practice with that in other centers using the guidance levels proposed by Balter et al. Our median KAP values were below these proposed guidance levels; our mean KAP values were above these proposed action levels. From a first application of the proposed reference levels, it appears that, according to the recommendations of Balter et al. an investigation into local practice is not necessary.

A human melanoma cell line transduced with an interleukin-4 gene by a retroviral vector releases biologically active IL-4 and maintains the original tumor antigenic phenotype.

Experimental models of vaccination with tumor cells engineered to produce interleukin-4 (IL-4) have shown that the local release of this cytokine is associated with the development of antitumor immunity that may induce regression of established cancer. The aim of this study was to transduce a human melanoma cell line with the gene coding for human IL-4, and to analyze cytokine production, phenotypic characteristics, and antigen expression after transduction. A retroviral vector, constructed by inserting IL-4 cDNA into the LXSN vector, was used to infect the human melanoma cell line Me14932, known to express the MHC class I HLA-A2 and the melanoma-associated antigen Melan-A/MART-1, recognized by HLA-A2-restricted T-cells. The confluence of all G418-resistant cells (Me14932/IL-4) was then analyzed for proviral integration and IL-4 mRNA expression. Substantially stable IL-4 release was detected by ELISA in the supernatant of transduced cells, ranging from 1.6 to 4.6 ng/ml per 10(5) cells per 24 hr; such a cytokine displayed a specific biologic activity, as revealed by the stimulation of blast cell proliferation and the inhibition of lymphokine activated killer cell (LAK) induction by IL-2. After 200 Gy irradiation, IL-4 release remained detectable for 5 weeks, whereas cell proliferation ceased within 7 days. Morphology and immunophenotypic characteristics of the parental cell line (expression of MHC classes I and II, ICAM-1, LFA 3, melanoma-associated antigens, etc.) were retained by the IL-4 gene-transduced melanoma as assayed by microscopy and immunofluorescence; likewise, susceptibility to lysis by LAK cells as well as a T-cell clone recognizing the Melan-A/MART-1 antigen did not change. These results, together with the lack of replication-competent retrovirus, suggest that the Me14932/IL-4 cell line displays suitable characteristics for its use in the treatment of HLA-matched melanoma patients.

Synthetic peptides homologous to prion protein residues 106-147 form amyloid-like fibrils in vitro.

Gerstmann-Sträussler-Scheinker disease (GSS) is a prion-related encephalopathy pathologically characterized by massive deposition of prion protein (PrP) amyloid in the central nervous system. The major component of amyloid fibrils isolated from patients of the Indiana kindred of GSS (GSS-Ik) is an 11-kDa fragment of PrP spanning residues 58 to approximately 150. These patients carry a missense mutation of the PRNP gene, causing a Phe-->Ser substitution at codon 198. We investigated fibrillogenesis in vitro by using synthetic peptides homologous to consecutive segments of GSS-Ik amyloid protein (residues 57-64, 89-106, 106-126, and 127-147) as well as peptides from the PrP region with the GSS-Ik mutation (residues 191-205 and 181-205, both wild type and mutant). Peptide PrP-(106-126) formed straight fibrils similar to those extracted from GSS brains, whereas peptide PrP-(127-147) formed twisted fibrils resembling scrapie-associated fibrils isolated from subjects with transmissible spongiform encephalopathies. Congo red staining and x-ray fibril diffraction showed that both straight and twisted fibrils had tinctorial and conformational properties of native amyloid. Conversely, the other peptides did not form amyloid-like fibrils under similar conditions. These findings suggest that the sequence spanning residues 106-147 of PrP is central to amyloid fibril formation in GSS and related encephalopathies.

Molecular characteristics of a protease-resistant, amyloidogenic and neurotoxic peptide homologous to residues 106-126 of the prion protein.

In the prion-related encephalopathies the prion protein is converted to an altered form, known as PrPSc, that is partially resistant to protease digestion. This abnormal isoform accumulates in the brain and its protease-resistant core aggregates extracellularly into amyloid fibrils. We have investigated the conformational properties, aggregation behaviour and sensitivity to protease digestion of a synthetic peptide homologous to residues 106-126 of human PrP, which was previously found to form amyloid-like fibrils in vitro and displayed neurotoxic activity toward primary cultures of rat hippocampal neurons. A scrambled sequence of peptide PrP 106-126 was used as a control. By circular dichroism, PrP 106-126 exhibited a secondary structure composed largely of beta-sheet, whereas the scrambled sequence of PrP 106-126 showed a random coil structure. The beta-sheet content of PrP 106-126 was much higher in 200 mM phosphate buffer at pH 5.0 than in the same buffer at pH 7.0. Laser light scattering analysis showed that PrP 106-126 aggregated immediately after dissolution in 20 mM or 200 mM phosphate buffer, pH 5.0 and 7.0, whereas scrambled PrP 106-126 did not. PrP 106-126 aggregates had an average hydrodinamic diameter of 100 nm and an average molecular weight of 12 x 10(6) +/- 30% Daltons, corresponding to the aggregation of 6000 +/- 30% molecules. Peptide PrP 106-126 showed partial resistance to digestion with Proteinase K and Pronase, whereas scrambled PrP 106-126 was completely degraded by incubation with the enzymes at 37 degrees C for 30 minutes.

B-myb antisense oligonucleotides inhibit proliferation of human hematopoietic cell lines.

The B-myb gene is highly homologous to the c-myb protooncogene in several domains and also shares some of the functions of c-myb in that it can act as a transcriptional activator. In addition, the expression of both the B-myb and c-myb genes correlates with proliferation of normal hematopoietic cells. We investigated more directly the role of B-myb in proliferation of hematopoietic cell lines using B-myb-specific antisense oligonucleotides. We showed that several anti-B-myb oligonucleotides, complementary to distinct regions of the gene, inhibit significantly and in a dose-dependent manner the proliferation of all myeloid or lymphoid cell lines tested. This block in proliferation was not accompanied by detectable differentiation of U937 or HL60 cells to macrophages or granulocytes either spontaneously or after exposure to chemical agents. These data suggest that the B-myb gene, like c-myb, is necessary for hematopoietic cell proliferation.

Role of beta 1 integrins in tumor cell adhesion to cultured human endothelial cells.

We investigated the effects of beta 1 integrins on tumor cell (TC) adhesion to unstimulated and interleukin-1 (IL-1) activated endothelial cells (EC). IL-1 treatment (20 units/ml for 6 hours) of cultured human umbilical vein EC significantly increased adhesion of seven human TC lines of different origin. A goat antiserum raised to purified alpha 5 beta 1 integrin abolished the IL-1 induced increment in adhesion of two osteosarcomas, one melanoma, one lung, and one kidney carcinoma, whereas it did not affect adhesion of two colon carcinoma cell lines. Further studies were performed on MG63 osteosarcoma cells. Adhesion of MG63 osteosarcoma cells to EC was dependent on time of EC treatment with IL-1: it was maximal at 12 hours and declined at 24 hours. alpha 5 beta 1 antiserum blocked IL-1 induced increase in MG63 adhesion at any time of EC treatment. This effect appears to be mainly directed to MG63 integrins since selective incubation of the antiserum with EC, but not with MG63, did not modify TC adhesion. Using a series of antibodies to different alpha and beta chains, we found that only monoclonal antibodies (mAb) to alpha 4, alpha 5, and beta 1 could inhibit MG63 adhesion to IL-1 activated EC, whereas alpha 2, alpha 6, and beta 3 antibodies were ineffective. Antibodies to fibronectin had very little activity on MG63 adhesion to EC matrix and did not significantly affect MG63 adhesion to control or IL-1 treated EC. Antibodies to alpha 4, alpha 5, and beta 1 were only partially effective in inhibiting MG63 adhesion to EC matrix. These data indicate that the capacity of alpha 4 beta 1 and alpha 5 beta 1 integrins to bind fibronectin contributed very little to MG63 adhesion to EC. The importance of beta 1 integrins in promoting a direct interaction between EC and MG63 was further shown by inhibition of rosette formation among these cells in suspension by the alpha 5 beta 1 antiserum. Only a VCAM-1/INCAM110 mAb, but not ELAM-1 or ICAM-1 mAbs, could inhibit MG63 adhesion to IL-1 activated EC. Overall these data indicate that at least two members of the beta 1 integrin subfamily (alpha 4 beta 1 and alpha 5 beta 1) are involved in MG63 adhesion to cytokine treated EC. This integrin function might be important at early stages of TC interaction with the vessel wall.

[The structure of distribution of pharmaceutical products in the countries of the EEC]. / La struttura distributiva dei prodotti farmaceutici nei Paesi della CEE.

The aim of the study is to focus on the basic aspects of the distribution structure in the pharmaceutical industry of the EEC countries. The unique features of the pharmaceutical business, which make it different from all other industrial areas are pointed out with an analytical approach. The industry examination performed and the comparison between the structures existing in each country, have given the opportunity to underline certain typical behaviours of the pharmaceutical industries within the 1992 European scenario.

Thiopental efficacy in phenobarbital-resistant neonatal seizures.

The successful treatment with thiopental (10 mg/kg, i.v.) of 9 severely asphyxiated newborns, under artificial ventilation, with neonatal seizures resistant to phenobarbital, is reported in this pilot study. The clinical and electroencephalogram control of seizures was prompt and resolute. No adverse effect on cardiovascular function (heart rate, blood pressure) was observed. The terminal half-life of thiopental averaged 9 h, the total plasma clearance 0.20 l/h/kg, and the steady-state volume of distribution 3.6 l/h/kg. The kinetic profile of the drug compared to phenobarbital and phenytoin in newborns suggests that its action is quicker and shorter lasting. Thus, from these findings, thiopental may offer a useful and handy approach for the safe and effective treatment of phenobarbital-resistant neonatal seizures.

Placental transfer, tissue distribution, and pharmacokinetics of cyclosporine in the pregnant rabbit.

The disposition of cyclosporine during pregnancy is described for the first time using the pregnant rabbit model. After a detailed kinetic study, in which a 5 mg/kg dose of cyclosporine was used, the apparent tissue-to-blood partition coefficients were determined at steady state in six pregnant rabbits after a two-step infusion of cyclosporine for 8 hr at a mean arterial blood concentration of 1.25 mg/liter, detected by HPLC. Muscle and fat were major drug deposits, and the maternal kidney--site of considerable side effects--accumulated the highest concentration of the drug. Spleen, mammary gland, liver, lung, heart, bile, and adrenal gland showed intermediate ability to accumulate the drug. The whole fetus accumulated little cyclosporine, and the drug was not detectable in maternal and fetal brains and in the amniotic fluid. At delivery, the mean cyclosporine concentration in fetal blood was 0.07 mg/liter, amounting to 6% of the mother's concentration. It would appear that diffusional resistance governs the transfer of cyclosporine into brain and fetus. Although caution obviously must be applied in extrapolating experimental data to clinical situations, the present findings do suggest that: a) exposure of the fetus to cyclosporine is low at a high maternal steady-state concentration; and b) caution should be applied in suggesting breastfeeding by these patients, since cyclosporine was found in a considerable amount in the mammary gland.

Placental transfer and tissue distribution of thiopental in the pregnant rat.

The pharmacokinetic profile of thiopental was studied in pregnant rats after an iv bolus dose of 15 mg/kg. The unbound concentration-time profile of the drug in maternal plasma, placenta, fetal brain, fetal carcass, and amniotic fluid was described, developing an adequate pharmacokinetic model. Maternal plasma levels of thiopental fell rapidly after injection, distributing into tissues (half-life of distribution phase averaged 3 min). Thiopental crossed the placenta and entered the fetal body (brain included) and amniotic fluid. Peak levels were seen within 10 min of injection and declined in all tissues parallel to maternal plasma (rate constant range 0.012-0.017 min-1). The concentrations of drug in the fetal unit were smaller than in the central compartment and maternal plasma. However, the absolute transfer ratios (calculated using the pharmacokinetic parameters obtained from the model) and the relative exposure ratios (as the ratio of the area under the unbound concentration-time curve in tissue to that in maternal plasma) suggested that fetuses were exposed to a potentially efficacious level of the drug. The model formulated to describe the tissue distribution of thiopental may offer a useful approach for analysis of the kinetic profile of other compounds administered during pregnancy or at delivery in rats and other species.

Nodular intracerebral leukemic involvement in the course of acute nonlymphocytic leukemia. Case report and review of the literature.

A case of intracerebral nodular leukemic involvement arising during acute nonlymphocytic leukemia (ANLL)-M3 in complete remission is reported. Cerebrospinal fluid examination was normal. Computed tomography (CT) of the brain was consistent with nodular leukemic deposits. Cranial irradiation and intrathecal chemotherapy induced a complete resolution of the lesions. Twenty cases of nodular intracerebral leukemic involvement in ANLL are reviewed. About half of the patients with central nervous system (CNS) leukemia, when submitted systematically to neuroradiological investigations, presented intracerebral solid deposits. The value of CT scan is emphasized.

Size reduction of a prolactin secreting adenoma during long-term treatment with the dopamine agonist lisuride.

A 38-year-old amenorrhoeic woman suffering from a prolactin (PRL) secreting adenoma, which had suprasellar extension as shown by caroe agonist (lisuride). PRL levels were lowered and after 1 year of treatment CAT showed a marked reduction of the tumour size. After 2 years of treatment menstruation returned and CAT demonstrated a further reduction of the adenomatous tissue. This study supports the suggestion that dopamine agonists possess an anti-proliferative effect on tumoural lactotrophic cells of humans.