Incidence of erectile dysfunction in Italian men with diabetes.

PURPOSE: We determined the incidence of erectile dysfunction in Italian men with diabetes. MATERIALS AND METHODS: We estimated the incidence of erectile dysfunction, defined as failure to achieve and maintain erection sufficient for satisfactory sexual performance, after 2.8 years of followup in 1,010 men enrolled for a prevalence study of erectile dysfunction in diabetes. RESULTS: Of the 1,010 men 192 (19%) complained of erectile dysfunction. The crude incidence rate of erectile dysfunction was 68 cases per 1,000 person-years (95% confidence interval 59 to 77). The incidence of erectile dysfunction increased with increasing age (10-fold higher for ages 70 to 79 than for 19 to 29 years), duration of diabetes (1.6-fold higher a history of 11 years or greater than for less than 5) and deteriorating metabolic control (1.7-fold higher for hemoglobin A1c greater than 9% than less than 7.5%). Moreover, it was higher in type 2 than in type 1 diabetes (74 versus 45 cases per 1,000 person-years). The relative risk was 1.75, 2.02, 1.97, 1.16, 1.86, 3.79 and 1.52 for associated obliterative arterial disease of the lower legs, ischemic heart disease, renal disease, autonomic neuropathy, sensitive and motor neuropathy, diabetic foot and retinal disease, respectively. Of the characteristics at study enrollment patient age, duration of diabetes, renal disease and hypertension were multivariate predictors of the erectile dysfunction 2.8 years later. CONCLUSIONS: The incidence of erectile dysfunction in Italian men with diabetes at a mean followup of 2.8 years was 68 cases per 1,000 person-years, more than 2-fold that in the Massachusetts Male Aging Study of the general population. The knowledge of this incidence should promote specific preventive and therapeutic interventions for erectile dysfunction in men with diabetes.

Management of erectile dysfunction in diabetic subjects: results from a survey of 400 diabetes centres in Italy.

We report the results of a survey on erectile dysfunction (ED) conducted in 400 Italian Diabetes Centres in 1998. A questionnaire consisting of 10 items was sent to the Centres recorded by the Italian Association of Diabetologists and the Italian Society of Diabetology; 400 Centres returned the completed questionnaire (58%). Forty-nine percent of the Centres declared that they investigated ED systematically but less than half of them (46%) had done it autonomously. The percentage of Centres performing intracavernous injection (ICI) was 84%. This maneuvre was most commonly performed by diabetologists (61%), followed by urologists (29%) and andrologists (18%) (categories are not mutually exclusive). ICI was also the most common type of treatment (85%), followed by oral (32%) and topic (7%) therapies (categories are not mutually exclusive). Slightly more than half of the interviewed Centres (51%) did not investigate ED routinely, attributing this to structural problems, lack of specific training and the availability of more specialised Centres as the main reasons for this. However, the majority of Centres expressed interest in managing ED. Among the available tests for ED, ICI was the most frequently employed. While most Centres seek the collaboration of external specialists to diagnose ED, the diabetologist is the physician who most frequently performs ICI. We conclude that Italian diabetologists need specific training to reach a greater degree of autonomy in the management of ED in their patients.

Evaluation of the presence of bovine proteins in human milk as a possible cause of allergic symptoms in breast-fed children.

BACKGROUND: It is generally believed that the elimination of certain foods from the diet of mothers during the lactation period produces a significant improvement in breast-fed children who develop allergic symptoms. Several studies have shown the presence of food proteins in human milk; on the other hand, no study has been able to correlate unequivocally the presence of these allergens in human milk with newborn sensitization. OBJECTIVE: The aim of this study was to evaluate the presence of bovine proteins in breast milk. METHODS: Milk samples were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). To detect bovine proteins in human milk, immunoblotting was performed by using monoclonal antibodies (MA) specific for beta-lactoglobulin and bovine caseins. RESULTS: The results of this study do not confirm the presence of bovine proteins in breast milk suggested by other authors and shows unequivocally that the conflicting results reported in the literature about the presence of betalactoglobulin in human milk are due to cross-reactivity between bovine milk proteins and human proteins. CONCLUSIONS: Components other than bovine betalactoglobulin or caseins could be involved in the induction of allergic symptoms in exclusively breast-fed children.

Cross-reactivity between milk proteins from different animal species.

BACKGROUND: Cow's milk allergy is quite frequent in the first years of human life. When breast-feeding is not possible, a cow's milk substitute must be provided for allergic subjects. Different alternatives to cow's milk have been suggested as protein sources (soy, hydrolysed proteins, goat's milk, etc.), but all these dietetic solutions are not without risks for polyallergic or more sensitive subjects. OBJECTIVE: To obtain new information on the suitability of other mammalian milks for allergic children, we evaluated the cross-reactivity between milk proteins from different animal species. METHODS: Milk samples were analysed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). To detect antibody-antigen complexes, immunoblotting was performed by using sera from children allergic to cow's and ewe's milk (RAST class >/= 4) and monoclonal antibodies (MoAb) specific for bovine proteins (caseins and beta-lactoglobulin). RESULTS: IgEs from children allergic to cow's milk are capable of recognizing most part of milk proteins from mammals bred in European countries (ewe, goat, buffalo), while no serum used in this study contains IgEs reacting with camel's milk proteins. Camel's milk was also not recognized from circulating IgEs from a child specifically allergic to ewe's milk. Specific antibovine monoclonal antibodies cross-reacted with proteins from other mammalian species, apart from those of camel. CONCLUSIONS: Homologies in amino acidic composition could justify the cross-reactivity observed between proteins from different animal species. On the other hand, the phylogenetic difference could be responsible for the failed recognition of camel's proteins by circulating IgEs and monoclonal antibodies.

Protein profiles in breast milk from mothers delivering term and preterm babies.

During the last few years, advances in the care of low-birth-weight and preterm neonates has stimulated research on the best dietetic program to improve survival and to reduce handicap incidence. At present, fortification of human milk with artificial formulas is the most usual dietetic solution. As yet, however, little is known about the composition of milk from mothers giving birth prematurely. The aim of this study was the quantification of different proteins in human milk during the lactation period. By use of an electrophoretic method, lactoferrin (LF), alpha-lactalbumin, beta-casein, and lysozyme concentrations were measured in milk from mothers delivering normally (TM) or prematurely (PM). LF concentration in milk from TM presented higher values in the very first days and a fast decrease to d 10. After d 10, the concentration reached a plateau. In milk from PM, the LF concentration in the first days was lower than for TM. Similar profiles of alpha-lactalbumin, beta-casein, and lysozyme concentrations were found in milk from TM and PM. A general higher variability in PM samples was observed both between different mothers and for the same woman during the lactation period. Lactation profiles for four human milk proteins are described here. No significant difference was observed (apart from LF in the very first days) between preterm and term milk samples, confirming the unsuitability of unfortified breast milk for preterm neonates.

Effects of structure modifications on IgE binding properties of serum albumins.

BACKGROUND: Bovine serum albumin (BSA) is one of the most widely studied proteins; its structure is well-known and its antigenic characteristics have been described in studies performed in in vitro and animal models. The aim of our work was to evaluate the role of BSA conformation in its antigenicity (recognition by circulating IgEs from allergic children). METHODS: This study was performed using electrophoresis associated with the immunoblotting technique, where sera from children sensitized to BSA (as shown by double-blind placebo-controlled food challenge) were used. RESULTS AND DISCUSSION: Heat treatment and chemical denaturation (SDS treatment) are not able to decrease the BSA capability to bind circulating IgEs. Only by reducing treatment with 2-mercaptoethanol is it possible to modify but not to eliminate the antigenicity of this protein. The reactivity to other serum albumins from different animal species was also investigated and in this study we show a direct correlation between the number of IgE-mediated responses observed in immunoblotting and the percentage of sequence identity (phylogenetic similarity) of serum albumins. CONCLUSION: Data obtained in this research indicate that serum albumin antigenicity is only partially correlated to its native three-dimensional structure.

Effect of technological treatments on digestibility and allergenicity of meat-based baby foods.

OBJECTIVE: When suitability prepared according to particular characteristics of hygiene and digestibility, meat is an important food for human weaning. The present knowledge on meat digestibility and allergenicity are not enough to justify removal of meat from a child's diet when there is risk but no clinical evidence of allergy. Based on these considerations, the role of technological treatments on digestibility and allergenicity of meat-based baby foods is considered. SUBJECTS: Eight children (five males and three females) suffering from atopic dermatitis (AD), aged 3.8 to 7.1 years (mean age 4.86 +/- 1.10 years). STUDY DESIGN AND METHODS: An in vitro multienzymatic digestibility assay was used to evaluate proteolysis in meat samples (from four different animal species). The experimental design included raw, steam-cooked (home-made and industrial cooking), homogenized (strained) and freeze-dried meat samples. Skin prick test (SPT) was performed to evaluate positive responses to meat samples (raw, cooked, strained and freeze-dried) from four animal species. RESULTS: Our data indicate that enzymatic attack is strongly affected by heat treatment as shown in steam-cooked meat samples. On the other hand, blending, homogenization and freeze-drying processes are able to partially reverse the phenomenon. Data on modification of sodium dodecyl sulfate-polyacrylamide gel rlectrophoresis (SDS-PAGE) protein pattern during the multienzymatic assay are reported. Cooking and technological treatments reduce positive responses obtained in SPT. CONCLUSIONS: Technological treatments improve digestibility and reduce antigenicity of meat products.

Meat allergy: III--Proteins involved and cross-reactivity between different animal species.

BACKGROUND: Although relatively infrequent, meat allergy represents a serious problem for children both because it is generally associated with intolerance to other protein sources and because of the suggested role of meat in stimulating the gastrointestinal development during weaning. OBJECTIVE: With these considerations, the aim of our work was to improve biological-biochemical knowledge of meat allergy. METHODS: This study was performed using in vivo skin prick test (SPT) and in vitro (electrophoresis associated with the immunoblotting technique) tests. RESULTS: Bovine serum albumin (BSA) and actin were the proteins most frequently involved in binding with the circulating IgE. BSA involvement was confirmed by SPT; the high number of positive responses observed with actin in immunoblotting was not confirmed by SPT data. Cross-reactivity between serum albumins from different animal species was demonstrated. Our studies show that in this group of children, the correspondence between the percentage of sequence identity (phylogenetic similarity) and the number of positive responses was surprisingly high. CONCLUSIONS: Although further studies are necessary, the data reported here provide new biochemical data on meat allergy.

Use of immunoblotting and monoclonal antibodies to evaluate the residual antigenic activity of milk protein hydrolysed formulae.

BACKGROUND: Partial and extensive hydrolysed protein formulae have been developed to lower or eliminate the antigenicity of milk proteins. Although normally well tolerated, extensive hydrolysates have been reported to induce serious allergic reactions in very sensitive children. Moreover, clinical practice has often raised concern about the role of partial hydrolysates in cow's milk allergy prevention. OBJECTIVE: Starting from these considerations, we used anti-casein monoclonal antibodies to evaluate the presence of residual antigenic activity in both partially and extensively protein hydrolysates. METHODS: Electrophoretic analyses associated with immunoblotting technique were performed using nine protein-enriched commercial formulae. RESULTS: The presence of different amounts of residual intact cow's milk proteins and/or polypeptidic material with conserved antigenic activity (according to the extensive or partial hydrolysis) was verified in most milk-based samples considered. CONCLUSION: The use of monoclonal antibodies and immunoblotting could be useful for the quality of commercial 'hypoallergenic' formulae.

Evaluation by SDS-PAGE and immunoblotting of residual antigenicity in hydrolysed protein formulas.

BACKGROUND: Extensively hydrolysed protein formulas are widely used as an alternative diet for children with cow's milk allergy. Partially hydrolysed protein formulas have been noted in some studies as useful in the prevention of allergy in infants at high risk of atopy. Although normally well tolerated, these 'hypoallergenic' products have been reported to cause serious immunological reactions in very sensitive subjects. OBJECTIVE: Starting from these considerations, we studied some commercial hydrolysed formulas in search of biological data supporting the observed clinical reactions. METHODS: We set up an electrophoretic method sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) which allowed us to study the molecular weight of peptides contained in hydrolysed products. Then, using the immunoblotting technique we evaluated the reactivity of circulating IgE (from serum of children allergic to cow's milk proteins) with the residual intact proteins and with the peptides present in these formulas. RESULTS: Both group of milk proteins (caseins and whey proteins) were important allergens for children included in this study. The presence of high-molecular polypeptides was shown in partial hydrolysed formulas as such and in extensive hydrolysed products after protein enrichment by trichloroacetic acid (TCA) precipitation. Intact residual proteins were mainly responsible for the formation of IgE-antigen complexes observed in immunoblotting. More rarely, polypeptides of partial hydrolysed formulas were involved in immunological responses. CONCLUSIONS: Both partial and extensive hydrolysed formulas could induce clinical reactions in very sensitive subjects. These responses are mainly associated with allergy to the small amounts of residual intact proteins.