Observing and modeling long-term persistence of P. noctiluca in coupled complementary marine systems (Southern Tyrrhenian Sea and Messina Strait).

In the Mediterranean Sea, the Strait of Messina (MS) is a very peculiar area, connecting highly different regions and representing a privileged observatory for an early comprehension and assessment of ecosystems shifts. It is hypothesized that the outbreaks observed near the coast of many sites in the Mediterranean Sea may be the result of transport of permanent populations of P. noctiluca in pelagic waters to the coast, caused by specific hydrodynamic conditions. By both visual observations and numerical experiments our objective is twofold: (A) to help clarify whether the basin of the Aeolian Islands Archipelago (AIA), in the Southern Tyrrhenian Sea (STS), may be the site from which large populations of P. noctiluca are transported to the MS, and (B) to evaluate whether the upwelling turbulent system of the MS can be an energetic opportunity for this species. It should offer a rich habitat without jeopardizing the overall survival of the population, that is subject to stranding due to strong currents. Although very different, the two involved ecosystems (AIA and MS ) are complementary for the success of Pelagia noctiluca life cycle. Outputs obtained by coupling the 3D hydrodynamic model (SHYFEM) with a Lagrangian particle tracking model support the hypothesis of a connectivity between these two ecosystems, particularly in the first half of the year, indicating the coastal areas around the AIA as potential optimal source location for Pelagia larval stages. We support the very attractive hypothesis that two connected systems exist, the former one favours Pelagia's reproduction and acts as a nursery and the latter favours its growth due to higher productivity. We speculate that the reproductive population of the AIA is not permanent, but is renewed every year by individuals who have fed and quickly grown in the MS and who are passively transported by downwelling along canyon "corridors".

Seasonal dynamics of prokaryotic abundance and activities in relation to environmental parameters in a transitional aquatic ecosystem (Cape Peloro, Italy).

This study examines the effects of temporal changes on microbial parameters in a brackish aquatic ecosystem. To this aim, the abundances of prokaryotes and vibrios together with the rates of enzymatic hydrolysis of proteins by leucine aminopeptidase (LAP), polysaccharides by ß-glucosidase (GLU) and organic phosphates by alkaline phosphatase (AP), heterotrophic prokaryotic production (HPP), respiration (R), were seasonally investigated, during a 2-year period in the coastal area of Cape Peloro (Messina, Italy), constituted by two brackish lakes (Faro and Ganzirri). In addition, physical and chemical parameters (temperature, salinity, nutrients) and particulate organic carbon and nitrogen (POC, PN) were measured. The influence of multiple factors on prokaryotic abundances and activities was analysed. The results showed that Cape Peloro area is characterised by high seasonal variability of the microbial parameters that is higher than the spatial one. Combined changes in particulate matter and temperature (T), could explain the variability in vibrios abundance, GLU and R activities in both lakes, indicating a direct stimulation of the warm season on the heterotrophic prokaryotic metabolism. Positive correlations between T (from 13.3 to 29.6 °C) and HPP, LAP, AP, POC, PN are also observed in Ganzirri Lake. Moreover, the trophic status index and most of the microbial parameters show significant seasonal differences. This study demonstrates that vibrios abundance and microbial activities are responsive to the spatial and seasonal changes of examined area. The combined effects of temperature and trophic conditions on the microbial parameters lead us to suggest their use as potential indicators of the prokaryotic response to climate changes in temperate brackish areas.

Assessment of the ecological status of transitional waters in Sicily (Italy): first characterisation and classification according to a multiparametric approach.

A 1-year cycle of observations was performed in four Sicilian transitional water systems (Oliveri-Tindari, Cape Peloro, Vendicari and Marsala) to characterise their ecological status. A panel of variables among which trophic and microbial (enzyme activities, abundance of hetetrophic bacteria and of bacterial pollution indicators) parameters, were selected. Particulate organic carbon (POC) and nitrogen (PON) and chlorophyll-a (Chl-a) contents defined the trophic state, while microbial hydrolysis rates and abundance gave insights on microbial community efficiency in organic matter transformation and on allochthonous inputs. To classify the trophic state of examined waters, the synthetic trophic state index (TRIX) was calculated. Microbial hydrolysis rates correlated positively with POC and Chl-a, which increased along the eutrophication gradient. The significant relationships among TRIX, trophic and microbial parameters suggested the use of leucine aminopeptidase, alkaline phosphatase and POC as suitable parameters to implement the Water Framework Directive when assessing the ecological status of transitional water systems.

Development of a fluorescent antibody method for the detection of Enterococcus faecium and its potential for coastal aquatic environment monitoring.

A direct, microscopic fluorescent antibody method was developed to detect the occurrence of Enterococcus faecium in coastal aquatic environments and was compared with the conventional membrane filtering method. The "in situ" application of the antibody-based protocol in the analysis of water samples collected from coastal polyhaline habitats demonstrated good sensitivity and ease of implementation. Data obtained with the microscopic technique were in agreement with those obtained from culture counts. The fluorescent antibody method proved to be a rapid and reliable technique for the detection of E. faecium. The advantages and limitations intrinsic to the method are discussed, highlighting the potential of this new technique for monitoring coastal aquatic environments.

Changes in the metal content of surficial sediments of Boston Harbor since the cessation of sludge discharge.

Temporal trends of metals in surficial sediments (1991-1998) at two sites in Boston Harbor were analyzed to evaluate the effect of stopping sludge dumping in December 1991. Metal contents of sediments from the old sludge disposal site were higher than those of a station in the central Harbor. Since 1991, carbon, copper, and lead contents have significantly decreased in sediments from the disposal site. Chromium and Zn have shown smaller decreases while Fe, and Mn, have remained relatively constant. Metal content in the central Harbor station, located in an area of sediment reworking, has been quite variable, but, with the exception of Zn which has shown a large decrease relative to iron, the changes seemed to be well correlated with changes in the organic carbon content at this site due to resuspension. Ratios of metals in the sediments are fairly similar at both sites and similar to those of sewage-derived particles, with the exception of Cr, which appears to be enriched in the sediments.

[Parathyroid carcinoma. Therapeutic strategies derived from 20 years of experience]. / Il carcinoma delle paratiroidi. Strategie terapeutiche derivate da 20 anni di esperienza.

BACKGROUND: Carcinoma of the parathyroid is a rare endocrine tumour which can be difficult to diagnose even for expert anatomopathologists. METHODS: A retrospective study was carried out on all the cases of parathyroid pathology observed between January 1980 and October 2000: parathyroid carcinoma was diagnosed in 17 (3.59%) out of 478 patients treated for hyperparathyroidism. We describe their clinical presentation, treatment and results obtained. The patients included 9 women and 8 men, with a male/female ratio of 1.14 and a mean age at diagnosis of 56.9 years (range 30-83). All the patients, except one, the only non-secreting case, presented hypercalcemia, and 10 patients presented serum calcium levels above 3 mmol/L. The symptoms at onset included: nephrolithiasis in 10 cases, osteoporosis in 4 (3 of which presented uremic syndromes), gastrointestinal symptoms (gastritis) in 1 case, a palpable cervical mass in 1 patient and recurrent nerve palsy in one case suffering from familial IPT. A variety of imaging techniques were used for the preoperative localisation: high-resolution ultrasonography of the neck was carried out in all 17 patients and was positive in 15 cases; scintigraphy (99mTcO4/201Tl or 99mO4/MIBI) was carried out in 16 patients and was positive in 14; CAT was positive in 6 out of 17 patients. Three patients underwent the first operation in another hospital and were referred to our department for resistance or recidive. Initial surgery was restricted to simple parathyroidectomy in 4 cases; parathyroidectomy was extended to the entire gland in 3 patients with uremic syndrome and to the ipsilateral thyroid lobe in 7 cases. Three patients underwent parathyroidectomy extended en bloc to the adjacent structures, and recurrent lymph node dissection was also performed in 2 of these patients. Lymph node involvement was never demonstrated during the first operation. The dimensions of the tumour varied from 1 to 6.7 cm; we found signs of invasion of the neighbouring structures in 3 patients. RESULTS: Parathyroid carcinoma was correctly diagnosed during the first operation in 14 cases (this diagnosis was suspected in 10 cases following intraoperative frozen session), whereas the first diagnosis was of benign disease in 3 patients. Blood levels of calcium, phosphorus and PTH returned to normal after the first operation in 13 patients. These values diminished, but did not return to normal in 2 cases. Two patients relapsed, respectively 5 and 175 months after the first operation. A total of 10 reoperations were performed in 4 patients with persistent/recurrent symptoms (from a minimum of 1 to a maximum of 4). Recidive presented characteristics of local invasiveness in one case and the persistence was supported by micro-insemination of the pre-thyroid compartment and muscles in another two cases. At reoperation, lymph node metastasis was associated with local recidive only in one case. Two patients underwent radiotherapy after surgery and one received chemotherapy. At the last check-up (October 2000), 14 patients were alive and disease-free (82.25%). Two presented slight persistent hypercalcemia (with values ranging between 2.65 and 2.80 mmol/L), but without any macroscopic localisation of disease (11.76%). Only 1 patient died (5.88%) (one year after the first operation and 7 months after the last one). Death was caused by uncontrollable hypercalcemia supported by widespread metastasis to the bones and lungs. The 5 and 10-year survival rates were calculated as 94.12%. CONCLUSIONS: In conclusion, high blood levels of calcium and PTH, a palpable mass at the neck, with recurrent nerve paralysis, aspects of local invasiveness should alert the surgeon and guide him towards surgery that includes resection of the parathyroid en bloc with the adjacent structures, although there is no proof that a more extensive surgery is correlated with a more favourable prognosis. Being the majority of recidive functional, monitoring serum calcium and PTH levels offers a useful market which precedes their macroscopic demonstration.

[Radio-guided parathyroidectomy. A prospective study in 54 patients with primary hyperparathyroidism]. / Paratiroidectomia radioguidata. Studio prospettico in 54 pazienti affetti da iperparatirodismo primitivo.

BACKGROUND: The contribution of nuclear-medical mapping using 99mTc-MIBI (MIBI) and the use of an intraoperative probe in primary hyperparathyroidism (I degrees HPT) surgery was evaluated prospectively in a series of patients undergoing parathyroidectomy. METHODS: Fifty-four patients, who were operated between May 1999 and July 2000, under-went a systematic preoperative evaluation using scintigraphy with a dual tracer 99Tc04/MIBI and image subtraction, and high-resolution neck ecotomography. Surgery was performed using a mini-invasive technique through an incision measuring 2-2.5 cm at the base of the neck in 46 patients; the other 8 patients underwent open surgery with bilateral exploration of the neck. MIBI was injected intravenously in the operating theatre following the induction of anesthesia and after 32 minutes on average, radioactivity was measured using a manual gamma probe. Radioactivity was also counted intraoperatively at the tip of the lung contralateral to the pathological gland, a parameter used as the base activity (B), in the presumed seat of the hyperfunctioning parathyroid (P), in correspondence with healthy thyroid tissue (T) and any associated thyroid nodes (N). Radioactivity was also recorded at the level of the empty parathyroid compartment after removal of the corresponding gland, and on the parathyroid removed ex vivo . RESULTS: The ratio between the three main parameters, T/B, P/B and P/T was respectively 1.6 (range=1.5 - 1.8), 2.7 (range=1.6-4.0) and 1.6 (range=1.1-2.8). In 4 cases (7.4%), the small size of the parathyroids, adjacent to thyroid nodes, meant that the parathyroid measurement of MIBI was smaller than the thyroid measurement. The histological finding was consistent with: single parathyroid adenoma in 49 cases, multiple adenomas in 3 cases, parathyroid carcinoma in 2 cases. Rapid intraoperative PTH normalised in all patients. CONCLUSIONS: The significant difference in radioactivity levels recorded in the patients, showed that the technique is useful to the surgeon as a means of intraoperative assay for hyperfunctioning parathyroids, even if it cannot obviously replace experience or the value of preoperative scientigraphic and ecotomographic imaging.

Prognostic factors correlated with survival in AIDS patients.

The authors present the AIDS cases (CDC '93) observed in Brescia from 1983 to 1994. They observed 1189 subjects (M 84%, F 16%) with a mean age of 32.7 years (intra-venous drug users 75.1%, heterosexuals 14%, homosexuals 9.6%). The mean survival observed was 56.7 weeks from the diagnosis of AIDS (mortality per year 78%). The most frequent AIDS-defining events were Visceral Candidiasis, P. carinii Pneumonia (PCP) and Neurotoxoplasmosis, while the longest and shortest mean survival was for Kaposi's Sarcoma (89 weeks) and Wasting Syndrome (8.4). The mean value of CD4+ lymphocyte counts on AIDS diagnosis was 72.6/microl (1166 cases) and the highest and lowest were in non-Hodgkin's Lymphoma (NHL; 147.6/microl) and Cryptosporidiosis (18.8/microl). Antiretroviral therapy had been given for at least a month in 41.4% subjects (mean treatment duration of 74.8 weeks). The Cox model has demonstrated the favourable effect on survival of high CD4+ lymphocyte counts on diagnosis, antiretroviral therapy, the diagnosis of Tuberculosis (TBC) and PCP as initial markers and the diagnosis of TBC, PCP or Cytomegalovirus infection (CMV) during the entire clinical evolution. Moreover, the unfavourable effect of high age, diagnosis of Progressive Multifocal Leucoencephalopathy (PML), Wasting Syndrome and NHL as initial markers and diagnosis of PML or NHL in any moment of the disease has been demonstrated.

Active anti-interferon-alpha immunization: a European-Israeli, randomized, double-blind, placebo-controlled clinical trial in 242 HIV-1--infected patients (the EURIS study).

This randomized, double-blind, placebo-controlled, phase II/III study was designed to evaluate safety, immunogenicity, and efficacy of an active anti-interferon-alpha (anti-IFN-alpha) vaccine in asymptomatic HIV-1-infected patients. The active immunization was aimed at inducing anti-IFN-alpha antibodies to counteract IFN-alpha overproduction. In all, 242 patients, recruited between December 1995 and July 1996 in eight centers in Europe and Israel, with CD4+ counts from 100 to 634 cells/mm3 who were receiving or not receiving antiretroviral therapy (including protease inhibitors) were randomized to receive either anti-IFN-alpha vaccine or placebo. The anti-IFN-alpha immunization regimen consisted of three priming injections delivered intramuscularly at 1-month intervals in a water-in-oil emulsion of inactivated recombinant IFN-alpha-2b (i-IFN-alpha) followed by intramuscular booster injections of i-IFN-alpha adsorbed onto calcium phosphate every 3 months. Immunogenicity to vaccine was defined as an increase of anti-IFN-alpha antibody level of more than twofold the preimmunization value. Clinical progression, changes in antiretroviral treatment, and decrease of CD4+ counts to <200 cells/mm3 were considered endpoints for efficacy evaluation. Contrary to our previous experience, in which six to seven oil priming injections induced a >90% response rate, the three oil-adjuvanted injections in this trial were suboptimal because only 40 of 122 vaccinees (33%) had raised anti-IFN-alpha antibody following immunization. In vaccinees, both antibody responders (AbRV) and nonresponders (AbNRV), the tolerance to the vaccine was good and was without evidence of significant safety concerns. During the course of the trial, 62% of vaccine responders, 64% of nonresponders, and 63% of placebo patients elected to add protease inhibitor-containing regimens as new treatment guidelines were established, resulting in a marked decrease in clinical and laboratory progression such that the expected endpoints of the study could not be achieved and further follow-up was halted. Despite the unexpectedly low immunogenicity and fewer than expected endpoints, anti-IFN-alpha vaccine recipients, in comparison with placebo recipients, showed a lower rate of disease progression, nonelective treatment changes, and/or CD4+ count decrease to <200 cells/mm3, but the difference was not statistically significant. Nevertheless, the subgroup of patients immunized to IFN-alpha who experienced a rise in anti-IFN-alpha antibodies had a significantly lower rate of occurrence of HIV-1-related events and of any combination of the endpoints compared with those of either placebo patients or vaccinees who failed to develop anti-IFN-alpha antibodies, the latter two groups behaving similarly. Further studies of this approach are warranted because these data suggest a beneficial effect of this adjuvant approach.

[Vaginal topical chemical contraception with C-film]. / Contraccezione chimica topica vaginale con C-film.

PIP: C-film is a plastic sheet of 4 sq cm, 28% of which is made up of a spermicidal agent; the plastic leaf is folded and introduced deep into the vagina; its spermicidal action lasts 1-2 hours. Tests conducted in Europe and in the U.S. have shown C-film to be highly acceptable, safe, and to have a Pearl index of 2.5. The authors investigated the use of C-film on 37 patients, for a total of 924 woman-months. There were only 3 pregnancies, of which 1 was due to incorrect use of the device, and 6 cases of vaginitis which resolved spontaneously. This contraceptive method may be particularly recommended to young women and to women over 40 as an alternative to hormonal contraception or the IUD.^ieng