[Improving dietary habits in the effective prevention of excess weight and obesity]. / Migliorare le abitudini alimentari nutrizionali per contra- stare efficacemente sovrappeso e obesità.

The new research survey "Okkio alla salute", conducted in children in the 3rd year of elementary school, has confermed the worrisome phenomenon of the high number of obese and overweight children. Therefore, it is necessary, also in light of the few available resources, to fight back against this phenomenon that has been demonstrated to be a cause of disabling illnesses in adults. There must therefore be collaboration between Departments of Prevention and Hygiene and Nutrition services (SIAN) to build valid and efficient pathways. In this presentation we describe some national projects carried out by various local health agencies to address this health problem.

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs

Shock and resuscitation render patients more susceptible to acute lung injury due to an exacerbated immune response to subsequent inflammatory stimuli. To study the role of innate immunity in this situation, we investigated acute lung injury in an experimental model of ischemia-reperfusion (I-R) followed by an early challenge with live bacteria. Conscious rats (N = 8 in each group) were submitted to controlled hemorrhage and resuscitated with isotonic saline (SS, 0.9 percent NaCl) or hypertonic saline (HS, 7.5 percent NaCl) solution, followed by intratracheal or intraperitoneal inoculation of Escherichia coli. After infection, toll-like receptor (TLR) 2 and 4 mRNA expression was monitored by RT-PCR in infected tissues. Plasma levels of tumor necrosis factor α and interleukins 6 and 10 were determined by ELISA. All animals showed similar hemodynamic variables, with mean arterial pressure decreasing to nearly 40 mmHg after bleeding. HS or SS used as resuscitation fluid yielded equal hemodynamic results. Intratracheal E. coli inoculation per se induced a marked neutrophil infiltration in septa and inside the alveoli, while intraperitoneal inoculation-associated neutrophils and edema were restricted to the interseptal space. Previous I-R enhanced lung neutrophil infiltration upon bacterial challenge when SS was used as reperfusion fluid, whereas neutrophil influx was unchanged in HS-treated animals. No difference in TLR expression or cytokine secretion was detected between groups receiving HS or SS. We conclude that HS is effective in reducing the early inflammatory response to infection after I-R, and that this phenomenon is achieved by modulation of factors other than expression of innate immunity components.

Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs.

Shock and resuscitation render patients more susceptible to acute lung injury due to an exacerbated immune response to subsequent inflammatory stimuli. To study the role of innate immunity in this situation, we investigated acute lung injury in an experimental model of ischemia-reperfusion (I-R) followed by an early challenge with live bacteria. Conscious rats (N = 8 in each group) were submitted to controlled hemorrhage and resuscitated with isotonic saline (SS, 0.9% NaCl) or hypertonic saline (HS, 7.5% NaCl) solution, followed by intratracheal or intraperitoneal inoculation of Escherichia coli. After infection, toll-like receptor (TLR) 2 and 4 mRNA expression was monitored by RT-PCR in infected tissues. Plasma levels of tumor necrosis factor alpha and interleukins 6 and 10 were determined by ELISA. All animals showed similar hemodynamic variables, with mean arterial pressure decreasing to nearly 40 mmHg after bleeding. HS or SS used as resuscitation fluid yielded equal hemodynamic results. Intratracheal E. coli inoculation per se induced a marked neutrophil infiltration in septa and inside the alveoli, while intraperitoneal inoculation-associated neutrophils and edema were restricted to the interseptal space. Previous I-R enhanced lung neutrophil infiltration upon bacterial challenge when SS was used as reperfusion fluid, whereas neutrophil influx was unchanged in HS-treated animals. No difference in TLR expression or cytokine secretion was detected between groups receiving HS or SS. We conclude that HS is effective in reducing the early inflammatory response to infection after I-R, and that this phenomenon is achieved by modulation of factors other than expression of innate immunity components.

Light induction of cell type differentiation and cell-type-specific gene expression in cotyledons of a C(4) plant, Flaveria trinervia.

In Flaveria trinervia (Asteraceae) seedlings, light-induced signals are required for differentiation of cotyledon bundle sheath cells and mesophyll cells and for cell-type-specific expression of Rubisco small subunit genes (bundle sheath cell specific) and the genes that encode pyruvate orthophosphate dikinase and phosphoenolpyruvate carboxylase (mesophyll cell specific). Both cell type differentiation and cell-type-specific gene expression were complete by d 7 in light-grown seedlings, but were arrested beyond d 4 in dark-grown seedlings. Our results contrast with those found for another C(4) dicot, Amaranthus hypochondriacus, in which light was not required for either process. The differences between the two C(4) dicot species in cotyledon cell differentiation may arise from differences in embryonic and post-embryonic cotyledon development. Our results illustrate that a common C(4) photosynthetic mechanism can be established through different developmental pathways in different species, and provide evidence for independent evolutionary origins of C(4) photosynthetic mechanisms within dicotyledonous plants.

Role of endogenous nitric oxide in the nucleus tratus solitarii on baroreflex control of heart rate in spontaneously hypertensive rats.

OBJECTIVE: Toinvestigate the modulatory effect of endogenous nitric oxide (NO) in the nucleus tractus solitarii (NTS) on the baroreceptor reflex control of heart rate in conscious spontaneously hypertensive (SHR) and normotensive (WKY) rats. DESIGN AND METHODS: Male age- and weight-matched SHR and WKY chronically instrumented with cannulas in the NTS, artery and vein were used. Basal pressure (AP), heart rate (HR) and reflex HR responses during loading/unloading of baroreceptors (phenylephrine/sodium nitroprusside, iv) were recorded during vehicle (3 nl/min) NG-monomethyl-L-arginine (L-NMMA) and L-arginine (L-Arg) infusions into the NTS. Constitutive NO synthase (NOS) activity was inferred by 3H-citrulline formation in the dorsal brain stem of other SHR and WKY groups. RESULTS: In SHR a small dose of L-NMMA (30 ng/kg/min) restricted to the NTS did not change AP and HR (185+/-4 mmHg, 373+/-12 beats/min, respectively), but decreased the HR range (57+/-7 beats/min, a 34% reduction, P< 0.05) without changing further the impaired gain of baroreceptor reflex control of HR. In the WKY group similar results (significant 32% reduction in HR range, gain unchanged) were only attained with a dose 10 times higher (L-NMMA(NTS) = 300 ng/kg/min), no effect being observed with the small dose (HR range = 163+/-12 beats/min). In SHR, L-Arg(NTS) (900 ng/kg/min) did not improve baroreflex control of HR, but restored the depression of HR range when given after L-NMMA(NTS). Basal NOS activity in the dorsal brain stem was reduced in SHR (P < 0.05) when compared to WKY group. CONCLUSIONS: NO modulates, at the NTS level, the baroreceptor reflex control of HR in both SHR and WKY not by altering the gain, but by increasing HR range during afferent stimulation. In SHR the depressed NO modulation is in accordance with the smaller NOS activity in the dorsal brain stem.

Losartan improves baroreflex control of heart rate of coarcted hypertensive rats.

To assess the role of angiotensin (ANG) II in both the increased heart rate (HR) and the impaired baroreceptor reflex control of HR that characterize the chronic phase of coarctation hypertension (CH), we compared basal HR, mean arterial pressure (MAP), and baroreflex sensitivity of coarcted hypertensive rats treated chronically with losartan, captopril, or vehicle. Baseline HR was recorded daily, and MAP and reflex HR changes and plasma renin activity (PRA) were measured in coarcted and sham-coarcted rats on the 5th day after coarctation. Both captopril (10 mg.kg-1.day-1 po) and losartan (10 mg.kg-1.day-1 po) caused a small nonsignificant reduction of hypertension (132 +/- 5 and 133 +/- 5, respectively, vs. 147 +/- 9 mmHg in vehicle-treated rats), but equally inhibited the late tachycardic phase (-37 +/- 13 and -29 +/- 12 beats/min in captopril- and losartan-treated groups, respectively, vs. +79 +/- 19 beats/min in vehicle treated rats). Similar results were obtained for other groups of coarcted hypertensive rats after suppression of PRA by bilateral nephrectomy. Although hypertensive levels were the same during both treatments, only losartan given orally or intracerebroventricularlly (1.25 micrograms.kg-1.h-1) was effective in improving the reflex bradycardia. The depressed reflex tachycardia was corrected by chronic oral treatment with losartan. The data suggest that the tachycardia occurring in the chronic phase of CH is mediated by blood-borne ANG II and that the normalization of the reflex control of HR by losartan is achieved by blockade of type I receptors of ANG II in central areas accessible to oral or centrally administered losartan but not to oral captopril.

Hypotensive effect of captopril. Role of bradykinin and prostaglandinlike substances.

Captopril (0.15-10 mg/kg) administration in the anesthetized dog causes immediate hypotension concomitant with an increase in tonus of the assay tissue (cat terminal ileum) superfused with circulating blood (Vane's cascade method). The increase in cat terminal ileum tonus was antagonized by a bradykinin receptor antagonist, L-349b. Treatment of the animals with indomethacin blocked or reversed the hypotensive effect of captopril without affecting the increase in tonus of the cat terminal ileum. Captopril potentiated the hypotension induced by bradykinin injected intra-arterially, and indomethacin reduced the hypotensive effect of intra-arterially injected bradykinin. Addition of captopril or enalapril to the superfusing blood maintained at 37 degrees C in an extracorporeal circuit caused a long-lasting increase in the tonus of the cat terminal ileum. The present results support the hypothesis that immediate hypotension induced by captopril involves a prostaglandin-dependent component possibly resulting from increased bradykinin levels generated in the vicinity of captopril action.

Effects of aspirin-like drugs on Walker 256 tumor growth and cachexia in rats.

Several studies have shown the relationship between prostaglandins (PGs) and cell proliferation. Some PGs may trigger cell division or are involved in this process. This study analyzes the effect of PG biosynthesis inhibitors on tumor growth in vivo and cachexia in Walker 256 tumor-bearing rats. Indomethacin markedly inhibited tumor growth (95.5%) while ibuprofen and aspirin reduced tumor growth by 73.9% and 59.4%, respectively. In addition, all drug-treated rats partially recovered body weight and food intake as compared to the saline-treated group. These findings suggest that PG synthesis inhibitors improve cancer cachexia.

Effects of aspirin-like drugs on Walker 256 tumor growth and cachexia in rats

Several studies have shown the relationship between prostaglandins (PGs) and cell proliferation. Some PGs may trigger cell dibision or are involved in this process. This a=study analyzes the effect of PG biosyntheseis inhibitors on tumor growth in vivo and cachexia in Walker 256 tumor-bearing rats. Indomethacin markedly inhibited tumor growth (95.5% while ibuprofen and aspirin reduced tumor growth by 73.9% and 59.4%, respectively. In addition, all drug-treated rats partially recovered body weight and food intake as compared to the saline-treated group. These findings suggest that PG synthesis inhibitors improve cancer cachexia

Hypertonic resuscitation from severe hemorrhagic shock: patterns of regional circulation.

Severe blood loss can be reverted to normal circulatory function and indefinite survival by a small volume of 2,400 mOsm/liter NaCl (7.5%). This response requires functioning cervical vagal trunks at the time of hypertonic injection. Other equally hypertonic solutes (glucose, mannitol) are ineffective. This paper examines the effects of hypertonic (2,400 mOsm/liter) NaCl (7.5%) and glucose (50%) on femoral, mesenteric, splanchnic, renal, and coronary circulations. Hypertonic NaCl was given to dogs with intact or blocked vagi. Femoral flow was measured in innervated or denervated hindlimbs. Hemorrhage severely restricted both innervated and denervated femoral flows. Hypertonic glucose and NaCl, vagi blocked, redilated both femoral territories. Hypertonic NaCl, intact vagi, redilated denervated femoral vasculature but severely restricted innervated flow. Renal, mesenteric, total splanchnic, and coronary flows were restricted by hemorrhage and undistinguishable redilated by glucose or NaCl, blocked or intact vagi. It appears therefore that hypertonic NaCl induces permanent survival, partly because of its ability to elicit a pulmonary reflex, which induces muscular/cutaneous precapillary constriction. This shunts essentially required flow into the viscera, which are unspecifically vasodilated by hypertonicity.

Hyperosmotic NaCl and severe hemorrhagic shock: role of the innervated lung.

Infusions of hyperosmotic NaCl (2,400 mosmol/l; 4 ml/kg) were given to dogs in severe hemorrhagic hypotension by intravenous injection (72 expts) or intra-aortic injection (25 expts). In 46 experiments intravenous infusions were given during bilateral blockage of the cervical vagal trunks (local anesthesia or cooling). Intravenous infusions (without vagal blockade) restore arterial pressure, cardiac output, and acid-base equilibrium to normal and cause mesenteric flow to overshoot prehemorrhage levels by 50%. These effects are stable, and indefinite survival was observed in every case. Intra-aortic infusions of hyperosmotic NaCl produce only a transient recovery of arterial pressure and cardiac output but no long-term survival. Intravenous infusions with vagal blockage produce only a transient recovery of cardiac output, with non long-term survival. Measurement of pulmonary artery blood osmolarity during and after the infusions shows that a different pattern is observed in each of these three groups and strongly indicates that the first passage of hyperosmotic blood through the pulmonary circulation at a time when vagal conduction is unimpaired is essential for the production of the full hemodynamic-metabolic response, which is needed for indefinite survival.

Hyperosmotic NaCl and severe hemorrhagic shock.

Intravenous infusions of highly concentrated NaCl (2,400 mosmol/l; infused volume 4 ml/kg; equivalent to 10% of shed blood), given to lightly anesthetized dogs in severe hemorrhagic shock, rapidly restore blood pressure and acid base equilibrium toward normality. No appreciable plasma volume expansion occurs for at least 12 h, indicating that fluid shift into the vascular bed plays no essential role in this response. Initial effects wee sustained indefinitely; long term survival was 100%, compared to 0% for a similar group of controls treated with saline. Hemodynamic analysis of the effects of hyperosmotic NaCl showed that these infusions substantially increase mean and pulse arterial pressure, cardiac output and mesenteric flow, whereas heart rate was slightly diminished. These effects immediately follow infusions with no tendency to dissipate with time (6-h observation). We conclude that hyperosmotic NaCl infusions increase the dynamic efficiency of the circulatory system, enabling it to adequately handle oxygen supply and metabolite clearance, despite a critical reduction of blood volume.