Use of agricultural by-products in the development of an agro-energy chain: A case study from the Umbria region.

Use of agricultural and livestock by-products for anaerobic digestion (AD), in total or partial substitution of the maize silage was evaluated from an environmental and economical point of view. The evaluation process included three methodological interdependent and consequential steps: the chemical stage at laboratory and plant level, the environmental and economic steps developing the Life Cycle Assessment and Life Cycle Costing jointly. The laboratory test showed that the two mixtures prepared with by-products, in partial (MIX A) and total (MIX B) substitution of maize silage, did not show differences in bio-methane production compared to a reference mixture with the 33% of maize silage. All mixtures tested at full-scale plant, showed the same performances, resulting in a similar energy production. Environmentally, MIX B increased greenhouse gas credits derived from the avoided production of mineral fertiliser for the energetic crops, resulting also in better economic performances. The break-even transport distances follow the positive environmental pattern result, in contrast to what was found for the break-even transport distances from the economic point of view.

[Use of diuretics in congestive heart failure: renal effects]. / Diuretici nello scompenso cardiaco e conseguenze renali.

Diuretics are an integral part of the management of symptomatic heart failure. Although they have been used for several decades, there is still some ambiguity and confusion regarding the outcome and the optimal way of using these common agents. There are no large-scale randomized controlled trials that have evaluated the effect of diuretics on mortality and long-term morbidity in diastolic and systolic dysfunction. Nonetheless, in short-term studies furosemide has demonstrated to reduce symptomatic congestive heart failure and hospitalization, and to improve exercise capacity in the setting of systolic dysfunction. In this review, the classes, sites of action and renal effect of diuretics are reviewed and the various indications, optimal doses and recommendations on effective use and disuse are discussed. Namely, this review addresses the effects of emerging diuretic agents such as eplerenone--a selective mineral corticoid receptor antagonist, nesiritide--a brain natriuretic peptide-recombinant, and conivaptan--a vasopressin antagonist, in attempt to provide an update on current knowledge, even though adequate clinic data are not available for all agents.

[Emerging risk factors and prevention of atherosclerosis in uraemia]. / Fattori patogenetici emergenti e prevenzione della cardiovasculopatia aterosclerotica nell'uremia.

A high rate of cardiovascular morbidity and mortality in uremic patients was documented early in the 1970s, and this remained unchanged according to more recent European and U.S. American registry report. In large cross-section studies of uremic patients, traditional cardiovascular risk factors such as hypertension and hypercholesterolemic have been found to have low predictive power, while emerging factors such as markers of inflammation and malnutrition, are strongly correlated with cardiovascular mortality. In addition, retained uremic solute such as b-2-microglobulin, advanced glycosylated end product (AGE), homocysteine, cysteine, sulfate may contribute to the pro-atherogenic milieu of uremia. Exhaled alkanes such as isoprene, increased during and after hemodialysis sessions, have been identified as accelerating factors of the atherosclerotic process. In patients with renal disease, even when GFR is still normal, increased sympathetic activity is demonstrable. The rising catecholamines turnover is a risk factor for cardiovascular disease for the high sensitivity of the heart and the arteries to increased sympthetic activity.

Linkage to atopy on chromosome 19 in north-eastern Italian families with allergic asthma.

BACKGROUND: Allergic asthma is a multifactorial disease for which there is a widely assessed, although poorly understood, genetic involvement. Genome-wide screens reported evidence for linkage of allergic asthma-related phenotypes to several chromosomal locations. Markers on chromosome 19 have been linked to allergic asthma phenotypes in different populations in independent studies. OBJECTIVE: The aim of this study was to perform a genetic linkage analysis on chromosome 19 to search for DNA markers linked to phenotypes related to allergic asthma. METHODS: Using non-parametric multipoint linkage analysis on a total of 22 random DNA markers in 2 stages, a sample of 111 families (542 subjects) from north-eastern Italy, recruited through an asthmatic allergic proband, was investigated. Phenotypes examined were: clinical asthma, total serum elevated IgE, skin prick test positivity, bronchial hyper-responsiveness, and atopy defined as skin prick test positivity and/or elevated IgE. Simulation studies were performed to confirm the significance of the results. RESULTS: A novel linkage of atopy and skin prick test positivity to marker D19S601 (19q13.3) was found. Modest evidence for linkage of atopy, skin prick test positivity, and IgE was also found to marker D19S591 (19p13.3). Simulation analysis for atopy gave an NPL-Z > 3.326 in 2 replicates out of 1000 (P = 0.002) for D19S601, and an NPL-Z > 2.56 in 16 replicates out of 1000 (P = 0.016) for D19S591. CONCLUSIONS: On chromosome 19, suggestive linkage of atopy and skin prick test positivity with marker D19S601 (19q13.3) and modest evidence of linkage of marker D19S591 (19p13.3) to the atopic phenotypes investigated were found. These results suggest that these regions may contain susceptibility loci associated to atopic phenotypes.

Blood pressure in nuns in a secluded order: A 30-year follow-up.

The powerful effect of psychosocial and acculturating influences on population blood pressure trends seems to be confirmed, through longitudinal observations, in the nuns in a secluded order. After initial observations had been made on culture, body form, blood pressure, diet, and other variables in 144 nuns and 138 lay women, included as a control group, a 30-year follow-up study was undertaken. Most striking were opposite trends noted between the two groups in blood pressure trend. During the follow-up period, blood pressure remained remarkably stable among the nuns. None showed an increase in diastolic blood pressure over 90 mm Hg. By contrast, the control women showed the expected increase in blood pressure with age. This resulted in a gradually greater difference (delta>30/15 mm Hg) in systolic and diastolic blood pressure between the two groups, which was statistically significant. In addition, cardiovascular morbidity and mortality, expressed as the outcome of fatal and nonfatal events, were different in the two groups. They were significantly more common in the lay women than in the nuns. Comparisons between survival curves were statistically significant (p = 0.0043 for fatal events; p = 0.0056 for nonfatal events) between the two groups. In conclusion, it seems reasonable to attribute much of the difference in blood pressure and cardiovascular events, to the different burden in psychosocial factor and to the preserved peaceful lifestyle of the nuns.

Differential expression of the HMG box transcription factors XTcf-3 and XLef-1 during early xenopus development.

The recent discovery that the HMG box transcription factor XTCF-3 is involved in early axis specification in Xenopus laevis (Molenaar, M., van de Wetering, M., Oosterwegel, M., Peterson-Maduro, J. Godsave, S., Korinek, V., Roose, J., Destree, O., Clevers, H., 1996. XTcf-3 transcription factor mediates beta-catenin-induced axis formation in Xenopus embryos. Cell 86, 391-399) led us to search for other members of the TCF/LEF family in this species. A newly identified HMG box factor was cloned with highest homology to human LEF-1, called XLEF-1. Unlike XTcf-3, XLef-1 is not expressed maternally, but its transcripts become detectable directly after the mid blastula transition (MBT). At later stages, both genes are expressed in the central nervous system (CNS), eyes, otic vesicles, head mesenchyme, neural crest and derivatives, branchial arches, developing heart, tailbud and limb buds. The expression pattern of Lef-1 during later stages of development is evolutionarily conserved.

The uvp1 gene on the R46 plasmid encodes a resolvase that catalyzes site-specific resolution involving the 5'-conserved segment of the adjacent integron In1.

The product of the uvp1 gene of the R46 plasmid, a member of the DNA invertase-resolvase family, was studied to characterize its recombination activity on the R46 plasmid. The purified Uvp1 protein specifically binds to a 256-bp DNA fragment located immediately upstream of the uvp1 gene itself, and overlapping the 5'-conserved segment (5'-CS) of the R46 integron In1. We identified on this fragment a putative resolution (res) site. Using an in vitro assay, we demonstrated the ability of the protein to resolve a synthetic cointegrate containing a direct repeat of the res site. In vivo, we obtained cointegrate resolution in Uvp1-expressing recA- cells. Sites I and II, subsites of the putative res site, lie within the outer boundary of the integron 5'-CS which is common to all the known integrons. Furthermore, a 69-bp DNA element (containing site I) is required for cointegrate resolution. We propose that this recombination mechanism protects R46 plasmid against unequal distribution following fusion with either identical or different integron-bearing plasmids. Moreover, Uvp1 might have a role in generating gene cassette diversity between the two conserved segments of the integron.

Analysis of HIV-1 Tat effects in Xenopus laevis embryos.

Tat is one of the regulatory proteins of the HIV-1 virus. To date, besides the transactivation activity, a myriad of effects exerted by HIV-1 Tat on cellular and viral genes have been observed. The present study investigated the in vivo effects of HIV-1 Tat protein in the Xenopus embryo. We adopted the Xenopus system since expression of putative regulatory factors in the embryo has been widely used as a quick and effective first screen for protein function. Xenopus' early development is well characterized by stage-specific phenotypes, therefore, an in vivo HIV-1 Tat-mediated aberrant phenotype can easily be detected and analyzed. HIV-1 Tat protein expression through injection of synthetic mRNA into zygotes produced a marked delay in gastrulation leading to altered specification of the anterior-posterior axis and to partial or total loss of anterior structures. HIV-1 Tat effects resulted in a general suppression of gene expression, including that of Xbra and gsc, two early genes whose expression is required for proper gastrulation. The specificity of Tat effects was demonstrated by injecting a 'loss of function' mutant (Tat-C37S), lacking a single cysteine residue, which did not yield any effect. Both Tat and Tat-C37S were found to be localized mainly in the nucleus. The importance of subcellular targeting for the effects caused by HIV-1 Tat was demonstrated by injecting a second mutant (Tat-BDM), carrying an altered nuclear localization signal sequence. The Tat-BDM protein localized in the cytoplasm and accumulated at the cell membrane. Embryos injected with Tat-BDM mRNA did not develop beyond gastrulation. The importance of proper protein conformation and subcellular localization in determining Tat effects is discussed.

Blood pressure trend and cardiovascular events in nuns in a secluded order: a 30-year follow-up study.

30-year data are presented on blood pressure and cardiovascular morbidity and mortality for 144 nuns living in a secluded order in six nunnerlie in Umbria, central Italy and 138 lay women from the same region. There were no significant differences at baseline regarding age, blood pressure, body mass index, race, ethnic background, menarche, family history of hypertension or 24-hour urinary sodium excretion. None of the women were smokers and none took birth control pills nor did they use estrogen replacement therapy. During the observation period blood pressure remained remarkably stable among the nuns. None showed a rise in diastolic blood pressure to above 90 mm Hg. On the contrary the lay women showed the expected rise in blood pressure with age. This resulted in a gradually greater difference (delta > 30/15 mm Hg) in blood pressure between the two groups, which was statistically significant. There were 31 fatal and 69 non-fatal cardiovascular events during the 30 years of follow-up. These were significantly more common in the lay women, 10 vs. 21 fatal and 21 vs. 48 non-fatal in the nuns and lay women respectively. It appears reasonable to assume that the difference in psychosocial stress is the main underlying factor for the observed findings.

Fetal macrosomia and management of delivery.

During the period 1988-1966, 737 pregnancies, in which the infant birth weight was > or = 4000 grams were studied. During the same period there were 11,631 newborns, and 6.3% of them were infants with a birth weight > or = 4000 grams. Normal vaginal delivery occurred in 583 cases (79.1%), vacuum extraction in 24 cases (3.3%) and caesarean section in 130 cases (17.6%). Regarding the caesarean section, 38 (29.2%) of them were elective and 92 (70.8%) were done in different periods of the labour. In these macrosomic babies perinatal death never occurred, but different pathological neonatal outcomes were observed and the majority of these were clavicle abruptions (39 cases: 5.3%). Maternal morbidity observed in the 607 (82.4%) cases with vaginal delivery is characterized by: 60 cases (9.8%) of vaginal and perineal tears, 4 cases (0.6%) of cervical tears, and 2 cases (0.3%) of pubic symphysis traumatic diastasis. Shoulder dystocia is the most likely outcome in fetal macrosomic delivery; for this reason we considered the diagnostic and therapeutic management of this obstetrical complication. Because the normal outcome of neonatal births actually encourages the preference for normal vaginal delivery, we concluded that mothers with macrosomic fetuses can safely be managed expectantly unless there is a high maternal and fetal risk.

"Non-dipper" hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study.

Patients with a blunted or absent nocturnal blood pressure (BP) drop may be subject to increased risk for target organ damage. In this 3-year longitudinal case-control study we tested the hypothesis that an association exists between a reduced or absent night-time fall in BP and a future decline of kidney function in renal hypertensive patients. The case subjects were 48 hypertensives with renal insufficiency, divided into two groups according to the presence (dippers: n 20) or absence (non-dippers: n 28) of a nocturnal diastolic BP decline greater than 10% of daytime values, detected by ambulatory BP monitoring. At the baseline evaluation the two groups did not differ with respect to age, sex, body weight, office systolic and diastolic BP, mean daytime ambulatory BP, creatinine clearance, 24 h proteinuria. In the ambulatory BP profiles over a 3-year follow-up the nocturnal reductions of systolic and diastolic BP in the dippers were 14% and 15%, respectively, vs 7% and 5% in the non-dippers (p = 0.002/0.003). The non-dippers had a faster rate of creatinine clearance decline than the dippers (0.37 +/- 0.26 vs 0.27 +/- 0.09 ml/min/month; p = 0.002). Urinary protein excretion increase was higher in the non-dipper group than in the dipper group (993 +/- 438 vs 691 +/- 222 mg/24 h; p = 0.009). This longitudinal study suggests that the non-dipping pattern of ambulatory BP can be associated with a faster progression of renal insufficiency in renal hypertensives and that a proper nocturnal BP control is an additional aim of antihypertensive therapy.

Time-course study of blood pressure over a 20-year period in congenital blindness.

In a prospective study blood pressure was recorded for 20 years in 132 white patients with congenital blindness and in 138 white control schoolchildren. The subjects for both groups were consecutively enrolled without any selection parameters. During the study period a similar proportion of blind patients and controls reported identical consumption of tobacco (above the age of 14 years) and of oral contraceptives (above 21 years) among women. Mean 24-h urinary sodium excretion, collected randomly in both groups, did not differ between the blind patients and the controls. During the 20-year period systolic and diastolic blood pressure rose with age in the control group as expected and much less in blind patients; after 14-17 years the difference was statistically significant. The mean slope of the regression line (beta coefficient) for systolic blood pressure versus age was 1.143 in the blind patients and 1.794 in the controls (P less than 0.001), and for diastolic blood pressure 0.908 in the patients and 1.353 in the school children (P less than 0.001). The mean weight and body mass index increased more in the blind patients than in the controls (difference 5.9 and 2.8 kg, respectively). The results support the hypothesis that low visual and cognitive stress levels determine a lower level of cardiovascular reactivity with ageing.

Age and blood pressure changes. A 20-year follow-up study in nuns in a secluded order.

In a prospective study, 144 white nuns belonging to a secluded monastic order and 138 white control laywomen were followed for 20 years to investigate whether living for a long time in a stress-free environment influences the effect of aging on blood pressure. Silence, meditation, and isolation from society are the distinctive features of the life-style examined. At study entry, blood pressure was not dissimilar in the nuns and the control group, but it increased over time only in the controls, with a mean slope of the regression line (beta coefficient) of 0.089 in the nuns (NS) and 2.171 in the controls (p less than 0.0001) for systolic blood pressure and of 0.054 in the nuns (NS) and 0.742 in the controls (p less than 0.0001) for diastolic blood pressure. Weight and body mass index increased similarly over time in the two groups. Family history of hypertension was not dissimilar between the groups. Serum cholesterol and triglycerides, higher at study entry in the nuns, increased similarly over time in the two groups. Twenty-four-hour urinary sodium excretion, collected randomly in both groups, did not differ over time between nuns and controls. None of the women smoked or used oral contraceptives. Educational level was higher in the control group, but subgroups of 48 nuns and 52 laywomen of comparable educational level maintained the same difference in the blood pressure trend over time as in the main cohort. Parity affected the increase of systolic, but not of diastolic, blood pressure with age among the laywomen, but nuns and no-childbirth controls maintained a significantly different blood pressure trend over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversal of left ventricular hypertrophy after one-year treatment with clonidine: relationship between echocardiographic findings, blood pressure, and urinary catecholamines.

Previous studies have shown that some antihypertensive drugs, beside controlling arterial pressure (AP), reverse left ventricular hypertrophy (LVH) by reducing adrenosympathetic activity. The aim of our study was to evaluate the relationship between AP levels, echocardiographic LVH and 24-h urinary excretion of epinephrine (UE) and norepinephrine (UNE) in 23 previously untreated stable hypertensive individuals with LVH and in 18 healthy normotensive control subjects before and after 1-year treatment with oral clonidine. Intraventricular septal (IVS) and posterior wall (PW) thickness and left ventricular mass index (LVMI) were related to systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP), as well as to UE and UNE by multivariate regression analysis. Before clonidine treatment increased values for IVS and PW thickness correlated with DAP (r = 0.54; p less than 0.05), and MAP (r = 0.50; p less than 0.05), a positive relation between IVS thickness and LVMI and UNE was found. After clonidine treatment, in addition to a statistically significant reduction in SAP, DAP, MAP, and in NE and UNE (all p less than 0.01), a decrease in IVS (12.5 to 9.5 mm; p less than 0.01) and in PW (11.2 to 9.3 mm; p less than 0.01) thickness as well as in LVMI (152.3 to 108.6 g/m2; p less than 0.01) was observed in hypertensive patients. LVMI weakly correlated with UNE change (r = 0.50; p less than 0.05). These data support a possible influence of catecholamines in modulating the development of LVH. They also confirm the parallel action of clonidine in controlling AP, in reducing UE and UNE, and in reversing LVH in hypertensive patients.

Effect of biofiltration on cardiac arrhythmias.

The effect of biofiltration-PAN system and acetate-cuprophan hemodialysis on ventricular arrhythmias detected by long-term ECG monitoring was assessed in 12 patients with end-stage renal failure, studied according to a randomized cross-over design. Low and high risk ventricular ectopic beats were significantly (p less than 0.001) more frequent both during acetate dialysis and in the post-dialytic period than with biofiltration at any time. A significant inverse correlation was found in regression analysis (r = 0.40, p less than 0.001) between total ventricular ectopic beats and pH values in the pre-dialytic, intra-dialytic, early post-dialytic and total post-dialytic periods. The lower frequency of ectopic ventricular beats in biofiltration dialysis makes this technique more suitable for patients with dangerous and disabling arrhythmias.

[Left ventricular function in patients under peritoneal dialysis treatment]. / La funzione ventricolare sinistra nei pazienti in trattamento dialitico peritoneale.

M-Mode echocardiogram and systolic time intervals were obtained in 24 patients with end-stage chronic renal failure before and after peritoneal dialysis in order to evaluate their left ventricular function. Before dialysis 9 patients (group A) showed an echocardiographic pattern of dilated cardiomyopathy, i.e. increased left ventricular end-diastolic dimension (EDD) and volume (EDV), reduction of fractional shortening (FS%), of circumferential fiber shortening (Vcf) and of ejection fraction (EF). Seven patients (group B) had the morphological and functional features of asymmetric septal hypertrophy: ratio of interventricular septum to posterior wall thickness (IVS/PWT) greater than 1.3, reduced EDD and EDV. Eight uraemics (group C) had no specific feature of cardiac disease, but only aspecific echocardiography signs of myocardial derangement. Peritoneal dialysis appeared to be associated with gradual improvement of the contractile state in group A patients, with reduction in echocardiographic asymmetric septal hypertrophy in group B uraemics, and with an aspecific increase in cardiac performance in group C patients. It is concluded that: end-stage chronic renal failure may have echocardiographic pattern of dilated or asymmetric hypertrophic cardiomyopathy; peritoneal dialysis significantly improves the morphological and functional derangements of both clinical conditions.