[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.

Correlation between psychometric and biological parameters in anorexic and bulimic patients during and after an intensive day hospital treatment.

This study describes: 1. The therapeutic effects on anorexia nervosa (AN) and bulimia nervosa (BN) patients of a psycho-nutritional intensive day-hospital program; 2. The possible correlation between the changes observed in the psychometric tests and the variations of a number of biological parameters. Forty-six female patients (24 AN and 22 BN) were assessed through a semi-structured clinical interview based on DSM-IV criteria for Eating Disorders (ED) and a number of psychometric tests (SCL-90R, BDI, EDI-2, EAT-40, BITE, BAT) at the beginning and at the end of treatment, and after a 6-month follow-up. At these three times, we also assessed the plasma level of leptin, cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17beta-estradiol together with body mass index (BMI) and menstrual cycle. From beginning to discharge, the scores on all psychometric tests improved in the whole sample, except for the Perfectionism subscale of EDI-2 in both groups (AN and BN), the Anger-Hostility, Phobic Anxiety and Paranoid Ideation subscales of SCL-90 and the Interpersonal Distrust subscale of EDI-2 in the BN group. At follow-up, there was a worsening of the BITE scores and of a number of EDI-2 subscales, especially in the AN subgroup - with these changes correlating with the trend of BMI. In AN patients, plasma leptin levels changed from the beginning to the end of treatment and at follow-up according to BMI changes. The mean plasma leptin level in the BN subgroup was higher than in the AN one. We found a statistically significant correlation with the scores of BDI, SCL-90R Depression and Ineffectiveness subscales, EAT-40, BITE-Symptom subscale and the trend of menses dividing these patients into two subgroups (according to the plasma leptin concentration, higher or lower than the top leptin level in the anorexics). These data seem to confirm that leptin secretion doesn't correlate univocally to BMI.

Hyperuricaemia: relationships to body fat distribution and other components of the insulin resistance syndrome in 38-year-old healthy men and women.

The aim of this work was to evaluate whether hyperuricaemia correlates with the cluster of metabolic and haemodynamic disorders closely associated with insulin resistance syndrome (IRS) in young apparently healthy individuals also, and, if so, whether hyperinsulinaemia itself or some other component of this syndrome, are independently associated with hyperuricaemia. The subjects were a random population sample of 181 (M = 94/F = 87) 38-year-old apparently healthy subjects, non-diabetic, without a history of gout. Obesity (overall and regional), serum lipid profile, uric acid, fasting glucose and insulin, 2 h insulin after glucose-load (only in men), blood pressure and main behavioural variables were measured. As expected, most parameters were statistically different between men and women. In particular, serum uric acid levels were significantly higher in the male group than in female group (348 +/- 59 mumol l-1 vs 277 +/- 59 mumol l-1, P < 0.0001). After adjustment for sex, in pooled individuals, serum uric acid concentration showed positive associations with BMI (r = 0.21; P < 0.001), waist/hip girth (WHR; r = 0.45; P < 0.0001), waist/thigh girth (WTR; r = 0.35; P < 0.0001) and subscapula/triceps skinfold ratios (STR; r = 0.30; P < 0.001). Furthermore, serum uric acid was also positively correlated with fasting insulin (r = 0.23; P < 0.001), serum triglycerides (r = 0.34; P < 0.0001), LDL cholesterol (r = 0.16; P = < 0.01), diastolic blood pressure (r = 0.26; P < 0.001), and negatively with HDL/total cholesterol ratio (r = 0.28; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Relationships of plasminogen activator inhibitor-1 to anthropometry, serum insulin, triglycerides and adipose tissue fatty acids in healthy men.

Increased plasma levels of plasminogen activator inhibitor-1 (PAI-1), responsible for reduced fibrinolytic activity, have been shown to be an important risk factor for cardiovascular disease. PAI-1 plasma levels are influenced by several factors which have not yet been fully clarified, including dietary fat intake. The relationships of PAI-1 with other cardiovascular risk factors are still not well known. In a random sample of 38-year-old healthy men (n = 94), the association of PAI-1 plasma levels (measured as activity and antigen) with anthropometric parameters, serum lipids, fasting and 2 h insulin and glucose concentration after oral glucose-load was analysed. Furthermore, the fatty acid composition of subcutaneous adipose tissue, as an objective and reliable index of dietary fat intake, was measured. The univariate analysis showed that plasma levels of PAI-1 were significantly associated with body mass index (BMI) (r = 0.37, P < 0.001), waist/hip ratio (WHR) (r = 0.26, P < 0.01), serum triglycerides (r = 0.47, P < 0.0001), HDL/total cholesterol ratio (r = -0.35, P < 0.001), fasting and 2-h insulin (r = 0.27, P < 0.01 and r = 0.34, P < 0.001) and glucose concentrations (r = 0.25, P < 0.05 and r = 0.28, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Role of degranulation in activation of the respiratory burst in human neutrophils.

The neutrophil response to infection and inflammation includes membrane fusion or degranulation and activation of the membranous respiratory burst oxidase. The role of degranulation in the activation of the burst was explored in resting and activated cells. Exposed membrane proteins of intact cells were labeled with impermeant reagents. Phorbol ester-activated neutrophils and enucleated cells which are granule depleted both exhibit increased labeling with [125I]lactoperoxidase over that of resting cells. The binding of antibodies to granule membranes by cells activated with phorbol ester or treated with cytochalasin B and lithium chloride were similarly increased. These data indicate that insertion of granule membrane into the cell membrane occurs during activation and enucleation of neutrophils. Hyperosmolarity, known to inhibit degranulation, also exhibited an inhibitory effect on the respiratory burst oxidase in the presence of phorbol ester or latex. Pre-treatment of cells with phorbol ester followed by an increase in osmolarity, however, still resulted in activation. Temperatures below 17 degrees C abruptly and simultaneously abolish degranulation and activation of the respiratory burst oxidase. Pre-treatment of neutrophils with phorbol ester at 37 degrees C, followed by measurement of oxidase activity at decreased temperatures, on the other hand, revealed a linear Arrhenius plot above and below 17 degrees C. These results suggest that membrane fusion or degranulation is a step in activation of the respiratory burst.

Acidification activity of human neutrophils. Tertiary granules as a site of ATP-dependent acidification.

The acidification activity of human neutrophils, known to occur extracellularly and intraphagolysosomally, was studied in intact and in fractionated cells. The subcellular location of the acidification activity was investigated by rate zonal sedimentation of post-nuclear supernatants from resting cells on continuous sucrose gradients. The acidification measurements indicated a dominance of activity in gelatinase-rich tertiary granules. On the other hand, ATPase activities were located in plasma membrane and in the membranes of the cytoplasmic granules (specific, azurophilic, and tertiary). All of these activities were diminished by the inhibitors dicyclohexylcarbodiimide and diisothiocyanostilbene disulfonic acid; however, studies with other inhibitors, especially N-ethylmaleimide and duramycin, suggested ATPase enzymatic differences depending on location. The results taken together provide direct and strong indication of involvement of a proton pump ATPase in acidification inside neutrophils. Furthermore, the dominant location of acidification activity in tertiary granules that very readily degranulate presumably has significant implications for the importance of low pH in cidal events and the inflammatory process.

The activation of the human neutrophil respiratory burst occurs only at temperatures above 17 degrees C: evidence that activation requires membrane fusion.

By considering the effects of temperature on the respiratory burst activity of human neutrophils stimulated by phorbol myristate acetate, we have found that activation only occurs at 17 degrees C and above. Between 20 and 30 degrees C, the rates of oxygen consumption rose dramatically in correspondence with cellular release of gelatinase and lactoferrin. Inasmuch as these mark tertiary and specific granules, respectively, a necessity for membrane fusion of one or both granules with the plasma membrane during triggering of the respiratory burst is very probable.

[Oral contraception and multiple sclerosis]. / Contraccezione orale e sclerosi multipla]

The uncertain question of the use of oral contraceptives by women with multiple sclerosis is discussed. Reference is made to results observed in animals with experimentally induced allergic encephalitis subjected to oestroprogestin management. The course of M.S. during pregnancy is examined and the effects of blood lipid changes produced by oestrogens and progesterone, on the assumption that M.S. is due to a deficiency of unsaturated fatty acids. Lastly, attention is directed to interference with immunity, clotting, and platelet changes, these being factors in the spread off the disease. The data point to a protective rôle on the part of oestrogens, while the picture for progesterone is less conclusive. It would seem that these biological and immunological findings justify the use of oral contraceptives in subjects with M.S., though due caution is imposed by the absence of clinical and epidemiological data.

PIP: The article investigates whether the use of oral contraception (OC) might be detrimental to women affected by multiple sclerosis (MS). Studies conducted on laboratory animals with induced allergic encephalitis and treated with estroprogestational agents, are not conclusive. It is well known that estrogen and progesterone produce blood lipid changes which can cause clotting and platelet changes, factors which are considered determinant in the spreading of MS. Recent data, however, suggests that, in certain doses, estrogen can play a protective role in patients with MS. Though extreme caution is essential, biological and immunological findings justify, at the present time, the use of OC for MS patients.

[Biochemical aspects of lipid metabolism in multiple sclerosis]. / Aspetti biochimici del metabolismo dei lipidi nella sclerosi multipla.

The biochemical features of lipid metabolism in multiple sclerosis are discussed and the contribution made by work on the aetiopathogenesis of the disease is illustrated. Reference is made to diagnostic tests (E-UFA and MEM tests), whose premisses are based on lipid metabolism. A link between biochemical and immunological research in this field is put forward.

2 [(methylsulfinyl) acetyl] pyridine (Oxisuran): a new immunosuppressive agent in EAE.

The authors discuss the effects of a new immunosuppressive agent on the development of EAE. Animals (albino rabbits) were inoculated with an encephalitogenic emulsion, according to Kies' method, whereas a control group was inoculated by a physiological saline solution. Some animals were treated by Oxisuran in the first day after challenge; some others after initial symptoms (18th day). Thirty days after challenge, the animals were sacrificed. No toxicity was found in thoracic and abdominal structures neither in blood count. Pharmacological effectiveness of Oxisuran is well documented either in pretreatment or in therapy; the course was positively influenced in animals, when treated after the appearance of initial symptoms.

[Bilateral occlusion of the internal carotid artery with compensatory circulatory through the ophthalmic arteries]. / Occlusione bilaterale dell'arteria carotide interna con supplenza delle arterie oftalmiche

This study is referred to a patient with bilateral occlusion of the internal carotid artery with anastomotic compensatory circle through ophthalmic arteries.