Influence of body mass index, comorbidities and prior systemic therapies on the response of psoriasis to adalimumab: an exploratory analysis from the APHRODITE data.

Adalimumab is a fully human monoclonal antibody directed against tumor necrosis factor (TNF)-alpha, which is effective for the treatment of psoriasis and psoriatic arthritis (PsA). The aim of this study is to determine whether the response of psoriasis to adalimumab treatment might be influenced by certain particular factors, such as body mass index (BMI), history of biologic therapy, blood hypertension and metabolic comorbidities. For this reason, an exploratory analysis was conducted on 144 patients with psoriasis and concomitant PsA treated with adalimumab 40 mg every other week, evaluating the influence of such factors on the Psoriasis Area and Severity Index (PASI) response rate at week 12. Our preliminary results suggest that the response rate at week 12, in terms of both PASI-50 and PASI-75, appeared to be independent of the presence of hypertension and/or metabolic comorbidities. The PASI-50 response was observed more frequently in patients with BMI less than 30 as compared to obese patients (79% vs 58%, p = 0.02). Previous use of anti-TNF biologics did not appear to affect per se the rate of responders, although it was associated with a lower PASI-75 rate among responders.

The fermentable fiber content of the diet alters the function and composition of canine gut associated lymphoid tissue.

The ingestion of plant fibers and their susceptibility to microbial fermentation in the large bowel modulate intestinal morphology but little is known about effects on the gut associated lymphoid tissue (GALT). The aim of the present study was to determine the effect of consuming diets containing different levels of fermentability fiber on immune function. Sixteen adult mongrel dogs (23 +/- 2 kg) were fed (14 days) in a randomized cross over design two isoenergetic isonitrogenous diets containing 8.3 g/kg non-fermentable or 8.7 g/kg fermentable fibers. Lymphocytes were isolated from blood prior to starting the study and at the end of each diet period. At study completion, lymphocytes were isolated from the gut associated lymphoid tissue (GALT) of the small intestine for characterization by immunofluorescence and to determine their ability to respond to mitogenic stimulation. Feeding high fermentable fibers increased (P < 0.05) the CD4/CD8 ratio and decreased (P < 0.05) the proportion of B cells in peripheral blood without changing natural killer cell activity or the response to mitogens. Mesenteric lymph node cells from dogs fed the low then high fermentable fiber diet contained a higher (P < 0.05) proportion of CD4+ cells and a higher (P < 0.05) response to mitogens. Intraepithelial, Peyer's patches and lamina propria cells contained a greater (P < 0.05) proportion of CD8+ cells when dogs were fed a low fermentable fiber diet followed by a high fermentable fiber diet. T cell mitogen responses in vitro were higher for intraepithelial but lower for Peyer's patches and lamina propria cells from dogs who were fed the low fermentable fiber diet followed by the high fermentable fiber diet (P < 0.05). In conclusion, the fermentable fiber content of the diet had very little effect on the type and function of immune cells in peripheral blood. However, feeding dogs a high fermentable fiber diet for 2 weeks (after 2 weeks of consuming a low fermentable fiber diet) altered the T-cell composition of GALT and produced a higher mitogen response in the predominantly T cell tissues and a lower response in areas involved in B cell functions. In conclusion, the level of fermentable fiber in the diet appears to alter GALT properties. Further studies are required to determine the direct contribution of a high or low fiber diet to these changes and the physiological implications to the health of the animal.

Fermentable dietary fiber increases GLP-1 secretion and improves glucose homeostasis despite increased intestinal glucose transport capacity in healthy dogs.

Ileal proglucagon gene expression and postprandial plasma concentrations of proglucagon-derived peptides are reported to change with the type and quantity of dietary fiber ingested by rats. Within the intestine, proglucagon encodes several proglucagon-derived peptides known to modulate intestinal absorption capacity and pancreatic insulin secretion. To determine whether the chronic ingestion of fermentable dietary fiber regulates the expression and synthesis of proglucagon-derived peptides in the distal intestine to modulate glucose homeostasis, the following study was conducted: 16 adult dogs (23 +/- 2 kg) were fed isoenergetic, isonitrogenous diets containing a mixture of high fermentable dietary fibers (HFF) or low fermentable (LFF) wood cellulose for 14 d in a randomized cross-over design. Food was withheld for 16 h before an oral glucose tolerance test was conducted supplying 2 g of glucose/kg body wt, and peripheral blood was collected via a hind-leg catheter at 0, 15, 30, 45, 60, 90 and 120 min for plasma glucose, insulin and glucagon-like peptide-1(7-36)NH2 (GLP-1) analyses. Intestinal samples were collected after the second dietary treatment. Ileal proglucagon mRNA, intestinal (GLP-1) concentrations and the integrated area under the curves (AUC) for plasma GLP-1 and insulin were greater and plasma glucose AUC was reduced when dogs were fed the HFF diet compared to the LFF diet (P < 0.05). Intestinal villi heights, brush border and basolateral glucose transporter protein abundance and jejunal transport capacities were significantly greater when dogs were fed the HFF diet than when fed the LFF diet. In conclusion, improvements in glucose homeostasis are observed in healthy dogs when they ingest fermentable fibers.

[Costa's acrokeratoelastoidosis. Apropos of a sporadic case]. / Acrocheratoelastoidosi di Costa. A proposito di un caso sporadico.

A sporadic case of acrokeratoelastoidosis is reported. It is very interesting one because it presents some peculiar data we have found such as the beginning at the age of 3 months, the rapid manifestation of the complete clinical aspect within the first year of life, the total involvement of palms and soles. Also so far the literature on the subject does not describe the microcirculatory district's ischaemic attitude, the reduction in elasticity of large and medium arteries.

[Determination of circulating antibodies in cutaneous leishmaniasis by immunofluorescence test]. / Determinazione degli anticorpi circolanti al test di immunofluorescenza nella leishmaniosi cutanea.

Using a gradient purified leishmania donovani infantum antigen, the sensitivity and specificity of the IIF test in detecting anti-leishmania antibodies are investigated. The "purified" antigen increases the specificity and sensitivity of the IIF test, at the same time, eliminating false positiviness caused by connective diseases, tuberculosis, etc.

[Our experience in tailoring definitive terminal colostomies and in the follow-up of such patients]. / Nostra esperienza nel confezionamento delle colostomie terminali definitive e nel follow-up di tali pazienti.

Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.

[Acute mesenteric infarct. II. Problems of early diagnosis]. / Infarto mesenterico acuto. Nota II. Problemi di diagnosi precoce.

The symptomatology and diagnostic procedure adopted in 11 cases of acute mesenteric infarction are examined. Stress is laid on the importance of early, aetiologically accurate diagnosis for the purpose of instituting profitable treatment. In order to comply with such needs it is essential to perform urgent selective arteriography and/or urgent laparoscopy which only with rare exceptions is carried out even in hospitals that should be better equipped.

[Acute mesenteric infarct. III. Therapeutic problems]. / Infarto mesenterico acuto. Nota III. Problemi terapeutici.

The treatment adopted in 11 cases of acute mesenteric infarction is described: 6 cases involved arterial occlusion due to embolism and 5 arterial occlusion due to thrombosis. Six explorative laparotomies, 4 intestinal resections and one embolectomy of the superior mesenteric artery were carried out. Mortality was 63%. Stress is therefore laid on the need for very early, etiopathogenetic accurate diagnosis so as to commence treatment during the phase of reversible ischaemic intestinal lesion, targeting treatment to the cause of the ischaemia. The problem of the postoperative treatment problem is then discussed with special regard to the treatment of shock, the prevention of recurrences and the short intestine syndrome.

[Anomalies in gastric stump emptying of patients who have undergone resections for duodenal ulcer previously treated with histamine H2 receptor antagonists]. / Anomalie dello svuotamento del moncone gastrico nei pazienti gastroresecati per ulcera peptica duodenale, precedentemente trattati con farmaci antagonisti dei recettori H2 dell'istamina.

The problem of obstructed emptying of the gastric stump after Billroth II operations in patients previously treated with H2 receptors is discussed. Statistical comparison using the Student's "t" test revealed a significant difference (t = 2.173) between those given and not given H2-antagonists and confirmed the existence of greater postoperative hypotonia in the gastric stumps of the former group. This clinical syndrome demands careful monitoring of the hydroelectrolytic balance and possibly the use of a double naso-gastric and nasojejunal tube as a precaution to ensure the delivery of the jejunal contents to the stomach. The gastrokinetic drugs metoclopramide and domperidone are also beneficial.

[False positive reactions to the fluorescence test (FTA-ABS) in skin disease patients]. / False reazioni positive al test di fluorescenza (FTA-ABS) in dermopazienti.

False positive reactions to the fluorescence test (FTA-ABS) were found in a group of dermatological patients compared to another group, made up of healthy subjects and blood-donors. Reactivity to FTA-ABS test was particularly evident in patients suffering from Herpes simplex genitalis, allergic diseases and collagenoses. Practical and theoretical aspects of this finding are discussed.

[Separation and purification of Treponema pallidum by density gradient. Technical note]. / Separazione e purificazione di Treponema pallidum mediante gradiente di densità. Nota tecnica.

The reported possibility of obtaining purified suspension of Treponema pallidum through a Percoll density gradient is evaluated. The maintenance of motility and antigenicity of the purified T. pallidum allows further studies on antigenic structure of treponemes.