Functional characteristics of the growth factor receptor family and some ligands in the oropharyngeal cavity of the Chukar partridge (Alectoris chukar).

1. The aim of the present study is to describe, immunohistochemically, the expression and cell type localisation of growth factor receptors and some of their ligands in the oropharyngeal organs of the Chukar partridge. 2. The tissue samples from 10 healthy adult partridges were dissected under ether anaesthesia and then embedded in paraffin following routine histological procedures. The immunoreaction for receptors and ligands of the epidermal growth factor receptor (EGFR)/ligand system was localised in the cell membrane, nucleus and cytoplasm of the luminal and glandular epithelial cells, stromal and striated muscle cells, and vascular endothelial and smooth muscle cells. 3. Variations were observed in the avian oropharyngeal organs. The immunostaining for the erbB1/HER1 (human epidermal growth factor receptor 1) and the EGF (epidermal growth factor) and AREG (Amphiregulin) ligands in the luminal epithelial cells was higher than in the glandular epithelial, stromal and striated muscle cells. However, the immunostaining for erbB3/HER3 (human epidermal growth factor receptor 3) and erbB4/HER4 (human epidermal growth factor receptor 4) were similar in the luminal epithelium, stromal and striated muscle cells. 4. Growth factor receptors and some of their ligands were localised in different cell types in the oropharyngeal organs. We suggest that erbB/HERs (human epidermal growth factor receptors) and their ligands play an important role in proliferation, differentiation, growth, survival and migration of the cells.

Effect of fermentation and subsequent pasteurization processes on amino acids composition of orange juice.

The fermentation of fruit produces significant changes in their nutritional composition. An orange beverage has been obtained from the controlled alcoholic fermentation and thermal pasteurization of orange juice. A study was performed to determine the influence of both processes on its amino acid profile. UHPLC-QqQ-MS/MS was used for the first time for analysis of orange juice samples. Out of 29 amino acids and derivatives identified, eight (ethanolamine, ornithine, phosphoethanolamine, α-amino-n-butyric acid, hydroxyproline, methylhistidine, citrulline, and cystathionine) have not previously been detected in orange juice. The amino acid profile of the orange juice was not modified by its processing, but total amino acid content of the juice (8194 mg/L) was significantly increased at 9 days of fermentation (13,324 mg/L). Although the pasteurization process produced partial amino acid degradation, the total amino acid content was higher in the final product (9265 mg/L) than in the original juice, enhancing its nutritional value.

Alcoholic fermentation induces melatonin synthesis in orange juice.

Melatonin (N-acetyl-5-methoxytryptamine) is a molecule implicated in multiple biological functions. Its level decreases with age, and the intake of foods rich in melatonin has been considered an exogenous source of this important agent. Orange is a natural source of melatonin. Melatonin synthesis occurs during alcoholic fermentation of grapes, malt and pomegranate. The amino acid tryptophan is the precursor of all 5-methoxytryptamines. Indeed, melatonin appears in a shorter time in wines when tryptophan is added before fermentation. The aim of the study was to measure melatonin content during alcoholic fermentation of orange juice and to evaluate the role of the precursor tryptophan. Identification and quantification of melatonin during the alcoholic fermentation of orange juice was carried out by UHPLC-QqQ-MS/MS. Melatonin significantly increased throughout fermentation from day 0 (3.15 ng/mL) until day 15 (21.80 ng/mL) reaching larger amounts with respect to other foods. Melatonin isomer was also analysed, but its content remained stable ranging from 11.59 to 14.18 ng/mL. The enhancement of melatonin occurred mainly in the soluble fraction. Tryptophan levels significantly dropped from 13.80 mg/L (day 0) up to 3.19 mg/L (day 15) during fermentation. Melatonin was inversely and significantly correlated with tryptophan (r = 0.907). Therefore, the enhancement in melatonin could be due to both the occurrence of tryptophan and the new synthesis by yeast. In summary, the enhancement of melatonin in novel fermented orange beverage would improve the health benefits of orange juice by increasing this bioactive compound.

Immediate prepectoral breast reconstruction in nipple-sparing mastectomy with Wise-pattern incision in large and ptotic breasts: Our experience and short-term results.

INTRODUCTION: Current breast cancer treatment trends advocate nipple-sparing mastectomy (NSM) as the preferred technique for selected patients. A considerable and ptotic breast is often considered a relative contraindication for NSM due to the increased risk of skin and nipple necrosis. METHODS: A retrospective review was performed for patients who underwent immediate prepectoral breast reconstruction (PPBR) after NSM with Wise-pattern incision between February 2020 and February 2023 at our institution. This procedure was offered to patients with grade II or III ptosis or large breasts eligible for NSM for therapeutic or prophylactic purpose. Exclusion criteria comprised a preoperative nipple-sternal notch distance greater than 30 cm, previous radiotherapy, pinch test <1 cm, body mass index (BMI) greater than 34 and active smoke. We present our short-term results with this technique. RESULTS: During the study period, 62 patients (76 breasts) had NSM with Wise-pattern incision. Patients had immediate PPBR with implant or tissue expander, both entirely wrapped with ADM. The median age of the patients was 57.0 years [The Interquartile Range (IQR 50.0-68.6)] with a median BMI of 25.5 (IQR 23.3-28.4). The median mastectomy specimen weight was 472 g (341-578). Median implant volume was 465 g (IQR 370-515). Major complications occurred in 8 patients (10.5%). Three patients experienced total nipple-areolar complex (NAC) necrosis (3.9%), and partial NAC necrosis occurred in 2 patients (2.6%). Two patients developed implant infection (2.6%). Univariate analysis showed a statistically significant correlation between major complications and the mastectomy specimen weight (p = 0.003). CONCLUSION: If oncologically indicated, NSM with Wise-pattern incision and immediate PPBR can safely be performed in selected patients with large and ptotic breasts.

Surfactant protein B and RAGE increases in the plasma during cardiopulmonary bypass: a pilot study.

Surfactant derived protein B (SPB) and plasma receptor for advanced glycation end products (RAGE) have been proposed as markers of lung injury. The former is produced specifically by pneumocytes while RAGE production is present in several body tissues. Cardiopulmonary bypass (CPB) generates a transient lung injury. We measured SPB and RAGE in plasma before surgery and after CPB, as well as 24 h and 48 h later. We analysed plasma samples from 20 subjects scheduled for elective coronary artery bypass grafting. We performed a quantitative analysis of plasma levels of RAGE and SPB mature form (8 kDa) by ELISA and a semi-quantitative analysis of SPB immature form (~ 40 kDa) by Western blotting. Surgery procedures were uneventful. After CPB RAGE median (75th-25th interquartile difference) increased from 633 (539) pg·mL⁻¹ to 1,362 (557) pg·mL⁻¹ (p < 0.01), while mature SPB increased from 5,587 (3,089) ng·mL⁻¹ to 20,307 (19,873) ng·mL⁻¹ (p < 0.01). RAGE and mature SPB returned to normal values within 48 h. This behaviour was confirmed when RAGE and SPB were normalised for protein content. Parallel changes were observed for immature SPB. Plasma RAGE and SPBs are sensitive and rapid markers of lung distress.

Carotenoids from persimmon juice processing.

The aim of this study was the use and revalorization of two persimmon by-products A and B generated in the juice production process. The by-product B resulting from a pectinase enzymatic treatment of peels and pulp to optimize juice extraction was especially suitable for recovery of valuable bioactive carotenoids. The extraction solvents and solvent combinations used were: ethanol, acetone, ethanol/acetone (50:50 v/v) and ethanol/acetone/hexane (25:25:50 v/v/v). HPLC-DAD analysis detected and identified a total of nine individual carotenoids namely violaxanthin, neoxanthin, antheraxanthin, lutein, zeaxanthin, ß-cryptoxanthin 5,6-epoxide, ß-cryptoxanthin, α-carotene, and ß-carotene. ß-cryptoxanthin and ß-carotene represented 49.2% and 13.2% of the total carotenoid content (TCC) in the acetone extract from by-product B. TCC contributed greatly to antioxidant activity of acetone extract derived from this by-product. Pectinase enzymatic treatment of persimmon peels and pulp followed by absolute acetone extraction of carotenoids could be an efficient method to obtain a rich extract in these compounds that could be used as nutraceutical ingredient.

The role of self-efficacy in vascular risk factor management: a randomized controlled trial.

OBJECTIVE: Given the large number of patients at high risk of vascular events, new strategies are needed to reduce vascular risk. We investigated whether self-efficacy promotion could change self-efficacy levels in patients with vascular diseases and whether baseline self-efficacy and changes in self-efficacy were related to changes in vascular risk factors. METHODS: One hundred fifty-three recently referred patients with symptomatic vascular diseases (cerebrovascular, abdominal, or peripheral arterial) participated in a randomized trial investigating the effect of nursing care, as compared with usual care, on vascular risk factors. Nursing care consisted of self-efficacy promotion and medical treatment of vascular risk factors. Self-efficacy and vascular risk factors (smoking, BMI, waist, blood pressure, lipid, and glucose levels) were measured at baseline and after 1 year. RESULTS: While total self-efficacy did not change over the 1-year intervention period in either treatment group, self-efficacy in choosing healthy food (mean +0.4+/-1.4, p-value 0.01) and in doing extra exercise (mean +0.3+/-1.3, p-value 0.03) increased in the intervention group. No relation was seen between baseline total self-efficacy or change in composite self-efficacy and change in vascular risk factors. CONCLUSION: The nursing intervention did not influence total self-efficacy but did improve self-efficacy in choosing healthy food and doing extra exercise. Change in composite self-efficacy was not related to change in vascular risk factors in patients at high risk of developing (new) cardiovascular diseases. PRACTICE IMPLICATIONS: Influencing self-efficacy in choosing healthy food and doing extra exercise could be incorporated in vascular risk reduction programs in addition to medical treatment of vascular risk factors.

Effect of ovariectomy and female sex hormones administration upon gastric ulceration induced by cold and immobility restraint stress.

OBJECTIVE: To investigate the protective effects of estrogen and progesterone administrations on gastric mucosal barrier of rats applied ovariectomy, cold and immobility stress. METHODS: Seventy female Wistar rats, obtained from Medical Science Application and Research Center, Dicle University, Turkey on the year 2004, were divided into 10 separate groups (n=7). Nothing was applied to the animals of Group 1 (control); bilateral ovariectomy was performed on the animals of the Groups 2, 4, 5, 6, 7, 8, 9, and 10. Groups 5 and 6 was applied 5 mg/kg 17beta-estradiol and groups 7 and 8 was applied 10 mg/kg progesterone for 7 days. The animals in the Groups 9 and 10 were applied 2.5 mg/kg 17beta-estradiol and 5 mg/kg progesterone during 7 days. The animals in the groups 3, 4, 6, 8 and 10 were exposed to cold and immobility stress for 4 hours at 4degrees celsius. RESULTS: The levels of mucus and phospholipids were decreased in the rats applied ovariectomy and stress as compared to the control groups (p<0.001). The increase determined the mucus and phospholipids levels in estrogen and progesterone administered rats as compared to stress applied group (p<0.001). While the cold and immobility stress causes important damages in gastric mucosa, estrogen and progesterone administrations has protective effects in ovariectomized rats. CONCLUSION: The estrogen and progesterone administration prevents the stress that caused decrease in the levels of mucus and phospholipids, thus females are more resistant to gastric ulcer rather than males due to their sex hormones.

Self-efficacy in patients with clinical manifestations of vascular diseases.

OBJECTIVE: Patients with established cardiovascular disease are at high risk of developing new vascular events or death. This risk can be reduced by lifelong treatment of risk factors and by permanent changes in lifestyle. Self-efficacy is important for achieving behavior change by self-management. The self-efficacy of different vascular risk factors subgroups in patients with clinical manifestations of atherosclerotic vascular diseases was investigated. METHODS: From January 2001 to September 2003, 192 patients with recently established clinically manifest atherosclerotic disease with > or = 2 modifiable vascular risk factors were selected for the study. The mean self-efficacy scores were calculated for vascular risk factors (age, sex, vascular disease, weight, diabetes mellitus, smoking behavior, hypercholesterolemia, hypertension, and hyperhomocysteinemia). RESULTS: Diabetes, overweight, and smoking, but none of the other risk factors, were significantly associated with the level of self-efficacy in these patients. CONCLUSIONS: Patients with vascular diseases appear to have high levels of self-efficacy regarding medication use, exercise, and controlling weight. In patients with diabetes, overweight, and in smokers, self-efficacy levels were lower. PRACTICE IMPLICATIONS: In nursing care and research on developing self-efficacy based interventions, lower self-efficacy levels can be taken into account for specific vascular patient groups.

The comparative investigation of left ventricle papillary muscle arteries in different species.

OBJECTIVE: To determine whether similar histologic findings exist in left ventricle papillary muscle arteries in different species and to elicit whether those animal hearts may be used as models for human heart in experimental studies related to papillary muscles. METHODS: We examined 360 samples taken from the tip, mid-portion and base of papillary muscles in 60 normal adult hearts (15 each from human, dog, sheep, goat). The samples were obtained from Dicle University and Kahramanmaras Sutcu Imam University, Turkey and the study was conducted in June-September 2004. Tissues were processed by routine histologic methods, stained with hematoxylin-eosin and van giesson, and later evaluated under a light microscope. RESULTS: While the values of human and dog heart resembled each other by means of left ventricle papillary muscle arteries, the hearts of sheep and goat were also found to be similar. The number of thin walled arteries increased from the tip (18%) to the base (48%), intermediate walled arteries decreased from the tip (56%) to the base (14%), thick walled arteries decreased from the tip (62%) to the mid-portion (38%). The differences among human and animals were not statistically significant in any group. We found that the thickness values of papillary muscle arterial walls at the tip, mid-portion and base varied from 4.86 microm to 107.7 microm in all species. The difference among values of human and animals was not significant statistically (p>0.05). CONCLUSION: The values for arterial walls of tip, mid-portion and base of papillary muscles were similar between human and dog, sheep and goat. These morphologic findings in human and animal hearts of different species prove that anatomists, cardiologists, experimental investigators, pathologists and physiologists may benefit from the hearts of those animals as a good model to imitate the human heart in experiments concerning papillary muscles.

Insulin-secreting cells derived from embryonic stem cells normalize glycemia in streptozotocin-induced diabetic mice.

Embryonic stem (ES) cells display the ability to differentiate in vitro into a variety of cell lineages. Using a cell-trapping system, we have obtained an insulin-secreting cell clone from undifferentiated ES cells. The construction used allows the expression of a neomycin selection system under the control of the regulatory regions of the human insulin gene. The chimeric gene also contained a hygromycin resistance gene (pGK-hygro) to select transfected cells. A resulting clone (IB/3x-99) containing 16.5 ng/microg protein of total insulin displays regulated hormone secretion in vitro in the presence of various secretagogues. Clusters obtained from this clone were implanted (1 x 10(6) cells) in the spleen of streptozotocin-induced diabetic animals. Transplanted animals correct hyperglycemia within 1 week and restore body weight in 4 weeks. Whereas an intraperitoneal glucose tolerance test showed a slower recovery in transplanted versus control mice, blood glucose normalization after a challenge meal was similar. This approach opens new possibilities for tissue transplantation in the treatment of type 1 and type 2 diabetes and offers an alternative to gene therapy.

A mutational analysis of leaf morphogenesis in Arabidopsis thaliana.

As a contribution to a better understanding of the developmental processes that are specific to plants, we have begun a genetic analysis of leaf ontogeny in the model system Arabidopsis thaliana by performing a large-scale screening for mutants with abnormal leaves. After screening 46,159 M2 individuals, arising from 5770 M1 parental seeds exposed to EMS, we isolated 1926 M2 putative leaf mutants, 853 of which yielded viable M3 inbred progeny. Mutant phenotypes were transmitted with complete penetrance and small variations in expressivity in 255 lines. Most of them were inherited as recessive monogenic traits, belonging to 94 complementation groups, which suggests that we did not reach saturation of the genome. We discuss the nature of the processes presumably perturbed in the phenotypic classes defined among our mutants.

Effect of ovariectomy and of estrogen treatment on the adrenal gland and body weight in rats.

OBJECTIVE: To determine the effect of estrogen on adrenal gland histology, and to ascertain whether or not estrogen regulates body and adrenal gland wet weight gain in the ovariectomized rat model. Two experiments investigated the effects of ovariectomy and estrogen replacement on the body and adrenal gland weight. METHODS: We used 36 female Wistar Albino rats in this study. The study took placed in the Department of Medical Science Application and Research Center of Dicle University, Diyarbakir, Turkey, in 2002. Group 1 (control group) received no ovariectomy; all animals in the other groups were bilaterally ovariectomized and kept for 60 days. We designated group 2 and 3 as sham-operated group and bilaterally ovariectomized then in addition, group 3 received estradiol. We then cut the paraffin sections, which we obtained by routine histologic methods, into 5 mm and stained them with hematoxylin-eosin. We later evaluated the stained sections under a light microscope. RESULTS: The body weight was higher in the ovariectomized rats compared to the control groups. Ovariectomy did not result in significant changes in the wet weight of the adrenal gland. Furthermore, body weight increased after estrogen therapy, and the wet weight of the adrenal gland increased in the estrogen group. It was obtained in the sham-operated group that ovariectomy resulted in a decrease in the activity of the adrenal cortex. In the sham-operated and estrogen group, we observed a prominent capsule, expanded zona glomerulosa cells, regular parallel columns in zona fasciculata and there was an increased vascularization in the medulla, after the estrogen treatment. CONCLUSION: We determined that bilateral ovariectomy can result in a decrease in the activity of the adrenal cortex. In contrast, estradiol injection can cause a significant increase in the activity of the adrenal cortex and medulla.

Vascular risk management through nurse-led self-management programs.

In current clinical practice, adequate cardiovascular risk reduction is difficult to achieve. Treatment is primarily focused on clinical vascular disease and not on long-term risk reduction. Pertinent to success in vascular risk reduction are proper medication use, weight control, healthy food choices, smoking cessation, and physical exercise. Atherosclerotic vascular disease and its risk constitute a chronic condition, which poses specific requirements on affected patients and caregivers who should be aware of the chronicity. In patients with vascular disease, there is lack of awareness of their chronic condition because of the invisibility of most risk factors. In other patient groups with chronic illness, self-management programs were successful in achieving behavioral change. This strategy can also be useful for patients with vascular disease to adapt and adhere to an improved lifestyle. Self-management refers to the individual's ability to manage both physical and psychosocial consequences including lifestyle changes inherent to living with a chronic condition. Interventions that promote self-management are based on enhancing self-efficacy. In self-management, attention can be given to what is important and motivational to the individual patient. In this article the challenge of nursing care promoting self-management for patients with vascular risk and how this care can be applied will be explained. Nurses can play a central role in vascular risk management with a self-management approach for patients with chronic vascular disease. In vascular prevention clinics, nursing care can be delivered that includes medical treatment of vascular risks (hypertension, hypercholesterolemia, hyperglycemia, and hyperhomocystinemia) and counseling on promoting self-management (changes in diet, body weight, smoking habits, and level of exercise). Nursing interventions based on self-management promotion can provide a new and promising approach to actually achieve vascular risk reduction.

Exercise echocardiography versus exercise electrocardiography in the diagnosis of coronary artery disease in hypertension.

In hypertension, coronary artery disease (CAD) can be overestimated by stress electrocardiography (ECG) and scintigraphy due to frequent false-positive results. Exercise tests are also limited by an excessive blood pressure increase, and pharmacologic pressure normalization decreases the accuracy of the test. The aim of this study was to assess the accuracy of exercise echocardiography as an alternative test for CAD detection in hypertension, both before and after adequate blood pressure control. We studied 59 hypertensive and 59 normotensive patients undergoing coronary angiography for chest pain. Upright bicycle exercise ECG and echocardiographic tests were performed in each group in the absence of therapy; in hypertensives, the tests were repeated a day apart after blood pressure normalization with sublingual nifedipine. Significant CAD (lumen narrowing >50%) was detected in 22 hypertensive and 41 normotensive patients. In the two groups, sensitivity, specificity, and diagnostic accuracy of exercise echocardiography performed before treatment were not statistically different (95%, 94%, 94% in hypertensives and 82%, 77%, 83% in normotensives, respectively), but were significantly higher than for the exercise ECG test (68%, 70%, and 69%, respectively). After blood pressure lowering, exercise echocardiography sensitivity slightly decreased (91%), whereas specificity (100%) and diagnostic accuracy (96%) did not vary; on the contrary, exercise ECG sensitivity decreased to 45%. Therefore, according to our data, exercise echocardiography can be an accurate test and more reliable than exercise ECG to detect CAD in normotensives as well as in hypertensives. Normalization of blood pressure with nifedipine does not affect its accuracy, but markedly reduces the sensitivity of exercise ECG.

Lowering of blood pressure and coronary blood flow in isolated systolic hypertension.

BACKGROUND: In essential hypertension, the lower limit of autoregulation of coronary flow shifts to higher perfusion and the hypertensive ventricle is at a higher than normal risk of ischemia, and less able to tolerate acute reduction of coronary perfusion pressure. Little is known about pattern of coronary flow in isolated systolic hypertension, a pathologic condition in which the elevated systolic blood pressure is associated with a lower than normal vascular compliance and normal or slightly greater than normal mean arterial pressure and vascular resistance. OBJECTIVE: To evaluate the effects of rapid normalization of blood pressure on coronary blood flow in isolated systolic hypertension. METHODS: We subjected 20 patients with isolated systolic hypertension to intraoperative hemodynamic and transesophageal echocardiographic monitoring during peripheral vascular surgery. Coronary flow velocity integrals and diameters in the left anterior descending coronary artery were evaluated under baseline conditions and after normalization of blood pressure, which occurred spontaneously during anesthesia (10 cases; group 1A) or was induced by infusion of nitrate (10 cases, group 1B). RESULTS: After normalization of systolic blood pressure integrals decreased significantly only for patients in group 1A; percentage changes of diameter were significantly greater for patients in group 1B. Therefore, coronary blood flow after normalization of systolic blood pressure increased for patients in group 1B (by 28+/-25%) and decreased for patients in group 1A (by 30+/-21%). Changes in integrals were inversely related to those in diameter (r= -0.72, P < 0.001); for patients in group 1A changes in coronary perfusion pressure and diameter were related to those of integrals (r= 0.94; P < 0.0005). CONCLUSIONS: In isolated systolic hypertension, despite there being similar changes of the systolic blood pressure, administration of nitrates caused a marked increase of coronary flow through direct effects on coronary circulation, whereas spontaneous normotension was associated with a significant reduction of coronary flow.

Stem cells and diabetes.

Diabetes mellitus is a metabolic disorder affecting 2-5% of the population. Transplantation of isolated islets of Langerhans from donor pancreata could be a cure for diabetes; however, such an approach is limited by the scarcity of the transplantation material and the long-term side effects of immunosuppressive therapy. These problems may be overcome by using a renewable source of cells, such as islet cells derived from stem cells. Stem cells are defined as clonogenic cells capable of both self-renewal and multilineage differentiation. This mean that these cells can be expanded in vivo or in vitro and differentiated to produce the desired cell type. There exist several sources of stem cells that have been demonstrated to give rise to pluripotent cell lines: 1) embryonic stem cells; 2) embryonic germ cells; 3) embryonic carcinoma cells; and 4) adult stem cells. By using in vitro differentiation and selection protocols, embryonic stem cells can be guided into specific cell lineages and selected by applying genetic selection when a marker gene is expressed. Recently, differentiation and cell selection protocols have been used to generate embryonic stem cell-derived insulin-secreting cells that normalise blood glucose when transplanted into diabetic animals. Some recent reports suggest that functional plasticity of adult stem cells may be greater than expected. The use of adult stem cells will circumvent the ethical dilemma surrounding embryonic stem cells and will allow autotransplantation. These investigations have increased the expectations that cell therapy could be one of the solutions to diabetes.

Diastolic ventricular interaction in normal and dilated heart during head-up tilting.

BACKGROUND: The normal human heart behaves as a single functional unit during preload reduction; adaptations of the left ventricle to head-up tilting is mediated through ventricular interdependence and biventricular-lung interaction. HYPOTHESIS: We hypothesized that reduction of venous return in dilated cardiomyopathy is likely to have a great effect on ventricular chamber geometry and filling. The aim of this study was to evaluate the effects of gradual head-up tilting in normal subjects and in patients with dilated cardiomyopathy, addressing special attention to right (RV) and left ventricular (LV) dimensions, geometry, and filling, and to biventricular-lung interaction. METHODS: Twenty normal subjects and 23 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position and after 20 degrees, 40 degrees, and 60 degrees tilting. Right ventricular and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study. Geometric changes of the LV were evaluated by measurements of volumes and diameters in the apical four-chamber view (which identifies the interventricular septum and lateral wall) and apical two-chamber view (which identifies the inferior and anterior wall of the LV). RESULTS: In the two groups, tilting was associated with reduction of RV area and LV diameter and volumes; percent variations in LV diameter and volumes recorded in four-chamber view were lower at each step of tilting than with those derived from the two-chamber view in controls and in patients. In normal subjects, mitral and tricuspid peak early flow velocities were decreased at any tilting level; peak late velocities were unchanged; peak velocity of systolic forward flow of the pulmonary vein was reduced, diastolic forward flow was unchanged, and the difference in duration between reverse pulmonary flow and forward mitral A wave was reduced. Doppler findings were qualitatively similar in patients, but tilting induced a more marked redistribution of LV filling to late diastole because of a significant increase in atrial contribution. CONCLUSIONS: Preload reduction by tilting induces profound effects on left and right dimensions, geometry, and filling in normal and dilated heart; reduction or RV dimensions are associated with changes in LV ventricular geometry (minimal reduction in septal-lateral diameter, marked reduction in anterior-posterior diameter), redistribution of right and left diastolic filling to late diastole, and redistribution of pulmonary venous flow to early diastole. These mechanisms are probably due to a favorable interaction between heart and lungs, which increases compliance within the pericardial space and facilitates redistribution of flow from the lungs. Even a minimal amount of preload reduction causes more marked effects in LV filling patterns in dilated cardiomyopathy than in normal hearts, confirming that ventricular interaction and pericardial constraint are increased when heart volume enlarges.

Nicotinamide induces both proliferation and differentiation of embryonic stem cells into insulin-producing cells.

In contrast to the consistent observation that methods that promote proliferation also dedifferentiate insulin-producing cells, useful in vitro differentiation protocols must drive both proliferation and differentiation. We herein describe an strategy in which the combination of nutrient restriction and nicotinamide supplementation results in a consistent increase in the mass of insulin-producing cells.

[Diagnosis and treatment of gastrointestinal carcinoid. Report of a clinical case with duodenal site]. / Diagnosi e trattamento del carcinoide gastrointestinale. Descrizione di un caso clinico a sede duodenale.

Carcinoid tumors are among the most frequently neuroendocrine neoplasms of the gastrointestinal tract. They occur more commonly as benign diseases but malignant ones can also be found. The peak age incidence varies with the location of the tumor, with appendiceal tumors being diagnosed at an overage of 36 years, whereas non appendiceal tumors are found typically in the fifth sixth decades of life. There is no sex predilection of the tumors. Most carcinoid tumors are found within the appendix (40-50%) or small intestine (25%). Less common sites include the rectum (15%), main bronchus (10%), duodenum (3-8%) and stomach (2%). Most carcinoid tumors are found incidentally at operation and cause no symptoms. If symptoms do occur, they can be either non specific include intermittent crampy abdominal pain, vomiting and distension caused by intestinal obstruction. The prognosis depends on the site of the tumor and its size. Most carcinoid tumors (75%) are less than 1 cm in size and only 5% are greater than 2 cm. The incidence of metastatic disease is related directly to the size of the tumor at all locations. Carcinoid tumor with size less than 1 cm give linfonodal metastasis only in 3-5%; the other with size over 2 cm give metastasis in the 70-75% of the cases. The 5-years survival for all carcinoid tumors are approximately 85%. Five years rate is higher (> 80%) in carcinoid tumors of appendix and rectum than in gastroduodenal, ileal and colonic neoplasm (< 60%). In this paper the authors report a case of malignant carcinoid of the duodenum.