[3-year course after successful therapy of extreme anorexia nervosa]. / Dreijahresverlauf nach erfolgreicher Therapie schwerstgradiger Anorexia nervosa.

Anorexia nervosa is a common psychiatric disorder in adolescents and young adults and is often associated with high rates of comorbidities and a chronic course of the disease. Additionally, it still shows the highest rates of mortality among all psychiatric disorders. The case presented describes a female patient with severe and enduring anorexia nervosa who achieved remission after strict adherence to inpatient treatment and showed a full recovery in the 3­year follow-up. Shortly after achieving a minimum weight of 25 kg (171 cm, body mass index 8.5 kg/m2) the 21-year-old, chronically ill patient was admitted to an intensive care unit. After a phase of stabilization and achieving a BMI of 10 kg/m2, she was transferred to a hospital specialized in treating eating disorders. It came to a full recovery of the patient including full weight restoration during regular follow-ups (BMI 20.0 kg/m2) and normalization of the psychopathology of the eating disorder. In a 3-year follow-up, the patient presented with an enduring and complete remission of all symptoms, which were extremely expressed during the illness.

The role of processing on ochratoxin A content in Italian must and wine: a study on naturally contaminated grapes.

Available data show that ochratoxin A (OTA) is a possible contaminant of wine and its concentration is higher in red wines than in white and rosé. The aim of this work was to study the fate of OTA during the main stages of the winemaking process (crushing, maceration, alcoholic fermentation, malo-lactic fermentation, bottle-aging) and the influence of technological treatments on OTA concentration in order to identify the critical process steps. Attention was focused on red winemaking, in different wineries in the south of Italy, with two naturally OTA contaminated grape varieties ('Negroamaro' and 'Primitivo') and on different vintages (2001-2002-2003). The results show that no OTA is produced during winemaking, but each operation during winemaking can modify OTA content. The OTA present in grapes to a certain degree is released to the juice during crushing. Maceration increases the OTA content, while alcoholic and malo-lactic fermentation cause a reduction in OTA in the wine.

[Role of outpatient psychiatry in therapy of patients with eating disorder].

Eating disorders are common illness but the proportion of those in treatment is still low and their liability to abandon treatment is a constant danger. This is largely due to the pathology: in particular splitting and denial. Thus, the integration of various types of treatment is essential and the process of integration will be efficiently managed if a psychiatric clinic works as a center of the therapeutic network. Formerly, long-term in-patient treatment was regarded as the best choice for treating the patient thoroughly. Nowadays such treatment is not recommended due to the large cost involved in such treatment. Also, removing the patient from a community environment and confining them to an institution over a long period is now regarded as discouraging independence. Thus, the focus of treatment has shifted from in-patient to out-patient treatment. A new model for multi-disciplinary work is now needed because sharing patient information between professionals is more difficult at the outpatient clinic than on an in-patient ward with shared case notes. In order to make the treatment network functional, patients themselves are expected to possess a clear understanding of the illness and its treatment. The application of motivational enhancement theory is useful in this respect. It is the responsibility of psychiatric clinics to encourage the continuous improvement of patient motivation for treatment and to make patients tolerant towards changes in treatment settings.

Consumer interest in specialty beers in three European markets.

This study explores the quality perception of specialty beers (SBs) in Italy, Spain and Poland. Five-hundred and fifty mainstream beer consumers were enrolled in this study (two-hundred and thirty Italians, one hundred and sixty Poles and Spaniards respectively). The authors adopted a conjoint rating experiment in which the respondents were given forty SB profiles to evaluate. Each profile was described on six attributes (malt type, adjuncts, alternative source of sugars, characterizing ingredients, sensory characteristics, and retail price) varied at different levels and were asked to state his/her preference for each profile on a 9-point scale of interest. The results of this study showed that the ideal SB: (1) for the aggregate Polish panel is brewed from malted wheat, raw wheat, honey, and tropical fruits, is alcoholic and is priced below 2.00 Euros; (2) for the aggregate Italian panel consists of a beer brewed from malted wheat, maize, honey, and vanilla, is blonde and costs a maximum of 2.00 Euros; (3) for the aggregate Spanish panel is brewed from malted wheat, rye or maize, vanilla, is fruity and is priced below 2.00 Euros. The heterogeneity of interest in specialty beers observed in the three countries under test requires for the adaptation of a SB specifically to each culture in which it is sold. In this process of customization, brewers must take into account that gender modulates the effect of culture on consumer interest in SB sensory characteristics and ingredient formulation.

Evaluating diagnostic accuracy of anti-tissue Transglutaminase IgA antibodies as first screening for Celiac Disease in very young children.

BACKGROUND: Small bowel biopsy is the gold standard for Celiac Disease (CD) diagnosis, nevertheless serum assays are the first step in ascertaining a diagnosis of CD. New ESPGHAN Criteria 2012 (European Society of Pediatric Gastroenterology Hepatology and Nutrition) suggest using exclusively anti-tissue Transglutaminase IgA antibodies (anti-tTGA) as initial approach to symptomatic subjects. The aim of our study was to evaluate the diagnostic accuracy of anti-tTGA as initial screening assay for CD in a large cohort of pediatric patients. METHODS: We selected 730 subjects aged between 6 months and 4 years ("Group A") and 348 subjects younger than 2 years (which are part of the 730 subjects) ("Group B"). We performed anti-Deamidated Gliadin Peptides IgA and IgG antibodies (a-DGP IgA/IgG) and anti-tTGA assays by ELISA test. We evaluated the agreement between anti-tTGA and a-DGP IgA/IgG assays and compared the diagnostic accuracy of a-DGP IgA/IgG with that of anti-tTGA in both groups of patients. RESULTS: There was a substantial agreement between anti-tTGA and a-DGP IgA in "Group A" and an almost perfect agreement in "Group B"; the strength of agreement between anti-tTGA and a-DGP IgG was moderate in "Group A" and substantial in "Group B". anti-tTGA were more sensitive and specific than a-DGP IgA/IgG in both groups. CONCLUSIONS: anti-tTGA could be used as initial screening assay for CD in all subjects from 6 months of age according to ESPGHAN Criteria 2012.

Emx2 developmental expression in the primordia of the reproductive and excretory systems.

The development of the urogenital system has always attracted many investigators owing to the peculiar aspects of the embryology of the reproductive and excretory organs and to the high number of congenital anomalies related to these structures. It is remarkable because of the common origin of the kidneys, gonads, and genital tracts from the intermediate mesoderm and because differentiation of these organs involves extensive mesenchyme to epithelium transition. Our knowledge about the molecular mechanisms controlling the differentiation of these diverse structures from the same precursor has taken advantage of gene expression data and gene-targeting experiments using genes with a specific expression pattern in the urogenital system. A more detailed function in kidney development has been postulated for transcription factors such as WT-1, Pax-2 or other molecules such as glial cell line-derived neurotrophic factor (GDNF), Wnt-4, c-ret. In the present work we have described the expression pattern of the homeobox-containing gene Emx2 during the development of the urogenital system in mouse embryos. We have found that Emx2 is expressed in the early primordia of the organs that will form the excretory and reproductive systems. In particular we have found that Emx2 is expressed in the epithelial components of pronephros and mesonephros, in Wolffian and Müllerian ducts, in the ureteric buds with their branches and in the early epithelial structures derived from metanephrogenic mesenchyme. Emx2 is also intensely expressed in the "bipotential" or "indifferent" gonads and ovaries. These data and the recent finding that Emx2 homozygous mutant mice die soon after birth because of the absence of kidneys indicate an essential role of Emx2 in the morphogenesis of the urogenital system.

Automated quantification of apoptosis in B-cell chronic lymphoproliferative disorders: a prognostic variable obtained with the Cell-Dyn Sapphire (Abbott) automated hematology analyzer.

INTRODUCTION: B-chronic lymphocytic leukemia CLL, a neoplastic clonal disorder with monomorphous small B lymphocytes with scanty cytoplasm and clumped chromatin, can be morphologically differentiated in typical and atypical forms with different prognosis: Smudge cells (Gumprecht's shadows) are one of the well-known features of the typical CLL and are much less inconsistent in other different types CLPD. Abbott Cell-Dyn Sapphire uses the fluorescence after staining with the DNA fluorochrome propidium iodide for the measurement of nucleated red blood cells (NRBCs) and nonviable cells (FL3+ cell fraction): We have studied the possible correlation between presence and number of morphologically identifiable smudge cells on smears and the percentage of nonviable cells produced by Cell-Dyn Sapphire. METHODS: 305 blood samples from 224 patients with B-cell lymphoproliferative disorders and 40 healthy blood donors were analyzed by CBC performed by Cell-Dyn Sapphire, peripheral blood smear, and immunophenotype characterization. RESULT: FL3+ fraction in CLPD directly correlated with the percentage of smudge cells and is significantly increased in patients with typical B-CLL. This phenomenon is much less evident in patients with atypical/mixed B-CLL and B-NHL. CONCLUSION: In small laboratories without FCM and cytogenetic, smudge cells%, can be utilized as a preliminary diagnostic and prognostic tool in differential diagnosis of CLPD.

Off-flavours in wines through indirect transfer of volatile organic compounds (VOCs) from coatings.

This paper assesses the impact of volatile organic compounds (VOCs) from the drying of coatings on the sensory characters of corks and wines. According to Italian National Standard Method 11021:2002, a small-scale chamber was used (1) to expose wines to the drying of coatings with both low and high VOCs, and (2) to expose corks to the same coatings. After exposure to the coatings, the corks were then placed in direct contact with wine. Different styles of white, red and rose wines were tested. In both directly exposed wines and in wines after contact with the exposed cork, the taste and smell off-flavour perception and intensity were assessed by a panel of eight experienced wine tasters using a five-point numerical scale according to International Organization for Standardization (ISO) standard methods. The results showed that the sensory characters of wines, especially taste, were influenced by the VOC content of the coatings. The taste off-flavour perception was found to be higher than the smell in wines exposed to coatings with either high or low VOCs contents. Analysis of variance (ANOVA) and Duncan analysis prove that: (1) panellist's answers were significantly different, (2) it was difficult to differentiate the off-flavour perception on the high-level scale, and (3) the panellist off-flavour perceptions versus wine style discriminated the wines into two groups (red and white/rose). For all the wine styles, Pearson's test showed no significant correlation between off-flavour perception levels and the main chemical characters of the wines. For the wines that were in direct contact with the exposed corks, the panellists detect the off-flavours according to the levels of VOCs in the coating and wine styles and they assessed the highest levels of alteration were to the taste.

Transformation ability of fungi isolated from cork and grape to produce 2,4,6-trichloroanisole from 2,4,6-trichlorophenol.

The ability of eight fungal strains to transform 2,4,6-trichlorophenol (TCP) to 2,4,6-trichloroanisole (TCA) was studied. These fungi were isolated from cork, belonging to the genera Penicillium, Aspergillus, Trichoderma and Chrysonilia, and from grapes Botrytis cinerea. All, except Chrysonilia, produced TCA when grown directly on cork in the presence of TCP, Aspergillus and Botrytis cinerea being the ones with the highest level of production. It is the first time that Botrytis cinerea, a microorganism often present on grapes and in winery environments, has been shown to transform TCP into TCA. This result can partially explain the wine cork taint before being bottled.

Agenesis of the scapula in Emx2 homozygous mutants.

The shoulder and pelvic girdles represent the proximal bones of the appendicular skeleton that connect the anterior and posterior limbs to the body trunk. Although the limb is a well-known model in developmental biology, the genetic mechanisms controlling the development of the more proximal elements of the appendicular skeleton are still unknown. The knock-out of Pax1 has shown that this gene is involved in patterning the acromion, while the expression pattern candidates Hoxc6 as a gene involved in scapula development. Surprisingly, we have found that scapula and ilium do not develop in Emx2 knock-out mice. In the homozygous mutants, developmental abnormalities of the brain cortex, the most anterior structure of the primary axis of the body, are associated with important defects of the girdles, the more proximal elements of the secondary axis. These abnormalities suggest that the molecular mechanisms patterning the more proximal elements of the limb axis are different from those patterning the rest of appendicular skeleton. While Hox genes specify the different segments of the more distal part of the appendicular skeleton forming the limb, Emx2 is concerned with the more proximal elements constituting the girdles.

Gpc3 expression correlates with the phenotype of the Simpson-Golabi-Behmel syndrome.

Interest in glypican-3 (GPC3), a member of the glypican-related integral membrane heparan sulfate proteoglycans (GRIPS) family, has increased with the finding that it is mutated in the Simpson-Golabi-Behmel overgrowth syndrome (Pilia et al. [1996] Nat. Genet. 12:241-247). The working model suggested that the membrane-bound protein acts locally to limit tissue and organ growth and that it may function by interacting with insulin-like growth factor 2 (IGF2) to limit its local effective level. Here we have tested two predictions of the model. In situ hybridization with the mouse gene cDNA was used to study the expression pattern during embryonic and fetal development. In agreement with predictions, the gene is expressed in precisely the organs that overgrow in its absence; and the patterns of expression of Gpc3 and those reported for Igf2 are strictly correlated.