Emerging and re-emerging infections at the turn of the millennium.

After World War II, mankind believed that infectious diseases were on the way to being defeated. Unfortunately, they still are the second worldwide cause of death. Globalization changes promote the emergence of new infections and pandemics; international deliveries and travelling facilitate the dissemination of infectious agents; man-induced environmental changes create new opportunities for contacts between species, leading to infections in aberrant hosts, including man; global warming enables insects, a major vector of pathogens, to thrive in more countries. The main pandemics have been caused by viruses, such as HIV and novel subtypes of influenza viruses. In addition, prion proteins are a threat. The transmission of the Creutzfeld Jakob disease variant through blood transfusion and the recent discovery of prion protein in the spleen of a haemophilia patient are a matter of further concern. The end of the war against infectious diseases is not in sight. Mankind's battle with pathogens has lasted millennia and is destined to continue.

Molecular characterization and phylogenetic analysis of human influenza A viruses in three consecutive seasons with different epidemiological profiles.

INTRODUCTION: Influenza activity and influenza virus circulation were observed in Lombardy (northern Italy) during three consecutive seasons and the molecular characteristics of circulating viruses analysed to control for introduction of new variants. METHODS: The molecular characterization of 38 isolates, namely 20 A/H3N2 and 18 A/H1N1 influenza strains from the 2005/06, 2006/07 and 2007/08 seasons, was performed by sequence analysis of the globular head region of the HA protein (HA1 subunit), specific for influenza virus A/H3 and A/H1. RESULTS AND DISCUSSION: The last three influenza seasons in the study region were characterized by medium-low activity. A typical co-circulation of several variants was shown for A/H3 viruses for approximately two years and were subsequently almost entirely substituted by new emerging variants. Vice versa, A/H1 viruses had a more homogeneous circulation with a single lineage clearly dominating each season. The HA sequences of the A/H3 and the A/H1 viruses isolated in the last three seasons fell into 4 and 3 principal phylogenetic groups, respectively. No evidence of positive or negative selection in the sequence alignments was observed. CONCLUSIONS: Molecular characterization of the influenza viruses in three consecutive seasons highlighted considerable heterogeneity in their HA sequences. A careful surveillance of genetic changes in the HA1 domain during seasonal influenza epidemics may reveal immune escape and provide early information on newly emerging strains with epidemiologic inference.

Surgical treatment of carotid kinking.

The authors take in exam 34 anatomical variation in the extracranial internal carotid artery (compared with more than 450 operated carotid artery), 15 of which involved kinking in patients with overt neurological symptoms, underwent corrective surgical treatment, and test the most useful and appropriate techniques in any case.

Relationships between adipose tissue characteristics of newborn pigs and subsequent performance: I. Characteristics at 8 days of age and growth rate until slaughter.

The genetic influence on body and adipose tissue characteristics of newborn pigs and their correlations to growth rate, BW, body length, backfat thickness and adipocyte size in the outer and inner layers of backfat in 8-d-old Large White piglets were determined. Samples of adipose tissue were obtained by biopsy. Pigs were born to 32 sows mated with the same boar. Heritability and genetic correlations were estimated with dam component of variance; therefore, bias due to common environmental effects cannot be excluded. The heritability estimate for adipocyte volume (.89 +/- .28) was higher than that for backfat thickness at the first and last thoracic vertebrae (.50 +/- .22; .63 +/- .24) and for body weight (.59 +/- .23) at 8 d. Backfat thickness was more closely related genetically and phenotypically to body weight and length than to adipose tissue cellularity. Heritability estimates were .75 +/- .28 for gain from 8 d to weaning and from weaning to 95 d (probably because of common environmental effects) but were .31 +/- .20 for ADG from 95 d to slaughter. Characteristics at 8 d were closely correlated phenotypically with growth rate until weaning. These correlations became lower in the two subsequent periods (to 95 d and to slaughter). Corresponding genetic correlations were nonsignificant.

Relationships between adipose tissue characteristics of newborn pigs and subsequent performance: II. Carcass traits at 95 and 145 kilograms live weight.

Backfat thickness, carcass length, area of M. longissimus and carcass composition were determined for 253 Large White barrows and gilts to examine the genetic influence on the main characteristics of the carcass and the correlation of these traits with body measurements and fat characteristics at 8 d of age. Pigs were born to 32 sows mated to the same boar. At the age of 8 d, weight, body length and backfat thickness and cellularity were measured. Pigs were slaughtered at 95 and 145 kg live weight. Heritability and genetic correlations were estimated with dam component of variance. Higher adiposity of carcasses was noted for barrows than for gilts and for those animals slaughtered at the heavier vs at the lighter weight. High h2 values were observed for carcass length (.89 +/- .29), area of the M. longissimus (.67 +/- .26) and backfat thickness at the gluteus medius (.77 +/- .28). Percentage of commercial cuts also had high heritabilities. Phenotypic and genetic correlations between the characteristics at 8 d and backfat thickness, carcass length and M. longissimus area at slaughter were not statistically significant. However, significant phenotypic correlations were found between cellularity of the outer and inner layers at 8 d and percentage of major cuts (e.g., rp = .27 with total fat cuts); cellularity of the outer layer at 8 d also was correlated genetically with carcass composition (e.g., rg = .50 +/- .19 with total fat cuts). Genetic predisposition toward intensive fat deposition was more clearly predicted by cellularity than by thickness of adipose tissue in newborn pigs.

Relationships between adipose tissue characteristics of newborn pigs and subsequent performance: III. Histological and chemical characteristics of backfat.

Genetic and phenotypic relationships between adipose tissue characteristics of 253 piglets aged 8 d and qualitative characteristics of their backfat at 95 and 145 kg live weight were studied. Heritability of these qualitative aspects was estimated as well. Backfat samples were tested for cellularity, moisture, lipid content and fatty acid composition of the outer and inner layers. Adipose cellularity at birth proved to be correlated with cell volume, moisture and total unsaturated fatty acid, C18:0 and C18:2 contents present in backfat at slaughter. Estimates of heritability calculated for the outer layer of backfat indicated that progress can be made by selecting for water content and fatty acid composition. Neonatal cellularity furnishes a useful indicator not only of the backfat cell size at slaughter but also of the chemical factors important in determining the physical and organoleptic characteristics of porcine fat.

[Early diagnosis of intestinal infarcts]. / La diagnosi precoce degli infarti intestinali.

In view of the often poor prognosis of intestinal infarctions personal experience and reports in the literature are reviewed in order to identify the clinical, laboratory and radiological dates that can contribute to early diagnosis. It is concluded that only emergency selective arteriography of the upper mesenteric artery will enable the surgeon to diagnose and accurately locate the infarction.

[Palliative gastric resection]. / Le resezioni gastriche palliative.

The surgical treatment of stomach carcinoma is reassessed. Stress is laid on the more aggressive attitude with regard to advanced gastric cancer where total or partial palliative resection is the only operation offering good results. This tendency emerges both from the series presented and those reported in the literature. It is concluded that if more aggressive surgery is justified in IVth stage stomach tumours it must still depend on the patient's general condition.

[Tumors of the anus]. / I tumori dell'ano.

On the basis of an analysis of a personal series of anal tumours, it is concluded that the polychemotherapeutic protocol with mitomycin and 5-fluorouracil and extensive local tumour removal proposed by Nigro et al. could present a valid alternative to Miles anorectal amputation. The treatment proposed offers better quality of life for the patient without changing oncological radicality and survival.

[Lesions of the colon caused by pancreatitis]. / Lesioni del colon da pancreatite.

A case of stenosis of the splenic flexure of the colon consequent on acute pancreatitis is reported. Literature reports on the colic complications of pancreatitis are examined, analysing the pathogenetic mechanisms, clinical pictures and therapeutic problems involved in this pathology.

[Hepatic resection. A contribution and its analysis]. / Resezioni epatiche. Un contributo e la sua analisi.

The authors outline their experience in the field of resective hepatic surgery, both with regard to benign and malignant pathologies, and analyse the results in relation to indications and techniques, but also focusing attention on the assessment of postoperative functional alterations, in order to evaluate the hepatic reserve and the organ's response to demolitive surgery. All operations were carried put in the First Division of Surgery at the Ospedale Civile, Asti, from January 1989 to September 1992. In all cases, even in major hepatectomies, a "trans-parenchymal" technique was adopted. Before surgery tests were carried out in relation to the topography of disease, its nature, associated pathologies and the functional hepatic reserve. Operative mortality was zero and morbidity was negligible, probably because rigorous selection criteria and indications for surgery were adopted. Morbidity was even restricted in the two patients suffering from HCC on cirrhosis (?) and this may probably be attributed to the limitation of resection to solely oncological purposes and their classification as Child-Pugh's stage A. The results regarding the liver response to demolitive surgery appear to be indicative and revealed a highly significant and discriminating difference between elective and emergency surgery.

[Invasion of the chest wall in primary lung neoplasms]. / L'invasione della parete toracica nelle neoplasie polmonari primitive.

The authors analyse a series of 5 patients who underwent pulmonary and parietal resection between 1990 and 1993 due to non.microcytoma bronchogenic carcinoma with invasion of the thoracic wall. The patients comprised four men and one woman aged between 45 and 69 years old. Thoracic pain was present in two patients. Pulmonary resection with extrapleural stripping was performed in two patients whereas a block resection from one to five ribs and the corresponding intercostal spaces was performed in the other three patients. The authors' approach is not to perform these operations according to rigid protocols but to adapt them according to the local status of tumour invasion. Therefore to resort to extrapleural resection when there is a free cleavage plane between parietal pleura and rib wall; resection in block of the wall where the carcinoma has infiltrated the endothoracic fascia or deeper. The authors do not report any major complications and record a postoperative mortality rate of 0%. In two cases the thoracic wall was reconstructed using a sheet of Gore-Tex which did not provoke rejection phenomena. Radiotherapy was carried out in cases with positive lymph nodes. The series presented here is too recent to provide significant data regarding survival. However, the only factor seen to influence prognosis in the five patients was the presence or otherwise of lymph node metastasis, irrespective of the histological type and operation performed. The five year survival rate of T3N0M0 patients is in fact similar to that of T2N0M0 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spinal cord protection in surgery of the thoracic, descending, and thoraco-abdominal aorta. Comparison of methods]. / La protezione midollare nella chirurgia dell'aorta toracica, discendente e toraco-addominale. Metodiche a confronto.

The authors compare the strategus needed for the elimination of paraplegia and for protection of abdominal organs after replacement of descending thoracic or thoraco-abdominal aorta. They analyse single technique considering the advantages and the controindications; furthermore they compare these properties and those of possible variants in the light of the presentation; type of disease and general conditions of the patient. These considerations are in agreement with later literature as well as the attitude of the surgeon.

[Pseudoaneurysms after carotid endarterectomy]. / I pseudoaneurismi postendoarterectomia carotidea.

Pseudoaneurysms after TEA of the internal carotid artery are one of the rarest and most severe complications of this form of surgery. Their etiology appears to depend on 3 causes: a suturing defect due to technical errors made by the surgeon or to the incorrect choice of threads; an infections, and lastly the arterial wall weakened by TEA. The patch increases the risk of false aneurysm approximately four fold. We therefore agree with other authors that, in spite of the undoubted value of the patch in the prevention of restenosis, it must only be used in the presence of an internal carotid of small diameter (less than 4 mm). Contrary to what is reported in the literature we performed both these operations under loco-regional anesthesia and a detailed knowledge of this method allows is to be performed on the carotid axis. Only through a careful follow-up of all the carotids operated can the small dilations which often do not require surgical treatmente identified. The two cases reported here were treated by the removal of the pseudoaneurysms and its replacement with a prosthesis in one case and with the vena saphena in the other. Both were monitored with clinical examination and echo-Doppler and no recidivation has been reported to date.

[Major and minor complications in carotid surgery]. / Complicanze maggiori e minori in chirurgia carotidea.

The Authors report their experience of major and minor complications in carotid surgery. They analyse the causes and emphasize that a thorough preoperative study and a quick surgical technique are very important in reducing the rate of complications in this essentially preventive form of surgery.

[Risks and benefits of influenza and pneumococcal immunization in HIV-1 infected individuals]. / Rischi e benefici delle vaccinazioni anti-influenzale ed anti-pneumococcica in individui HIV-1 positivi.

Influenza and Streptococcus pneumoniae diseases can cause severe complications in HIV-1 infected individuals leading to increases in hospital admission and even death. Both vaccinations are recommended for such individuals, but some studies reported that such immunizations may stimulate an increase of HIV-1 viral load and decrease of CD4+ cells count. A review of published studies, including our studies carried out in HIV-1 infected former drugs addicts, indicates that influenza and pneumococcal vaccinations are well tolerated in individuals with HIV-1, and do not induce deterioration of the course of HIV-1 infection, even though the immune response to vaccination is lower than that one observed in immunocompetent individuals. Therefore the lack of significant changes of virological and immunological parameters indicates that such immunizations can be safely administrated to HIV-1 infected individuals.

Human papillomavirus (HPV) infection and genotype frequency in the oral mucosa of newborns in Milan, Italy.

Human papillomavirus (HPV) causes cutaneous and mucosal infections in both adults and children. In order to evaluate HPV prevalence and the spectrum of genotypes in the oral cavity of paediatric subjects, a retrospective study was carried out on oral-pharyngeal swabs collected from 177 newborns aged 0-6 months. HPV-DNA was detected by a nested-PCR; the viral typing was made through DNA sequencing. HPV infection was identified in 25 subjects (14.1%) and the sequence analysis showed eight distinct genotypes. These data confirm HPV detection in newborn oral mucosa. Further investigations are needed to clarify the methods of HPV acquisition.

Genetic variability in the major capsid L1 protein of human papillomavirus type 16 (HPV-16) and 18 (HPV-18).

HPV-16 and HPV-18 infections result in nearly 73% of cervical cancers worldwide. The L1 protein comprising HPV vaccine formulations elicit high-titre neutralizing antibodies. The aim of this study was to detect L1 HPV-16 and HPV-18 gene polymorphisms and analyze intratypic variations. HPV-16 (n = 29) and HPV-18 (n = 5) L1 gene sequences were obtained from cervical samples harvested from Italian women. Phylogenetic trees were constructed using the Neighbor-Joining and the Kimura 2-parameters methods (MEGA software). To estimate selection pressures acting on the L1 gene, codon-specific non-synonymous (d(N)) and synonymous (d(S)) substitutions were inferred using the Nei-Gojobori method and Jukes-Cantor model (MEGA software) and integrated analyses carried out using SLAC, FEL and REL methodologies. All the HPV-16 L1 sequences analyzed fell into the European branch (99.4-99.7% similarity). Thirty-four single nucleotide changes were observed and 18 (52.9%) were non-synonymous mutations (7/18 were identified in sequences encoding an immunodominant loop and one occurred in the sequence encoding the α-4 domain associated with VLP conformation). There was no evidence of positive selection in the sequence alignment of L1 HPV-16 genes (P-value < 0.1). One mutation was identified in a negatively selected codon. HPV-18 L1 analyzed sequences fell into two phylogenetic branches: the HPV-18 European branch (99.5-100% similarity) and the HPV-18 African branch (99.8% similarity). Nine single nucleotide changes were observed and 4/9 (44.5%) of these nucleotide mutations were non-synonymous and one was present in a sequence encoding the immunodominant FG loop. There was no evidence of positive selection in the sequence alignment of L1 HPV-18 genes (P-value < 0.1). This study identified polymorphisms of undefined biological activity in HPV-16 and HPV-18 L1 sequences. Information regarding the genetic diversity of HPV-16 and HPV-18 L1 gene sequences may help define the oncogenic potential of respective strains and to better understand immune escape mechanisms.

Comparison of three nucleic acid amplification assays of cerebrospinal fluid for diagnosis of cytomegalovirus encephalitis.

The diagnostic reliabilities of three cytomegalovirus (CMV) nucleic acid amplification assays of cerebrospinal fluid (CSF) were compared by using CSF samples from human immunodeficiency virus-infected patients with a postmortem histopathological diagnosis of CMV encephalitis (n = 15) or other central nervous system conditions (n = 16). By using a nested PCR assay, the quantitative COBAS AMPLICOR CMV MONITOR PCR, and the NucliSens CMV pp67 nucleic acid sequence-based amplification assay, sensitivities were 93.3, 86.6, and 93.3%, respectively, and specificities were 93.7, 93.7, and 87.5%, respectively. The COBAS AMPLICOR assay revealed significantly higher CMV DNA levels in patients with diffuse ventriculoencephalitis than in patients with focal periventricular lesions.