Study of liver function in healthy elderly subjects using the 13C-methacetin breath test.

BACKGROUND: The issue of whether or not liver function is compromised in the healthy elderly population remains unsolved. AIM: To investigate the putative age-related modifications of hepatic function using the 13C-methacetin breath test. Because endogenous CO2 production changes with age, motor activity and nutrition, a different form of processing the results was investigated. PATIENTS AND METHODS: Twenty-nine elderly subjects (mean age, 79.8 +/- 7.9 years; female/male ratio, 17/12) and 28 adult subjects (mean age, 40.6 +/- 12.3 years; female/male ratio, 13/15) underwent 13C-methacetin breath test and trans-abdominal echosonography with Doppler pulsed wave analysis of the coeliac axis and portal vein. RESULTS: Although the 13CO2 peak occurred within 15-30 min in both elderly and adult subjects, it was significantly decreased in the former (30.66% +/- 9.2% vs. 38.33% +/- 6.05%; P < 0.001), as was the cumulative excretion (33.07% +/- 7.06% vs. 39.81% +/- 5.68%; P < 0.001). When correcting for the effects of CO2 excretion by age, the age-related modification of the cumulative dose became more evident (elderly group 30.15% +/- 6.46% vs. adult group 37.97% +/- 5.92%; P < 0.0001). The elderly group also showed an increase in the intra-hepatic resistance index using Doppler pulsed wave analysis, which inversely correlated with the results of the breath test. CONCLUSIONS: Hepatic function is not well preserved in healthy humans throughout life and may be due to an increase in vascular resistance.

High prevalence of HCV infection among the general population in a rural area of central Italy.

The hepatitis C virus infection (HCV) is the most frequent cause of hepatic infection in Europe. In Italy, anti-HCV positivity values are extremely variable, depending on the age and geographic location of the population being analysed. The aims of the study were: (1) evaluating positivity for anti-HCV antibodies in various age groups and determining the HBsAg in a mountainous and predominantly farming area in central Italy; (2) assessing some anamnestic and clinical variables through a questionnaire, submitted during the taking of blood samples, in order to determine HCV exposure and risk factors for the target population. 344 subjects selected by random sampling among 3308 people, older than 16, were considered as the target population. A prevalence study was carried out. The sources of data were: blood samples taken to carry out the HCV positivity test; a questionnaire including items about exposures at risk and case-historical and clinical patient data. The risk of infection was evaluated by a multiple logistic regression model. The inferred HCV+ prevalence rate is 22.4/100 (95% confidence interval (CI): 20.8-24.1). An increasing age trend is shown with a higher positive predominance among females (28.99/100 vs. 14.29/100 in males). The positive HBsAg prevalence in the examined survey is 1.2/100. Variables associated with the HCV occurrence are case history of pneumonopathy (OR: 4.9) and exposure to parenteral therapies with glass syringes (OR: 3.3). This study is consistent with literature about the hypothesis of a north-south geographic gradient in the hepatitis C occurrence in Italy. Data clearly show the effects of the inappropriate use of medical or surgery practices on the population, with particular reference to the use of glass syringes. No elements prove that the farming features of the area may be predictive of HCV infection risk. The extent of the recorded prevalence values calls for the implementation of programmes aimed at detecting clusters or population areas at risk.

The impact of malnutrition on the quality of life in the elderly.

Malnutrition is a frequent condition, both widely represented in geriatric population and underestimated in diagnostic and therapeutic work-up, and is known to affect health status and life expectancy of elderly people. The unexpected weight loss is a pathological condition, recently classified in three different ways (sarcopenia, wasting and cachexia) according to criteria of nutritional intake, functional abilities and age-related body composition modifications, that is caused by social psychological and medical factors. In this review, the authors highlight the ways that, through malnutrition, could lead to an impairment of quality of life in elderly people. Notwithstanding the great impreciseness and confusion that surrounds the term 'quality of life', the authors focus their attention on the correlation existing with the recently occurring changes to patients' health status and life-style, analysing the relationship with frailty, failure to thrive and homeostatic balance failure syndrome. With the latter term, the authors introduce a pathological condition widely represented in the late stages of malnutrition that often evolves in multiple organ failure and lastly in the death.

Influence of aging and exercise-induced stress on human platelet function.

Ten healthy nonsmoking old men (age 52-70 years, OM) and ten healthy nonsmoking young men (age 20-30 years, YM) were submitted to an exercise test on a bicycle ergometer to examine the combined influence of aging and exercise-induced stress on platelet function. Data were analyzed by two-way ANOVA test to determine the statistical significance of differences between baseline, after exercise and after recovery values, and by Mann-Whitney test to compare differences between young and old groups. Our results show in OM at rest an increased platelet aggregability induced by the higher values of intraplatelet basal free calcium (143.3 +/- 4.8 vs. 121.5 +/- 6.0 nM, p < 0.05) and a statistically significant increase of plasma oxidative by-products evaluated as thiobarbituric acid-reactive substances (TBA-RS: 5.9 +/- 0.7 vs. 1.5 +/- 0.1 micromol/l, p < 0.05). Further, significant modifications of calcium and TBA-RS levels were found in both groups because of exercise-induced stress. The positive relationships between calcium amount and plasma values of TBA-RS in OM before (r = 0.728, p = 0.017) and after (r = 0.772, p = 0.009) physical test and in YM only at the end of exercise (r = 0.853, p = 0.002), underline that oxidative stress may modulate platelet function by influencing calcium homeostasis and platelet membrane permeability.

Long-Duration Soft X-Ray Pulses by XeCl Laser Driven Plasmas and Applications.

We report the characterization of a soft x-ray plasma source generated by a long-pulse XeCl excimer laser system. The output energy is 4 J at a wavelength of 308 nm in a 100-ns pulse. The intensity of radiation on target is estimated to be 4 × 1012 W cm-2. X-ray emission spectra of the plasma have been recorded using a double focusing spatial resolution spectrometer with a spherical mica crystal. From these measurements, the plasma temperature and electron density have been estimated. Various applications of such a plasma source have been investigated. First images of whole intact living cells from our system, imaged using the technique of soft x-ray contact microscopy, utilizing x rays in the "water window" region (280-530 eV), are shown. The suitability of the source for other applications, for example, x-ray lithography and radiation damage studies, to living cells are discussed. Possible improvements to the x-ray source for the various applications are proposed.

[Variations in lymphocyte subsets in chronic inflammatory and neoplastic pathology in the elderly. II. Discriminant stepwise analysis]. / Variazioni delle sottoclassi linfocitarie nelle patologie infiammatorie croniche e neoplastiche dell'anziano. II. Analisi discriminante stepwise.

The variations of lymphocyte subsets in chronic inflammatory and neoplastic diseases in an elderly population, have been previously reported. The different behavior of all the subsets that had shown significant variations of frequencies and absolute values within the groups with the Multivariate Analysis of Variance, have been studied. The use of the Discriminant Stepwise Analysis has given the chance to spot the discriminant subsets and their ability in discriminating the inflammatory and the neoplastic groups from each other and from the controls and finally in pointing out all the subsets which did not affect such differentiation.

[Changes in lymphocyte subsets in chronic inflammatory diseases and neoplasms in the elderly. I. Multivariate analysis of variance and factoral analysis]. / Variazioni delle sottoclassi linfocitarie nelle patologie infiammatorie croniche e neoplastiche dell'anziano. I. Analisi della varianza multivariata ed analisi fattoriale.

The variations of lymphocyte subsets have been studied both in neoplastic and chronic inflammatory elderly patients compared to a control group. The interpretation of the Multivariate Analysis of Variance (MANOVA) and of the Factorial Analysis has demonstrated the opposite role of TCD4 subset, mainly involved in the inflammatory process, and of TCD8 subset in regard of the neoplastic ones. We report the slight and yet significant increase of NK related to age. Independently from the disease pattern, factorial analysis permitted a comparison between the variations of lymphocyte subsets and the different grades of immunoresponse.

[Evaluation of the anti-inflammatory effect and tolerability of tenoxicam in short-team treatment of osteoarthrosis in the aged]. / Valutazione dell'effetto antiflogistico e della tollerabilità del tenoxicam nella cura a breve termine dell'osteoartrosi in età senile.

The authors report their experience with short-term (10 days) tenoxicam treatment in 20 patients with osteoarthritis at various localizations. The drug was administered at the following dosages: 20 mg twice daily for the first two days, and 20 mg daily for the following 8 days. Treatment proved effective in controlling pain and functional impairment. No dropouts due to side effects nor significant changes of laboratory parameters were observed. Therefore, tenoxicam may be considered an effective and well tolerated non steroid antiinflammatory agent for the treatment of active stages of osteoarthritis.

Peripheral blood lymphocyte response to exogenous interleukin 2 by PHA-prestimulated and non-PHA-prestimulated cells in patients with cancer.

The study aims were to assess the response of peripheral blood lymphocytes (PBL) of cancer patients to exogenous Interleukin 2 (IL 2) either by PHA-prestimulated or non PHA-prestimulated PBL, and to carry out preliminary experiments for a direct quantitative evaluation of endogenous IL 2 production by PBL cultures of cancer patients in order to define the actual role of IL 2 in the disease. Analysis of PBL subsets was also carried out with monoclonal antibodies in a selected group of patients. A total of 134 patients entered the study. Cancer sites were: larynx 32, breast 36, lung (NSC) 24, colorectal 17 and gynecologic 25. In the former 3 cancer sites staging showed localized or only locally advanced disease, and in the last 2 sites disseminated disease. Our results provided evidence that cancer patients exhibit a T-cell functional immunodepression, which progresses during tumor growth, so that the localized disease shows a low-grade defect, and advanced disease a high-grade defect. Our data also clearly suggested that the factor involved with a primary role in this functional immune impairment is the IL 2 deficiency. A perspective may be drawn on the therapeutic administration in vivo of IL 2 and IL 2-activated lymphokine-activated killer cells in controlled clinical trials of selected groups of cancer patients.

[Serum gastrin in rheumatoid arthritis]. / Gastrine sérique au cours de la polyarthrite rheuatoïde.

Serum gastrin concentrations under basal conditions and following stimulation were assessed in 40 patients suffering from rheumatoid arthritis (RA) and compared with healthy individuals. The RA groups showed no significant differences in comparison with the control population. These conclusions lead the authors to seek the reasons for the rare instances of confirmed hypergastrinaemia in RA.

Evaluation of the specificity of the leukocyte migration inhibition test against histologically homologous and heterologous neoplastic antigens in cancer patients.

The aim of the present study was to verify whether the CMI response of the host's lymphocytes is directed towards tumor-associated antigens (TAA) specific for each histological type of tumor. The leucocyte migration inhibition (LMI) test was selected for this purpose, utilizing the cancer patients' leucocytes and, as neoplastic antigens, formalin-fixed cells of surgically removed cancer tissue. Two hundred and eighteen patients were studied, 110 of whom were affected by breast cancer, 48 by digestive tract and 60 by laryngeal cancer. The total amount of tests performed was 278. The leucocytes of 93 normal subjects were tested against the different tissues' cancer antigens, as were the leucocytes of 41 patients with cancer of different organs tested against the corresponding normal tissues' antigens. The breast cancer patients (122 tests performed) showed 82.35% positive tests against homologous antigen, 72.72% and 95.24% against heterologous (digestive tract and laryngeal cancer, respectively) antigens. The digestive tract cancer patients (69 tests performed) showed 70.27% positive tests against homologous, 66.66% and 43.48% against heterologous antigens (breast and laryngeal cancer respectively). The laryngeal cancer patients (87 tests performed) showed 74.29% positive tests against homologous, 38.10% and 80.65% against heterologous antigens (breast and digestive tract, respectively). The results led to the conclusion that the LMI test response of cancer patients was not "tissue specific": the test did not discriminate between the homologous and the heterologous cancer antigens, and it seems that the response was not directed towards specific TAA but only towards wide-range or "group" TAA, showed by several types of tumors.