Non-segmental vitiligo and psoriasis comorbidity - a case-control study in Italian patients.

BACKGROUND: A recent systematic evaluation of vitiligo and psoriasis comorbidity has not yet been reported in a large series of patients with vitiligo. OBJECTIVE: To investigate the practical/clinical implications in subjects with both vitiligo and psoriasis compared to those with vitiligo alone. METHODS: This was a case-control study on 463 vitiligo patients in our clinic from March 2008 to April 2011. Medical assessment was performed by dermatologists using the modified Vitiligo European Task Force form. RESULTS: In an univariate analysis, inflammation/pruritus [odds ratio (OR) 2.42, P = 0.03], use of drugs that can induce psoriasis (OR 2.74, P = 0.01), a family history (FH) of psoriasis (OR 2.87, P = 0.02), cardiovascular disease (OR 5.70, P = 0.001), hypertension (OR 4.7, P = 0.006) and type 2 diabetes mellitus (OR 3.87, P = 0.004), were significantly correlated with patients exhibiting vitiligo and psoriasis comorbidity. A trend was found in personal history of cardiovascular disease in patients with both diseases (OR 2.99, P = 0.07). FH of vitiligo was significantly associated with patients having only vitiligo (OR 0.35, P = 0.05). Multivariate analysis demonstrated that inflammation/pruritus in vitiligo macules (OR 2.56, P = 0.047) and a FH of cardiovascular disease (OR 4.07, P = 0.02) were the most significant predictors of patients having both psoriasis and vitiligo, while the presence of organ-specific autoantibodies (OR 0.24, P = 0.007) was significantly associated with patients having only vitiligo. CONCLUSION: The presence of vitiligo and even mild psoriasis is significantly correlated with a family history of cardiovascular disease, a factor that requires greater attention and follow-up with respect to that necessary for vitiligo patients.

A one-session circumferential reconstruction in thoracic and lumbar spine fractures using a small expandable cage.

AIM: Circumferential reconstruction of thoracic and lumbar vertebrae is most frequently performed in two sessions. The authors assessed feasibility, safety and results of a surgical technique in which the use of a small cage allows a less invasive strategy. In addition, since the authors perform urgent decompression in specific cases of spinal cord injury, feasibility of this technique in emergency was verified. METHODS: In two Neurosurgical Departments, between May 2001 and May 2006, 62 patients with thoracic or lumbar fractures were operated on using this technique. X-rays were performed postoperatively and around 45 days from surgery. Three-dimension-computed tomography (3D-CT) scans were performed at 3, 6 and 12 months. Neurological evaluations were repeated at every outpatient visit. After screw insertion at the adjacent levels and traditional transpedicular circumferential decompression, further bone is removed to excavate a niche in the vertebral body and the contiguous discs are removed. The expandable cage, filled with bone fragments, is inserted horizontal or oblique laterally to the sac and applied vertical inside that niche and then expanded. The circumferential stabilization is completed with bone grafting and posterior instrumentation. RESULTS: 3D-CT scans showed sound fusion and no manifest correction loss. Nineteen patients improved at least one grade in the ASIA scale and 11 gained neuromeric levels. CONCLUSION: This technique, fairly undemanding and feasible also in emergency, proved to be safe and resistant. Two-year follow-up demonstrated thriving fusion and steady alignment. It is a valuable surgical therapy to selected cases of burst fracture.

Psychosocial stress affects energy balance in mice: modulation by social status.

Stress has been associated with changes in eating behaviour and food preferences. Moreover, psychosocial and socio-economical challenges have been related with neuroendocrine-autonomic dysregulation followed by visceral obesity and associated risk factors for disease. In the current study, we provide a model of body weight development, food intake, energy expenditure of subordinate and dominant mice under psychosocial stress either in the presence of a standard diet or of a high palatable diet. When only standard chow was available stressed animals consumed more food in comparison to the control counterpart. Moreover, subordinate mice, at the end of the stress period were heavier in comparison to dominant animals. This last result was due to a decrease in the caloric efficiency of dominant animals in comparison to subordinates. Confirming this, the results of the experiment 2 showed that dominant mice significantly increase their energy expenditure at the end of the chronic psychosocial stress procedure in comparison to subordinate mice, as measured by indirect calorimetry. When a palatable high fat diet was available subordinate animals became heavier in comparison with both dominant and control animals. No differences in the caloric intake were found between groups. Subordinate mice ingested more calories from fat than controls, while dominant animals ingested more calories from carbohydrates. These results suggest that psychosocial stress can be a risk factor for overeating and weight gain in mice. However, social status influences the extent to which an individual keeps up with adverse environment, influencing the vulnerability toward stress related disorders.

Chronic administration of olanzapine induces metabolic and food intake alterations: a mouse model of the atypical antipsychotic-associated adverse effects.

RATIONALE: Most of atypical antipsychotics (AAPs) are highly related to a major risk of metabolic drawbacks leading to dyslipidemia and obesity. OBJECTIVE: To set up a mouse model of the AAP-associated weight gain in mice under the influence of chronic olanzapine regimen. MATERIALS AND METHODS: Female mice were housed in pairs and habituated to spontaneous feeding with a high-palatable diet (10% sucrose wet mash). Firstly, we orally administered olanzapine (0.75, 1.5 and 3 mg/kg), evaluating body weight and periuterine fat mass, as well as insulin, non-esterified fatty acids, triglycerides, and glucose levels. In a second experiment, we assessed the effect of olanzapine on energy expenditure through indirect calorimetry (IC). A third experiment was conducted to investigate the effects of olanzapine on a high fat-high sweet palatable diet (10% sucrose + 30% fat, HF-HS) in mice implanted with subcutaneous osmotic mini-pumps. Locomotor activity was also assessed. RESULTS: In experiment 1, the highest dose of chronically administered olanzapine (3 mg/kg) induced significant weight gain accompanied by augmentation of periuterine fat depots, with no changes in locomotor activity. In experiment 2, chronic administration did not alter energy expenditure, whereas, decreased respiratory quotient (RQ). In experiment 3, subcutaneously infused olanzapine evidenced a dose and time-dependent increase of body weight and HF-HS diet consumed. Notably, serum analyses revealed a hyperinsulinemia together with increased levels of triglycerides and glucose. CONCLUSIONS: In this study, we describe in female mice metabolic alterations matching the metabolic syndrome, thus resembling the clinical situation of schizophrenic patients taking AAPs.

Thyroid hormone effect on alpha-fetoprotein and albumin coordinate expression by a human hepatoma cell line.

The action of triiodothyronine on the production of alpha-fetoprotein and albumin in serum-free cultures of Hep G2 human hepatoma cells was examined. Our data showed that a marked inhibition (up to 8-fold) of alpha-fetoprotein secretion and an increase in albumin (up to 4-fold) are produced by 10(-8) M triiodothyronine. These effects were slow in their onset and for completion required 20-25 days of treatment with the hormone. However, an exposure of the cells to triiodothyronine for only the first 4 h was sufficient to affect, in a similar way, the secretion of alpha-fetoprotein and albumin when measured 15 days after treatment. The secretion of the two proteins parallels their intracellular levels. The decrease in alpha-fetoprotein production can be explained by a reduction of the RNA coding for the protein. The same is essentially true also for albumin increased secretion and related mRNA expression.

Insulin resistance, the metabolic syndrome, and nonalcoholic fatty liver disease.

BACKGROUND/AIMS: An association of nonalcoholic fatty liver disease with the insulin-resistant metabolic syndrome has been suggested. The aim of the study was to assess the association of fatty liver to different degrees of insulin resistance and secretion. METHODS AND RESULTS: The study was performed in 308 alcohol- and virus-negative consecutive patients attending a metabolic clinic, who underwent a complete clinical and biochemical work-up including oral glucose tolerance test and routine liver ultrasonography. Steatosis was graded as absent/mild, moderate, and severe. In nondiabetic subjects, a progressive (P < 0.05) increase in mean homeostasis model of insulin resistance was recorded from the group without steatosis to the groups with mild/moderate and severe steatosis. Severe steatosis was associated with the clustering of the five clinical and biochemical features proposed for the clinical diagnosis of the metabolic syndrome. Subjects with the metabolic syndrome with a more pronounced insulin resistance had a higher prevalence of severe steatosis (P < 0.01) compared with those with homeostasis model of insulin resistance below the median. CONCLUSIONS: The findings stress the heterogeneous presentation of patients with the metabolic syndrome when the diagnosis is based on the broad Adult Treatment Panel III clinical criteria and demonstrate that those who are more insulin resistant have a higher prevalence of severe steatosis.

Direct effect of thyroid hormone on intracardiac conduction in acute and chronic hyperthyroid animals.

Studies of intracardiac conduction utilizing His bundle electrograms demonstrate direct thyroid hormone action on the conduction system in both acute and chronic hyperthyroid animals.

Erythrocyte fatty acid composition and gallstone disease: results of an epidemiological survey.

Within a cross-sectional study on the epidemiology of gallstone disease (GD) and its related factors, relation of GD to habitual dietary fat types has been investigated. Gallbladder status was assessed by ultrasound; fatty acid composition of the habitual diet was estimated by GLC of erythrocyte fatty acids. No differences in erythrocyte fatty acid composition were observed between women without gallstones, women with gallstones (aware and unaware of their condition), and women who had cholecystectomies. Multivariate analysis, including other diet-dependent and gallstone-related variables, showed no significant association between erythrocyte fatty acids and risk for gallstones. However, raised erythrocyte linoleic:saturated ratio was associated with increased risk for gallstones only in women with very low serum triglycerides. This latter finding needs further confirmation and is presently unexplainable. Our results suggest that dietary fatty acids do not play a major role in GD.

Prognosis of breast cancer in males: an analysis of 170 cases.

A statistical analysis was performed on a series of 170 consecutive cases of operable (M0) breast cancer in males. All the patients underwent surgery. The end-points considered were: (i) overall mortality, (ii) all neoplastic events and deaths without evidence of breast disease (first event). Five- and ten-year overall mortalities were 26.9 and 54.3%, respectively. A multiple regression analysis showed that tumour size and nodal status (pT and pN) were statistically significant as prognostic factors. With regard to first events, 12 local recurrences (thoracic wall), one nodal relapse in the axilla and one contralateral tumour were observed. Primary tumours, other than breast cancer, occurred in 11 patients. The observed probability of surviving at 10 years from the treatment was definitely lower than that of the general population. For the follow-up periods of 0-5 and 6-10 years, the excess death rate per 100 man-years was 9.98 and 13.43, respectively. It appears from the analysis that prognosis of breast cancer is worse in men than in women.

Titrates for treatment of unstable angina pectoris and coronary vasospasm.

The treatment of a patient with unstable angina at the time of the initial presentation of the physician can begin with nitrates. The beneficial action of nitrates are several. Nitrates dilate epicardial coronary arteries as well as many coronary artery stenoses. They may be effective because of this action plus a marked effect on decreasing ventricular volume and ventricular end diastolic pressure. Perhaps the best way to manage patients with severe angina that may be in part related to coronary artery vasoconstriction is to combine a long-acting nitrate with a calcium antagonist. The combined use of nitrates and calcium antagonists will (1) dilate the coronary arteries to maintain coronary blood flow, (2) decrease systemic arterial pressure and thus decrease peripheral vascular resistance, and (3) dilate peripheral veins and thus decrease ventricular volume and pressure. When proper doses are used, the combination may be more effective than either drug alone. Of course, proper dosing must be determined for the individual patient by the physician. Initial treatment with the nitrates should begin with small doses and gradually build up. Similar dosing schedules should be used for the calcium antagonists. Both doses can be increased to high levels is the clinical situation warrants it.

Reversible carnitine palmitoyltransferase inhibitors with broad chemical diversity as potential antidiabetic agents.

A series of carnitine related compounds of general formula XCH(2)CHZRCH(2)Y were evaluated as CPT I inhibitors in intact rat liver (L-CPT I) and heart mitochondria (M-CPT I). Derivative 27 (ZR = -HNSO(2)R, R = C(12), X = trimethylammonium, Y = carboxylate, (R) form) showed the highest activity (IC(50) = 0.7 microM) along with a good selectivity (M-CPT I/L-CPTI IC(50) ratio = 4.86). Diabetic db/db mice treated orally with 27 showed a significant reduction of serum glucose levels.

L-carnitine uptake into primary rat cortical cultures: interaction with GABA.

The ability of the primary rat cortical cells to take up L-carnitine increased with the age of the cultures and plateaued at around day 11 up to 25 days in vitro (DIV) when a slight decline was evident and by 32 DIV there was a major decrease in L-carnitine uptake. The uptake of L-carnitine displayed complex components. Elimination of mitochondrial energy supply by NaCN (1 mM), rotenone (1.25 microM) and DNP (50 microM), caused a small but significant decrease in the uptake (21, 11 and 16%, respectively). The uptake was highly dependent on the Na gradient, since ouabain (0.5 mM) and Na free buffer (replaced by 250 mM sucrose), reduced uptake by 54 and 63%, respectively. There was competition of L-carnitine uptake by molecules resembling its structure, e.g. gamma-aminobutyric acid (GABA), acetyl-L-carnitine (ALC), D-carnitine, L-aminocarnitine and L-choline, with GABA being the most potent inhibitor (57% at 50 microM) and L-choline not being significantly active. The Na-dependent uptake of L-carnitine was saturable with a high Km (692 microM) and Vmax (839 pmol/min/mg). This Na-dependent component was not further additive with the GABA (500 microM) or the DNP (50 microM) inhibitable component, suggesting that it represented the same phenomenon, probably the Na gradient dependent transport of L-carnitine. The results indicate that the uptake of L-carnitine occurs by Na-dependent saturable process as well as non-saturable, Na-independent processes. At least the former uptake mechanism is potently inhibited by GABA.

Surgical treatment of 43 retroperitoneal sarcomas.

Forty-three cases of primary retroperitoneal sarcomas, observed and treated from 1970 to 1983 at this Institute, were analysed. The series consisted of 16 liposarcomas (37%), 10 leiomyosarcomas (23%), 7 rhabdomyosarcomas (16%), 5 fibrosarcomas (12%), 2 malignant histiocytomas (5%), 2 sarcomas NOS (5%) and 1 mesenchymoma (2%). All the patients underwent surgery. In order to evaluate the results of surgery, the patients were divided into three groups, according to the type of operation performed, that is open biopsy, resection and excision. Survival of the patients in the first group never exceeded 24 months. The symptom-free period for the patients treated by incomplete removal of the tumour (second group) lasted 3-24 months. Further surgery, in three cases for this group, did not result in a useful control of the disease. As regards radically treated cases, local recurrence was observed in 3 of the 7 liposarcomas, 2 of the 5 leiomyosarcomas, 1 of the 2 rhabdomyosarcomas and 1 fibrosarcoma. Out of 16 cases of the third group, regularly followed up, only 3 patients (liposarcomas) were alive and free of disease at 5 years from first operation. Overall 5-year survival for this group was 31.9%; disease-free survival was 18.7%. For the whole series of 43 cases, overall 5-year survival was 11.4%. As far as histology was concerned, liposarcomas showed the highest operability rate: out of 16, 7 were resected and 9 radically excised. There is a lack of convincing evidence for the utility of post-operative chemotherapy. On the contrary, post-operative radiotherapy seems to be worthwhile for liposarcomas, especially after non-radical operations.

Surgery for local recurrences following deficient radical mastectomy for breast cancer: a selected series of 39 cases.

Thirty-nine patients with locally recurrent cancer, previously treated elsewhere by mastectomy, were considered. At clinical examination, doubts arose as to the efficiency of previously performed mastectomies. Recurrent lesions, in the absence of distant metastases, were nodular, cutaneous or subcutaneous, in the area of previous 'radical mastectomy'. Second surgery consisted of a wide excision together with a surgical revision of axilla. No radiotherapy was administered to the thoracic wall after surgery. Adjuvant chemotherapy (CMF) was given to 26 node-positive women. Median follow-up was 48 months. Pathological reports showed that portions of mammary gland and axillary lymph nodes had been left behind by primary surgery in 29 and 34 cases, respectively. In 26 cases lymph nodes were metastatically involved. Local control has been maintained in 32 patients, 21 of whom are alive and free of disease.

Retrieval of broken pedicle screws by "friction" technique. Technical note.

The authors describe a simple and fast technique for removal of deeply situated broken pedicle screw fragments. The screw fragments are removed using a fine-serrated, conically cored bit with a light rough inner surface that is mounted on a common slow-speed drill capable of rotating clockwise and counterclockwise. The cored head of the bit is pressed and engaged on the cut surface of the broken screw, and the drill is made to turn in counterclockwise rotation; this, by means of friction, causes the two surfaces to interlock, and consequently the broken screw fragment backs out. This technique was used to retrieve both broken titanium and stainless steel screws, and satisfying results were obtained. There were no complications associated with the application of the technique, and the pedicle as well as the screw hole were always preserved, offering, in the event that the vertebral instability continued, the possibility of applying a new screw of slightly larger diameter at the same screw hole. This technical application offers the opportunity of removing deeply situated screw fragments by using a simple technique while maintaining the vertebral pedicle and screw-hole integrity.

Seasonal pattern of glycosylation in frog liver.

The circannual behaviour of glycosylation and protein synthesis in frog liver slices was studied following the incorporation of 3H-galactose and 14C-glucosamine into glycolipids and glycoproteins and 3H-leucine into proteins. The activity of two enzymes the galactosyl-transferase and the N-acetyl-glucosaminyl-1-P-transferase was determined. The incorporations of both sugars into the soluble fraction and into the lipid extract present a maximum during the spring-summer period. The incorporation into the protein fraction displays a different pattern: 14C-Glucosamine and 3H-leucine incorporation increases from winter to a maximum in autumn; the incorporation of 3H-Galactose has a sharp peak during spring. The pattern of glycosyltransferase activities is similar to the pattern of incorporation of the two saccharides into proteins, indicating these enzymes as important control points for glycosylation in Anurae.

Electric and/or magnetic field effects on DNA structure and function in cultured human cells.

Exposure of cultured K562 cells to 50 Hz electric (0.2-20 kV/m), magnetic (0.002-2 G), or combined electric and magnetic fields for up to 24 h did not result in the production of detectable DNA lesions, as assayed by the filter elution technique. The rate of cell growth was also unaffected as well as the intracellular ATP and NAD+ levels. These results indicate that, under the experimental conditions utilized in this study, 50 Hz electric, magnetic and electromagnetic fields are not geno- and cyto-toxic in cultured mammalian cells.