[Urinary evaluations of drug consumption among workers having high risk of accident: technical difficulties, limits and possibilities of increasing efficacy of the law]. / Le valutazioni bioumorali del consumo di stupefacenti nei lavoratori a rischio di infortunio per terzi: criticità tecniche, limiti e possibilità di incremento della efficacia della norma.

Urinary evaluations of drug consumption among workers having high risk of accident became compulsory in Italian legislation few years ago. We report results of 322.110 single urinary drug detections carried out between 2008 and 2011 on 35.789 subjects. We verified technical difficulties arisen during laboratory detections and organizational difficulties evidenced by Occupational Doctors during collections of samples. We screened 701 positive samples (1.96%), mostly to Cannabinoids and Cocaine, verified using first and second level screening according to national law. Many patients referred regular or irregular use of medicines active on Central Nervous System frequently ignoring their collateral effects. After the evidence of a positive result, during a second medical visit, many workers referred assumption of "natural diet supplements" acquired not in traditional commercial distributors. In two cases we have had the possibility of analyzing these supplements which have shown the presence of law concentrations of drugs in their compositions.

Increased plasma fibronectin concentration in diabetic patients with microalbuminuria.

Raised levels of plasma fibronectin (PF), an alpha 2-glycoprotein produced by vascular endothelia, have been previously described in diabetic patients with retinopathy and overt nephropathy. The aim of this study was to investigate whether the presence of microalbuminuria is associated with increased PF concentrations. Twenty Albustix-negative diabetic outpatients with microalbuminuria [median albumin excretion rate (AER): 30.2 micrograms/min; range 12.1-194 micrograms/min] were compared with 58 sex- and age-matched patients without microalbuminuria (median AER 3.1 micrograms/min; range 0.8-12 micrograms/min) and 34 control subjects (median AER 2.8 micrograms/min; range 0.8-12.1 micrograms/min). Mean PF was significantly higher in the group with microalbuminuria (406.7 +/- 85.5 micrograms/ml) than in the group without it (325.3 +/- 76.5 micrograms/ml or in control subjects (334.5 +/- 76 micrograms/ml; P less than .05). PF increase associated with microalbuminuria was independent of the presence of retinopathy. Furthermore, in the whole group of diabetic patients, PF was significantly correlated with AER (r = .33; P = .003). Such correlation also remained significant (P = .0002) after covariance analysis by a stepwise discriminant procedure taking into account age, duration of disease, sex, blood pressure, body weight, therapy, and HbA1. In conclusion, PF increase is associated with microalbuminuria independent of the other considered variables; its role as a possible marker for early diabetic nephropathy remains to be fully clarified.

Erythrocyte spermidine levels in IDDM patients.

OBJECTIVES: To evaluate whether erythrocyte levels of polyamines spermidine and spermine (expressed in nmol/ml packed erythrocytes [PRBCs]) are modified in insulin-dependent diabetes mellitus (IDDM) and are associated with the presence of retinopathy or nephropathy. RESEARCH DESIGN AND METHODS: We studied erythrocyte spermidine and spermine levels in 38 IDDM patients with or without persistent microalbuminuria (urinary albumin excretion rate [AER] between 20 and 200 micrograms/min), macroalbuminuria (AER greater than 200 micrograms/min), or retinopathy compared with 60 sex- and age-matched control subjects. RESULTS: Mean +/- SD erythrocyte spermine content was similar in both diabetic (9.7 +/- 5.5 nmol/ml PRBCs) and control (8.8 +/- 3.5 nmol/ml PRBCs) subjects, whereas spermidine was higher in diabetic (19.1 +/- 7.2 nmol/ml PRBCs) than in control (14.5 +/- 4 nmol/ml PRBCs, P = 0.0007) subjects. Moreover, spermidine was significantly higher in the groups with microalbuminuria (n = 11, 22.5 +/- 9.2 nmol/ml PRBCs) and macroalbuminuria (n = 4, 22.2 +/- 5.7 nmol/ml PRBCs) than in both normoalbuminuric (n = 23, 16.9 +/- 5.6 nmol/ml PRBCs) and control (F = 9.78, P = 0.0001) subjects, and correlated with log AER (r = 0.41, P = 0.009). Similarly, proliferative retinopathy was associated with a significant increase in spermidine (n = 5, 20 +/- 7 nmol/ml PRBCs compared with control subjects [P = 0.0009]). CONCLUSIONS: Our data suggest that erythrocyte spermidine content is increased in IDDM patients associated with both diabetic nephropathy and advanced retinopathy.

Plasma and platelet taurine are reduced in subjects with insulin-dependent diabetes mellitus: effects of taurine supplementation.

Plasma and platelet taurine concentrations were assayed in 39 patients with insulin-dependent diabetes mellitus (IDDM) and in 34 control subjects matched for age, sex, and both total and protein-derived daily energy intake. Platelet aggregation induced by arachidonic acid in vitro at baseline and after oral taurine supplementation (1.5 g/d) for 90 d was also studied. Plasma and platelet taurine concentrations (mean +/- SEM) were lower in diabetic patients (65.6 +/- 3.1 mumol/L, or 0.66 +/- 0.07 mol/g protein) than in control subjects (93.3 +/- 6.3 mumol/L, or 0.99 +/- 0.16 mol/g protein, P < 0.01). After oral supplementation, both plasma and platelet taurine concentrations increased significantly in the diabetic patients, reaching the mean values of healthy control subjects. The effective dose (mean +/- SEM) of arachidonic acid required for platelets to aggregate was significantly lower in diabetic patients than in control subjects (0.44 +/- 0.07 mmol compared with 0.77 +/- 0.02 mmol, P < 0.001, whereas after taurine supplementation it equaled the mean value for healthy control subjects (0.72 +/- 0.04 mmol). In in vitro experiments, taurine reduced platelet aggregation in diabetic patients in a dose-dependent manner, whereas 10 mmol taurine/L did not modify aggregation in healthy subjects.

Plasma fibronectin in normolipidaemic and hyperlipidaemic uraemic patients treated with haemodialysis.

Plasma fibronectin (PF) concentrations, were investigated in normolipidaemic and hyperlipidaemic (type IV) patients with chronic renal failure treated with hemodialysis (n = 29) and in controls (n = 34). Mean PF was significantly reduced in both subsets of dialysed patients. Among the hemodialysed patients the presence of hyperlipidaemia did not modify PF levels, which resulted, on the contrary, significantly higher in hyperlipidaemic controls as compared with the normolipidaemic group. In controls, according to a multivariate analysis model, PF was directly related with age and inversely with HDL-cholesterol. In the hemodialysed patients total cholesterol was the unique significant PF related variate, being this group, therefore, characterized by the lack of any inverse relation between PF and HDL-cholesterol. Finally, no PF modifications were observed in hemodialyzed patients affected by arterial hypertension or clinically evident atherosclerotic lesions.

Raised erythrocyte polyamine levels in non-insulin-dependent diabetes mellitus with great vessel disease and albuminuria.

Erythrocyte content of polyamines has been previously found increased in insulin-dependent diabetes mellitus with microalbuminuria. Since increased urinary albumin excretion (AER) is associated with the presence of vascular diseases in non-insulin-dependent diabetes mellitus (NIDDM) the aim of this study was to verify the hypothesis that the presence of increased urinary albumin excretion (AER), and of macroangiopathy in NIDDM would be related to a significant modification in polyamine erythrocyte levels. The erythrocyte content of spermine and spermidine was measured by a HPLC method in 39 patients affected with NIDDM and in 24 age- and sex-matched healthy control subjects, evaluating the relationship between erythrocyte polyamines of NIDDM patients with the presence of macroangiopathy as well as with retinopathy or increased AER (> or = 20 micrograms/ml). Both spermidine and spermine were not modified in the group of NIDDM patients while the presence of raised urinary AER was characterised by an increase in erythrocyte spermine (11 +/- 1.7 vs. 7.7 +/- 1.7 nmol/ml packed erythrocytes; P = 0.04) and spermidine (18.9 +/- 1.7 vs. 12.6 +/- 1.5 nmol/ml packed erythrocytes; P = 0.02), being both polyamines significantly related to AER and to metabolic control. Erythrocyte spermidine and spermine were moreover significantly higher in the group of patients with macroangiopathy (22.8 +/- 1.5 vs. 12.3 +/- 1.5 nmol/ml; P = 0.0001 and 11.5 +/- 1.7 vs. 7.8 +/- 1.7 nmol/l packed erythrocytes; P = 0.04) and being, moreover, erythrocyte spermidine augmented in patients with retinopathy (24.2 +/- 1.5 vs. 12.2 +/- 1.5 nmol/ml packed erythrocytes; P = 0.009). In conclusion the levels of erythrocyte spermine and spermidine are both associated with the presence of albuminuria and macroangiopathy in NIDDM, while spermidine is on the average increased in the group of diabetic patients with retinopathy.

[Effect of the photoperiod of the site of oviposition of Aedes mariae (Diptera,Culicidae)]. / Influenza del fotoperiodo sulla scelta del luogo di ovideposizione in Aedes mariae (Diptera, Culicidae)

The overwintering biology of Aedes (Ochlerotatus) mariae (one of the sibling species of the mariae complex) was studied in populations from the Tyrrhenian coast of Central Italy (Sperlonga and Formia). Ae. mariae has in this zone several generations per year and its larvae are commonly found from March to October exclusively in rock pools along the coast. Field and laboratory observations show in these populations an embryonic winter diapause induced by short-day photoperiods (9-12 hours). The photoperiod acts primarily on the parental females during their preimaginal life. The expression of diapause is influenced by temperatures and photoperiods experienced by the embryos. Full embryonic diapause is observed when the eggs are incubated at relatively low temperatures (less than 16 degrees C) and at short photoperiods. Short-day photoperiods also induce a remarkable change in the oviposition behavior of Ae. mariae. Laboratory observations show that the adult females readily oviposit on water surfaces when originating from larvae reared at long-day photoperiod while they are very reclutant to oviposit in the same situation when reared at short day photoperiod. Choice experiments involving four alternative oviposition sites (see Plate 1) demonstrate a preference for outside free water in long-day mosquitoes and for inside moist surfaces in short-day mosquitoes. The behavioral difference persists in successive gonotrophic cycles and it is not apparently affected by the photoperiod acting on the adult females. The above evidence together with recovery of overwintering eggs in holes and crevices of rock pools suggest that the shift in oviposition site shown in the laboratory reflects a similar shift occurring in nature. Such photoperiodically induced change in oviposition behavior seems to have an important adaptive significance in providing more constant microclimates to the diapausing eggs and in protecting them from the mechanical action of winter storms.

Renal excretion of ascorbic acid in insulin dependent diabetes mellitus.

Serum ascorbic acid (AA) is reduced in diabetic patients. Aim of this study was 1) to verify whether such a decrease might be due to an altered urinary excretion of AA, and 2) whether this latter was modified in presence of early diabetic nephropathy with microalbuminuria (albumin excretion rate [AER] > 20 micrograms/min) in a group of 21 patients affected by insulin-dependent (type 1) diabetes mellitus (IDDM) as compared with 13 healthy controls matched for sex, age, dietary AA intake, and creatinine clearance per 1.73 m2 (CCl). Mean serum AA (+/- SD) was lower in diabetics (40.3 +/- 14 microM/l) than in controls (85.1 +/- 23.5 microM/l; p = 0.0001) and there was no difference between serum AA of patients with or without microalbuminuria. Urinary excretion of AA to creatinine x 100 (UAA/Cr) was higher in micro- (n = 6; 4.6 +/- 1.7) as compared to normoalbuminurics (n = 15; 1.6 +/- 0.9) or controls (1.5 +/- 1.2; p = 0.0001). For values exceeding renal threshold of tubular AA reabsorption (39 microM) the regression line of serum AA to UAA/Cr was significantly (p = 0.001) steeper in diabetics than in controls, suggesting an impaired tubular reabsorption of filtered AA in IDDM. The ratio of AA clearance to CCl was moreover related to AER (r = 0.48; p = 0.03) and to blood glucose (r = 0.51; p = 0.01), being unrelated to uric acid clearance, glycosuria and to urinary excretion of both alanine aminopeptidase and N-acetyl-beta-glucosaminidase.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fluconazole in the therapy of candidiasis in intensive care]. / Fluconazolo nella terapia delle candidosi in terapia intensiva.

The authors studied four patients in ICU suffering from Candida infections who were treated with a new bis-triazole antimycotic, fluconazole. Various parameters of blood chemistry and blood and urine drug levels were monitored. After treatment all microbiological tests had become negative and clinical conditions had improved considerably within 30 to 60 days. No significant side effects were observed.

Simultaneous liquid-chromatographic determination of urinary vanillylmandelic acid, homovanillic acid, and 5-hydroxyindoleacetic acid.

We describe a liquid-chromatographic method for quantifying, simultaneously by a single procedure, vanillylmandelic acid (VMA), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA) in urine. After solvent extraction of acidified urine, the analytes were chromatographed on a C8 column, with use of a mobile phase of phosphate buffer (20 mmol/L, pH 4.0) and methanol with a variable gradient elution, and detected fluorometrically. We report the analytical recovery, sensitivity, precision, working linear range, and potential for interference from similar molecules or drugs. The results of such tests demonstrate that the proposed method is sensitive and reproducible. It is, furthermore, easy to perform, and thus is suitable for use in the clinical laboratory.

Raised plasma fibronectin concentration is related to the presence of diabetic retinopathy.

Plasma concentrations of fibronectin were studied in 152 diabetics (77 males, 75 females), divided according to their hypoglycemic treatment, and in 60 normal subjects (30 males, 30 females) closely matched for age. In both sexes no significant difference of plasma fibronectin (PF) levels was observed between controls and treated groups. In the whole group of diabetics PF levels were weakly correlated with age (r = 0.16; p less than 0.05) and not associated with HbA1 or duration of illness. Both male and female diabetics, either on sulfonylureas or insulin, with retinopathy (background, except for 2 proliferative in the group of insulin-requiring females) were characterized by significantly higher PF concentrations than either controls or patients without retinopathy.

Relation between urinary albumin excretion and skin involvement in patients with psoriasis.

The increase in urinary albumin excretion rate (AER), a hallmark of both diabetic nephropathy and hypertension, has also been described in patients affected with diffuse psoriasis. The aim of this study was to investigate whether such an increase is independent of the coexistence of diabetes or hypertension and whether it may be related to the extension and severity of skin lesions. Median AER, determined by radioimmunoassay, was significantly higher in a group of 32 normotensive nondiabetic psoriatic patients than in 36 age- and sex-matched controls (9.6 vs. 5.3 micrograms/min; p = 0.0006). AER was related with grading of skin involvement (r = 0.65; p = 0.001); patients with the most widespread skin lesions (psoriasis area and severity index: PASI greater than 11) were characterized by a significantly raised median AER (14.9 micrograms/min) compared with those with PASI scores between 4 and 11 (9.8 micrograms/min) or less (5.6 micrograms/min) and controls (F = 10.58; p = 0.0001), independent of other covariates such as age, sex and blood pressure (p = 0.001). This latter finding was confirmed by the prevalence of microalbuminuria (AER greater than 10 micrograms/min) which was present in 2 out of 8 patients with PASI less than 4, 0 out of 12 patients with PASI ranging between 4 and 11 and in 5 out of 12 psoriatics with PASI greater than 11 (p = 0.038 by two-tailed Fisher's exact test).

[Glycosylated hemoglobins and the oral glucose tolerance test in evaluation of glucose tolerance]. / Emoglobine glicosilate ed OGTT nella valutazione della tolleranza glicidica.

We performed OGTT and glycosylated hemoglobin (HbA1) determinations in 62 subjects. In those with IGT we noticed significantly increased average levels of HbA1 in comparison to normal or borderline ones, but 65.3% of the subjects with abnormal OGTT according to Fajans and Conn's criteria and 83.3% of those scored as borderline, had normal HbA1. This latter group showed a positive significant correlation with sum and peak of plasma glucose concentrations at 60 and 120 min during the test. Our opinion is that the mutual presence of abnormal OGTT and of increased HbA1 levels allows a reliable diagnosis of IGT, and the presence of normal HbA1 must induce us to suspect a false IGT diagnosis. 18 normal subjects showed, moreover, a remarkable HbA1 increase 30 days after the glucose load, with a return to basal levels after 40 days, while in 8 subjects with IGT, HbA1 remained constantly unmodified after 30 and 40 days. This is probably a consequence of a difference in daily glycemic profile between individuals with normal glucose tolerance and others with a reduced one.

[A and B apoproteins and serum lipids in clinically healthy males]. / Apoproteine "A" e "B" e lipidi sierici in soggetti clinicamente sani di sesso maschile.

Serum levels of total cholesterol (TC), triglycerides (TG), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), Apoprotein A (Apo A) and Apoprotein B (Apo B) were determined in 125 healthy male subjects (bank clerks), aged 20-59 years, in order to screen risk factors of atherosclerosis (ATS) in our population. TC, TG, LDL-C and Apo B increase with aging, while HDL-C and Apo A do not. HDL-C correlates inversely with LDL-C, Apo B ad TG and positively with Apo A. LDL-C, TC and TG show a positive correlation with Apo A. Weight index, cigarette smoking, systolic blood pressure (SBP) negatively affect HDL-C levels which present a positive relation with alcohol intake. Apo B, TC and TG are, moreover, significantly increased by smoking and body weight. A multiple linear regression analysis choosing HDL-C and Apo B as dependent variables indicates that Apo A, TG, SBP, age and alcohol consumption are the attributes mostly associated with HDL-C while TC, smoking, Apo A and SBP are the independent variables which best explain total variance of Apo B. It is worth noting, in this respect, the effect of smoking on Apo B: such a result could provide a further explanation of the well-known connection between smoking and ATS.

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy.

Maternal diabetes mellitus is complicated by fetal macrosomia and predisposes the offspring to diabetes, but recent evidence indicates that a low, not high, birthweight is associated with a higher incidence of Type 2 (non-insulin dependent) diabetes in adult life. To clarify the relationships between maternal glucose and insulin levels and birthweight, we measured oral glucose tolerance and neonatal weight in a large group (n = 529) of women during the 26th week of pregnancy. Women with gestational diabetes (n = 17) had more familial diabetes, higher pre-pregnancy body weight, and tended to have large-for-gestational-age babies. In contrast, women with essential hypertension (n = 10) gave birth to significantly (p < 0.01) smaller babies. In the normal group (without gestational diabetes or hypertension, n = 503), maternal body weight before pregnancy and at term, maternal height, week of delivery, gender of the newborn, and parity were all significant, independent predictors of birthweight, together explaining 23% of the variability of neonatal weight. In addition, both fasting (p < 0.006) and 2-h post-glucose (p = 0.03) maternal plasma glucose concentrations were positively associated with birthweight independent of the other physiological determinants, accounting, however, for only 10% of the explained variability. In a subgroup of 134 normal mothers with pre-pregnancy body mass index of less than 25 kg.m-2, in whom plasma insulin measurements were available, the insulin area-under-curve was inversely related to birthweight (p < 0.02) after simultaneously adjusting for physiological factors and glucose area.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of plasma fibronectin (Fn) levels. Comparison between normal subjects and patients with various pathological conditions]. / Determinazione dei livelli di fibronettina (Fn) plasmatica. Confronto tra soggetti normali e pazienti con vari tipi di patologia.

Fibronectin is a glycoprotein secreted by connective tissue cells into their environment and into the blood. Plasma fibronectin in circulation exhibits some important interactions with other proteins in several diseases. We have detected plasma fibronectin levels in 187 normal subjects and in 126 patients. The mean value of this glycoprotein was strongly influenced by age but not by sex. 99 cancer patients showed lightly lower fibronectin levels than in normal controls. On the contrary, 25 chronic hepatic failure patients had higher values than normal controls. The mean level of plasma fibronectin in 20 hemodialyzed patients and in 7 plasmocytoma patients did not offer from what we detected in normal controls.