Harmonisation of ethics committees' practice in 10 European countries.

BACKGROUND: The Directive 2001/20/EC was an important first step towards consistency in the requirements and processes for clinical trials across Europe. However, by applying the same rules to all types of drug trials and transposing the Directive's principles into pre-existing national legislations, the Directive somewhat failed to meet its facilitation and harmonization targets. In the field of ethics, the Directive 2001/20/EC conditioned the way of understanding and transposing the "single opinion" process in each country. This led to a situation in which two models of research ethics committees organisation systems exist, being the model in which the "single opinion" is considered to be the decision made by a single ethics committee more effective and simpler in terms of administrative and logistic workload. METHOD: A survey was conducted in 10 European countries. Members of the European Clinical Research Infrastructures Network working party number 1, with expertise in the field of ethics, responded. RESULTS: There is a major heterogeneity in the composition of ethics committees among the surveyed countries based on the number of members, proportion of experts versus lay members and expertise of the scientific members. A harmonized education of the ethics committees' membership based in common curricula is recommended by the majority of countries. CONCLUSIONS: Despite the efforts for harmonization of the European Clinical Trial Directive, from an ethical point of view, there remains a plurality of ethics committees' systems in Europe. It is important to comprehend the individual national systems to understand the problems they are facing.

Similar discontinuation symptoms for withdrawal from medium-dose paroxetine and venlafaxine after nine years in the same patient.

A woman who had developed a discontinuation syndrome nine years ago with paroxetine tapered from 10 to 5 mg/day represented the same syndrome recently when she occasionally missed her 75 mg q 12 h venlafaxine doses. The symptoms, comprising agitation, numbness, pricking sensations, sweating, difficulty concentrating, weakness, derealisation and perceived xerophthalmia, immediately subside upon drug dose reinstitution. The patient had used cannabis irregularly before the onset of pauci-symptomatic panic attacks, but none of her panic symptoms were present in her withdrawal symptomatology. Some symptoms waxed and waned during the withdrawal period. The syndrome is compatible with both hyper- and hypoactivity of the central serotonergic system.

Influence of postharvest treatments on qualitative and chemical parameters of Tarocco blood orange fruits to be used for fresh chilled juice.

Tarocco "Sant'Alfio" is a late ripening blood orange cultivar. Blood oranges are more and more appreciated from consumers for their high nutraceutical value due to the presence of bioactive compounds including vitamin C, polyphenols, flavonoids and hydroxycinnamic acids. The aim of this work is to set up a reliable protocol for postharvest storage of the very-late Tarocco "Sant'Alfio" orange to prolong the availability of this product in the market to be used for fresh chilled orange juice production. Fruits were subjected to three storage treatments (20days at 1°C plus 50days at 4°C; 70days at 4°C; 70days at 20°C). The results indicate that cold treatments, in particular at 4°C constantly, can extend Tarocco "Sant'Alfio" shelf life enhancing total anthocyanin content. The defined protocols allow prolonging market availability of a high value product and could induce relevant benefits for the citrus industry and consumers.

Mutation analysis of the RPGR gene reveals novel mutations in south European patients with X-linked retinitis pigmentosa.

The RPGR (retinitis pigmentosa GTPase regulator) gene has been shown to be mutated in 10-20% of patients with X-linked retinitis pigmentosa (XLRP), a severe form of inherited progressive retinal degeneration. A total of 29 different RPGR mutations have been identified in northern European and United States patients. We have performed mutation analysis of the RPGR gene in a cohort of 49 southern European males affected with XLRP. By multiplex SSCA and automatic direct sequencing of all 19 RPGR exons, seven different and novel mutations were identified in eight of the 49 families; these include three splice site mutations, two microdeletions, and two missense mutations. RNA analysis showed that the three splice site defects resulted in the generation of aberrant RPGR transcripts. Six of these mutations were detected in the conserved amino-terminal region of RPGR protein, containing tandem repeats homologous to the RCC1 protein, a guanine nucleotide-exchange factor for Ran-GTPase. Several exonic and intronic sequence variations were also detected. None of the RPGR mutations reported in other populations were identified in our series. Our results are consistent with the notions of heterogeneity and minority causation of XLRP by mutations in RPGR in Caucasian populations.

Relationship between volatile components of citrus fruit essential oils and antimicrobial action on Penicillium digitatum and penicillium italicum.

This study examined the effect of volatile components of citrus fruit essential oils on P. digitatum and P. italicum growth. The hydrodistilled essential oils of orange (Citrus sinensis cvv. "Washington navel", "Sanguinello", "Tarocco", "Moro", "Valencia late", and "Ovale"), bitter (sour) orange (C. aurantium), mandarin (C. deliciosa cv. "Avana"), grapefruit (C. paradisi cvv. "Marsh seedless" and "Red Blush"), citrange (C. sinensis x Poncirus trifoliata cvv. "Carrizo" and "Troyer"), and lemon (C. limon cv. "Femminello", collected in three periods), were characterized by a combination of GC and GC/MS analyses. The antifungal efficacy of the oils was then examined at progressively reduced rates. Findings showed a positive correlation between monoterpenes other than limonene and sesquiterpene content of the oils and the pathogen fungi inhibition. The best results were shown by the citrange oils, whose chemical composition is reported for the first time, and lemon. Furthermore P. digitatum was found to be more sensitive to the inhibitory action of the oils.

Determination of vitamin A, vitamin E, and their esters in tablet preparations using supercritical fluid extraction and HPLC.

A rapid and precise method for the isolation of vitamins A and E and their acetate or palmitate esters from table matrices was developed using supercritical fluid extraction (SFE). The vitamins were analyzed by nonaqueous reversed-phase high-performance liquid chromatography after a 15-min extraction of the dosage form with supercritical carbon dioxide at 40 degrees C and at a pressure of 250 atm. A quantitative comparison of SFE with an established liquid extraction procedure was performed on commercial tablet formulations. Vitamin recoveries of over 95.6% compared with conventional liquid extraction were achieved by the SFE technique with a much shorter sample preparation time (15 min vs 2h). Moreover, the automated SFE process minimized the number of sample handling operations, drastically reduced the consumption of harmful solvents, and provided mild extraction conditions for the analysis of the labile vitamins. The described SFE method is suitable for quality control analyses of pharmaceutical tablets.

Kinetic solvent effects on phenolic antioxidants determined by spectrophotometric measurements.

The effects of polar (acetonitrile and tert-butyl alcohol) and apolar (cyclohexane) solvents on the peroxyl-radical-trapping antioxidant activity of some flavonoids, catechol derivatives, hydroquinone, and monophenols have been studied. The inhibition rate constants k(inh) of the antioxidants have been determined by following the increase in absorbance at 234 nm of a dilute solution of linoleic acid at 50 degrees C containing small amounts of antioxidant and radical initiator. Despite the low concentration of linoleic acid, the peroxidation process has been confirmed to be a free radical chain reaction described by the classical kinetic laws for this process. However, in the evaluation of k(inh), a careful analysis of the peroxidation curve, absorbance versus time, must be done because the final oxidation products of phenols may absorb at 234 nm. Phenols with two ortho-hydroxyls are the most active antioxidants, with inhibition rate constants in the range of (3-15) x 10(5) M(-1) x s(-1) (in cyclohexane). Nevertheless, it has been observed that in tert-butyl alcohol (a strong hydrogen bond acceptor) the rate constants dramatically decline to values not detectable by the present kinetic method. In acetonitrile (a weaker hydrogen bond acceptor) instead, the phenols with two ortho-hydroxyls scavenge the peroxyl radicals with rate constants close to those in cyclohexane. From the kinetic solvent effect, the equilibrium constant of the first solvation step of hydroquinone with tert-butyl alcohol has been determined at 50 degrees C, K(1) = 2.5 +/- 0.5 M(-1).

Calorimetric evidence of differentiated transport of limonin and nomilin through biomembranes.

The effect exerted by two structurally similar limonoids possessing antifeedant and anticancer activity, limonin and nomilin, on the thermotropic behavior of model membranes constituted by dimyristoylphosphatidylcholine (DMPC) vesicles was studied by differential scanning calorimetry. Attention was directed to evaluate modifications in phytochemical-lipid interaction induced by compound structure and lipophilicity and to evidence their different membrane penetration. The two examined compounds, when dispersed in liposomes during their preparation, were found to exert a very different action on the L(beta)-L(alpha) gel-to-liquid crystal phase transition of DMPC multilamellar vesicles. Nomilin caused a detectable effect on the transition temperature (T(m)), shifting it toward lower values with a concomitant small decrease of the associated enthalpy (DeltaH) changes, while limonin was not able to modify the lipid vesicles thermotropic behavior. Modifications induced by nomilin were a function of phytochemical concentration, while the different behavior of limonin can be due to the different polarity induced by the presence of the single A ring in nomilin that possesses an acetyl group versus the A,A' ring system of limonin. Solid limonoids and aqueous dispersions of multilamellar (MLVs) or unilamellar vesicles (LUVs) (limonoids molar fraction 0. 045, 0.12, and 0.18) were left in touch for long incubation times at temperatures higher than T(m) to detect their spontaneous transfer through the medium. By following this procedure, no interaction was detected for limonin with lipid vesicles. The rate of transfer and interaction of nomilin was a function of the kind of vesicle species (faster for LUV, slower for MLV). The interaction, monitored by compound transfer from the solid phytochemical to the lipidic species after several periods of incubation, was on the same order as that detected by preparation carried out in organic solvent. The obtained results can be explained in terms of compound hydrophobicity, and a relation between compound structure and membrane interaction can be suggested. This allows the membrane interaction with nomilin, but the low water solubility of limonin hinders or totally blocks its transfer through the aqueous medium.

Assay of vitamin A palmitate and vitamin E acetate in cosmetic creams and lotions by supercritical fluid extraction and HPLC.

The use of supercritical fluid extraction (SFE) as an alternative to liquid extraction was examined for the isolation of vitamin A palmitate and vitamin E acetate from cream and lotion preparations. Investigation of the factors controlling the extraction efficiency in SFE indicated that vitamin recoveries were affected mainly by the extraction pressure and by the degree of sample dispersion. The vitamins were analysed by high-performance liquid chromatography after a 30-min extraction of the cosmetic product with supercritical carbon dioxide at 40 degrees C and at a pressure of 250 atm. Compared with conventional liquid extraction SFE produced slightly lower recoveries (> 91.6%) but afforded a more effective purification of the cosmetic matrices. Moreover, SFE minimized sample handling and the use of harmful solvents and provided mild extraction conditions for the analysis of the labile vitamins. Vitamin E acetate and vitamin A palmitate were assayed in commercial cream and lotion formulations using the proposed SFE technique.

Neuroscience and oncology. A unified view.

Evidence has been produced that the neoplastic event is the result of a multistep multifactorial process involving virtually every functional system within the organism. Traditional concepts such as cellular autonomy, uncontrolled growth and monoclonality of cancer are revised in the light of current data. Microenvironmental stimuli appear to affect relevant cancer cell functions, including locomotion, differentiation and gene expression. The complex interconnection between biological functions and messages, relevant among which are nervous inputs, requires the identification of new physiological models if the neoplastic process is to be understood.

Tumor necrosis factor alpha levels in serum and cerebrospinal fluid of patients with AIDS.

We used a sensitive enzyme-linked immunosorbent assay technique to measure tumor necrosis factor alpha (TNF alpha) levels in serum and cerebrospinal fluid (CSF) samples from 30 patients infected with human immunodeficiency virus type 1 and from 10 normal controls. We found detectable levels of TNF alpha in 19 of 30 CSF and in 17 of 30 serum samples. The values of TNF alpha ranged between 20-90 pg/ml. All the patients had overt AIDS. More elevated TNF alpha levels in CSF correlate with focal damage within the central nervous system (p less than 0.01). Our results suggest that an intrathecal production of TNF alpha may occur during active inflammation in course of AIDS.

[Compared progression of visual-evoked potentials in preterm and term newborns]. / Evolution comparée des potentiels évoqués visuels chez des enfants nés à terme et prématurément.

PURPOSE: To compare the development of the visual pathway in healthy preterm and full-term newborns using flash and patterned (both transient and steady-state) visual-evoked potentials (fVEP, pVEP-t, pVEP-ss). PATIENTS AND METHODS: Twenty-nine preterm newborns (28-35 weeks gestational age) were evaluated at four different times: at 3 months postnatal and corrected age, at 8 months postnatal and corrected age. They were matched with 92 term newborns tested at 3 and 8 months of life. RESULTS: The maximal perceived spatial frequencies in the groups were: 2 C/d at 3 months postnatal age, >2 C/d at 3 months corrected age and at 3 months at term, between 3 and 5C/d, >=5C/d at 8 months corrected age and at 8 months of life, respectively. The latencies of the P1 and P100 waves for the flash and the transient stimulation were, respectively, 192 ms and 207.9 ms at 3 months postnatal age, 144 ms and 137.7 ms at 3 months corrected age, 126.3 ms and 124.1 ms at 8 months postnatal age, 112.7 ms and 112.5 ms at 8 months corrected age, 137.3 and 110.1 ms at 3 months of life; and 122.3 and 100.5 ms at 8 months of life. DISCUSSION: In the preterm infants of 3 gestational months, the latencies of the fVEP are comparable to those of the 3-month-old full-term infants, although the pVEP-t latencies are still delayed at 8 months. In the fVEP; however, we noted a shorter latency in the preterm infants at 8 months corrected age compared to those of the full-term infants. This tendency inversion was also evidenced at the steady-state stimulation. CONCLUSIONS: As evidenced by our results, at 8 months of corrected age the preterm infants recovered the fVEP and pVEP-ss, but not the pVEP-t. Different results obtained with different visual-evoked stimulations suggest that similar neural pools are developed in not completely equal amounts of time.

[Annular pancreas in the adult (clinical study)]. / Il pancreas anulare dell'adulto (contributo clinico).

The authors report a double observation of anular pancreas which appeared with different signs. After discussing the different etiopathogenetic moments, they point out the variety of the therapeutical behaviour in front of such a rare disease.

Initial evidence for the role of CACNA1C on subcortical brain morphology in patients with bipolar disorder.

BACKGROUND: The polymorphism rs1006737 within the CACNA1C gene is associated with increased risk for bipolar disorder (BD) and variations in brain morphology and function of subcortical regions. Here we sought to investigate the influence of CACNA1C polymorphism on key subcortical brain structures implicated in the pathophysiology of BD. METHODS: Structural magnetic resonance imaging scans were acquired from 41 euthymic patients with BD and 40 healthy controls, who were also genotyped for the CACNA1C rs1006737 polymorphism. The effect of diagnosis, genotype and their interaction was examined in predefined volumes of interest in the basal ganglia, hypothalamus and amygdala extracted using SPM5. RESULTS: Carriers of the CACNA1C rs1006737 risk allele showed increased grey matter density in the right amygdala and right hypothalamus irrespective of diagnosis. An interaction between genotype and diagnosis was observed in the left putamen which was smaller in BD patients carrying the risk allele than in healthy controls. CONCLUSIONS: The CACNA1C rs1006737 polymorphism influences anatomical variation within subcortical regions involved in emotional processing.

Impact on patients' health status following early identification of a COPD exacerbation.

The current study aimed to assess the impact on patient health status during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A total of 421 COPD patients were enrolled in a multicentre, single-arm study with a 6-month observational follow-up period. Patients received two inhalations of Symbicort 200 Turbuhaler(R) twice a day. Patients were assessed before the run-in period, at baseline and at 1, 3 and 6 months. Patients were instructed to report a change in respiratory symptoms lasting >24 h. This defined an AECOPD. In addition to the initial call, the St George's Respiratory Questionnaire (SGRQ), COPD Control Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and activities of daily living (ADL) were completed at 5-7 and 12-14 days. A group of 176 patients reported at least one AECOPD. Exacerbations were associated with statistically significant mean changes (worsening) in the SGRQ activity and impact domains at onset (mean +/- sd 12.1 +/- 18.1 and 14.0 +/- 15.2), during the first (9.8 +/- 19.0 and 9.4 +/- 16.6) and second weeks (3.1 +/- 15.5 and 3.3 +/- 14.7). Clinically significant deterioration in SGRQ impact scores was shown in 71% of patients following early identification, with 55 and 37% during the first and second weeks of an AECOPD, respectively. Acute exacerbation severely impacts on health status. The current study provides valuable information on the change in health status during an acute exacerbation of chronic obstructive pulmonary disease that can be utilised for future trials that evaluate therapeutic intervention.

Cycloartane triterpene glycosides from Astragalus siculus.

Based on spectroscopic analysis and chemical degradation, the structures of two saponins isolated from the methanol extract of fresh roots of Astragalus siculus Biv. were established to be that of astrasieversianin II and astragaloside I (also known as astrasieversianin IV), two saponins previously isolated from A. sieversianus Pall and A. membranaceus Benge. A complete assignment of NMR data to the two compounds is reported for the first time.

Bioactive metabolites from Sicilian marine fennel, Crithmum maritimum.

Bioactivity-guided fractionation of the lipid extract of Crithmum maritimum using the brine shrimp lethality assay led to the isolation of three bioactive compounds. Two of these are known C17 polyacetylenic metabolites, falcarinol [1] and falcarindiol [2], previously isolated from several species of the Umbelliferae and Araliaceae. The third active principle was identified as O-geranylvanillin [3], an aromatic ether described in the literature as a synthetic compound but unknown as a natural product. Cytotoxic activity of the pure compounds was significant for 1 and 2, much less intense for 3.

Anterior uveitis associated with Mycoplasma pneumoniae pneumonia: a case report.

The authors report a case of bilateral uveitis following Mycoplasma pneumoniae pneumonia verified by IgM and rising IgG antibodies against the organism. Uveitis is a rare manifestation of Mycoplasma pneumoniae pneumonia and since it is a common pathogen, it should be considered in the differential diagnosis, even in the absence of respiratory symptoms or neurological findings. Immunobiological hypotheses are briefly discussed.

Immunochemical characterization of a human high molecular weight--melanoma associated antigen identified with monoclonal antibodies.

Sodium dodecyl sulfate polyacrylamide gel analysis of a high molecular weight (HMW) human melanoma associated antigen (MAA) defined by murine monoclonal antibodies revealed a number of distinct polypeptides ranging from 80,000 up to 280,000 daltons, in addition to an extremely heterogeneous group of components distributed over a wide range in apparent molecular weight (300,000-700,000 daltons). The 280,000 dalton and the larger heterogeneous molecular weight material are glycosylated since they are labeled with 3H-sugars. The HMW-MAA is readily solubilized in the absence of detergents and the entire series of polypeptides fractionates together in the void volume of a Sephadex G200 column. Peptide maps of the various polypeptides of the HMW-MAA, generated by Staphylococcus aureus V-8 protease, are essentially the same except that some of the proteolytic fragments derived from the lower molecular weight polypeptides (80,000 daltons) are present in greater amounts than are similar fragments derived from the larger molecular weight polypeptides; the latter finding suggests that the complexity in molecular weight of the MAA may reflect combinations of several base subunits. Proteolytic cleavage of the HMW-MAA generates a number of peptides ranging in molecular weight from 77,000 daltons to less than 12,000 daltons, which still react with monoclonal antibodies and can distinguish monoclonal antibodies specific for different antigenic determinants of this MAA.