The Sapienza count-down for a healthy and sustainable diet.

Abstract: The prevalence of obesity and of other non-communicable diseases related to overnutrition is significantly increasing in the past few years. Policy makers are called to counteract this pandemic, orienting consumers towards a healthier and more sustainable diet. Most of the proposed initiatives are dedicated to the content of nutrients with "unfavourable" effects but, in fact, focusing the attention only or mainly on single foods or nutrients is not effective in decreasing the incidence/prevalence of non-communicable diseases. Whole dietary patterns play by far a more important role than specific dietary components in promoting health and modulating survival; and the adherence to eating patterns like the Mediterranean diet reduces the risk of non-communicable diseases. The challenge is therefore to be able to transmit information relating to a healthy eating pattern through positive messages in a few simple indications which in turn represent the nutritional, but also the socio-cultural, environmental and economic characteristics of a healthy and sustainable dietary model. The Mediterranean Diet is normally proposed through a graphic depiction that represents a pyramid which is a simple and effective representation but not of immediate impact. For this reason, we are proposing to adopt the "Sapienza Count-down for a Healthy and Sustainable Diet" that will integrate the pyramid with a more immediate approach.

Understanding public attitudes to death talk and advance care planning in Northern Ireland using health behaviour change theory: a qualitative study.

OBJECTIVES: Advance care planning is a key preparatory step in ensuring high-quality palliative and end of life care, and should be considered as a process, beginning with community-level conversations among lay persons. There is, however, indication that death talk among community-dwelling adults is not occurring, and there is a dearth of research examining why this is the case. This study aims to provide the first examination of barriers and facilitators to talking about death and dying among the general population in a UK region (Northern Ireland), and to provide a novel application of health behaviour change theory towards developing a theoretical understanding of the sources of this behaviour. METHODS: The study involved qualitative analysis of responses (n = 381 participants) to two open-ended questions within a cross-sectional online survey, with recruitment via social media of adults currently living in Northern Ireland. Reflexive thematic analysis was conducted on open text responses per question, with the barriers and facilitators mapped on to health behaviour change models (the Behaviour Change Wheel COM-B and the Theoretical Domains Framework). RESULTS: The findings evidence a myriad of barriers and facilitators to engaging in death talk, with themes aligning to areas such as lack of acceptance of death in social contexts and fear of upsetting self or others, and a need to improve interpersonal communication skills for facilitating conversations and improve knowledge of the existing services around death and dying. A theoretical understanding of the drivers of death talk is presented with findings mapped across most components of the COM-B Behaviour Change Model and the Theoretical Domains Framework. CONCLUSIONS: This study contributes to a small but emergent research area examining barriers and facilitators to talking about death and dying. Findings from this study can be used to inform new public health programmes towards empowering adults to have these conversations with others in their community towards upstreaming advance care planning.

Localized myxedema histologically mimicking spindle cell lipoma.

In this report, a 55-year-old woman with Graves disease and exophthalmos had a recurrent nodule on the foot. Her initial biopsy and excision specimens were believed to be consistent with spindle cell lipoma, which aligned with her early tumor-like clinical morphology. Her tumor recurred after excision, which is not consistent with spindle cell lipoma. As her condition progressed, her clinical morphology became more consistent with localized myxedema and her biopsies were congruent, securing clinicopathologic correlation. With standard treatment for localized myxedema, she improved significantly. This case emphasizes how clinicians need to have high suspicion for localized myxedema in patients with history of Graves disease and exophthalmos. It also emphasizes how localized myxedema should be included in the histologic differential diagnosis for spindle cell lipoma with prominent myxoid stroma, particularly in those not responding to treatment as anticipated.

Exploring the perceptions of emotional distress among couples living with Type 2 diabetes and among diabetes healthcare providers, and consideration of support needs.

AIMS: To compare the emotional distress experienced by people with Type 2 diabetes with the perceptions of their partners, and to explore the perceptions of healthcare providers and how these differ from the perceptions and experiences of couples living with Type 2 diabetes regarding their support needs. METHODS: A purposive sample of people with Type 2 diabetes and their partners was recruited through Diabetes UK media outlets and support groups, while healthcare providers were recruited through hospital and diabetes education teams. Inductive thematic analysis was conducted. RESULTS: Seven people with Type 2 diabetes and six partners took part in separate semi-structured interviews and seven healthcare providers took part in focus groups. Themes emerged regarding unique psychological struggles for people with Type 2 diabetes: 'sense of restriction'; 'disempowerment'; and 'acceptance of diabetes'. For partners the themes of 'feeling responsible' and 'need for greater involvement' emerged. Common themes arising from people with Type 2 diabetes, partners and healthcare providers highlighted diabetes-related stresses: 'self-care struggles' and 'perceived need for appropriate psychological support'. A key theme drawn from healthcare providers was 'perceived professional barriers to psychological support', which captures concerns related to providing emotional support in clinical practice. CONCLUSIONS: People with Type 2 diabetes, partners, and healthcare providers share a common understanding of the emotional stresses of living with Type 2 diabetes, but also experience diabetes differently depending on their role and responsibilities. All face barriers that need to be considered to ensure that emotional support in diabetes is meaningful and feasible in routine practice.

Determination of gastrointestinal tract colonization sites from feedlot cattle transiently shedding or super-shedding Escherichia coli O157:H7 at harvest.

AIMS: The objective of the study was to determine levels of Escherichia coli O157:H7 colonization in the gastrointestinal tract (GIT) of naturally shedding cattle shedding the pathogen at low- or super-shedder levels. METHODS AND RESULTS: Over 2 years, feedlot cattle were sampled multiple times for faecal shedding of E. coli O157:H7. Just prior to harvest (1-2 days), animals that were super-shedders (≥104  CFU per gram of faeces) were specifically identified, and based on the longer term screening data, pen cohorts that were low-shedders (years 1 and 2) or chronic-shedders (year 1) were also identified. At harvest, samples were collected from throughout the GIT, including the rectoanal junction (RAJ) for enumeration and enrichment of E. coli O157:H7. The mouth samples exhibited the greatest prevalence for the pathogen, and the abomasum and rumen exhibited the lowest prevalence (P < 0·05). Super-shedders had significantly greater prevalence for all GIT locations except the mouth and abomasum compared to low-shedders, but the super-shedders were the only animals with positive abomasum samples. Samples from the super-shedders were enumerable for most GIT locations, and the rectum and RAJ locations were the only locations that were significantly greater than other locations (P < 0·05). CONCLUSIONS: Across all animals naturally exposed to E. coli O157:H7, the risk of ingestion is high, but rumen and abomasum are potential barriers to passage. In super-shedders, the passage through the GIT was greater, allowing colonization in the rectum and at the RAJ. SIGNIFICANCE AND IMPACT OF THE STUDY: Escherichia coli O157:H7 low-shedding cattle had lower pathogen levels throughout the GIT, indicating intrinsic GIT factors to these cattle may reduce pathogen passage through the GIT, including the abomasum, and minimize risk of RAJ colonization.

Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents.

BACKGROUND: The possible associations between adherence to the Mediterranean diet and micronutrient and energy intakes are unknown among Israeli adolescents. METHODS: A cross-sectional, nationally representative, school-based study was conducted in Israeli adolescents. Schoolchildren (n = 5005), aged 11-18 years, who completed a food frequency questionnaire and had complete data to compose a 14-item modified KIDMED score were included. RESULTS: The nutrient intakes for all the micronutrients showed a significant monotonic increase in the poor, average and good KIDMED groups (all P < 0.001). The same monotonic increasing was also shown in nutrient densities for most micronutrients (for calcium, magnesium, potassium, copper, vitamin A, vitamin E, vitamin C, thiamin, riboflavin, vitamin B6 , folate in both genders, additionally for phosphorus in girls) (all P < 0.05). A positive association was shown between the percentages of students with adequate intakes (AIs) or recommended dietary allowances (RDAs) in micronutrients and modified KIDMED scores. The positive association also existed between the number of micronutrients with AIs or RDAs and modified KIDMED scores (r = 0.495 and 0.501, P < 0.001) for boys and girls, respectively. By contrast, dietary energy density (calibrated by 1000 kcal) was negatively linearly associated with modified KIDMED scores, and a significant monotonic decrease in energy density was shown among the poor, average and good KIDMED groups (all P < 0.001). CONCLUSIONS: The modified KIDMED score was positively associated with better micronutrient profile and negatively associated with dietary energy density in Israeli adolescents, indicating that the KIDMED index is a useful tool for combating the malnutrition of micronutrient deficiency and overweight/obesity.

Rural-urban patterns of disability: The role of migration.

Disability rates are higher in rural than in urban areas of the United States, raising the question: do residential preferences and selective migration of people with disabilities play a role in higher rural disability rates? Utilising concepts of environmental fit from the disability literature and ideas from classic, residential preference, and household migration studies, we examine the 2011-2015 American Community Survey Public Use Microdata Sample to understand whether migration contributes to higher rural disability. Results show only slightly different propensities to stay in rural than in urban areas and similar destination choices of people with or without disability, suggesting that migration does little to explain higher rates of rural disability. However, we detect noteworthy differences in age migration schedules for persons with disability, persons without disability in households with disability, and persons without disability in households without disability. Disability emerges as a relevant, although underresearched, dimension in household migration research.

Iris pigmented lesions as a marker of cutaneous melanoma risk: an Australian case-control study.

BACKGROUND: Iris naevi and iris freckles have a frequency of 4% and 50% in the European population, respectively. They are associated with dysplastic naevi, but few studies have examined their link to cutaneous melanoma. OBJECTIVES: To assess whether iris pigmented lesions are a predictive indicator for cutaneous melanoma. METHODS: This is a melanoma case-control study of 1254 European-background Australians. Sun exposure and melanoma history, a saliva sample for DNA analysis and eye photographs taken with a digital camera were collected from 1117 participants. Iris images were assessed by up to four trained observers for the number of iris pigmented lesions. The data were analysed for correlations between iris pigmented lesions and melanoma history. RESULTS: Case participants over the age of 40 had similar numbers of iris pigmented lesions to age matched controls (mean 5·7 vs. 5·2, P = 0·02), but in younger case and control participants there was a greater difference (mean 3·96 vs. 2·19, P = 0·004). A logistic regression adjusted for age, sex, skin, hair and eye colour, skin freckling and naevus count found that the presence of three or more iris pigmented lesions increases the melanoma risk 1·45-fold [95% confidence interval (CI) 1·07-1·95]. HERC2/OCA2 rs12913832 and IRF4 rs12203592 influenced both eye colour and the number of iris pigmented lesions. On the HERC2/OCA2 A/A and A/G genotype background there was an increasing proportion of blue eye colour when carrying the IRF4 T allele (P = 3 × 10-4 ) and a higher number of iris pigmented lesions with the IRF4 T/T homozygote (P = 3 × 10-9 ). CONCLUSIONS: Iris pigmented lesion count provides additional predictive information for melanoma risk above that from conventional risk factors.

The impact of the bovine faecal microbiome on Escherichia coli O157:H7 prevalence and enumeration in naturally infected cattle.

AIMS: The objective of this study was to determine if the faecal microbiome has an association with Escherichia coli O157:H7 prevalence and enumeration. METHODS AND RESULTS: Pyrosequencing analysis of faecal microbiome was performed from feedlot cattle fed one of three diets: (i) 94 heifers fed low concentrate (LC) diet, (ii) 142 steers fed moderate concentrate (MC) diet, and (iii) 132 steers fed high concentrate (HC) diet. A total of 322 585 OTUs were calculated from 2,411,122 high-quality sequences obtained from 368 faecal samples. In the LC diet group, OTUs assigned to the orders Clostridiales and RF39 (placed within the class Mollicutes) were positively correlated with both E. coli O157:H7 prevalence and enumeration. In the MC diet group, OTUs assigned to Prevotella copri were positively correlated with both E. coli O157:H7 prevalence and enumeration, whereas OTUs assigned to Prevotella stercorea were negatively correlated with both E. coli O157:H7 prevalence and enumeration. In both the MC diet group and the HC diet group, OTUs assigned to taxa placed within Clostridiales were both positively and negatively correlated with both E. coli O157:H7 prevalence and enumeration. However, all correlations were weak. In both the MC diet group and the HC diet group, stepwise linear regression through backward elimination analyses indicated that these OTUs were significantly correlated (P < 0·001) with prevalence or enumeration, explaining as much as 50% of variability in E. coli O157:H7 prevalence or enumeration. CONCLUSIONS: Individual colonic bacterial species have little impact on E. coli O157:H7 shedding but collectively groups of bacteria were strongly associated with pathogen shedding. SIGNIFICANCE AND IMPACT OF THE STUDY: Bacterial groups in the bovine colon may impact faecal shedding of the zoonotic pathogen E. coli O157:H7, and manipulation of the intestinal microbiota to alter these bacteria may reduce shedding of this pathogen and foodborne illnesses.

The Importance of Ground Critical Care Transport.

Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.

Med Diet 4.0: the Mediterranean diet with four sustainable benefits.

OBJECTIVE: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns. DESIGN: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined. RESULTS: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet. CONCLUSIONS: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

Evaluation of essential oils in beef cattle manure slurries and applications of select compounds to beef feedlot surfaces to control zoonotic pathogens.

AIMS: To evaluate natural terpene compounds for antimicrobial activities and determine whether these compounds could be used to control microbial activities and pathogens in production animal facilities. METHODS AND RESULTS: Thymol, geraniol, glydox, linalool, pine oil, plinol and terpineol were tested in laboratory studies for ability to control the production of odorous volatile fatty acid compounds and reduce pathogen levels in manure slurry preparations. Thymol is a terpene phenolic compound and was most effective for reducing fermentation products and pathogen levels (P < 0.05), followed by the extracts linalool, pine oil and terpineol, which are terpene alcohols. Select compounds thymol, linalool and pine oil were further evaluated in two separate studies by applying the agents to feedlot surfaces in cattle pens. Feedlot surface material (FSM; manure and soil) was collected and analysed for fermentation products, levels of coliforms and total Escherichia coli, and the presence of E. coli O157:H7, Campylobacter, Salmonella, Listeria and L. monocytogenes. The reduction in fermentation products but not pathogens was dependent on the moisture present in the FSM. Treatment with 2000 ppm thymol reduced the prevalence of E. coli O157:H7 but not Listeria. In a separate study, treatment with 4000 ppm pine oil reduced E. coli O157:H7, Listeria and Campylobacter (P < 0.05). Linalool was tested at two levels (2000 and 4000 ppm) and did not affect pathogen levels at either concentration. CONCLUSIONS: Natural compounds bearing terpenes can control pathogenic bacteria in treated manures and when applied to the feedlot surface in production cattle systems. Pine oil is a cheaper alternative to thymol and may be a useful treatment for controlling pathogens. SIGNIFICANCE AND IMPACT OF THE STUDY: The control of bacterial pathogens in animal productions systems is an important step in preharvest food safety. Waste products, such as pine oil extract, from the pulp wood industry may have application for treating feedlot pens and manures to reduce the pathogen load.

Effect of lysozyme or antibiotics on faecal zoonotic pathogens in nursery pigs.

AIMS: The objective of this study was to determine the effect of lysozyme and antibiotics on zoonotic pathogen shedding in faeces from nursery pigs housed without and with an indirect disease challenge. METHODS AND RESULTS: Two replicates of approximately 650 pigs each were weaned and randomly assigned to one of 24 pens in either a nursery room that had been fully disinfected or a nursery room left unclean. Pigs were randomly assigned to control diet (Control), control diet + antibiotics (Antibiotic; chlortetracycline and tiamulin), or control diet + lysozyme (Lysozyme; 100 mg kg(-1) diet). Rectal swab samples were collected on day 0 and 28 of treatment, and enriched and cultured for Campylobacter spp. and shiga-toxigenic Escherichia coli (STEC). Enrichments from rectal swab samples also were analysed for presence of enterohaemorrhagic E. coli (EHEC) virulence genes (hlyA, eae, stx1 and stx2). Room hygiene had little effect on day 28 results. Percentage of samples culture positive for Campylobacter spp. was lowest for lysozyme diets (P < 0·01), but similar for control and antibiotic diets (43·2, 83·7, and 84·8 respectively). Diet had little effect on the EHEC virulence genes hlyA or eae (P > 0·1), but there was a tendency for fewer samples positive for stx1/stx2 in antibiotic or lysozyme diet groups (P < 0·07) compared to control diet (1·2, 2·1 and 5·8% respectively). Salmonella spp. and specific STEC types tested were rarely detected in the study. CONCLUSIONS: In nursery swine, room hygiene had little effect on pathogen shedding. Dietary chlortetracycline and tiamulin did not reduce pathogen shedding but dietary lysozyme reduced faecal shedding of Campylobacter. SIGNIFICANCE AND IMPACT OF THE STUDY: Lysozyme can effectively replace antibiotics in the diet of nursery swine and can be effective for pathogen control.

Delayed leptin administration after stroke induces neurogenesis and angiogenesis.

Leptin is a potent AMP kinase (AMPK) inhibitor that induces neuroprotection, neurogenesis, and angiogenesis when administered immediately after stroke. To dissociate these effects, we explored the effects of delayed administration of leptin, at 10 days after stroke onset, on neurogenesis and angiogenesis after stroke. Sabra mice underwent photothrombotic stroke and were treated with vehicle or leptin given either as a single dose or in triple dosing, 10 days later. Newborn cells were labeled with bromodeoxyuridine. Functional outcome was studied with the neurological severity score for 90 days poststroke, and the brains were then evaluated via immunohistochemistry. Final infarct volumes did not differ between the groups. Exogenous leptin led to significant increments in the number of proliferating BrdU(+) cells in the subventricular zone and in the cortex abutting the lesion (2.5-fold and 1.4-fold, respectively). There were significant increments in the number of newborn neurons and glia (4- and 3.4-fold, respectively) in leptin-treated animals. Leptin also significantly increased the number of blood vessels in the perilesioned cortex. However, animals treated with leptin failed to demonstrate significantly better functional states. In conclusion, leptin induces neurogenesis and angiogenesis even when given late after stroke but does not lead to better functional outcome in this delayed-treatment paradigm. These results suggest that the main beneficial effects of leptin after stroke are associated with its early neuroprotective role rather than with its proneurogenic or proangiogenic effects.

Effects of antimicrobials fed as dietary growth promoters on faecal shedding of Campylobacter, Salmonella and shiga-toxin producing Escherichia coli in swine.

AIMS: To determine whether antimicrobials commonly used in swine diets affect zoonotic pathogen shedding in faeces. METHODS AND RESULTS: Barrows (n = 160) were sorted into two treatments at 10 weeks of age (week 0 of the study), and fed growing, grow finishing and finishing diets in 4-week feeding periods. For each feeding phase, diets were prepared without (A-) and with (A+) dietary antimicrobials (chlortetracycline, 0-8 week; bacitracin, 9-12 week) typical of the United States. At week 0, 4, 8, 9, 10 and 12 of the study, faecal swabs or grabs were collected for analyses. Campylobacter spp. was absent at week 0, but prevalence increased over time with most isolates being identified as Campylobacter coli. When chlortetracycline was used in A+ diets (week 4 and 8), prevalence for Campylobacter spp., pathogenic Escherichia coli O26 and stx genes was lower in faeces. On week 12 after the shift to bacitracin, Campylobacter spp. and stx genes were higher in faeces from piglets fed A+ diet. Pathogenic E. coli serogroups O103 and O145 were isolated throughout the study and their prevalence did not differ due to diet. Pathogenic E. coli serogroups O111 and O121 were never found in the piglets, and Salmonella spp. prevalence was low. CONCLUSIONS: In production swine, growing diets with chlortetracycline may have reduced pathogen shedding compared with the A-growing diets, whereas finishing diets with bacitracin may have increased pathogen shedding compared with the A-finishing diet. SIGNIFICANCE AND IMPACT OF THE STUDY: Inclusion of antimicrobials in the diet can affect zoonotic pathogen shedding in faeces of swine.

The effect of lipoic acid and vitamin E therapies in individuals with the metabolic syndrome.

The metabolic syndrome is associated with abnormal glucose and lipid metabolism, insulin resistance, increased oxidative stress and pro-inflammatory activity that increase the risk of type 2 diabetes and cardiovascular disease. The aim of this study was to investigate the effect of treatment with the antioxidant α-lipoic acid (ALA) with or without vitamin E supplementation, on markers of insulin resistance and systemic inflammation and plasma nonesterified fatty acid (NEFA) concentrations in individuals with the metabolic syndrome. In a randomized, double-blind, placebo-controlled trial, subjects with the metabolic syndrome received ALA (600 mg/day, n = 34), vitamin E (100 IU/day, n = 36), both ALA and vitamin E (n = 41), or matching placebo (n = 40) for 1 year. Fasting circulating concentrations of glucose and insulin were measure every 3 months and NEFA, markers of inflammation, adiponectin and vitamin E were measured at 6 monthly intervals. Plasma NEFA concentrations decreased [-10 (-18, 0)%] at a marginal level of significance (p = 0.05) in those who received ALA alone compared with placebo and decreased [-8 (-14, -1)% (95% CI)] significantly (P = 0.02) in participants who were randomised to ALA with and without vitamin E compared with those who did not receive ALA. Fasting glucose, insulin, homeostatic model assessment of insulin resistance, adiponectin, and markers of inflammation did not change significantly during the study. These data suggest that prolonged treatment with ALA may modestly reduce plasma NEFA concentrations but does not alter insulin or glucose levels in individuals with the metabolic syndrome.

Comparison of a novel form of zinc with zinc oxide bolus licensed for prevention of facial eczema, and interaction with copper oxide in sheep.

To evaluate a novel elemental zinc bolus compared with a registered positive control zinc oxide bolus and assess serum zinc concentrations following concomitant treatment with a capsule containing copper oxide needles. Forty Romney-cross ewes were randomly allocated in a 2 × 2 factorial design study. On Day 0, 20 ewes received novel boluses containing elemental zinc (Investigational Veterinary Product, IVP) while 20 received a zinc oxide bolus (control; CP). Half the animals in each zinc treatment group (n = 10) were treated with a copper oxide needle capsule [Copasure® - Ewe]. Weekly, from Day -7 to 56, all ewes were assessed for signs of photosensitization, and for 10 ewes from each zinc treatment groups, samples were collected for analysis of serum GGT activity, serum zinc concentrations, faecal zinc concentrations and on Days -7 and 56, liver copper concentrations. Multivariable random-effects models assessed the effects of zinc treatment, copper treatment, treatment interactions and time on all analytes. Regression models examined associations between serum and faecal zinc concentrations and GGT activity. Low spore numbers indicated low Pithomyces chartarum challenge. Serum zinc levels were significantly higher in the IVP than in the CP group [p < 0.0001] and varied by time [p < 0.001] and positively associated with faecal zinc concentration [p < 0.001]. Copper treatment did not affect serum zinc [p = 0.82] or faecal zinc [p = 0.92] concentrations. Liver copper concentrations did not differ between zinc treatment groups on Day -7 [p = 0.6] or Day 56 [p = 0.95]. Only the CP/no copper group had no increase in liver copper concentrations.

Mediterranean diet pyramids: towards the Italian model.

There is a long history to the representation of the Mediterranean Diet Pyramid which may be seen as a form of cultural--culinary evolution as each country applies the foods best suited to its national diet. Different Mediterranean Diet pyramids have been designed for the population of Greece, Spain and Italy, tailored for their different food habits. These refer variously to portion sizes and frequency of consumption--daily, weekly and monthly and are not standardized. The 3rd CIISCAM Conference held in Parma, Italy was devoted to highlight the overall biodiversity and nutritional well being values and the sustainable benefits of the Mediterranean diet, recognised as one of the healthiest dietary pattern, and to reduce the rapid erosion of "lifestyle and food habits. It is necessary, therefore, to refer more to a Mediterranean Lifestyle of which diet is only a part. It should include physical and social activity, recreation and rest. It may be possible to construct a Mediterranean food lifestyle index both to assess such a holistic aspect and to correlate with improved morbidity & mortality.

Malignant melanoma of the vulva: an extension of cutaneous melanoma?

OBJECTIVE: To determine the prognostic significance of the 2002 revisions of the American Joint Committee on Cancer (AJCC) Staging System for cutaneous melanoma in melanoma of the vulva and review the current surgical utilized for treatment of this neoplasm. METHODS: Demographic, surgical and outcomes data were obtained from the records of vulvar melanoma patients treated from 1990 to 2006 at five academic medical centers. The 2002 modifications of the AJCC staging system for cutaneous melanoma, Breslow thickness and Clark level, were applied to all subjects. Kaplan-Meier Modeling and Linear Regression analysis were utilized for data analysis. Statistics were performed with SAS v 9.1. RESULTS: Seventy-seven patients were identified with a median age of 62 years. 73% had Stage I/II disease. Surgical radicality did not impact recurrence rates or survival. Breslow thickness was associated with recurrence (p=0.002) but not survival. Only the 2002 modified AJCC staging criteria were predictive of overall survival (p=0.006) in patients with malignant melanoma of the vulva. CONCLUSIONS: In the largest multi-site series of vulvar melanoma, the AJCC-2002 staging system for cutaneous malignant melanoma appears to be applicable to primary vulvar melanoma. Moreover, surgical radicality was associated with significant morbidity but not with improvement in survival. Utilization of standard operative staging and resection principles in cutaneous melanoma should be used for all vulvar melanoma patients. Moreover, these patients should also be considered for enrollment in cutaneous melanoma clinical trials.

Operative hysteroscopy in a Jamaican cohort.

OBJECTIVE: The objective of this study is to determine the indications, success, and complications of operative hysteroscopy performed at The University of the West Indies (UWI). METHODS: A five-year retrospective cohort study was done of women undergoing operative hysteroscopy at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies from January 1, 2001 to December 31, 2005. The demographics of the patients, indications, complications of the procedure and postoperative follow-up were assessed. Patient's post-procedural quality of life was assessed by a questionnaire. RESULTS: During this period, 92 operative hysteroscopies were performed on 87 patients, with repeat procedures being performed in three patients. The mean age of patients undergoing operative hysteroscopy was 36.65 years with a range of 23 to 50 years. The main indications for operative hysteroscopy at the HWFMU were submucosal fibroids (50%), intrauterine synechiae (26%) and removal of an intrauterine contraceptive device (11%). There were four procedure-related complications, all of which occurred during myomectomy and required hospitalization. CONCLUSION: Operative hysteroscopy is a safe and highly effective therapy for carefully selected women. As a consequence of technological advancements, an increasing number of gynaecological conditions, traditionally treated by laparotomy, can now be treated safely and effectively using outpatient operative hysteroscopy.