Polarization insensitive silicon photonic ROADM with selectable communication direction for radio access networks.

We report on an experimental prototype of a low-cost silicon photonic reconfigurable optical add/drop multiplexer (ROADM). The device is able to operate with up to 12 wavelength division multiplexing channels. In order to control the polarization of the multi-wavelength signal at the input of the device, an integrated polarization controller is investigated as an alternative to the polarization diversity device architecture. The integrated ROADM is equipped with optical switches for the selection of the path direction and variable optical attenuators for optical power control. We demonstrate the polarization insensitive routing of 10 Gb/s channels between two ROADM nodes with error-free transmission.

Changes in muscle damage, inflammation, and fatigue-related parameters in young elite soccer players after a match.

BACKGROUND: Professional soccer players are subjected to substantial physical loads during competitive seasons. We aimed to explore the changes induced by a soccer match on muscle damage and inflammation biomarkers, and their relationship with fatigue parameters. METHODS: Twenty young male professional in-field soccer players from an Italian Serie A team (age 17-20 years, weight 73.0±7.0 kg, height 1.81±0.05m) played a 90-minute soccer match. Players' distances and velocities were recorded during the match. Before the match and 30 minutes, 24 and 48 hours after the match, blood samples were drawn and a full blood cell count was determined, along with serum creatine kinase (CK), interleukin 6 (hsIL-6), cortisol and testosterone. At the same time intervals, counter-movement jump (CMJ) performance was recorded. RESULTS: The players covered fewer meters at low velocities in the second period while the meters covered at higher intensity remained unchanged. CMJ height was lower at all postgame time-points compared to the pregame measurement. Immediately after the match, CK, hs-IL6 and neutrophil counts were elevated. 24 and 48 hours after the match, CK and neutrophil counts remained significantly elevated. The distance covered during the game was found to be correlated with the values for postmatch hsIL-6 (ρ=0.521, P=0.027), post 24-hour cortisol (r=0.502, P=0.034) and the increase in cortisol at 48 hours with respect to prematch values (r=0.515, P=0.029). CONCLUSIONS: A soccer match provokes a transient systemic imbalance that results in muscle damage and inflammatory and performance-related parameter changes. HsIL-6 and cortisol could be used to monitor recovery processes and as fatigue markers, even for short time periods.

Adropin and apelin fluctuations throughout a season in professional soccer players: Are they related with performance?

Myokines are likely to be involved in the whole-body metabolic adaptive changes that occur in response to regular exercise. We aimed to investigate the association of the two myokines (adropin and apelin) with physical performance in professional soccer players. To this purpose, we analyzed the fluctuations of circulating levels of both adropin and apelin in professional soccer players during a season and evaluated the possible association of these myokines with the performance level. Creatine kinase (CK) and lactate dehydrogenase (LDH) activity as well as iron, transferrin and high-sensitivity C-Reactive protein (hsCRP), ferritin, soluble transferrin receptor (sTfR), free testosterone/cortisol ratio (FTCR), total iron binding capacity (TIBC) were also determined. Fifteen male professional soccer players from an Italian Serie A team were included in this study. Regarding the results of the biochemical analyses, the patterns of changes in the biomarkers of fatigue and inflammation, i.e., HsCRP, CK and LDH reflected the effects of the training throughout the season. No significant changes were observed in adropin, while apelin exhibited variations that seem not to be related with performance. In addition, both adropin and apelin did not represent valuable strategy to assist in the performance assessment of professional soccer players.

Inhibition of xanthine oxidase to prevent statin-induced myalgia and rhabdomiolysis.

Although statins remain the cornerstone of lipid-lowering therapy for reducing the burden of atherosclerotic vascular disease, their administration has been associated with muscle-related adverse effects, including myalgia and rhabdomyolysis. Such adverse events are probably due to reduced antioxidant defenses associated with fewer intermediate metabolites in the cholesterol synthesis pathway. We hypothesize that the concomitant inhibition of xanthine oxidase via coadministration of allopurinol with statins could diminish reactive oxygen species (ROS)-related muscle damage, which would have in turn have positive effects on both the incidence of muscle-related adverse events and cardiovascular outcomes. Accordingly, inhibition of xanthine oxidase has been previously shown to be effective for reducing biomarkers of muscle damage following exercise in professional athletes. Because of the widespread statin utilization and increasing trends in their therapeutic use in atherosclerotic vascular diseases, the proposed strategy could have important clinical implications for reducing statin-induced myalgia and rhabdomyolysis.

Enzymatic replacement therapy for Hunter disease: Up to 9 years experience with 17 patients.

Hunter disease is an X-linked lysosomal storage disorder characterized by progressive storage of glycosaminoglycans (GAGs) and multi-organ impairment. The central nervous system (CNS) is involved in at least 50% of cases. Since 2006, the enzymatic replacement therapy (ERT) is available but with no effect on the cognitive impairment, as the present formulation does not cross the blood-brain barrier. Here we report the outcome of 17 Hunter patients treated in a single center. Most of them (11) started ERT in 2006, 3 had started it earlier in 2004, enrolled in the phase III trial, and 3 after 2006, as soon as the diagnosis was made. The liver and spleen sizes and urinary GAGs significantly decreased and normalized throughout the treatment. Heart parameters improved, in particular the left ventricular mass index/m(2) decreased significantly. Amelioration of hearing was seen in many patients. Joint range of motion improved in all patients. However, no improvement on respiratory function, eye, skeletal and CNS disease was found. The developmental quotient of patients with a CNS involvement showed a fast decline. These patients were no more testable after 6 years of age and, albeit the benefits drawn from ERT, their quality of life worsened throughout the years. The whole group of patients showed a consistent residual disease burden mainly represented by persistent skeletal disease and frequent need of surgery. This study suggests that early diagnosis and treatment and other different therapies which are able to cross the blood-brain barrier, might in the future improve the MPS II outcome.

Red blood cell distribution width is not related with inflammatory parameters in morbidly obese patients.

OBJECTIVE: Red blood cell distribution width (RDW) is a hematological parameter that has been studied in several clinical settings and has been found to be related to both anemia and inflammatory status. As obesity is related to increased inflammatory pattern, we aimed to analyze the RDW in this setting. METHODS: We determined hematological and inflammatory parameters in morbidly obese patients before bariatric surgery (n=142) and normo-weight controls (n=144). RESULTS: RDW was higher in patients than in controls (p<0.001), along with C-reactive protein (p<0.001) and fibrinogen, (p<0.001) while hemoglobin (p=0.026), serum iron (p<0.001), MCH (p=0.002) and MCHC (p<0.001) were lower in morbidly obese patients. The logistic correlation analysis revealed that only low serum iron (<62 µg/dL) and MCH (<28.14 pg) levels were associated with RDW>14% (OR 7.61, 95% CI: 1.93-30.04, p=0.004; OR 5.67, 95% CI: 1.98-16.24, p=0.001; respectively). CONCLUSIONS: These data indicate that the elevated RDW in morbidly obese patients reflects a mild red blood cell hypochromia that does not relate to inflammatory parameters, but to hyposideremia and, consequently, to lower erythrocyte indices, possibly as a result of being on a very low-calorie diet before bariatric surgery. Therefore, RDW should not be considered as an inflammatory marker in this clinical setting.

Erythropoietin and the heart: physiological effects and the therapeutic perspective.

Erythropoietin (Epo) has been thought to act exclusively on erythroid progenitor cells. The identification of Epo receptor (EpoR) in non-haematopoietic cells and tissues including neurons, astrocytes, microglia, immune cells, cancer cell lines, endothelial cells, bone marrow stromal cells, as well as cells of myocardium, reproductive system, gastrointestinal tract, kidney, pancreas and skeletal muscle indicates that Epo has pleiotropic actions. Epo shows signals through protein kinases, anti-apoptotic proteins and transcription factors. In light of interest of administering recombinant human erythropoietin (rhEpo) and its analogues for limiting infarct size and left ventricular (LV) remodelling after acute myocardial infarction (AMI) in humans, the foremost studies utilising rhEpo are reviewed. The putative mechanisms involved in Epo-induced cardioprotection are related to the antiapoptotic, anti-inflammatory and angiogenic effects of Epo. Thus, cardioprotective potentials of rhEpo are reviewed in this article by focusing on clinical applicability. An overview of non-haematopoietic Epo analogues, which are a reliable alternative to the classic EpoR agonists and may prevent undesired side effects, is also provided.

Three weeks of erythropoietin treatment hampers skeletal muscle mitochondrial biogenesis in rats.

The blood O(2)-carrying capacity is maintained by the O(2)-regulated production of erythropoietin (Epo), which stimulates the proliferation and survival of red blood cell progenitors. Epo has been thought to act exclusively on erythroid progenitor cells. However, recent studies have identified the erythropoietin receptor (EpoR) in other cells, such as neurons, astrocytes, microglia, heart, cancer cell lines, and skeletal muscle provides evidence for a potential role of Epo in other tissues. In this study we aimed to determine the effect of recombinant human erythropoietin (rHuEpo) on skeletal muscle adaptations such as mitochondrial biogenesis, myogenesis, and angiogenesis in different muscle fibre types. Fourteen male Wistar rats were randomly divided into two experimental groups, and saline or rHuEpo (300 IU) was administered subcutaneously three times a week for 3 weeks. We evaluated the protein expression of intermediates involved in the mitochondrial biogenesis cascade, the myogenic cascade, and in angiogenesis in the oxidative soleus muscle and in the glycolytic gastrocnemius muscle. Contrary to our expectations, rHuEpo significantly hampered the mitochondrial biogenesis pathway in gastrocnemius muscle (PGC-1α, mTFA and cytochrome c). We did not find any effect of the treatment on cellular signals of myogenesis (MyoD and Myf5) or angiogenesis (VEGF) in either soleus or gastrocnemius muscles. Finally, we found no significant effect on the maximal aerobic velocity at the end of the experiment in the rHuEpo-treated animals. Our findings suggest that 3 weeks of rHuEpo treatment, which generates an increase of oxygen carrying capacity, can affect mitochondrial biogenesis in a muscle fibre-specific dependent manner.

Erythrocyte deformability in morbid obesity before bariatric surgery. Influence of abdominal obesity.

Although there are several studies dealing with erythrocyte deformability (ED) in obese patients, research on this topic in morbidly obese subjects is scarce. In these studies ED seems to be decreased, although the cause remains unknown. A case-control study in 76 morbid obese subjects (23 women and 53 men, aged 44 ± 13 years) and in 79 normal-weight controls (30 women and 49 men, aged 43 ± 13 years) was undertaken. ED has been determined by ektacytometric techniques in a Rheodyn SSD, by means of the elongation index (EI) at 12, 30 and 60 Pascals, along with anthropometric, lipidic, metabolic and inflammatory parameters. EI was statistically lower in morbidly obese subjects than in controls at all the shear stresses tested (EI12: 47.3 ± 2.14 vs. 47.9 ± 2.07; p = 0.047, EI30: 52.16 ± 2.1 vs. 53.12 ± 1.4; p = 0.007, EI60: 53.9 ± 2.4 vs. 55.2 ± 2.50; p = 0.001) as were anthropometric lipidic and inflammatory parameters (p < 0.001). In the bivariate correlation EI60 correlated negatively with most anthropometric, lipidic and inflammatory parameters. However, in the multivariate analysis, the case-control status was not significantly associated with EI60 and only triglycerides, glucose, hs-CRP and waist circumference were independently associated with EI60, constituting independent predictors of altered ED although, waist circumference, showed the highest statistical significance (p = 0.007). ED is decreased in morbidly obese subjects associated with insulin resistance and inflammation parameters although abdominal obesity seems to be of paramount importance in altering this rheological parameter.

Xanthine oxidase-induced oxidative stress causes activation of NF-kappaB and inflammation in the liver of type I diabetic rats.

We previously showed that xanthine oxidase activity increases in type I diabetic animals and that this is a significant cause of the oxidative stress which occurs in the disease. The aim of this work was to search for molecular links between xanthine oxidase-induced oxidative stress and inflammation in Type I diabetes and to assess the ability of allopurinol, a drug widely used in clinical practice, to prevent both processes. 3-month-old male Wistar rats were made diabetic by injection (i.p.) of either streptozotocin or alloxan. Allopurinol (32 mg/Kg) was administered (i.p) to diabetic rats after they had shown clear signs of diabetes such as glucosuria and polyuria. Hepatic phospho-IKKbeta and phospho-IkappaBalpha contents were increased in diabetic animals. This was accompanied by increased levels of NF-kappaB (p65 protein content) in liver nuclear extracts. Hepatic expression of NF-kappaB dependent inflammatory cytokines and enzymes, namely interleukin 1beta, iNOS and interleukin 6 were markedly increased. Both diabetes-induced activation of NF-kappaB signalling cascade and subsequent over expression of inflammatory cytokines and enzymes were abolished by administration of allopurinol. Moreover, we found a significant neutrophil infiltration in the liver of diabetic animals. These events were also prevented by administration of allopurinol.

Effectiveness of adenotonsillectomy in PFAPA syndrome: a randomized study.

OBJECTIVE: To evaluate whether adenotonsillectomy leads to complete resolution in children with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome. STUDY DESIGN: Thirty-nine children with PFAPA syndrome were randomized to either adenotonsillectomy (surgery group; n = 19) or expectant management (control group; n = 20). All patients were then invited prospectively to record all PFAPA episodes, and were evaluated clinically every 3 months for 18 months after randomization. RESULTS: The proportion of patients experiencing complete resolution was 63% in the surgery group and 5% in the control group (P < .001). The mean (+/- standard deviation) number of episodes recorded during the study period was 0.7 +/- 1.2 in the surgery group and 8.1 +/- 3.9 in the control group (P < .001). The episodes were less severe in the surgery group. CONCLUSIONS: Adenotonsillectomy is an effective treatment strategy for children with PFAPA syndrome.

Lymphomas of head and neck in pediatric patients.

Cancer among children is relatively uncommon, with approximately 1 in 7,000 children 0 to 14 years of age being newly diagnosed each year in the United States, and Hodgkin and non-Hodgkin's lymphomas constitute 10-15% of all childhood cancers in the more developed countries, after acute leukemias and brain tumors. The diagnosis of lymphoma frequently involves otolaryngologists that play also an important role in the its management. A high index of suspicion for lymphoma as a cause of complaints in the head and neck region can lead an early diagnosis and improved outcome for lymphomas. This article reviews the epidemiology, presentation, diagnosis, staging, treatment and prognosis of Hodgkin and non-Hodgkin's lymphomas in children.

Expression of cell cycle regulatory proteins and analysis of apoptosis in normal nasal mucosa and in nasal polyps.

BACKGROUND: The etiopathogenesis of nasal polyps still is to be clarified. Although hyperplasia is a typical feature of these pathological processes, little attention has been paid to specific aspects of cellular growth in polyps. We have evaluated the expression and localization of some of the regulatory proteins that direct the cell through the specific sequence of events culminating in mitosis or apoptosis in nasal polyps. METHODS: Twenty samples of nasal polyps and 20 samples of normal nasal mucosa have been analyzed for apoptotic index by detecting the DNA 3'OH ends deriving from DNA fragmentation. Moreover, they have been evaluated by immunohistochemical staining for expression of Ki-67, cyclins A and B1, p53, p21, p27, murine double minute clone 2, and Bcl-2. RESULTS: We have identified a greater proportion of proliferating cells in the lining epithelial cells of the polyps when compared with the normal mucosa as stained with anti-Ki-67 antibodies. An overexpression of p53, MDM2, and Bcl-2 and an increased apoptosis were observed in nasal polyps compared with the normal mucosa, whereas no variation of p27 expression was observed. The p21 and cyclins A and B1 were rarely expressed in both pathological and normal tissue. CONCLUSION: The p53-based control system of cell cycle progression appears to be altered in nasal polyps, potentially leading to an abrogation of the DNA damage checkpoint. Evaluation of the expression of the regulatory proteins that direct the cells throughout their cycle in nasal polyps may allow a better understanding of the biological behavior and clinical outcome of these benign pathological entities.

Incidence of unexpected malignancies in routine tonsillectomy specimens in children.

OBJECTIVES: Controversy continues to exist regarding the necessity to routinely send for histologic examination those specimens obtained after tonsillectomy with or without adenoidectomy in children. Otolaryngologists fear missing an unsuspected diagnosis, such as a tonsil malignancy. However, given the rare incidence of this event, the cost-effectiveness ratio of routine microscopic analysis is questionable. The purpose of this study was to assess the incidence of clinically relevant unexpected diagnosis among children who underwent tonsillectomy with or without adenoidectomy in our units and to review current available series on this topic. STUDY DESIGN: Retrospective study and review. METHODS: All patients aged less than 16 years who underwent routine tonsillectomy (with or without adenoidectomy) at San Gerardo Hospital, Monza, Italy from January 1994 to June 2002 were reviewed. Histologic examination is routinely performed in our units. Patients were excluded if the primary indication for surgery was to rule out a tonsil malignancy. RESULTS: One thousand one hundred twenty-three (1,123) patients were recruited. Two cases of non-Hodgkin's lymphoma were detected, corresponding to a rate of 0.18% (95% confidence interval [CI] 0.07-0.56). Three previously published series were identified. The reported incidences of unexpected clinically relevant diagnoses varied between 0.0% and 0.05%. CONCLUSIONS: The results of our study highlight that the incidence of unexpected clinically relevant diseases of the tonsil in pediatric patients is low, albeit not extremely rare. This finding could be used to perform a cost-effectiveness analysis.