High levels of mid-regional proadrenomedullin in ARDS COVID-19 patients: the experience of a single, Italian Center.

OBJECTIVE: This study evaluated the ability of mid-regional proadrenomedullin (MR-proADM) to identify disease severity in Coronavirus disease 2019 (COVID-19) patients in comparison to conventional inflammatory biomarkers and clinical scores. PATIENTS AND METHODS: In an observational trial, COVID-19 acute respiratory distress syndrome (ARDS) patients were enrolled. MR-proADM, C-reactive protein (CRP), procalcitonin (PCT) and lactic acid (LA) were measured in all patients at admission (T0), at 24 hours (T1) and in the third (T3) and fifth day (T5) of hospitalization. The aims of this study were to determine the role of MR-proADM to detect patients with high risk of mortality and compare the prognostic value of MR-proADM with commonly used clinical scores (Sequential Organ Failure Assessment score - SOFA score, Acute Physiologic Assessment and Chronic Health Evaluation II score - APACHE II score, and Simplified Acute Physiological score II - SAPS II score). RESULTS: Twenty-one COVID-19 ARDS patients admitted to the Intermediate Care Unit (IMCU) were enrolled. The median MR-proADM values were 2.28, 2.41, 1.96 and 1.89 nmol/L at T0, T1, T3 and T5, respectively. The 30-day all-cause mortality rate was 52.4%. Mean MR-proADM T0 value was significantly higher in non-survivors compared with survivors (3.5 vs. 1.1 nmol/L, p < 0.05). No significant differences were found for the other inflammatory biomarkers. In terms of the area under the receiver-operating characteristic curve (AUC), MR-proADM showed a similar discriminatory power compared with APACHE II, SOFA and SAPS II score (0.81, 0.91, 0.70 and 0.78, respectively). The optimal MR-proADM cut-point cut-off point was 1.07 nmol/L, which corresponds to a sensitivity of 91% and a specificity of 71%. CONCLUSIONS: MR-proADM, in addition to the clinical scores, could be useful to predict outcome in COVID-19 ARDS patients.

Severe acute dried gangrene in COVID-19 infection: a case report.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes. CASE PRESENTATION: A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died. DISCUSSION: In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC. CONCLUSIONS: In our patient, COVID-19 related coagulopathy was associated with poor prognosis.

The first case of systemic lupus erythematosus (SLE) triggered by COVID-19 infection.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, SARS-CoV-2. The acute phase may be followed by a second phase actually not yet completely understood but probably associated to an autoimmune activation. At the moment is not possible to clearly define an association between immunological findings and pathological symptoms, however, this case report describes the case of a patient who following COVID-19 infection development autoimmune antibodies who persist in time longer than viral phase. Those antibodies can be responsible for the multi pathological clinical picture showed from our patient that, according to EULAR 2019 criteria, could be classified as systemic lupus erythematosus (SLE). SLE is probably one of the possible chronic rheumatologic diseases triggers by COVID-19 and this is the first case of SLE with vasculitis actually described in literature.

[Nutritional and Functional assessment of peritoneal dialysis patients in the clinical practice: Report from MITO-DP Group]. / Valutazione Nutrizionale e Funzionale dei pazienti in dialisi peritoneale nella pratica clinica: l'esperienza del Gruppo Medico-Infermieristico Toscano di Dialisi Peritoneale (M.I.TO.-DP).

Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice. The study includes all the 133 prevalent patients (80 m, 53 f, age 65 14 years), in peritoneal dialysis treatment (vintage 26 19 months) in 9 centers in Tuscany. We performed anthropometry, bioimpedance (BIA), clinical biochemistry, evaluation of habitual physical activity (RAPA tests) and performance (Sit-To-Stand test), appetite-evaluation questionnaire, and indices including the Malnutrition Inflammation Score (MIS), Geriatric Nutrition Risk Index (GNRI), Charlson comorbidity index, Barthel and Karnowsky index. The latter showed a condition of dependence in 7.2% and 19.7% of cases, respectively. Poor appetite was recorded in 48.2%. The majority of patients fell within the overweight / obesity range (51%) with waist circumference values associated with increased cardiovascular risk in 51% of males and 60% of females. At the BIA analysis, a BCMI <8 kg/m2 was detected in 39% of patients; an estimated protein intake <1.0 g / kg/d was found in 59% of cases; 34% of patients had serum albumin <3.5 g / dl; control of acidosis was good (bicarbonate 25.4 3.8 mM) but hyperphosphatemia was present in 64.6% of patients. A condition of sedentary or light physical activity was reported by 65.1% of patients, vigorous activity only by 11.9%. The 86.5% of patients able to perform the Sit-to-stand test reported a lower than the reference values for age and sex. A diagnosis of PEW was possible in 8% of our series, while a MIS score> 11, indicative of PEW, took place in 12.7% of cases. The values of the MIS correlated directly with age and the degree of comorbidity and inversely with the sit-to-stand test, RAPA tests and appetite level. The data in this study show that single tests indicative of malnutrition disorders are frequent to be found in our series of peritoneal dialysis patients. However, a diagnosis of PEW is quite infrequent. A large percentage of patients are overweight with increased abdominal adiposity, and reduced cell mass and protein intake below recommended levels; the level of habitual physical activity is low, and the level of physical capability is scarce. Therefore it is conceivable a nutritional counseling intervention to increase the intake of proteins, limiting the phosphorus and (when indicated) energy intake and to stimulating spontaneous physical activity or arranging assisted programs for functional rehabilitation. Close monitoring of the nutritional status and implementation of programs of adapted physical activity should have a prominent role in the clinical management of patients on peritoneal dialysis.

Survey of neuropeptide-like immunoreactivity in supramedullary neurons of Coris julis (L.).

The supramedullary neurons of the marine teleost Coris julis (L.) were surveyed for neuropeptide-like immunoreactivity using antisera against 12 peptides. These neurons exhibit positive immunoreactivity to CCK-8, CCK-39 and gastrin(18-34). The presence of gastrin/CCK-like peptides in the supramedullary neurons is discussed.

Acid phosphatase activity in the supramedullary neurons of Coris julis (L.).

This work describes the acid phosphatase activity in supramedullary neurons of Coris julis, analyzed by a cytochemical method. The presence of both acid phosphatase-positive and -negative membrane bound granules indicates that only a part of the numerous electrodense granules in the supramedullary neurons can be interpreted as lysosomes. The great number of lysosomes in these large neurons of young animals is indicative of the rapid turnover of cell structures, which may be correlated with the high rate of synthesis. The electrodense granules showing no acid phosphatase activity are postulated to be vesicles containing gastrin/CCK-like peptide or precursors of this neuromediator.

Cytofluorimetric determination of DNA content in large neurons of Lophius piscatorius L. (Osteichthyes, Lophiiformes).

The central nervous system of Lophius piscatorius has a cluster of large neurons located at the boundary between the medulla oblongata and spinal cord. The DNA content of these neurons was evaluated by microfluorimetric methods. Results demonstrated a DNA content ranging from a minimum of 8C in the smaller to over 1000C in the larger neurons of L. piscatorius cluster. These data are exceptional for the nervous system of Vertebrates, and known only for the giant neurons of Mollusca.

Cytofluorometric evidence for differential genome endoreplication in the cluster neurons of Lophius piscatorius L. (Osteichthyes, Lophiiformes).

Quantitative microfluorometric evaluation indicated that, in Lophius piscatorius, the DNA content of large neurons of a cluster located at the boundary between the medulla oblongata and the spinal cord varied from 4C to more than 5000C. This finding must be considered exceptional for the nervous system of Vertebrates. DNA contents were correlated to both nuclear and animal size. Utilization of AT and GC specific fluorochromes showed that the increase in DNA content is due to differential genome amplification involving GC-rich DNA sequences.

Neuroanatomical and immunohistochemical studies on the dorsal neurons in the spinal cord of Trigla lucerna L. and Scorpaena porcus L. (Scorpaeniformes).

Peculiar dorsal neurons present in the dorsal spinal cord of Trigla lucerna L. and Scorpaena porcus L. were investigated by neuroanatomical and immunohistochemical methods. These neurons were previously defined as commissural cells, but have now been identified as supramedullary neurons. The following fundamental criteria for identifying the supramedullary neurons of Teleosts are proposed: a) dorsomedial location in the spinal cord; b) large size of the soma and axon; c) immunoreactivity to gastrin/CCK-like peptides.

Blood pressure measurement in haemodialysis patients.

Several studies suggest that the 24 hour ambulatory blood pressure monitoring (ABPM) predicts left ventricular hypertrophy more accurately than conventional blood pressure measurement (CBPM) with mercury sphygmomanometer. We estimated the left ventricular mass by M-mode echocardiography in 58 patients on regular haemodialysis treatment during the midweek haemodialysis (HD) interval. ABPM was recorded during the 24 hours preceding the dialysis session and the average of values were compared with the average of the 13 pre HD CBPM recorded by nurses during the month preceding the echocardiography study. The two types of BP measurements correlated significantly with each other, (systolic BP r = 0.62; p < 0.001 and diastolic BP r = 0.74; p < 0.001). The correlation of left ventricular mass with pre-HD systolic BP was stronger (r = 0.54; p < 0.001) than with 24h-systolic BP (r = 0.33; p < 0.01). The overall accuracy of prediction was also similar (68% for pre HD-CBPM; 67% for 24h-ABPM). Measurements of diastolic BP did not correlate significantly with LVM. Our data suggest that 24h-ABPM does not offer any advantage over pre HD-CBPM in predicting left ventricular hypertrophy in HD patients.

Preliminary findings on the nucleus of large neurons in Lophius piscatorius L. (Osteichthyes, Lophiiformes).

Some Teleosts belonging to the orders Batrachoidiformes, Lophiiformes, Perciformes and Tetraodontiformes show a cluster of large neurons dorsally located at the boundary between the spinal cord and medulla oblongata. These elements have traditionally been grouped with the supramedullary neurons aligned in the dorso-medial region of the spinal cord of other teleosts (see Marini and Benedetti, in press). However, recent morphological and immunohistochemical studies have suggested that the neurons grouped in a cluster on the spinal cord of Lophius piscatorius may not be of the same nature as the supramedullary neurons aligned within the dorsal gray matter of the spinal cord (Benedetti and Mola, 1988; Mola, 1990). Over the course of these previous investigations, it seemed that the nucleus of the neurons in the cluster showed more abundant chromatin than other neurons in the dorsal spinal cord. This prompted a series of investigations on the nucleus of these neurons.

Localization and pattern of the mitotic activity in the central nervous system of developing oviparous and viviparous teleosts.

The subject of this work is an analysis of the mitotic activity in the developing spinal cord and rhombencephalon of the oviparous teleost Jordanella floridae and the viviparous teleost Gambusia affinis (Cyprinodontoidei). In Gambusia there is considerable and long lasting mitotic activity that decreases gradually and is still present 20 days after birth. In Jordanella the mitotic activity is concentrated in the early stages of development, it then decreases drastically and practically disappears even before hatching and reappears 20 days later. These differences are probably due to the variations in speed and pattern of development in the two teleosts. As regard the localization of mitoses, it emerged that migration towards the lumen may be prevented by physiological conditions related to normal development. It emerged moreover, that migration towards the lumen is not a generalised phenomenon in development of the central nervous system since it is related, in the spinal cord of teleosts at least, to the modality and speed of embryo development.

Glycogen in the central nervous system of adults and developing anamnia.

The distribution of glycogen in the central nervous system of the viviparous teleost Gambusia affinis and of the oviparous teleost Jordanella floridae during development and in the adults, was examined. It emerged that the glycogen pattern in adults of Gambusia and Jordanella is very similar, whereas there are considerable differences during development. These differences were related to the different ways in which development takes place in the two species.

Ultrastructural features of supramedullary neurons in Crenilabrus quinquemaculatus.

The ultrastructural study of the supramedullary neurons in Crenilabrus quinquemaculatus shows that these cells are engaged in intense synthetic activity as is testified by the nuclear morphology, the plentiful rough endoplasmic reticulum and polysomes, and finally the remarkably developed Golgi complexes, many of them active. Moreover the cytoplasm of the supramedullary neurons shows numerous membrane-bounded bodies (1,800-4,000 A) containing electron dense material, more or less finely granular. Research is presently being carried out to establish the meaning of these electron dense bodies.

Effect of pollution on some freshwater species. I. histochemical and biochemical features of lead pollution on some organs of Viviparus viviparus L. (Mollusca Gastropoda).

Experimental lead pollution was studied in some organs (foot, mantle and digestive gland) of Viviparus viviparus L. The amount of lead contained after 48h, 96 h and one week of pollution were established using an atomic absorption spectrophotometer. On the basis of physicochemical determination, it turns out that lead is mainly concentrated in the mantle. The biochemical tests (cholesterol, sulpholipids and phospholipids) were aimed at evaluating the lipids involved in the membranes. The histochemical research was carried out chiefly to evaluate the modifications of polysaccharides and proteins. Some hydrolytic enzymes (Na+ and K+ dependent ATPase) and some ooreductive enzymes (NADH+ and NADPH+ dependent diaphorases, D-lactate dehydrogenase, succinate dehydrogenase and glucose-6-P-dehydrogenase) were also tested. The digestive gland is the most severely damaged organ as proved by histomorphological and biochemical analyses.