Immunomodulatory effect of vitamin D and its potential role in the prevention and treatment of thyroid autoimmunity: a narrative review.

The main role of vitamin D is to control mineral homeostasis. However, recent studies suggested the existence of a number of extraskeletal effects. Among the latter, preclinical studies provided consistent data on the involvement of vitamin D in innate and adaptive immunity and autoimmunity. Molecular biology studies showed that both vitamin D receptor and vitamin D enzymatic complexes are expressed in a large number of cells and tissues unrelated to mineral homeostasis. In contrast, only a few randomized clinical trials in humans investigated the possible role of vitamin D in the prevention or treatment of immunological disorders. In this regard, low serum vitamin D levels have been reported in observational trials in human autoimmune disorders. The aim of the present paper was to review the potential implications of vitamin D in immune modulation, with special focus on thyroid autoimmune disorders.

Composition, proteolysis, and volatile profile of Strachitunt cheese.

Strachitunt, a blue-veined Italian cheese, received the Protected Designation of Origin (PDO) label in 2014. Its unique technological feature is represented by the dual-curd method of production. Strachitunt is produced from raw bovine milk with or without the inoculation of natural starter cultures of lactic acid bacteria, and the addition of secondary cultures of mold spores is not permitted by the product specification. Physico-chemical properties, proteolysis, and volatile profile of Strachitunt were investigated in 10 cheese samples (ripened for 75 d) made throughout spring 2015 and provided by the main cheese maker. Overall, composition parameters showed a large variability among samples. Cheese was characterized by an acid paste (pH 5.46) and a lower extent of proteolysis compared with other blue-veined varieties. The main chemical groups of volatile organic compounds were alcohols and esters, whereas ketones represented only a minor component. The erratic adventitious contamination by mold spores of the cheese milk, the unique dual-curd method of cheese-making, and the large time variability between the piercing time and the end of ripening could be highlighted as the main causes of both the distinctive analytical fingerprint and the scarce standardization of this blue-veined cheese.

Extracellular thermostable proteolytic activity of the milk spoilage bacterium Pseudomonas fluorescens PS19 on bovine caseins.

We studied the thermostable proteolytic activity of Pseudomonas fluorescens PS19 isolated from raw bovine milk. The heat-treated cell-free supernatant (HT-CFS) contained a thermostable protease of approximately 45 kDa, as revealed by casein zymography. We assigned this enzyme to P. fluorescens AprX metalloprotease (UniProtKB Acc. No. C9WKP6). After concentration by ultrafiltration at 10 kDa, the HT-CFS showed 2 other thermostable proteolytic bands on zymogram, with molecular masses of approximately 15 and 25 kDa. The former resulted a fragment of the AprX protease, whereas the 25-kDa protease was not homologous to any known protein of Pseudomonas spp. Subsequently, we assessed the proteolytic activity of the HT-CFS on bovine αS-, ß-, and κ-casein during in vitro incubation at 7 or 22°C. By means of ultra-performance liquid chromatography-tandem mass spectrometry we identified the released peptides (n=591). Some of them resisted proteolysis during the whole incubation period at both incubation temperatures and, therefore, they could be assumed as indicators of the proteolytic action of P. fluorescens PS19 on bovine caseins.

Release of angiotensin converting enzyme-inhibitor peptides during in vitro gastrointestinal digestion of Parmigiano Reggiano PDO cheese and their absorption through an in vitro model of intestinal epithelium.

The occurrence of 8 bovine casein-derived peptides (VPP, IPP, RYLGY, RYLG, AYFYPEL, AYFYPE, LHLPLP, and HLPLP) reported as angiotensin converting enzyme-inhibitors (ACE-I) was investigated in the 3-kDa ultrafiltered water-soluble extract (WSE) of Parmigiano Reggiano (PR) cheese samples by ultra-performance liquid chromatography coupled to high-resolution mass spectrometry via an electrospray ionization source. Only VPP, IPP, LHLPLP, and HLPLP were revealed in the WSE, and their total amount was in the range of 8.46 to 21.55 mg/kg of cheese. Following in vitro static gastrointestinal digestion, the same ACE-I peptides along with the newly formed AYFYPEL and AYFYPE were found in the 3 kDa WSE of PR digestates. Digestates presented high amounts (1,880-3,053 mg/kg) of LHLPLP, whereas the remaining peptides accounted for 69.24 to 82.82 mg/kg. The half-maximal inhibitory concentration (IC50) values decreased from 7.92 ± 2.08 in undigested cheese to 3.20 ± 1.69 after in vitro gastrointestinal digestion. The 3-kDa WSE of digested cheeses were used to study the transport of the 8 ACE-I peptides across the monolayers of the Caco-2 cell culture grown on a semipermeable membrane of the transwells. After 1h of incubation, 649.20 ± 148.85 mg/kg of LHLPLP remained in the apical compartment, whereas VPP, IPP, AYFYPEL, AYFYPE, and HLPLP accounted in total for less than 36.78 mg/kg. On average, 0.6% of LHLPLP initially present in the digestates added to the apical compartment were transported intact to the basolateral chamber after the same incubation time. Higher transport rate (2.9%) was ascertained for the peptide HLPLP. No other intact ACE-I peptides were revealed in the basolateral compartment. For the first time, these results demonstrated that the ACE-I peptides HLPLP and LHLPLP present in the in vitro digestates of PR cheese are partially absorbed through an in vitro model of human intestinal epithelium.

Cross-cultural adaptation and validation of the Italian version of the Western Ontario Rotator Cuff (WORC) index.

The aim of the study was to accomplish translation, cross-cultural adaptation and validation of the Western Ontario Rotator Cuff (WORC) Index questionnaire for its use in Italy. The WORC original version was translated and cross-culturally adapted into Italian. Subsequently, it was administered to a population of 60 patients suffering from rotator cuff disease to evaluate the validity and reliability of the Italian version. The content validity evaluated the correlation between questions and total score of each domain through Pearson's correlation coefficient. The construct validity was similarly assessed through Pearson's correlation coefficient by testing the correlation between the Italian WORC and the Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Reliability was assessed using two methods: internal consistency by calculating the Cronbach's alpha coefficient for each domain; and test-retest by means of the intraclass correlation coefficient (ICC). The translation and cross-cultural adaptation of the Italian version did not reveal any major problems. No significant floor or ceiling effects were found. All the questions were linearly related to the concept expressed by the domain of belonging. Overall correlation with the DASH score was 0.75. Internal consistency was very high overall (α = 0.93) as well as reliability (overall ICC = 0.87). The Italian version of the WORC questionnaire is a valid and reproducible measuring instrument and can be considered a valid tool for the evaluation of the effectiveness of a treatment in terms of quality of life, in Italian patients affected by rotator cuff diseases.Level of evidence Diagnostic study, level II.

Detection of milk powder and caseinates in Halloumi cheese.

Halloumi cheese is traditionally manufactured from fresh milk. Nevertheless, dried dairy ingredients are sometimes illegally added to increase cheese yield. Lysinoalanine and furosine are newly formed molecules generated by heating and drying milk protein components. The levels of these molecular markers in the finished Halloumi have been investigated to verify their suitability to reveal the addition of skim milk powder and calcium caseinate to cheese milk. Because of the severe heating conditions applied in curd cooking, genuine Halloumi cheeses (n=35), representative of the Cyprus production, were characterized by levels of lysinoalanine (mean value=8.1 mg/100g of protein) and furosine (mean value=123 mg/100g of protein) unusual for natural cheeses. Despite the variability of the values, a good correlation between the 2 parameters (R=0.975) has been found in all cheeses, considering both the fresh and mature cheeses as well as those obtained from curd submitted to a prolonged cooking following a traditional practice adopted by a very small number of manufacturers. Experimental cheeses made by adding as low as 5% of skim milk powder, or calcium caseinate, or both, to cheese milk fell outside the prediction limits at +/-2 standard deviation of the above-reported correlation regardless of curd cooking conditions or ripening length. This correlation may be adopted as a reliable index of Halloumi cheese genuineness.

Improvement in the removal of micropollutants at Porto Marghera industrial wastewaters treatment plant by MBR technology.

This paper deals with the case of one of the most important industrial application of membrane technology in the world: the upgrading of the main industrial wastewater treatment plant (WWTP) of the petrochemical site of Porto Marghera, Northern Italy, completed on December 2005 and tested on September 2006. It describes the principal interventions of the plant upgrading and it discusses the removal obtained during the test periods for conventional pollutants as well as for micropollutants. The plant upgrading consisted of a series of improvements of the existing industrial WWTP, in order to increase the removal efficiency of the total suspended solids and the associate removal of ten micropollutant compounds, the so called forbidden substances. The most important intervention was the conversion of the existing activated sludge section into a membrane biological reactor, in order to guarantee adherence to the severe limits imposed by the special law issued to protect the Venice Lagoon, with particular reference to the mentioned 10 forbidden compounds. The experimental results and the numerous test-runs conducted confirmed the respect of the legal limits for the pollutants in the final effluent as well of the required removal rates for the different parameters. Therefore, the upgraded treatment plant was declared agreeing with the approved design.

Diazepam-binding inhibitor-derived peptides induce intracellular calcium changes and modulate human neutrophil function.

We studied the effects of two diazepam-binding inhibitor (DBI)-derived peptides, triakontatetraneuropeptide (DBI 17-50, TTN) and eiksoneuropeptide (DBI 51-70, ENP), on cytosolic free Ca2+ concentrations ([Ca2+]i), chemotaxis, superoxide anion (O2-) generation, and phagocytosis in human neutrophils. Both TTN and ENP induced a rapid and transient rise of [Ca2+]i. The effect of TTN depended on the presence of extracellular Ca2+, whereas the effect of ENP also persisted after extracellular Ca2+ chelation. TTN induced neutrophil chemotaxis, stimulated O2- generation, and enhanced phagocytosis. ENP did not affect cell migration and oxidative metabolism but enhanced phagocytosis. Both peptides modulated N-formyl-methionyl-leucyl-phenylalanine- and phorbol myristate acetate-induced O2- generation. Because neutrophils express benzodiazepine receptors of the peripheral type (pBRs) and DBI-derived peptides may interact with such receptors, we investigated the possible role of pBRs in TTN- or ENP-induced effects. The synthetic pBR ligand RO 5-4864 increased [Ca2+]i through extracellular Ca2+ influx and this effect was prevented by the pBR antagonist PK-11195. RO 5-4864, however, was ineffective on neutrophil migration and O2- generation and only slightly affected phagocytosis. Moreover, PK-11195 delayed the [Ca2+]i rise induced by TTN but did not significantly affect its extent, and had no effect on the [Ca2+]i rise induced by ENP. We conclude that DBI-derived peptides induce [Ca2+]i changes and modulate neutrophil function mainly through pBR-independent pathways. In view of the wide cell and tissue distribution of DBI in the brain and in peripheral organs, modulation of neutrophil function by DBI-derived peptides may be relevant for both the neuroimmune network and the development and regulation of the inflammatory processes.

Recurrent brain abscess: manifestation of pulmonary arteriovenous fistula and hereditary hemorrhagic telangiectasia.

A unique case of recurrent brain abscess as the primary manifestation of pulmonary arteriovenous fistula is presented. In the absence of hematologic abnormalities and characteristic physical findings, the diagnosis of pulmonary arteriovenous fistula is particularly elusive. Patients with brain abscess must be carefully evaluated for the presence of pulmonary arteriovenous fistula or hereditary hemorrhagic telangiectasia.

Selective sputum cultures. A bronchial culture technique using a modified nasotracheal suction catheter with a sterile, inner telescoping cannula.

The contamination of expectorated or catheter-aspirated sputum specimens by pathogenic microorganisms which have colonized the nose and oropharynx remains a formidable obstacle to the accurate interpretation of sputum cultures. This problem is encountered in all forms of acute and chronic bronchopulmonary infection. A standard suctioning technique via a nasotracheal catheter has been modified with a telescoping sterile inner cannula to obtain uncontaminated bronchopulmonary secretions for culture. Bacteriologic results of selective bronchial cultures obtained in 18 patients following major chest surgery have provided important considerations concerning the prophylactic use of antibiotics. The telescoping cannula method is a simple, safe, and practical means of selectively monitoring the bacteriologic flora of the lower respiratory tract.

Transbronchial mucus transfer of bronchogenic carcinoma.

The metastatic transfer of cells from a primary bronchogenic carcinoma to other portions of the lung as a result of mucus embolization and inoculation has been demonstrated. Histologic observations indicate tumor implantation and survival in peripheral bronchioles. In these regions mucosal dysplasia and carcinoma-in-situ changes which characteristically accompany a primary lesion are notably absent. Morphologic changes associated with acute bronchitis and focally denuded bronchial mucosa may be implicated.

Evaluation of hollow and full stems implanted in the rabbit tibia: preliminary results.

Full and hollow stems were implanted in the right and left tibiae of five rabbits to study the effects of the implant shape on revascularization and remodelling of the bone after 6 months. No significant difference of periosteal and endosteal circumference was observed when the left and right tibiae of each group were compared. Medullary area was, not surprisingly, significantly smaller in the full stem implanted tibiae. The cortical bone area result was significantly higher in the hollow stem group. In hollow stems, vessels were present both inside and outside the implant with connections through the holes of the implant. The observed differences of cortical bone area can be explained in terms of increased vascular spaces inside the cortical bone of full stem implanted tibiae. This supports the hypothesis that hollow implants provide more space for medullary revascularization and are consequently capable of inducing less endosteal remodelling. Cementless prostheses rely for mechanical fixation on a large interface of the implant with bone. Two factors, i.e. revascularization of the medullary canal and stiffness of the stem, can have a relevant effect on the quality of interface. This non-weight-bearing model suggests the relevance of vascular factors.

Nonpenetrating trauma to the thoracic aorta.

Twenty-seven patients underwent surgical repair for nonpenetrating injuries of the thoracic aorta. Emergency operation was performed in 19 patients with acute aortic injury and there were 12 survivors. Left heart bypass (LHB), external shunts, and simple aortic cross-clamping were methods employed during repair. All operative deaths occurred in the left heart bypass group. Morbidity, hospital stay, operative time, and blood loss all were markedly less in patients repaired with an external shunt or simple cross-clamping. Systemic heparinization related adversely to mortality and morbidity. Eight patients had repair of chronic post-traumatic descending aortic aneurysms. One of these had previous repair elsewhere with paraplegia and subsequent mycotic aneurysm at the graft repair site. He presented to us with massive hemoptysis. Surgical correction in the chronic group was performed using either left heart bypass, external shunt, or simple aortic cross-clamp with graft interposition. The only death occurred in a patient repaired on left heart bypass.

Intravenous isosorbide dinitrate in the management of acute hypertension following cardiopulmonary bypass.

Twenty-one patients with acute systemic hypertension following cardiopulmonary bypass received isosorbide dinitrate intravenously in order to determine its effectiveness in managing this postoperative problem. Twenty patients underwent coronary artery bypass operation, and 1 patient had a pulmonary valvotomy. Bolus administration (0.25 to 2.5 mg [3.0 to 40.0 micrograms per kilograms]) decreased systemic systolic blood pressure 23% and diastolic blood pressure 25% (both, p less than 0.01). Continuous controlled infusion (0.125 to 0.332 mg per minute [1.5 to 6.0 micrograms/kg/min]) caused a more modest drop in systemic blood pressure, with a 17% reduction in systolic blood pressure and an 11% drop in diastolic blood pressure (both, p less than 0.05). Additional pressure reduction and maintenance therapy were provided by intermittent bolus administration or a continuous infusion. Moderate venodilation (decrease in central venous pressure) accompanied the systemic pressure response. The heart rate was not appreciably altered and, with exception of 1 patient in whom systemic pressures were reduced to 105/60 mm Hg after bolus infusion, the desired level of systolic, diastolic, and mean arterial pressures were readily titrated and maintained in a stable, predictable manner. These observations suggest that intravenously administered isosorbide dinitrate is a practical, safe, and highly effective method of treatment of hypertension following cardiopulmonary bypass.

Aortic paravalvular leaks: alternative suture placement strategy for the left coronary cusp.

Repair of a left coronary cusp aortic paravalvular leak can be achieved by placing stitches through the main pulmonary artery, right pulmonary artery, and left atrium when removal of the previously inserted valve is contraindicated.

Hospital volume is related to clinical and economic outcomes of esophageal resection in Maryland.

BACKGROUND: Previous studies have documented a relationship between hospital volume and perioperative and economic outcomes. Our objective was to determine the effect of hospital volume on outcomes of esophageal resection. METHODS: Statewide database was analyzed for patients who underwent esophageal resection in Maryland (n = 1,136 patients) from 1984 to 1999. Multivariate regression was used to determine the association of hospital volume with in-hospital mortality, length of stay, and charges after adjusting for case mix and time period. RESULTS: Unadjusted in-hospital mortality rates were lower in high volume hospitals (2.7%) than medium (12.7%) and low (16%) volume hospitals (p < 0.001). High hospital volume was associated with (1) fivefold reduction in the risk of death (odds ratio, 0.21; 95% confidence interval, 0.10 to 0.42; p < 0.001); (2) a 6-day (95% confidence interval, 5 to 7 days; p < 0.001) reduction in length of stay; and (3) $11,673 (95% confidence interval, $9,504 to $12,841; p < 0.001) decrease in hospital charges. Conclusions. Hospitals that perform high volumes of esophageal resection have superior clinical and economic outcomes. By referring these patients to high volume centers, we may improve quality and reduce costs.

Changes in serum myoglobin, total creatine kinase, lactate dehydrogenase and creatine kinase MB levels in runners.

A comparison was made between pre- and post-run serum levels of total creatine kinase (CK), CK-MB isoenzyme, lactate dehydrogenase (LD) and myoglobin (MG) levels in 84 runners in each of three groups; male 5-10 mile run; female 5-10 mile run; and male 15-55 mile run. Levels of CK-MB and MG were quantified using radioimmunoassay, while total CK and LD were measured using spectrophotometric procedures. Post-run levels of all four markers were significantly higher than the pre-run levels (p less than 0.001). Although levels of enzymes and MG correlated with the sex and distance run, the post-run changes did not correlate with age nor with the smoking status of the runners. Elevation of these markers as a result of vigorous exercise in the absence of myocardial infarction requires cautious interpretation of serum enzyme changes in runners.

Drain-site tumour recurrence after laparotomy resection for colorectal cancer.

We report a case of drain-site tumour recurrence 2 years after right colon resection for adenocarcinoma of the ascending colon. A large number of case reports concerning port-site tumour recurrences after laparoscopic procedures have been reported. However, post-laparotomy incision site cancer recurrence is considered a rare occurrence.

Primary intimal sarcoma of pulmonary valve and trunk with osteogenic sarcomatous elements. Report of a case considered to be pulmonary embolus.

A 49-year-old woman had a six-week history of increasing shortness of breath and fatigue. X-ray films and pulmonary scans showed multiple areas of emboli, especially in the right lung. Treatment with heparin was unsuccessful, and although a repeat scan showed only slight changes, the patient's condition deteriorated. Acute pulmonary edema and ventricular tachycardia preceded her death. Autopsy revealed a primary intimal sarcoma with osteogenic elements arising in the posterior leaflet of the pulmonary valve and obstructing the main pulmonary artery and its right branch.

Surface EMG evaluation of quadriceps femoris muscle in hemiplegic patients.

The method applied consists of evaluating the power spectra of the electromyographic (EMG) surface signal obtained during maximal isometric effort of the quadriceps femoris muscle. In hemiplegic patients it is possible to observe a particular frequency distribution towards the lowest values of the range considered. This trend might be accounted for by the morphological and enzyme- histochemical studies on the quadriceps femoris showing a selective atrophy of type 2 fibers. During rehabilitation treatment, however, it is imperative to consider parameters such as muscle strength changes and frequency values preferentially activated during the isometric effort (time-course). Observation of the pattern of the power spectra time-course therefore seems to contribute to a better view of the rehabilitation strategies suitable for exploiting the residual motor abilities.