Open comparison study of oxidative stress markers between patients with chronic renal failure in conservative therapy and patients in haemodialysis.

AIMS: Oxidative stress is defined as tissue damage caused by an imbalance between the excessive production of the oxidant components and an insufficient defence mechanism. It has been observed, as in patients with chronic kidney failure, that there exists a pro-oxidant state characterised by a higher level of reactive oxygen species (ROS), and that oxidative stress in dialysis patients can be aggravated by the activation of neutrophils associated with the production of free radicals. In patients undergoing dialysis even the molecules other than those of cytokines can accumulate and provoke an inflammatory response. This study proposes an analysis based on the total antioxidant capacity (TAC), thiol concentration (TC) and pro-oxidant capacity (POC) in the serum of various groups of patients: one group of dialysis subjects who had been undergoing substitutive treatment for more than ten years at the time of the study; one group of subjects with chronic renal insufficiency in its pre-terminal stage and subjected to conservative therapy; and the control group consisting of healthy volunteers. MATERIALS AND METHODS: Three types of tests were employed to assess the level of oxidative stress: oxy-adsorbent test, d-ROMS test, and SHp- test. Thirty-three subjects were selected: 11 undergoing haemodialysis for over then years; 14 patients with chronic kidney failure in its pre-terminal stage, and 8 normal subjects. In patients undergoing renal substitutive treatment, the serum levels (mean±sd) of TAC were 272.98±20.54; TC, 249.19±92.48, and POC, 95.06±15.70. In patients with chronic renal insufficiency in its pre-terminal stage and undergoing conservative treatment, the value of TAC was 226.5±27.89; TC, 336.42±102.08; and POC, 80.78±15.69. The levels of TAC in the serum of the controls were 335.62±46.35; TC, 434.09±22.23; and POC, 56.31±7.41. CONCLUSION: The analysed data suggest that in dialysis the patients with chronic kidney failure, whether undergoing conservative therapy during its pre-terminal stage or in substitution treatment during its terminal stage, there is a reduction in the antioxidant defence (in terms of TAC and thiolic barrier) and an increase in POC compared to the healthy subjects in the control group. Uraemia and haemodialysis increase the inflammatory response: an initial signal provokes the inflammatory state with the production of cytokines and free radicals or reactive oxygen, so that the lack of an antioxidant defence mechanism can bring about a vicious circle with the continual production of other free radicals.

Assessment of the oxidative stress markers in patients with chronic renal insufficiency undergoing dialysis treatment.

AIMS: Uraemia is a disease characterised by a significant oxidative stress, and it is a wide agreement that oxidative stress which accompanies uraemia, increases the inflammatory state and promotes the alterations of tiny molecules such as amino acids, proteins, lipids, and carbohydrates. There are numerous records of how ROS are connected to the pathology of end stage renal disease (ESRD). The aim of this study is to assess the Total Antioxidant Capacity (TAC), the Thiolic Capacity (TC) and the Pro-Oxidant Capacity (POC) in the serum of patients undergoing dialysis treatment. MATERIALS AND METHODS: Forthy-six patients have been recruited (32 men, 14 women; mean age 68.5±15.8) who received hemodialytic treatment triweekly. Three methods have been used: oxy adsorbent test (mmol/l) to determine TAC values; d-ROM test (mg/100 mg/H2O2) to determine POC; SHp-test (mmol/l) to determine TC. RESULTS: In patients who underwent hemodialysis, TAC levels were: pre-dialysis, 265.9±30.5; post-dialysis, 300.0±40.6; TC levels: pre-dialysis, 267.4±59.1; post-dialysis, 303.2±116.7; POC levels: predialysis, 86.2±16.9; post-dialysis, 98.6±17.0; NS: TAC, 335.6±46.3; TC, 434.0±22.2; POC, 56.3±7.4. TAC in both pre- and post-dialysis is reduced compared to the NS (p < 0.05); moreover TAC increases after dialysis (p < 0.05). Pre- and post-dialysis TC is reduced compared to NS (p < 0.05); available TC increases after dialysis, although not statistically significant. Pre- and post-dialysis POC in patients undergoing dialysis is increased compared to the NS (p < 0.05); moreover, POC tends to increase after dialysis ( p < 0.05). The data obtained from our study also show that the TAC is reduced in the patients subjected to hemodialysis compared to the NS, both before and after dialysis treatment; TAC increased after dialysis, even though it did not reach the level of the control group. CONCLUSION: Our study has demonstrated that exists a profound imbalance between antioxidants and the production of ROS in ESRD patients, which determines oxidative stress and eventually leads to atherosclerosis and cardiovascular complications. This, in turn, represents the major cause of morbidity and mortality in these patients.

Oxidant/antioxidant status in patients with chronic HIV infection.

The infection caused by HIV leads to an activation of the immune system, which involves local and systemic oxidative stress. In HIV-positive (HIV+) patients, oxidative damage is the result of HIV infection and its progression through the replication of the virus. We have examined 52 subjects: 26 HIV+ patients, and 26 healthy subjects (NC). Analysis of the parameters of the oxidant/antioxidant status (total antioxidant capacity (TAC), hydroperoxides (free radicals, PRO), thiols as thiolic capacity, TC) was carried out by means of the OXY-Absorbent test, the d-Rom test, and the -SHp test, respectively. Healthy subjects presented the following values: TAC (micromol/ml) 259.5+/-40.5; TC (micromol/l) 434.09+/-18.31; PRO (mg/dl) 54.09+/-7.3; CD4+ cells (cells/ml) 850+/-333. Values of HIV+ patients were the following: TAC 218.73+/-18.55 (ns vs NC; TC 250.88+/-93.11 (p 0.001 vs NC); PRO 110.5+/-23.61 (p 0.0005 vs NC); CD4+ cells 354+/-323.35 (p 0.0005 vs NC). The statistical analysis shows a direct correlation between TAC vs CD4+ cells; an indirect correlation between hydroperoxides vs CD4+ cells; not significant result between thiolic capacity vs CD4+ cells; finally, good correlations between TAC, hydroperoxides, and thiolic capacity vs HIV-RNA. The data obtained have proven that HIV+ patients present a condition of important oxidative stress. We may affi rm that this disease concurs with an increase of extreme stress; a condition in which the antioxidant defences are present, but are insufficient in neutralising the damaging actions of reactive species of oxygen, thus contributing to an acceleration in the natural history of HIV infections.

Modern therapeutic approach to ANCA-associated vasculitis.

The systemic vasculitis are characterised by an inflammatory process of the blood vessel walls. These may affect any of the vessels and organs, resulting in a diverse range of signs and symptoms. These polymorphic clinical manifestations, combined with the non-specific aetiology of the histological lesions, render the diagnosis for any single form of vasculitis more complicated. The problem lies in the various forms of vasculitis with analogous clinical presentations, requiring very different prognosis and treatment. This review has been realised in order to examine the modern approach to achieve and to maintain the clinical remission and to treat the relapse.

Study of bone metabolism in patients with chronic HIV infection.

AIMS: Various studies have confirmed the high incidence of skeletal homeostasis modifications in subjects who are carriers of chronic HIV infections, and specific pharmacological treatments, which modify the metabolism and condition both the weight loss and the reshaping of the bones. The presence of a reduction in body mass index seems to contribute to the progressive deterioration of the skeletal framework. The aim of this study was to see whether the presence of HIV-seropositivity could constitute a risk factor for the development of osteoporosis/osteopenia, even in the light of the fact that our group was composed of patients with a concentrated age span well under the limit for both post-menopausal and senile osteoporosis, and with a median age superimposable for both sexes. MATERIALS AND METHODS: Our study involved 26 HIV+ patients with an average duration of infection equal to 6.7 +/- 4.8 years, and a range of seropositive duration between 6 months to 16 years. The prominent ultrasonometrical parameters are as follows: Broadband Ultrasound Attenuation, Speed of Sound, Stiffness Index or Quantitative Ultra-sound Index, Bone Mineral Density, and T-score. The biochemical study was carried out by assessing a marker of neoformation such as seric osteocalcine, and uninary pyridinoline and deoxipyridonoline as resorption markers. RESULTS: The results confirmed the presence of osteoporosis/osteopenia in 46% of the samples (11%, and 35%, respectively), with a progressive reduction in bone mineral density in relation to the duration of HIV infection. Assessment of the marker for bone metabolism showed a significant increase in osteocalcine in the female population compared to the males, without any significant variations in the normal values. CONCLUSIONS: Extreme variability in the morphological appearance at bone level during the course of HIV infection would lead us to believe that in the genesis of various forms, depending on the mechanisms and the time involved only in the parts defined, other attributable factors are responsible, not only for the progression of the core pathology and the possible interference of hormonal factors (behavioural and/or nutritional) directly correlated with the state of infection, but also for the dismetabolic effects of the antiretroviral drugs.

Functional assessment of patients with systemic sclerosis by the use of 'Six-minutes-walking-test'.

AIMS: Systemic Sclerosis (SS) is a chronic inflammatory disease of the connective tissues, characterised by alterations in the functions and structures of the small blood vessels (capillaries and arterioles) and by modifications associated with the disposition of collagen in the tissues. One of the most frequent complication of the SS is the pulmonary arterial hypertension (PAH). Aim of this study was to assess the various pathophysiological relationships betweens SS and PAH in order to establish whether the presence of this systemic disease can represent a risk factor. MATERIALS AND METHODS: Ten patients affected by SS (9 women and 1 man, with a mean age of 55.7 +/- 11.4 years) were enrolled in our study, as inpatients at Dept. of Internal Medicine and Rheumatology Unit of Perugia University School of Medicine in the "Santa Maria" General Hospital in Terni, Italy. A control group of 10 clinically healthy subjects (CHS, 9 women and 1 man, ranging in age from 35 to 55 years) was also recruited in order to obtain normal clinical data of reference In subjects recruited, we have conducted a functional evaluation, based on physical tests (6-minute-walking-test, 6MWT), equipment and laboratory, on subjects suffering from SS with suspected PAH, in order to calculate the degree of cardio-pulmonary compromission brought on by this disease, taking into consideration important variables such as age and gender. RESULTS: The 6 MWT showed that the mean value at rest of the O2 saturation (%) was 97.1 +/- 1.20, heart rate (hr/min) 76 +/- 8.8, and respiratory rate (rr/min) 20.4 +/- 2.8. HS had 98.6 +/- 0.52, 75.7 +/- 6.86, and 16.8 +/- 1.61, respectively. After the the test, the results showed that the patients had O2 saturation 93.8 +/- 3.42, hr 113 +/- 20.27, and rr 31 +/- 2.86. HS had 97.6 +/- 0.69, 90.7 +/- 5.67, and 20.1 +/- 1.59, respectively. CONCLUSIONS: Our study has confirmed the high involvement of PAH and other cardio-respiratory disturbances in patients with SS. In fact, we have verified PAP to be above the normal range in 3 out of 10 patients, while the other 3 patients presented borderline values. Because it is a simple method to conduct at low cost, in addition to being non-invasive, reproducible and well accepted, we must affirm that the 6MWT should be more utilized and exploited, especially during the fi rst phases of diagnosis. This in turn can help us to assess the patients and to determine a course of treatment which is more complex and onerous, as in therapeutic monitoring for verifying efficacy.

Evaluation of oxidative stress in rheumatoid and psoriatic arthritis and psoriasis.

INTRODUCTION: The aim of the present study is to discuss the importance of the processes of oxidative stress in the pathogenesis of certain autoimmune diseases, to search for an appropriate assessment marker, and to debate current approaches which have been proposed for the treatment of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), and Psoriasis (Ps). MATERIALS AND METHODS: The total antioxidant capacity (TAC), the thiolic capacity (TC), and the serum hydroperoxide concentration (SHC) were measured in 37 subjects: 13 with RA, 8 with PsA, 8 with Ps, and 8 healthy controls. RESULTS: SHC levels were significantly higher in patients with RA (p = 0.01), as well as in those with PsA (p = 0.005) and Ps (p = 0.002) in comparison with the control group. However, a significant reduction in the TAC values in the serum of all three groups (RA, p = 0.03; PsA, p = 0.005; Ps, p = 0.001) were observed in comparison with the healthy controls. The thiolic concentration were found to have significantly diminished in patients with RA (p =0.0005) and Ps (p = 0.0005) in comparison with the control group. Our findings have brought out the fact that the therapeutic treatment of RA using biological drugs is more than satisfactory in accord with the considerable increase in the TAC values, although not significantly, compared to those patients treated with DMARDs. CONCLUSIONS: The determination of the parameters of oxidative stress utilising these methods may be useful as a quick test, and as routine in monitoring the state of oxidative stress in patients suffering from RA, PsA, and Ps, so that a more effective treatment for ROS can be undertaken accordingly. The administration of biological drugs seems to have a role in increasing the mechanism of the barrier which the body possesses against oxidative stress.

Oxidant/antioxidant status in patients with Raynaud's disease.

OBJECTIVE: Despite several studies concerning the oxidative stress in Raynaud's phenomenon secondary to systemic sclerosis (secondary Raynaud, SR), little is known regarding the relationship between Raynaud's disease (primary Raynaud, PR) and oxidative stress at present. The aim of the present research was to study the parameters of oxidative stress in PR patients and to compare them to those of SR patients. MATERIALS AND METHODS: Serum hydroperoxide (Hydrop) level, serum total antioxidant capacity (TAC) and serum total thiol (-SHp) barrier were measured in 19 patients with SR, 15 patients with PR and 14 healthy control subjects (CS). The statistical contrasts were performed via one-way ANOVA. RESULTS: The serum Hydrop concentrations were significantly higher in SR (p = 0.0043) and PR (p = 0.0038) groups in comparison with CS. A significant decrease in serum TAC level in SR (p = 0.00005) and PR (p = 0.00128) patients in respect to the CS was revealed. No significant change in the -SHp barrier in SR and PR patients in respect to CS has been demonstrated. However, there were no significant differences in serum Hydrop and TAC levels between the groups of patients. CONCLUSIONS: The study of serum oxidative stress parameters, in terms of Hydro and TAC levels may be used as a routine and rapid test to verify the oxidative stress status in SR and PR patients and to undertake a strategy of treatments by a supplementation of antioxidant molecules.

The therapy of Sjogren's syndrome: a review.

The Sjogren's syndrome (SS) is an chronic inflammatory autoimmune disease of the exocrine glands as well as of internal apparatus. The therapy of exocrinopathy is represented by parasympathomimetic drugs such as pilocarpine and cevimeline. The therapy of systemic manifestations, actually is represented by the inhibitors of TNF alfa, as well as leflunomide, methotrexate and cyclosporine-A, but the results are quite insufficient and disappointed. In order to the involvement of B-cell function in the pathogenesis of SS, one of the most important option in the future should be specific inhibitors of that cells.

Definition of adult-onset rheumatoid arthritis from elderly-onset rheumatoid arthritis by studying T-lymphocyte subpopulations, their soluble receptors and soluble receptor of interleukin-2.

AIMS: The study of the distribution of T-lymphocyte sub-populations has revealed some immune characteristics of rheumatoid arthritis (RA) as well as polymyalgia rheumatica (PMR). There is much evidence that the subsets of T-lymphocyte subpopulations are well correlated with the age of the patient and the precise diagnosis of RA and PMR. The aims of the study were to evaluate the absolute number and percentage of T-lymphocyte subpopulation subsets in peripheral blood and their soluble receptors and serum soluble receptors of interleukin-2. MATERIAL AND METHODS: Thirty-six patients with RA were divided into 21 adult-onset RA (AoRA) and 15 elderly-onsets RA (EoRA) patients. They were compared with 48 PMR patients, 21 normal subjects under 45 years and 17 healthy elderly subjects over 65 years. T-lymphocyte subsets were studied by FACSCAN with double stained specific monoclonal antibodies. The EL ISA method was used to determine soluble receptors of CD4+ and CD8+ and IL-2. RESULTS: The AoRA patients had a significant alteration of T-lymphocyte sub-populations as well as their specific soluble receptors compared to EoRA patients. On the other hand, distribution of T-lymphocyte sub-populations in EoRA patients was quite similar to that in PMR patients. CONCLUSIONS: This method is probably not applicable for daily routine clinical practice but provides some interesting data for differential diagnosis between RA and PMR.

[Osteoporosis and anorexia nervosa: ultrasonometric and biochemical evaluation--preliminary data]. / Osteoporosi e anoressia nervosa: valutazione ultrasonometrica e biochimica--dati preliminari.

AIMS: To evaluate the relationship between Anorexia Nervosa (AN) and Osteoporosis (OP) by bone heel ultrasonometric measurement and biochemical bone metabolic data. MATERIALS AND METHODS: AN, 15 patients (2 males / 13 females; mean age 27.5 yr, range 16-44; mean BMI 15.78, range 13-19.3); normal subjects (NS), 10 (2 males / 8 females; mean age 27.5 yr, range 17-40; mean BMI 26.2, range 25-28). An Hologic Sahara ultrasound heel instrument has been utilized in order to obtain the following parameters: broadband ultrasound attenuation (BUA), speed of sound (SOS), Stiffness' index, bone mineral density (BMD) and T-score. As markers of bone formation osteocalcin (OC, ng/ml) and of resorption pyridinolines (Pyr, pmol/umol creatinine e deoxy-Pyr) have been studied by standardized analytical methods. RESULTS: (expressed as x+/-SD). PATIENTS: BUA, 65+/-11.22 (p<0.01); SOS, 1544.14+/-73.5 (ns); Stiffness, 89.8+/-19.4 (p<0.01): BMD, 0.55+/-0.53 (p<0.01); T-score, -1.4+/-1.12 (p<0.01); OC, 4.05+/-2.3 (p<0.01); Pyr, 53+/-21 (ns); d-Pyr, 7.17+/-4.5 (ns). NS: BUA, 88.57+/-8.63; SOS, 1567.72+/-11.88; Stiffness, 108.07+/-4.97; BMD, 0.611+/-0.027; T-score, 0.22+/-0.3; OC, 8.5+/-4.5; Pyr, 60+/-25; d-Pyr, 8.5+/-3.5. CONCLUSIONS: Our data seem to confirm that AN represents an important risk factor for OP. The ultrasonometric data in AN patients document some statistically significant differences from SN in term of BMD and T-score reduction. The metabolic data show that OC is reduced in AN patients, on the contrary, no differences appear in term of resorption bone markers.

Intima-media thickness of common carotid as cardiovascular risk factor in rheumatoid arthritis and metabolic disorders.

OBJECTIVES: To study the intima-media thickness (IMT) of the common carotid artery and the lipid profile in patients with rheumatoid arthritis (RA), type 1 diabetes mellitus T1DM), and obesity (Ob), against a control group of normal subjects (NS), in order to determine the relationship between cardiovascular risks and pro-atherosclerosis conditions in various inflammatory and metabolic disorders. MATERIALS AND METHODS: 147 subjects, with written consent, were divided into the following categories: 38 patients with RA (6m/32f; average age 51.7+/-4.4 years, range 42-71); 42 patients with T1DM (20m/22f; average age 52.1+/-6.2 years, range 45-65); 37 patients with obesity (20m/17f; average age 53.8+/-5.3 years, range 46-70); 30 normal subjects, age and sex matched, that make up the control group (14m/16f; average age 52.5+/-4.6, range 40-62). The IMT and the plaques were measured (values expressed in mm) according to the guidelines of the GIUV (Gruppo Italiano Ultrasonologia Vascolare, Italian Group of Vascular Ultrasonology). RESULTS: Our research has revealed the presence of a thickening of the intima-media complex in patients suffering from RA, highlighting, at the same time, that the atherosclerotic risk factor in these patients manifested regardless of the activity of the disease or the serum level. CONCLUSIONS: The presence of an inflammatory systemic chronic disease such as rheumatoid arthritis, seems to constitute a significant and independent atherosclerosis risk in itself, which apparently does not correlate with the lipid profile.

Short term efficacy of intra-articular injection of hyaluronic acid in osteoarthritis of the first carpometacarpal joint in a preliminary open pilot study.

OBJECTIVE: The use of hyaluronic acid (HA) in osteoarthritis (OA) is based on the findings that viscoelasticity of the synovial fluid is entirely due to its HA content and that HA itself may influence the disease by interacting with components of the synovial fluid. The aim of this pilot study was to evaluate the efficacy of HA in OA of the first carpometacarpal joint. MATERIALS AND METHODS: This study was performed on 43 patients with 56 total joints. Five parameters were been relieved: spontaneous pain; provoked pain; joint performances and related pain; algofunctional index of Dreiser; assumption of drugs. The administrations of HA have been performed with 0.5 ml of HA at each injection. RESULTS: The behaviour of pain shows a significant (p < 0.0005 for all the comparisons) reduction from base time to the end of the study and the Dreiser Index decreased as well. At base time 81.4% of the patients assumed NSAIDs and only 13.8% analgesics. During the following weeks a smaller requirement of NSAIDs (from 81% to 23%) and a greater number of patients without analgesic therapy were observed. CONCLUSIONS: Intra-articular HA seems to be effective in OA of CMC joint. This short term study suggests to observe and to treat these patients during a longer period of time in order to evaluate not only the efficacy but also the clinical safety.

Proposal of a questionnaire to evaluate the foot in the rheumatic diseases.

OBJECTIVE: To compile a simple questionnaire, named 'Foot Health Questionnaire-1' (FHQ1), which would evaluate the state of the foot in rheumatic diseases, such as osteoarthritis (OA) and rheumatoid arthritis (RA). MATERIALS AND METHODS: Sixty-three consecutive subjects entered the study: 25 with RA; 14 with OA; 10 with CTD and 14 healthy control subjects. RESULTS: It was possible to establish that the highest mean value of FHQ1 refers to RA patients (median FHQ1 value, 41) and OA patients (median FHQ1 value, 37) whereas for CTD patients the mean value was 14 and for healthy subjects was = 0, as expected. It results that 72% of RA patients and 65% of OA patients enter classes III and IV of FHQ1, whereas 70% of CTD patients were in class I. CONCLUSIONS: An evaluation questionnaire regarding the algo-functioning of the foot could be a useful tool in routine rheumatologic clinical practice.

Osteoporosis prevention: a reasoned examination of food habits and physical activities in a schoolchildren population in central Italy.

OBJECTIVE: The dietary intake of calcium is fundamental for prevention of osteoporosis, especially in the first three decade of age to gain a valid peak bone mass; moreover physical activity is important for the same reason. The objective of our research is to examine the food habits and the way to practice sport in a homogenous population of schoolchildren. MATERIALS AND METHODS: Data were collected by an original questionnaire in 500 schoolchildren (238 males, 262 females, 9-12 yrs) living in the centre of Italy. RESULTS: Data show that the calcium intake decreases while the age increases. According to the recommended daily calcium dose, the percentages of insufficient calcium intake were 21% in the 6 years old group, 35% in the 7 to 10 years old group and 52.5% in the 11 to 14 years old group. Milk and dairy products cover 57% of the calcium needs (17% and 40% respectively), water covers 24% and the other foodstuffs 19%; moreover most children (43.5%) practice non competitive sports with a preference (58.3%) for no-weightbearing sports (mainly cycling) over weightbearing sports (mainly football). CONCLUSIONS. This survey suggests that a high percentage of young people do not take the recommended daily dose of calcium (especially interesting that becoming older with consequent lower parental control over the diet, the higher the incidence of poor calcium intake increases), then it would be recommendable to establish a national health program promoting appropriate physical exercise plus a correct calcium intake as early as the primary school.

Insulin glargine in patients with severe hepato-gastroenterology diseases and hyperglycemia receiving parenteral nutrition.

OBJECTIVE: The aim of this nonrandomized observational study is to verify and confirm whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving parenteral nutrition (PN) and whether the analogue is capable of obtaining and maintaining good glycemic control without inducing hypoglycemia. MATERIALS AND METHODS: The sample is made up of 25 patients with severe hepato-gastroenterology diseases receiving parenteral nutrition, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving PN. RESULTS: Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first eight months of 2005. Four out of these 25 cannot be evaluated, either because (2/4) they did not begin or complete the treatment with Lantus or because the proper number of glycemic tests were not done (2/4); 21/25 patients, 84% of the sample with a mean age of 65.9 years (range 46-93 yr), finished the study and can be evaluated. The mean glycemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycemias occurred which required medical intervention. CONCLUSIONS: This study confirms the possibility of using insulin glargine in patients receiving parenteral nutrition with hyperglycemia diagnosed diabetics or not diabetics.

Use of insulin glargine in patients with hyperglycaemia receiving artificial nutrition.

The purpose of this study was to verify whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving artificial nutrition (AN) and if the analogue is capable of obtaining and maintaining good glycaemic control without inducing hypoglycaemia. The sample considers 25 patients receiving AN, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving AN. Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first two months of 2005. Four out of these 25 could not be evaluated, either because they did not begin or complete the treatment with Lantus (3/4) or because the proper number of glycaemic tests were not carried out (1/4); 21/25 patients, 84% of the sample with a mean age of 68.7 years (range 46-91 years), finished the study and could be evaluated. The mean glycaemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycaemia requiring medical intervention occurred. This study confirms the possibility of using insulin glargine in patients receiving AN with hyperglycaemia regardless of the type of nutrition and whether or not the patient is diabetic.

[Study of lymphocyte subpopulations in chronic autoimmune inflammatory rheumatic diseases. II. Polymyalgia rheumatica: behaviour of lymphocyte subpopulations during treatment with two different corticosteroids]. / Studio delle sottopopolazioni linfocitarie nelle connettiviti. II. La polimialgia reumatica: comportamento delle sottopopolazioni linfocitarie durante terapia con due diversi corticosteroidi.

AIM: The aim of this paper was to study the distribution of CD8+ subsets, of soluble receptors of CD8 and IL-2 during a steroid treatment with prednisone and deflazacort. METHODS: Forty-eight patients (9 males and 39 females, mean age 69.4(6.5 years) with active polymyalgia rheumatica (ESR 74 (18 mm, 1(st) h) were studied. In order to determine the distribution of lymphocyte subpopulations a panel of monoclonal antibodies was utilised. Flow cytometry with a FACSCAN machine and ELISA method were utilized. RESULTS: At base-time in comparison with normal subjects: reduction (P<0.05) of CD4(-)/CD8(+) (356+/-112/mL vs 564(132/mL), due to reduction (P<0.001) of CD8(+)bright (224(86/mL vs 426+/-124/mL) and CD8(+)bright/CD57(-) (123+/-44/mL vs 256(58/mL); increasing (P<0.001) of sCD8 (514+/-123 U/mL vs 312+/-102 U/mL) and (P<0.005) sIL-2r (984(346 U/mL vs 244+/-58 U/mL). Group-PDN: significant (P<0.001) reduction of CD4(-)/CD8(+) (466+/-102), CD89(+))bright (302(74), CD8+bright/CD57- (186+/-51), sCD8 (418+/-96) and of sIL-2r (450+/-163) at 1(st) week, and toward the normal range at 1(st) month. Group-DFZ: normal values at 6th month: CD4(-)/CD8(+) (497+/-133), CD8(+)bright (401+/-98), CD8(+)bright/CD57(-) (240+/-64), sCD8 (317+/-82), while sIL-2r è (P<0.0005) higher vs group-PDN. Group-PDN: VES <50 at 1st week, normal value (14+/-7) at 3(rd) month; PCR, 2.2+/-1.2 at 3(rd) month and 1(0.8 at 6th month. Group-DFZ: VES >20 (24+/-5) at 6th month e PCR increased. CONCLUSIONS: PDN shows a faster action vs DFZ. DFZ does not seem to be able in reducing sIL-2r probably showing a persistent inflammation and immune activation status.

[Study of lymphocyte subpopulations in chronic autoimmune inflammatory rheumatic diseases. I) Polymyalgia rheumatica]. / Studio delle sottopopolazioni linfocitarie nelle connettiviti. I) La polimialgia reumatica.

AIM: The polymyalgia rheumatica (PMR) is a chronic autoimmune inflammatory rheumatic disorder, characterised by pain and stiffness on the shoulder and pelvic girdles, increasing of erythrocyte sedimentation rate (ESR) and good clinical and laboratory recovery by steroid therapy with a good outcome of the disease. There is now a wide agreement about an alteration of the distribution of lymphocyte subpopulations, characterised by a decreasing of CD8+ subset, at the onset of PMR. The aim of this paper is to study the distribution of lymphocyte subpopulations and their soluble receptors and the distribution of CD4+ and CD8+ subsets in patients with active PMR. METHODS: Forty-eight patients (9 males and 39 females, mean age 69.4+/-6.5 years) with active PMR (ESR 74+/-18 mm, 1st hour) were studied. In order to determine the distribution of lymphocyte subpopulations a panel of monoclonal antibodies was utilised. Flow cytometry was performed with a FACSCAN machine. RESULTS: The absolute number of CD4-/CD8+ cells were reduced (p<0.05) in comparison to normal subjects (356+/-112/ml vs 564+/-132/ml); the reduction was due to a decrease (p<0.001) of CD8+bright cells (224+/-86/ml vs 426+/-124/ml) and of CD8+bright/CD57- subset (123+/-44/ml vs 256+/-58/ml); an increase (p<0.001) of sCD8 (514+/-123 U/ml vs 312+/-102 U/ml) and an increase (p<0.0005) of sIL-2r (984+/-346 U/ml vs 244+/-58 U/ml) were also observed in comparison to normal subjects. No alterations of CD4+/CD8, CD8+bright/CD57+, CD8+dim/ CD57+/- cells and sCD4 were observed. CONCLUSION: Our study seems to confirm that in early and active PMR there are significant alterations of lymphocyte subpopulations and their subsets as well as of soluble receptors.

[Evaluation of the peak bone mass by quantitative heel ultrasound in young women of the centre of Italy]. / Valutazione ultrasonometrica calcaneare del picco di massa ossea in giovani donne dell'Italia centrale.

OBJECTIVE: To measure the reference young adult mean values in healthy women of the centre of Italy by Quantitative heel UltraSound (QUS). METHODS: The study group was composed by 70 caucasian women: mean age was 25.4 years (Standard Deviation 4.7), mean weight was 58 Kg (SD 8.2), mean height was 166 cm (SD 5.8), mean BMI was 20.9 kg/m 2 (SD 2.5). Every subject was evaluated firstly with an original questionnaire to discover risk factors (like for example steroids consumption, recent fractures of the lower limb), then was measured by quantitative heel ultrasonometry Hologic Sahara. RESULTS: Mean extimated Bone Mineral Density (BMD) 0.588 g/cm 2 (SD 0.124) mean Quantitative Ultrasound Index (QUI) 105.0 (SD 19.6), mean Speed of Sound (SOS) 1564.2 m/s (SD 31.4), mean Broadband Ultrasound Attenuation (BUA) 84.8 dB/MHz (SD 17.4). No significant correlation was found between QUS parameters and anthropometric data. A correlation was found between every QUS parameters. No significant differences were found about QUI and extimated BMD, between our results and Hologic normative data for European women. CONCLUSIONS: It is very important to develop specific reference values for any measurement device and site of skeleton especially in the age of reaching the peak bone mass because the T score is then measured referring to these data. Usually the normative data are supplied by manufacturer and are based on large multicentric study. In our opinion it could be helpful to verify if these data are compatible with the population examined in every region.