Usefulness of Methotrexate in the Reduction of Relapses and Recurrences in Polymyalgia Rheumatica: An Observational Study.

OBJECTIVES: Methotrexate (MTX) has been studied with conflicting results in patients with polymyalgia rheumatica (PMR). Our objective was to evaluate the effectiveness of MTX to reduce relapses and recurrences in patients with PMR. METHODS: This observational longitudinal cohort study included 94 consecutive patients with PMR. Patients were assigned to 3 groups according to the prescribed treatment: group 1, treated with glucocorticoids (GCs) alone; group 2, treated with GCs initially plus MTX after a relapse or recurrence; and group 3, treated with GCs plus MTX since diagnosis.Factors associated with a first relapse were studied in the population. To evaluate MTX effect, patients from group 2 were evaluated comparing results from the first treatment period (GCs alone) to the second treatment period with GCs plus MTX. RESULTS: Ninety-four patients were included. The median follow-up time was 21.3 months (interquartile range [IQR], 11.7-56.2). Fifty-three patients (56.4%) were in group 1, 33 (35.1%) in group 2, and 8 (8.5%) in group 3. We found that female sex had a tendency to be associated with a first relapse (p = 0.07).In group 2, 35 relapses were identified during the first treatment period and only 8 relapses during the combined treatment period (p < 0.001). In this group, after the addition of MTX, the GCs dose at relapse was lower (5.1 vs 3 mg/d, p = 0.02) and the time to accomplish remission was shorter (22.9 vs 8.7 months, p = 0.01). There were no differences in the number of recurrences. CONCLUSIONS: The use of MTX in PMR patients who already had a relapse reduced the number of future relapses and decreased the time to achieve remission. Adding MTX allowed a reduction of GCs dose at relapse.

Skin substitutes based on allogenic fibroblasts or keratinocytes for chronic wounds not responding to conventional therapy: a retrospective observational study.

Chronic wounds are an expression of underlying complex pathologies and have a high incidence. Skin substitutes may represent an alternative approach to treat chronic ulcers. The aim of this retrospective observational study was to evaluate the wound reduction using skin substitutes based on allogenic fibroblasts or keratinocytes in 30 patients not responding to conventional therapy. Wound bed was prepared, then keratinocytes on Laserskin(®) to treat superficial wounds or fibroblasts on Hyalograft 3D(R) to treat deep leg ulcers were applied, and finally wounds were treated with a secondary dressing composed of nanocrystalline silver. Once a week constructs were removed and new bioengineered products were applied, as well as nanocrystalline silver medication. In none of the cases under examination did any complications arise relating to the treatment. We also achieved a reduction in wound dimension and exudates, and an increase in wound bed score. Postoperative assessment shows a degree of healing that is statistically higher in the group treated with keratinocytes as compared with the fibroblast group. This retrospective study improves our understanding and defines the clinical indications for the various uses of the two types of skin substitutes.

Bioencapsulation of Oocytes and Granulosa Cells.

A protocol for the encapsulation in sodium alginate of granulosa cells in primary culture and coculture of oocyte-cumulus complexes is reported. Sodium alginate forms strong gels when jellified with barium ions, allowing the self-organization of cells into a 3D structure. This method of encapsulation is simple and cheap, allowing the culture of cells in a three-dimensional fashion.

Role of pituitary dysfunction on cardiovascular risk in primary empty sella patients.

OBJECTIVE: Primary empty sella (PES) is a frequent anatomical condition rarely causing pituitary dysfunction. We assessed cardiovascular risk in a cohort of PES patients referred to Endocrine Units. DESIGN: The study was performed in three Italian tertiary referral centres. We evaluated pituitary function and cardiovascular risk, on the basis of lipid and glucose metabolism parameters and of Framingham score (FS), in 94 consecutive patients with PES diagnosis and in 94 gender, age and BMI matched controls. PATIENTS: Pituitary function was normal in 30 patients (group A), whereas a single or multiple pituitary hormone deficiency was demonstrated in 64 (group B). Growth hormone deficiency (GHD) was diagnosed in 56, central hypothyroidism in 35, hypogonadotropic hypogonadism in 32 and central hypoadrenalism in 24 cases. RESULTS: Framingham score was higher and glucose and lipid profile were worse in PES patients than in controls. Cardiovascular risk parameters were not different between group A and B. In group B, increased cardiovascular risk was associated with hypothyroidism and hypogonadism, but not with GHD. In group A, cardiovascular risk was higher and FT3 and FT4 levels were lower than in controls. Moreover, PES patients stratified for BMI showed a worse glucose and lipid profile and (in the overweight subgroup) higher FS than matched controls. CONCLUSIONS: Primary empty sella patients show increased cardiovascular risk, regardless of BMI. A worse lipid and glucose profile and higher FS were associated with secondary hypothyroidism, even subclinical, as well as hypogonadism.

Prognostic value of testosterone castration levels following androgen deprivation and high-dose radiotherapy in localized prostate cancer: Results from a phase III trial.

BACKGROUND/OBJECTIVE: The optimal prognostic value of testosterone following androgen deprivation therapy (ADT) is controversial. We studied the effect of serum testosterone levels on clinical outcome in localized prostate cancer (PCa) treated with ADT and high-dose radiotherapy (HRT). PATIENTS AND METHODS: The DART01/05 trial randomized 355 men with intermediate and high-risk PCa to 4 months of ADT plus HRT (STADT, N = 178) or the same treatment followed by 24 months of ADT (LTADT, N = 177). This study included patients treated with LTADT who had at least 3 determinations of testosterone during ADT (N = 154). Patients were stratified into 3 subgroups by testosterone level: minimum <20 ng/dL; median 20-49 ng/dL; and maximum ≥50 ng/dL. Kaplan-Meyer and Cox regression analysis were used for overall survival (OS) and Fine & Gray regression model for metastasis free survival (MFS), biochemical disease-free survival (bDFS) and time to TT recovery. RESULTS: There were no statistically significant differences in 10-year bDFS, MFS, or OS between the <20 ng/mL and 20-49 ng/dL subgroups. Multivariate analysis showed that a median testosterone ≥50 ng/dL was significantly associated with a decrease in bDFS (HR: 6.58, 95%CI 1.28-33.76, p = 0.03). Time to testosterone recovery after ADT did not correlate with bDFS, MFS, or OS and was not significantly associated with any of the testosterone subgroups. CONCLUSIONS: Our results do not support the concept that additional serum testosterone suppression below 20 ng/dL is associated with better outcomes than 20-49 ng/dL. Time to testosterone recovery after ADT and HRT did not impact clinical failure.

Lymphocytic hypophysitis: differential diagnosis and effects of high-dose pulse steroids, followed by azathioprine, on the pituitary mass and endocrine abnormalities--report of a case and literature review.

We report on a man with a progressively increasing pituitary mass, as demonstrated by MRI. It produced neurological and ophthalmological symptoms, and, ultimately, hypopituitarism. MRI also showed enlargement of the pituitary stalk and a dural tail phenomenon. An increased titer of antipituitary antibodies (1:16) was detected in the serum. Pituitary biopsy showed autoimmune hypophysitis (AH). Neither methylprednisolone pulse therapy nor a subsequent treatment with azathioprine were successful in recovering pituitary function, or in inducing a significant reduction of the pituitary mass after an initial, transient clinical and neuroradiological improvement. Anterior pituitary function evaluation revealed persistent hypopituitarism. AH is a relatively rare condition, particularly in males, but it represents an emerging entity in the diagnostic management of pituitary masses. This case shows that response to appropriate therapy for hypophysitis may not be very favorable and confirms that diagnostic management of nonsecreting pituitary masses can be a challenge. Clinical, imaging, and laboratory findings are useful for suggesting the diagnosis, but pituitary biopsy may be necessary to confirm it.

Temozolomide-induced shrinkage of a pituitary carcinoma causing Cushing's disease--report of a case and literature review.

Temozolomide (TMZ) is an alkylating chemotherapeutic agent that has recently been used in some cases as a new therapeutic tool for pituitary carcinomas and aggressive pituitary adenomas. In this report, we present the case of effective TMZ treatment in a 42-year-old man with ACTH-secreting carcinoma. The tumor grew progressively over 4 years, from 2.2 to 31.1 cm³, despite three surgical approaches and γ-knife treatment. Ki-67 increased from 2 to 18%. An intradural metastasis at the foramen magnum was detected by MRI after the third operation. Thereafter, four cycles of 5-day TMZ administration (200 mg/m²/day during the first, and 150 mg/m²/day during the following cycles) induced dramatic tumor size reduction (>90%). Clinical conditions improved progressively and, after 17 months from the beginning of TMZ administration, the patient is still alive. The treatment was well tolerated except for a transient thrombocytopenia (grade 4 WHO).

Combination of inulin and ß-cyclodextrin properties for colon delivery of hydrophobic drugs.

Colon drug delivery is aimed at the administration of selected drugs to act locally or even systematically. Corticosteroid drugs are often used exerting even pronounced side effects due to systemic absorption. Here a new drug delivery system (DDS) based on the chemical conjugation of ß-cyclodextrin to inulin to form the INUCD bioconjugate is described. It was designed with the aim to provide this DDS with colon degradable portions (inulin) which degradation products have direct beneficial effects on the well-being of the colon and with a carrier that can solubilize hydrophobic drugs (ß-cyclodextrin). This system was specifically designed to promote a local/topical activity with a significant reduction of the drug systemic absorption. The INUCD bioconjugate was obtained by a simple chemistry binding ß-cyclodextrin to an inulin succinate previously synthesized. The bioconjugate was then characterized in terms of physicochemical properties by ATR-FTIR, 1H NMR, DSC and TGA, DLS and SEM. Furthermore phase-solubility test by using curcumin as a model drug were performed as well as biologic evaluations for cytocompatibility and drug transport across in vitro simulated physiological barriers. Moreover enzymatic degradation studies by inulinase were performed. From the gained results a predictable local drug release of the payload could be attained so allowing a local delivery of e.g. corticosteroids thus avoiding a systemic absorption especially in prolonged therapies.

Freeze-dried and GMP-compliant pharmaceuticals containing exosomes for acellular mesenchymal stromal cell immunomodulant therapy.

AIM: To validate the use of ultrafiltration (UF) as an alternative applicable industrial method to replace ultracentrifugation (UC) in the purification of mesenchymal stromal cell (MSC)-secretome. MATERIALS & METHODS: Pharmaceutical formulations containing secretome and/or extracellular vesicles were extracted from adipose-MSCs and bone marrow-MSCs by combining UF or UC with lyophilization. RESULTS & CONCLUSION: UF led to higher protein, lipid, cytokine and exosomes yields compared with UC. The isolation procedure and cell source influenced immunomodulatory activity, which was in vitro evaluated by inhibition of phytohemagglutinin-activated peripheral blood mononuclear cell proliferation, and by modulation of IL-10, IFN-γ and IL-6. A secretome dosage was identified to obtain the same immunomodulatory activity of MSCs, paving the way for cell-free therapy.

Bioencapsulation of Oocytes and Granulosa Cells.

A protocol for the encapsulation in sodium alginate of granulosa cells in primary culture and co-culture of oocyte-cumulus complexes is reported. Sodium alginate forms strong gels when jellified with barium ions, allowing the self-organization of cells into a 3D structure. This method of encapsulation is simple and cheap, allowing the culture of cells in a 3-dimensional fashion.

Increased Serum Al Levels in Hemodialysis Patients Kept Enhanced during a 2-Year Prospective Study.

The regulation of mineral homeostasis is altered in hemodialysis patients with renal insufficiency, producing increased risk for secondary diseases like cardiovascular ones. We hypothesized that risen serum aluminum (Al) concentration in hemodialysis patients kept enhanced during a 2-year longitudinal study is associated with enhanced cardiovascular risk and influenced by medical treatments. This study reports the prospective monitoring of serum Al levels in six-monthly samplings over 2 years in 116 hemodialysis patients and a control group of 50 healthy adults. The influence of other factors like sex, age, kidney transplant, disease etiology, and drug consumption was also considered. At each sampling, serum Al levels were significantly higher in the patients than in the healthy controls (P < 0.05). Levels in the patient group were statistically significantly lower at the third and fourth versus first and second samplings, which may be related to Al accumulation in tissues. Increased Al levels in patients were positively and significantly related to serum calcium (Ca) and uric acid levels. Serum Al concentrations were significantly lower in patients receiving vasodilators and diuretics. Higher serum Al levels in hemodialyzed patients administered with phosphate binders or anti-hyperkalemics are attributable to their usual Al salt content. The consumption of antianemic drugs increases Al absorption by forming more bioavailable complexes with the compounds in these drugs. In conclusion, this is the first study to indicate that cardiovascular problems associated with elevated serum Al levels in hemodialysis patients may be in part mitigated by administrating vasodilators and diuretics, which reduce these levels.

Una revisión de la literatura experimental sobre los efectos motivacionales del alcohol y su modulación por factores biológicos y ambientales / A review of experimental literature on alcohol´s motivational effects and its modulation by biological and environmental factors

El alcohol es posiblemente la droga psicoactiva más consumida en el mundo. La ingesta moderada es común, pero para algunos individuos el consumo de alcohol se convierte en un trastorno adictivo. La progresión desde un consumo moderado de alcohol hasta el abuso podría deberse a la existencia de una sensibilidad diferencial, genéticamente determinada, a los efectos reforzantes y aversivos del alcohol. Así mismo, se sugiere que factores ambientales, como el estrés, podrían intervenir en el inicio del alcoholismo, influyendo sobre dicha sensibilidad diferencial y, en última instancia, sobre el consumo de alcohol. En el presente trabajo se revisa la literatura experimental existente acerca de los elementos protagonistas en la relación entre estrés y etanol. Por una parte se revisan los principales modelos de estrés existentes y, por otra, se aborda el estudio de las propiedades reforzantes y aversivas de esta droga, incluyendo datos sobre la influencia de variables como la edad, el sexo, y la experiencia previa con la droga. Finalmente, se expone un resumen de los datos existentes sobre la investigación con animales sobre la influencia del estrés en la percepción de las propiedades motivacionales opuestas del etanol. Nuestro objetivo es contribuir a clarificar el conocimiento existente acerca de las relaciones entre determinados factores biológicos (como el sexo o la edad) y ambientales (experiencia previa y estrés), y la conducta de ingesta de alcohol, poniendo de manifiesto la importancia de algunos factores de riesgo para el desarrollo del alcoholismo (AU)

Alcohol is probably the most consumed psychoactive drug in the world. Controlled consumption of alcohol is common, but for many individuals this consumption becomes an addiction. The progression from an habitual consumption of alcohol to abuse of the substance could be due to the existence of a differential sensitivity, which would be genetically determined, to the reinforcing and aversive effects of alcohol. Likewise, it has been suggested that environmental factors such as stress might be involved in the onset of alcoholism, influencing on such a differential sensitivity and, ultimately, on the consumption of alcohol. In this paper it is reviewed the experimental published data on each of the elements of the relationship between stress and ethanol. Thus, on the one hand they are reviewed the main animals models of stress and, on the other hand, we approached the study of the reinforcing and aversive properties of ethanol, including data on the influence of variables such as age, sex, and previous experience with the drug. And, finally, we present a resume of data collected from animal research on the influence of stress on the perception of the motivational opposing properties of ethanol. Our purpose is help to clarify the existing knowledge about the relations between biological factors (such as sex or age) and environmental factors (previous experience and stress), and the behavior of alcohol intake, thus highlighting the importance of some factors of risk for developing alcoholism (AU)

Cell encapsulation in mammal reproduction.

Cell encapsulation is an evolving branch of biotechnology with numerous applications including the enhancing of reproductive performance both in humans and other mammal species. Over the last twenty years male and female gametes and embryos have been encapsulated with or without somatic cells, for different purposes, such as semen controlled release, in vitro gametogenesis, embryo culture after in vitro fertilization and cell preservation. In this paper the state-of-the-art of this field (leaving aside that involving embryonic stem cells) is reviewed in terms of scientific literature and patent production. The patents and papers underline a widespread use of alginate which is a natural anionic, biocompatible, biodegradable polymer that mimics the extracellular matrix or the basal membrane and supports cell functions and metabolism. Gamete and embryo encapsulation techniques tend to fall into two main groupings: the "classical" three-step method, and the more recent one-step method. However, all of these encapsulation techniques are moving towards new, interesting applications since they can be easily tailor-made to fit a variety of cell lines.

MRI finding of simultaneous coexistence of growth hormone-secreting pituitary adenoma with intracranial meningioma and carotid artery aneurysms: report of a case.

Coexistence of pituitary adenoma, intracranial meningioma and cerebral aneurysm has never been described. We report on a patient with GH-secreting pituitary macroadenoma associated with a right frontal meningioma and with two intracavernous asymptomatic aneurisms. A 61-year-old woman was referred to our Endocrine Unit 13 years after a right frontal craniotomy for a pituitary tumour. Endocrine investigation showed high levels of IGF-1 (560 ng/ml) and increased basal serum GH (56 ng/ml) levels, not suppressed after OGTT. MRI showed persistence of a homogeneously enhancing intra- and suprasellar lesion, compressing the visual pathways, with bilateral intracavernous invasion and simultaneous coexistence of a right intracavernous internal carotid artery (ICA) aneurysm in direct contact with the pituitary tumour. Somatostatin analog treatment normalized GH and IGF-1 levels. Eight months later, the patient underwent a balloon ICA occlusion with disappearance of the right ICA aneurysm. One year later, a new MRI confirmed the presence of the pituitary mass showing also a right intracranial frontal meningioma and a new ICA aneurysm on the left side. Previous studies have suggested that prolonged GH hypersecretion could play a role in the genesis of intracranial aneurysms, inducing atherosclerotic and/or degenerative modification of the arterial walls. Other aetiological factors include a mechanical effect due to a direct contact between adenoma and aneurysm. Coexistence of pituitary adenoma and intracranial meningioma is a rare event, but also for this association it has been suggested that GH or other growth factors could play a role in appearance or in growth of meningioma. In our case, meningioma appeared and grew, despite the effective treatment of acromegaly.