Emerging and re-emerging infectious disease in otorhinolaryngology.

SUMMARY: Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

Fluticasone propionate downregulates nasal fibroblast functions involved in airway inflammation and remodeling.

BACKGROUND: Besides being highly effective in the treatment of allergic and nonallergic rhinitis with eosinophilia, intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. We evaluated the ability of fluticasone propionate to downregulate fibroblast functions related to nasal inflammation and remodeling. METHODS: Primary nasal polyp tissue-derived fibroblasts were stimulated with tumor necrosis factor (TNF)-alpha or interleukin (IL)-4 or basic fibroblast growth factor (bFGF) in the presence of fluticasone propionate (0.1-100 nM). Fibroblast proliferation, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 expression and eotaxin release were then evaluated. RESULTS: As compared with unstimulated cultures, a significant increase in fibroblast proliferation was observed when the cells were stimulated with bFGF (p < 0.05), but not with TNF-alpha or IL-4 (p > 0.05). TNF-alpha induced an upregulation of ICAM-1 expression (p < 0.05), which was not seen in fibroblasts cultured in the presence of IL-4 or bFGF. No changes in VCAM-1 expression were induced by TNF-alpha, IL-4 or bFGF, whereas both TNF-alpha and IL-4 increased eotaxin release (p < 0.05). Both bFGF-induced fibroblast proliferation and TNF-alpha-induced ICAM-1 expression were significantly reduced by fluticasone, starting at the dose of 1 and 10 nM, respectively (p < 0.05). Fluticasone at concentrations of 1-100 nM effectively inhibited eotaxin release by TNF-alpha- or IL-4-stimulated fibroblasts (p < 0.05). CONCLUSIONS: The pharmacologic activity of fluticasone in patients with chronic upper airway inflammatory disease may include inhibition of resident fibroblast functions involved in airway inflammation and remodeling.

Auriculo-condylar syndrome or new syndrome?

We describe a girl with peculiar auricular dysmorphism, renal agenesis and supernumerary rib. Some different diagnostic hypotheses are discussed.

Inhibition of eosinophil transepithelial migration and downregulation of adhesion molecule expression on eosinophils and airway epithelial cells induced by budesonide.

In asthma, eosinophil migration through the bronchial mucosa is mediated by the expression of surface molecules on eosinophils and airway epithelial cells. To characterize the activity of budesonide on eosinophil transepithelial migration, blood eosinophils were isolated from atopic asthmatic subjects and human bronchial epithelial cells (HBECs) from surgically resected bronchi. In the presence of different concentrations of budesonide (0.1-100 nM), we tested: a) eosinophil migration induced by C5a through HBEC monolayers; b) ICAM-1 expression on HBECs, stimulated with C5a and c) LFA-1 and Mac-1 expression on eosinophils, stimulated with C5a or with ah-CD23 mabs plus GM-CSF. Eosinophils showed a remarkable chemotactic response to C5a (P<0.001), that was effectively down-regulated by the presence in the chemotactic chambers of budesonide at all the concentrations tested (P<0.05). A weaker, but still present, inhibitory activity on cell locomotion was observed when HBECs or eosinophils were preincubated with budesonide before the chemotaxis assay, which was performed in absence of the drug. Preincubation of the cells with different concentrations of budesonide was also effective in down-regulating the C5a-induced ICAM-1 expression on HBECs and the ah-CD23 and GM-CSF-induced LFA-1 and Mac-1 expression on eosinophils. Thus, budesonide-induced down-regulation of eosinophil migration through airway epithelial cells is associated with, and possibly partially dependent on inhibition of adhesion molecule expression on both cell types.

[Mid-latency auditory evoked responses in Alzheimer's disease: evaluation of P1 and P3 waves]. / Studio dei potenziali evocati uditivi a media latenza nella malattia di Alzheimer: valutazione delle onde P1 e P3.

A great deal of research has revealed a frequent association between hearing impairment and Alzheimer's disease. Many of these studies have, however, been criticized for the lack of statistical significance, for the methodology used and for doubts regarding the diagnostic criteria used. The lack of uniform results prompted the present research. On the basis of some works in the literature, the authors felt that the study of middle and long-latency auditory evoked potentials, and their expression characterized by the P1 and P3 waves, the appropriate instrument for exploring the cortical and subcortical tracts of the auditory system which are most compromised in Alzheimer's disease. In fact, numerous studies have suggested that wave P1 is generated by peduncle-pontine nucleus cells of the tegmentum and that wave P3 is generated by sites located in the temporal lobes and hippocampus. The present study was conducted on 15 subjects suffering from Alzheimer's disease and 15 controls. Four subjects were excluded from the study because they were affected by Alzheimer's disease with severe dementia and were, thus, unable to cooperate. The 15 controls underwent accurate clinical and instrumental evaluation to rule out any neurological and intellectual disorders. The results for wave P1 show a statistically significant difference between the subjects affected by Alzheimer's disease and the controls. In fact, there was a difference in the presence of this potential. Moreover there was a statistically significant difference in P1 between those patients with average dementia and the controls but not between those with slight dementia and the controls. Finally, comparison of the abnormalities in P1 potential and P3 latency showed that in Alzheimer's disease alterations in P3 arise earlier and are more constant than alterations in P1. The physiopathological meaning of these results is discussed.

[Cardiofacial syndrome. A case report]. / La sindrome cardio-facciale. Descrizione di un caso.

A case of cardio-facial syndrome with dysmorphic and asymmetric crying face, congenital heart defects, failure to thrive is described. The authors review the literature and underline the importance of asymmetric crying face as a marker of associated congenital anomalies.

[Muscle phosphorylase deficiency in childhood. A case report]. / Il deficit di fosforilasi muscolare nell' età pediatrica. Contributo clinico.

Myophosphorylase deficiency or McArdle's disease is rarely recognized in childhood. The onset is generally in adolescence or in adult age with exercise intolerance, muscle cramps and myoglobinuria. Two siblings of 6 and 2 years of age are described. The first patient showed early fatigue and both had elevated CK levels. Morphological and biochemical studies of muscle biopsies revealed a defect of myophosphorylase.

Hormonal stimulation of 3H-orotic acid incorporation into RNA by serum-free cultured hepatocytes.

Insulin and dexamethasone greatly stimulate the incorporation of 3H-orotic acid into RNA. Such a stimulation is associated to an increase in the uptake of the labelled precursor into the acid soluble fraction as well as in the the specific radioactivity of the nucleoside plus nucleotide pool suggesting that hormone supplementation does not affect RNA synthesis by cultured cells. The lack of effect of insulin and dexamethasone on the level of total RNA polymerase activity in nuclei isolated from cultured hepatocytes is in line with this assumption. The hormone stimulated uptake of orotic acid is dependent on protein synthesis since it is completely abolished by cycloheximide.

RNA synthesis in primary cultures of adult rat hepatocytes.

The ability of hepatocyte monolayers to synthesize RNA was investigated by measuring [3H]orotic acid incorporation into RNA and the total nuclear RNA polymerase activity as a function of the time in culture. The results demonstrate that primary cultures of hepatocytes maintained in a chemically defined serum- and hormone-free medium are able to synthesize RNA actively. This ability increases within the first 2 d of culture, despite the concomitant decrease in [3H]orotic acid uptake, and decreases only after 3 d. Factors such as serum, insulin, and dexamethasone, known to improve maintenance of functional hepatocytes, markedly stimulate the uptake of labeled precursor without apparently affecting the rate of RNA synthesis by cultured cells. It is suggested that the culture of adult rat hepatocytes provides a useful experimental model for the studies of hormonal regulation of transcription in liver.

[Uptake and incorporation of 3H-orotic acid in isolated perfused rat liver]. / Assunzione e incorporazione di acido orotico-3H nel fegato isolato e perfuso del ratto.

3H-orotic acid incorporation into RNA and the level of RNA polymerase activity in isolated rat liver perfused for 5 hrs were investigated. In spite of a dramatic decrease in 3H-orotic acid uptake by liver cells during perfusion, a constant rate of RNA synthesis was observed. Moreover, RNA polymerase I and II activities were not affected by a 5-hr perfusion. It is suggested that isolated perfused rat liver can be used to study direct effects of hormones and drugs on RNA synthesis.

[Characteristics of synthesized RNA in the isolated and perfused rat liver]. / Caratteristiche dell'RNA sintetizzato nel fegato isolato E perfuso del ratto.

The incorporation of 3H-orotic acid into nuclear and microsomal RNA from isolated perfused rat liver has been studied. The specific radioactivity of nuclear RNA indicates that the efficiency for RNA synthesis in the perfused liver is similar to that of the liver 'in vivo'. In contrast, the microsomal RNA specific radioactivity is well below that observed 'in vivo'. This may indicate a slower transport of the labelled RNA from the nucleus to the cytoplasm. Labelling pattern of total nuclear RNA, nuclear poly(A) containing RNA and microsomal RNA appear to be in line with these assumptions.

DNA-dependent RNA polymerase activities in hepatopancreas nuclei from Mytilus galloprovincialis Lamarck.

It has been shown that RNA synthesis in isolated hepatopancreas nuclei from Mytilus galloprovincialis is catalyzed by three DNA-dependent RNA polymerases (I, II and III) which resemble those identified in nuclei from mammalian cells. RNA polymerase I is active at 50 mM (NH4)2SO4, catalyzes the synthesis of GMP-rich ribosomal-like RNA and is completely resistant to the toadstool toxin alpha-amanitin. RNA polymerase II and III are active at higher (NH4)2SO4 concentrations, catalyze the synthesis of DNA-like RNA and are inhibited by very low (0.5-1 microgram/ml) and high (200 microgram/ml) concentrations of alpha-amanitin, respectively. Hepatopancreas nuclei retain considerable RNAase activity. Nuclear RNA polymerase activity may be underestimated since a part of the synthetized RNA is degraded.