Impact of gluten-free diet on quality of life in celiac patients.

BACKGROUND AND AIM: Celiac disease (CD) is a common gluten-related disorder, whose only treatment is a gluten-free diet (GFD). Since a unique view on psychological consequences of a GFD still lacks, our aim was to assess the quality of life (QoL) and the depression state in symptomatic CD patients after GFD. Socio-demographic features were considered. PATIENTS AND METHODS: 210 adult CD patients were recruited and divided into 3 groups : 70 newly diagnosed patients (​Group A​),70 patients who have been on GFD for 6-12 months (​Group B​), and 70 patients who have been on GFD for more than 12 months (​Group C​). We recruited 210 healthy controls (​Group D). Psychological General Well-Being Index (PGWBI) and Beck Depression Inventory (BDI) questionnaires were administered. Each group was evaluated according to age, gender and school ranking. RESULTS: Groups A ​and B showed lower PGWBI scores compared with both Group C ​and D (p <0.001 for each comparison). Moreover, Groups A and B showed higher BDI scores compared with both ​Group C ​and D (p <0.001 for each comparison).Women, the elderly and the poorly educated seemed to suffer more psychological stress. CONCLUSION: GFD induces an improvement of well-being and a decrease of depression state after 12 months of strict GFD. Negative psychological implications were observed only in specific risk categories. (Acta gastroenterol. belg., 2016, 79, 447-453).

The -665 C>T polymorphism in the eNOS gene predicts cardiovascular mortality and morbidity in white Europeans.

We recently identified rs3918226 as a hypertension susceptibility locus (-665 C>T), TT homozygosity being associated with higher hypertension risk. T compared with C allele transfected cells had lower endothelial nitric oxide synthase (eNOS) expression. In the family-based Flemish Study on Environment, Genes and Health Outcomes (50.9% women; mean age 40.3 years), we investigated whether 32 TT homozygotes had worse outcomes than 2787 C allele carriers. Over 15 years (median), total and cardiovascular mortality and cardiovascular and coronary events amounted to 269 (9.5%), 98 (3.5%), 247 (8.8%) and 120 (4.3%), respectively. While accounting for family clusters, the hazard ratios associated with TT homozygosity were 4.11 (P=0.0052) for cardiovascular mortality (4 deaths), 2.75 (P=0.0067) for cardiovascular events (7 endpoints) and 3.10 (P=0.022) for coronary events (4 endpoints). With adjustment for cardiovascular risk factors, these hazard ratios were 6.01 (P=0.0003), 2.64 (P=0.0091) and 2.89 (P=0.010), respectively. Analyses unadjusted for blood pressure and antihypertensive treatment produced consistent results. For all fatal plus nonfatal cardiovascular events, the positive predictive value, attributable risk and population-attributable risk associated with TT homozygosity were 21.9, 61.5 and 2.0%, respectively. In conclusion, TT homozygosity at the position -665 in the eNOS promoter predicts adverse outcomes, independent of blood pressure and other risk factors.

Evidence of the contribution of the X chromosome to systemic sclerosis susceptibility: association with the functional IRAK1 196Phe/532Ser haplotype.

OBJECTIVE: Several autoimmune disorders, including systemic sclerosis (SSc), are characterized by a strong sex bias. To date, it is not known whether genes on the sex chromosomes influence SSc susceptibility. Recently, an IRAK1 haplotype that contains the 196Phe functional variant (rs1059702), located on Xq28, was found to confer susceptibility to systemic lupus erythematosus (SLE). This study was undertaken to test for an association between SSc and the IRAK1 SLE risk haplotype. METHODS: We tested for an association with the IRAK1 SLE risk haplotype in a discovery set of 849 SSc patients and 625 controls. IRAK1 rs1059702 was further genotyped in a replication set, which included Caucasian women from Italy (493 SSc patients and 509 controls) and Germany (466 SSc patients and 1,083 controls). RESULTS: An association between the IRAK1 haplotype and SSc was detected in the discovery set. In both the discovery and replication sets, the rs1059702 TT genotype was found to be associated with specific SSc subsets, highlighting a potential contribution to disease severity. A meta-analysis provided evidence of an association of both the T allele and TT genotype with the overall disease, with an odds ratio (OR) of 1.20 and 95% confidence interval (95% CI) of 1.06-1.35 for the T allele (P = 0.003) and an OR of 1.49 and 95% CI of 1.06-2.10 for the TT genotype (P = 0.023). However, the most notable associations were observed with the diffuse cutaneous, anti-topoisomerase I antibody positive, and SSc-related fibrosing alveolitis subsets (OR 2.35 [95% CI 1.51-3.66], P = 1.56 × 10(-4), OR 2.84 [95% CI 1.87-4.32], P = 1.07 × 10(-6), and OR 2.09 [95% CI 1.35-3.24], P = 9.05 × 10(-4), respectively). CONCLUSION: Our study provides the first evidence of an association between IRAK1 and SSc, demonstrating that a sex chromosome gene directly influences SSc susceptibility and its phenotypic heterogeneity.

Endocrine cells in atresic chick embryo intestine: histochemical and immunohistochemical study.

Intestinal motility disorders are an important problem in the postoperative management of patients with intestinal atresia. Intestinal motility could be initiated by luminal factors that activate intrinsic and extrinsic primary afferent nerves involved in the peristaltic reflex. Endocrine cells act as a key point, because they transfer information regarding the intestinal contents and intraluminal pressure to nerve fibers lying in close proximity to the basolateral surface of the epithelium. In chick embryo, experimental intestinal atresia is associated with disorders in the development of the enteric nervous system, related to the severity of intestinal dilation. Our aim was to investigate the distribution pattern of endocrine cells in the developing endocrine system of chick embryo small intestine with experimentally-induced atresia on day 12 and on day 16. Changes in enteroendocrine population were examined in gut specimens (excised proximal and distal to the atresia) from experimental embryos 19 days old and in control sham-operated chick embryos at the same age. Sections from proximal and distal bowel and control bowel were stained with Grimelius silver stain, a valuable histochemical method for detecting the argyrophil and argentophilic cells, and with an immunohistochemical procedure for detecting serotonin and neurotensin immunoreactive cells. In chick embryo proximal bowel, intestinal dilation differed in the various embryos. We found significantly higher enteroendocrine cell counts in proximal bowel than in distal and control bowel. The differences depended on the precociousness of surgery and the severity of dilation. Considering the major contribution of enteroendocrine cells to the peristaltic reflex, our data may help to explain the pathogenesis of motility disorders related to intestinal atresia.

Endocrine cells in atresic chick embryo intestine: histochemical and immunohistochemical study.

Intestinal motility disorders are an important problem in the postoperative management of patients with intestinal atresia. Intestinal motility could be initiated by luminal factors that activate intrinsic and extrinsic primary afferent nerves involved in the peristaltic reflex. Endocrine cells act as a key point, because they transfer information regarding the intestinal contents and intraluminal pressure to nerve fibers lying in close proximity to the basolateral surface of the epithelium. In chick embryo, experimental intestinal atresia is associated with disorders in the development of the enteric nervous system, related to the severity of intestinal dilation. Our aim was to investigate the distribution pattern of endocrine cells in the developing endocrine system of chick embryo small intestine with experimentally-induced atresia on day 12 and on day 16. Changes in enteroendocrine population were examined in gut specimens (excised proximal and distal to the atresia) from experimental embryos 19 days old and in control sham-operated chick embryos at the same age. Sections from proximal and distal bowel and control bowel were stained with Grimelius silver stain, a valuable histochemical method for detecting the argyrophil and argentophilic cells, and with an immunohistochemical procedure for detecting serotonin and neurotensin immunoreactive cells. In chick embryo proximal bowel, intestinal dilation differed in the various embryos. We found significantly higher enteroendocrine cell counts in proximal bowel than in distal and control bowel. The differences depended on the precociousness of surgery and the severity of dilation. Considering the major contribution of enteroendocrine cells to the peristaltic reflex, our data may help to explain the pathogenesis of motility disorders related to intestinal atresia.

Early development of chick embryo respiratory nervous system: an immunohistochemical study.

The extrinsic and intrinsic respiratory nervous systems receive specific contributions from the vagal and sympathetic components. Using specific markers for vagal and sympathetic structures, we studied the distribution patterns of immunoreactivity to galanin (GAL), pituitary adenylate cyclase-activating polypeptide-27 (PACAP) and the tachykinin substance P in extrinsic and intrinsic nerve of chick embryo respiratory system, during development from the very early age to hatching. All peptides studied appeared in the intrinsic and extrinsic nervous systems early. We found substance P in both the vagal and sympathetic systems, PACAP in vagal components alone and GAL mainly in the sympathetic system. The intrinsic nervous system showed high immunoreactivity for all peptides studied. These data accord with the well known early trophic functions that peptides have on the development of nervous networks and modulatory activity on the intrinsic nervous system. The GAL again proves to be the main peptide in chick embryo sympathetic respiratory system.

Nervous system development in normal and atresic chick embryo intestine: an immunohistochemical study.

Intestinal motility disorders are a common complication after surgery for neonatal intestinal atresia. Although intestinal atresia causes alterations in the enteric nervous system, especially in its inner structures (nervous fibers in the mucosa, submucous and deep muscular plexuses), how these alterations develop is unclear. The chick model is a useful research tool for investigating the ontogenesis of the enteric nervous system and the pathogenesis of congenital bowel diseases. More information is needed on the overlap between the developing enteric nervous system and intestinal atresia. Because vasoactive intestinal polypeptide and substance P are typical intestinal neuropeptides, and vasoactive intestinal polypeptide acts as a modulator in neurodevelopment and an inhibitor of smooth muscle cell proliferation, our aim in this study was to investigate the distribution of their immunoreactivity in the developing enteric nervous system of normal and experimental chick models. We studied gut specimens excised from normal chick embryos (aged 12-20 days) and experimental chick embryos (aged 15-20 days) that underwent surgical intervention on day 12 to induce intestinal atresia (atresic embryos) or simply to grasp the bowel loop (sham-operated embryos). In normal chick embryos we showed vasoactive intestinal polypeptide and substance P immunoreactivity from day 12 in the submucous and myenteric plexuses. The distribution of peptide immunoreactivity differed markedly in atresic and normal or sham-operated gut embryos. These differences especially affected the inner structures of the enteric nervous system of specimens proximal to atresia and were related to the severity of dilation. Because nerve structures in the gut wall mucosa and submucous and deep muscular plexuses play a role in motility control and stretch sensation in the intestinal wall, our findings in the chick embryo may help to explain how gut motility disorders develop after surgery for neonatal intestinal atresia.

Ontogeny of galanin-immunoreactive elements in chicken embryo autonomic nervous system.

To elucidate the main ontogenetic steps of galanin immunoreactivity within the extrinsic nerve supply of the alimentary tract, we undertook an immunohistochemical study of chicken embryo specimens. Fluorescence and streptavidin-biotin-peroxidase protocols were combined, using a galanin polyclonal antiserum, on transverse serial sections obtained from chicken embryos from embryonic Day 3 (E3) to hatching, and from 9-day-old newborn chicks. Galanin-immunoreactive cells were first detected at E3.5 within the pharyngeal pouch region, the nodose ganglion, the primary sympathetic chain, primitive splanchnic branches and the caudal portion of the Remak ganglion. At E5.5 galanin-immunoreactive cells and fibers appeared in the secondary (paravertebral) sympathetic chain, splanchnic nerves, peri- and preaortic plexuses, adrenal gland anlage and visceral nerves. Galanin-immunoreactive cells also lay scattered along the vagus nerve, and in the intermediate zone of the thoracolumbar spinal cord. At E18, galanin-immunoreactive cells and fibers were found along the entire Remak ganglion and around the gastrointestinal blood vessels. In post-hatching-9-day old chicks, the para- and prevertebral ganglia, but not the intermediate zone of the spinal cord, contained galanin-immunoreactive cells. Data indicate the presence of a consistent "galaninergic" nerve system supplying the chick embryonal gut wall. Whether this system has growth or differentiating role remains to be demonstrated. Its presence and distribution pattern in the later stages clearly support its well known role as a visceral neuromodulator of gut function.

Ontogeny of PACAP immunoreactivity in extrinsic and intrinsic innervation of chicken gut.

An immunohistochemical study was conducted on the ontogeny of pituitary adenylate cyclase-activating polypeptide-27 (PACAP) immunoreactive elements within the extrinsic and intrinsic nerve supply of the chicken embryo gut. The first PACAP-immunoreactivity was detected in the extrinsic nerve supply at E 4 within the pharyngeal region and the primary sympathetic chain. At E 5.5 it appeared in the vagus nerve, the spinal cord, the secondary sympathetic chain, some perivascular plexuses and the Remak ganglion. In the intrinsic nerve supply, the first PACAP-immunoreactive elements were shown at E 4.5-E 5 in the mesenchymal bud of the proventriculus/gizzard. Then they gradually appeared also cranially and caudally both in myenteric and submucous plexuses.

Ontogeny of galanin-immunoreactive elements in the intrinsic nervous system of the chicken gut.

Galanin is a brain-gut peptide that is present in the central and peripheral nervous systems. In the gut, it is contained exclusively in intrinsic and extrinsic nerve supplies, and it is involved overall in the regulation of gut motility. To obtain information about the ontogeny of galanin, we undertook an immunohistochemical study of chicken embryos. The time of first appearance and the distribution patterns of galanin were investigated with fluorescence and streptavidin-biotin-peroxidase (ABC) immunohistochemical protocols by using a galanin polyclonal antiserum. The various regions of the gut and the pancreas were obtained from chicken embryos aged from 3 days of incubation to hatching. All specimens were fixed in buffered picric acid-paraformaldehyde, frozen, and cut with a cryostat. Galanin-immunoreactive neuroblasts were first detected at 4 days in the mesenchyme of the proventriculus/gizzard primordium and within the Remak ganglion. They then extended cranially and caudally, reaching all of the other gut regions at 6.5 days. Galanin-immunoreactive nerve elements mainly occupied the sites of myenteric and submucous plexuses. From day 15, galanin-immunoreactive nerve fibers tended to invade the circular muscular layer and part of the lamina propria of the mucosa. In the pancreas, weak galanin-immunoreactive nerve elements were detected at 5.5 days. They tended to be distributed among the glandular lobules according to the organ differentiation. The widespread distribution during the earlier embryonic stages represents evidence indicating that the neuropeptide galanin may have a role as a differentiating or growth factor. From late embryonic life, its predominant presence in sympathetic nerves and in muscular layers fits with the functions demonstrated previously in adults of other vertebrates for galanin as a modulator of intestinal motility.

An immunohistochemical study of the ontogeny of the neuroendocrine system in the chicken oesophagus.

The ontogenesis and distribution of serotonin-, chromogranin A-, chromogranin B-, galanin-, neurotensin-, bombesin- and neuropeptide Y-immunoreactive elements were studied in the chicken oesophagus during pre- and post-hatching life. Unlike positive nerve elements, that were present in pre- and post-hatching life, positive endocrine cells were observed only during embryonic life in the oesophageal epithelium. The first endocrine cells, immunoreactive for serotonin and chromogranins, appeared on day 12, in the cervical and thoracic portions of the oesophagus. At the same age, but only in its distal portion, a few bombesin- and neurotensin-immunoreactive cells also appeared. The number of the endocrine cells progressively increased, reaching a maximum on day 15. They then decreased, with a cranio-caudal progression, until they disappeared a few days after hatching. Almost all the serotonin-immunoreactive cells but only a subpopulation of bombesin- and neurotensin-immunoreactive cells colocalized chromogranins. About half of this subpopulation also colocalized serotonin. All these cells reacted positively with Grimelius argyrophile stain. The mucosa of the crop never contained positive endocrine cells. Positive nervous elements appeared first in the wall of the terminal oesophagus and only one or two days later in the proximal oesophagus including the crop. Nervous elements immunoreactive for galanin first appeared from days 6 to 7, for neurotensin from days 7 to 8, for neuropeptide Y from 13 to 15 and for bombesin from 15 to 18. At day 15 galanin-immunoreactive ganglionic cells and fibres occupied both the myenteric and submucous plexus and galanin-positive nerve fibres could be seen throughout the oesophageal wall from the adventitia to a thin subepithelial network. Neurotensin- and neuropeptide Y-immunopositive ganglionic cells and fibres, by contrast, invariably occupied the muscular and submucous layers. Scattered bombesin-immunoreactive ganglionic cells were observed only in the myenteric plexus. The number of positive nerve elements progressively increased until some weeks after birth. Density and intensity were always much higher for galanin and neurotensin than for neuropeptide Y and bombesin.

Ontogeny, distribution and amine/peptide content of chromogranin A- and B-immunoreactive endocrine cells in the small and large intestine of the chicken.

Chromogranin A-(CgA-) and chromogranin B-(CgB-)-immunoreactive endocrine cells were investigated in the chicken intestine during embryonic and post-hatching life. CgA- and CgB-immunoreactive cells first appeared in the intestinal tract at various embryonic ages from day 10 in the cloaca to day 16 in the distal ileum and colon. To identify the CgA- and CgB-immunoreactive cells, each tissue section was double-immunostained using a panel of polyclonal antibodies raised against gut amine/peptides. Almost all the serotonin-immunoreactive cells co-localised CgA and CgB along the entire intestinal mucosa and at all ages examined. In contrast, substance P-, peptide tyrosine tyrosine-, neurotensin- and secretin-immunoreactive cells displayed heterogeneous co-localisation patterns. For example, either all or only some cells of a given endocrine type co-stored Cg; they did so variously - only in the embryo, only after hatching, or at both stages, and co-localizing cells were sometimes located within the mucosa only in the villi and not in the glands, and sometimes vice versa. All the CgA/CgB-immunoreactive cells also displayed argyrophilia.

Ontogeny, distribution and amine/peptide colocalization of chromogranin A- and B-immunoreactive cells in the chicken gizzard and antrum.

The ontogeny and the distribution of chromogranin A (CgA)- and chromogranin B (CgB)-immunoreactive endocrine cells was studied in the chicken gizzard and gizzard-duodenal junction (also called pylorus or antrum) during embryonic and postnatal life. The same tissue sections were then double-immunostained to identify the CgA-and CgB-immunoreactive cells, with a panel of polyclonal antibodies raised against main gut amine/peptides. In the gizzard, positive cells were observed only in its two diverticula (proximal and distal caeca), where the first CgA- and CgB-immunoreactive cells were found on day 12 of incubation. They always remained moderate in number and co-stored mainly serotonin, gastrin/CCK and neurotensin. A few also co-stored somatostatin, but only during the embryonic period. Others co-stored PYY, but only after hatching. Co-localization with motilin was rare and never occurred with bombesin. In the chicken antrum, the first CgA- and CgB-immunoreactive cells were observed on day 12 of incubation and soon reached very high numbers. Antral positive cells showed almost the same co-localization pattern as the gizzard diverticula. Despite their high chromogranin content, the antral cells had weak argyrophilia, whereas in the gizzard diverticula the two staining patterns corresponded.

An immunohistochemical study on neurons and paraneurons of the pre- and post-natal chicken lung.

The indirect immunoperoxidase (PAP) method was used on chicken lung specimens from embryos ranging in age from 6 days to hatching, chicks and adult chickens of up to 6 months. The ontogenesis and distribution of neurons and paraneurons containing immunoreactivities for serotonin (5HT), bombesin, vasoactive intestinal polypeptide (VIP), substance P (SP) and galanin were investigated. Serotonin-immunoreactive paraneurons were first detected in the pulmonary mesenchyma of 8-day-old embryos, while in the 12-day-old embryos the following neurons and paraneurons were first detected in their respective locations: serotonin-immunoreactive paraneurons in the bronchial epithelium; VIP- and galanin-immunoreactive ganglionic cells and SP-immunoreactive nerve fibres in the intrapulmonary ganglia. At hatching, serotonin-immunoreactive paraneurons in the epithelium of the air capillaries and air sacs, and bombesin-immunoreactive paraneurons in the epithelium of the primary bronchus, VIP-, galanin- and SP-immunoreactive nerve fibres in the lamina propria of the primary and secondary bronchi and in the pulmonary septa could also be shown. Some serotonin-immunoreactive small paraneurons were also found in the intrapulmonary ganglia. In the adult specimens, VIP-, galanin- and SP-immunoreactive nerve fibre networks were observed throughout the primary bronchus wall and in the lung septa. In intrapulmonary ganglia, VIP- and galanin-immunoreactive neurons and serotonin-immunoreactive small paraneurons could be more numerously demonstrated. Moreover, bombesin paraneurons occurred in the epithelium of primary and secondary bronchi, and serotonin-immunoreactive paraneurons were found in the epithelia of the bronchi and air sacs and in some pluricellular bodies in the lamina propria of the air sac ostia.

[Atracurium in general surgery]. / L'atracurium in chirurgia generale.

The particular characteristics of atracurium in comparison with available relaxant agents are briefly analyzed. Afterwards the results of a clinical investigation regarding a group of 56 patients who underwent major abdominal surgery are referred to. The most important elements of this investigation involve: the priming technique, dosage variations of atracurium in respect to the two different administration techniques (further doses, continuous infusion), anticholinesterases need during neuromuscular block reverse and average neuromuscular recovery time without anticholinesterases.

Ontogenesis of endocrine cells in the chicken intestine: an immunohistochemical study.

The authors report the time of appearance, morphology and topographic distribution of gastrin/cholecystochinin- (G/CCK-), somatostatin- (SRIF-), neurotensin- (NT-), motilin- (MO-) and substance P-like immunoreactive (SP-LI) elements during embryonic and postnatal development, in ileum, caeca and colon of chick embryos (from 8 days of incubation to hatching), newborn chicks (up to 15-days old) and adult chickens. In the ileum, G/CCK-LI and SP-LI cells appeared on day 11, the others on about day 13. In the caeca the first cells of all types were seen from about day 17. In the colon, NT-LI cells appeared early, on day 9, SP-LI and occasional SRIF-LI cells from day 13 on and MO-LI and G/CCK-LI only from day 17. In the ileum all the cells studied were present, in the caeca and colon they were extremely scarce, apart from NT-LI cells which were more numerous. In the prenatal stages, SP-LI was found only in epithelial cells; after hatching, it was also present in metasympathetic nerve elements.

5-HT-like immunoreactive cells in chicken intestine: ontogenesis, morphology and topography.

The indirect immunoperoxidase method was used to describe time of appearance, morphology and topography of 5-hydroxy- tryptamine-like immunoreactive (5-HT-LI) cells in the gut of chick embryos, newborn and adult chickens. The earliest cells were seen in the ileum at 11 days, in the caeca at 14 and in the colon at 9 days. At first appearance they were ovoid or pyramidal but later became more irregular because of the numerous apical and basal processes. The peak of cell concentration at hatching, was in the ileal samples, whereas in the colon these cells were also abundant in adults both throughout the villi and the glands. In sections of adult ileum, on the contrary, they could be found mainly in the glands.

Immunohistochemical studies on the ontogenesis of some endocrine cells in the chicken antrum and duodenum.

The time of appearance, morphology and topographic distribution of gastrin/CCK-, somatostatin-, 5HT-, and bombesin-like immunoreactive cells during embryonic and postnatal development were studied in chicken antrum and duodenum with immunohistochemical methods. Gastrin/CCK-like cells appeared on or about the 11th day in the antrum and duodenum, somatostatin-like cells around the 12th day in the antrum and the 11th day in the duodenum, bombesin-like cells appeared only in the antrum and only at hatching. In the early stages of development all the immunoreactive cells were localized in the surface epithelium, descending deeper into the glands as these form, although some cells could always be seen in the surface epithelium. Around the 17th day the number of gastrin/CCK-like cells and somatostatin-like cells in the antrum increases, while 5HT-like already become more numerous in the duodenum from the 13th day onwards. Two territories were recognized in the antrum of the adult: the first was near the duodenum where gastrin/CCK-like and somatostatin-like cells, often in close contact, were very numerous; the other territory was near the gizzard where bombesin-like cells were more numerous. Both regions contained 5HT-like cells in smaller number. In adult duodenum, 5HT-like cells were the most numerous, while somatostatin-like cells and gastrin/CCK-like cells, found in more superficial locations, were more scanty.