Renal echo-3D and microalbuminuria in children of diabetic mothers: a preliminary study.

Maternal diabetes has assumed epidemic relevance in recent years and animal studies have provided some evidence that it may cause abnormalities in renal development and a reduction in nephron endowment in the offspring; however, human data are lacking. The renal cortex contains ∼95% of the glomeruli and its volume could be taken as a surrogate measure of glomerular number; based on this assumption, we measured renal cortex volume and in addition, microalbuminuria in a homogeneous sample of 42 children of diabetic (pregestational, n = 13, and gestational, n = 29) mothers, compared with 21 healthy children born of non-diabetic mothers. The offspring of diabetic mothers showed a significant reduction of renal cortex volume and higher albumin excretion compared with controls, possibly attributable to a reduction in the number of nephrons and the difference was statistically significant (P < 0.001). Although further studies on a larger sample are necessary, our preliminary findings suggest that maternal diabetes may affect renal development with sequelae later in life, requiring closer monitoring and follow-up. Furthermore, the importance of strict maternal diabetes management and control must be emphasized.

Altered frequency and phenotype of CD4+ forkhead box protein 3+ T cells and its association with autoantibody production in human immunodeficiency virus-infected paediatric patients.

The association between immune dysfunction and the development of autoimmune pathology in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is not clear. The frequency and phenotype of regulatory T cells, as well as the presence of autoantibodies, were evaluated in a paediatric cohort of HIV-infected patients without clinical evidence of autoimmune disease. Lower absolute counts but higher percentages of total CD4(+) forkhead box protein 3 (FoxP3)(+) T cells were recorded in children with severe immunosuppression than in those without evidence of immunosuppression. The frequencies of classical CD4(+) CD25(+) FoxP3(+) regulatory T cells were not altered, whereas CD4(+) FoxP3(+) CD25(-) T cells were found increased significantly in patients with severe immunosuppression. Like classical regulatory T cells, CD4(+) FoxP3(+) CD25(-) T cells display higher cytotoxic T-lymphocyte antigen 4 (CTLA-4) but lower CD127 expression compared with CD4(+) FoxP3(-) CD25(+) T cells. An improvement in CD4(+) T cell counts, along with a decrease in viral load, was associated with a decrease in CD4(+) FoxP3(+) CD25(-) T cells. The majority of the patients with severe immunosuppression were positive for at least one out of seven autoantibodies tested and displayed hypergammaglobulinaemia. Conversely, HIV-infected children without evidence of immunosuppression had lower levels of autoantibodies and total immunoglobulins. A decline in CD4(+) FoxP3(+) T cell numbers or a variation in their phenotype may induce a raise in antigen exposure with polyclonal B cell activation, probably contributing to the generation of autoantibodies in the absence of clinical autoimmune disease.

Expresión de L-selectina en linfocitos T y neutrófilos de niños infectados con HIV / L-selectin expression on T lymphocytes and neutrophils in HIV infected children

La capacidad de los leucócitos de abandonar la circulación y migrar hacia los tejidos es un paso crítica de la respuesta inmune. La L-selectina, selectina leucocitaria (CD62L), media la unión de linfócitos a las vênulas endoteliales altas de los ganglios linfáticos periféricos, y también participa en la adhesión de linfócitos, neutrófilos y monócitos al endotelio vascular activado en los sítios de inflamación. En este trabajo se estudiaron los niveles de expresión de L- selectina sobre los linfócitos T y polimorfonucleares neutrófilos en 25 niños HIV (+) sin tratamiento antirretroviral y 25 niños sanos HIV (-), avaluando además su comportamiento en 10 de los pacientes, luego de 6 meses de iniciada la terapéutica específica para el HIV. El número de linfócitos TCD3+, CD4+ y CD8+ que expresan CD62L se encontró significativamente disminuido en los niños HIV(+) con respecto al grupo control. El porcentaje de neutrófilos que expresan CD62L se encontro significativamente disminuido en los pacientes con mayor compromiso inmunológico. Se observó una correlación positiva entre los niveles de LTCD4+ y el porcentaje de neutrófilos que expresan CD62L. Luego de 6 meses de tratamiento antirretroviral no hubo câmbios significatios en los niveles de expresión de CD62L sobre LTCD4+ y LTCD8+ . La reducción en los niveles de expresión de L-selectina en estos tipos celulares sugiere que durante la infección por HIV las funciones leucocitarias tales como la migración y el asentamiento linfocitario son anormales, contribuyendo al progresivo deterioro inmune.

Expresión de L-selectina en linfocitos T y neutrófilos de niños infectados con HIV / L-selectin expression on T lymphocytes and neutrophils in HIV infected children

La capacidad de los leucócitos de abandonar la circulación y migrar hacia los tejidos es un paso crítica de la respuesta inmune. La L-selectina, selectina leucocitaria (CD62L), media la unión de linfócitos a las vÛnulas endoteliales altas de los ganglios linfáticos periféricos, y también participa en la adhesión de linfócitos, neutrófilos y monócitos al endotelio vascular activado en los sítios de inflamación. En este trabajo se estudiaron los niveles de expresión de L- selectina sobre los linfócitos T y polimorfonucleares neutrófilos en 25 niños HIV (+) sin tratamiento antirretroviral y 25 niños sanos HIV (-), avaluando además su comportamiento en 10 de los pacientes, luego de 6 meses de iniciada la terapéutica específica para el HIV. El número de linfócitos TCD3+, CD4+ y CD8+ que expresan CD62L se encontró significativamente disminuido en los niños HIV(+) con respecto al grupo control. El porcentaje de neutrófilos que expresan CD62L se encontro significativamente disminuido en los pacientes con mayor compromiso inmunológico. Se observó una correlación positiva entre los niveles de LTCD4+ y el porcentaje de neutrófilos que expresan CD62L. Luego de 6 meses de tratamiento antirretroviral no hubo cÔmbios significatios en los niveles de expresión de CD62L sobre LTCD4+ y LTCD8+ . La reducción en los niveles de expresión de L-selectina en estos tipos celulares sugiere que durante la infección por HIV las funciones leucocitarias tales como la migración y el asentamiento linfocitario son anormales, contribuyendo al progresivo deterioro inmune. (AU)

The behavior of several microionization chambers in small intensity modulated radiotherapy fields.

The aim of this work is to compare different ion chambers available for dose measurements in small fields used in intensity modulated radiotherapy. Some dosimetric aspects, related to these small radiation fields, i.e., lack of electronic lateral equilibrium and steep dose region, must be evaluated, in order to obtain an accurate technique implementation. Furthermore, the size of the sensitive volume of the chambers compared with the mapping of the beams or segments needs consideration. If the size of the chamber is too large for the flatness of the field, the measurement can deviate from the expected absorbed dose at a point. We propose a comparison of various dosimetric values between different microionization chambers with respect to a smaller dosimeter, such as the diamond detector.

A new tiazofurin pronucleotide: synthesis and biological evaluation of cyclosaligenyl-tiazofurin monophosphate.

Synthesis and biological activities of cyclosaligenyl-tiazofurin monophosphate (CycloSal-TRMP), a new tiazofurin pronucleotide, are reported. CycloSal-TRMP proved to be active in vitro against human myelogenous leukemia K562 cell line and as A1 adenosine receptor agonist.

[Behavior of soluble L-selectin in HIV infected children]. / Comportamiento de la forma soluble de L-selectina en niños infectados con HIV.

L-selectin is an adhesion molecule that is responsible for the initial attachment of leukocytes to endothelium. After leukocyte activation L-selectin is endoproteolytically released from the cell surface. In order to analyze the relationship between soluble L-selectin (sL-selectin) and parameters of immune activation and disease progression, 51 HIV infected children and 15 healthy controls were studied. Serum L-selectin concentrations were significantly higher in HIV infected children than in the control group. Levels of sL-selectin were higher in HIV infected patients with severe immunologic suppression than in those with moderate or no evidence of suppression. A positive correlation between sL-selectin levels and LTCD8 counts, sL-selectin and soluble intercellular adhesion molecule-1 (sICAM-1) and immunogobulin A (IgA) levels was detected. On the contrary sL-selectin concentration did not correlate with plasmatic viral load. The correlation with parameters of immune activation may implicate involvement of sL-selectin in the immunopathogenesis of HIV infection.

Comportamiento de la forma soluble de L-selectina en niños infectados con HIV. / [Behavior of soluble L-selectin in HIV infected children]

L-selectin is an adhesion molecule that is responsible for the initial attachment of leukocytes to endothelium. After leukocyte activation L-selectin is endoproteolytically released from the cell surface. In order to analyze the relationship between soluble L-selectin (sL-selectin) and parameters of immune activation and disease progression, 51 HIV infected children and 15 healthy controls were studied. Serum L-selectin concentrations were significantly higher in HIV infected children than in the control group. Levels of sL-selectin were higher in HIV infected patients with severe immunologic suppression than in those with moderate or no evidence of suppression. A positive correlation between sL-selectin levels and LTCD8 counts, sL-selectin and soluble intercellular adhesion molecule-1 (sICAM-1) and immunogobulin A (IgA) levels was detected. On the contrary sL-selectin concentration did not correlate with plasmatic viral load. The correlation with parameters of immune activation may implicate involvement of sL-selectin in the immunopathogenesis of HIV infection.

Prognostic value of soluble intercellular adhesion molecule-1 (s-ICAM-1) in HIV-infected children.

Central events in the host defence system and immune-mediated damage are tightly regulated by cell adhesion molecules. Sera from 28 human immunodeficiency virus (HIV)-1 infected children divided into groups according to disease severity, six seroreverting (SR) children and 25 healthy controls were studied to detect the presence of soluble intercellular adhesion molecule-1 (s-ICAM-1). Soluble ICAM-1 levels were found to be significantly increased in HIV-infected children in comparison with SR children or healthy controls. Levels of soluble ICAM-1 were higher in patients with severe forms of HIV-infection than in those with a milder form of the disease. Significant differences in titers of s-ICAM-1 were recorded between SR children and HIV-infected children with mild disease or healthy controls. There was a significant correlation between s-ICAM-1 levels and the concentrations of beta 2 microglobulin (beta 2m) and, to a lesser extend, immunoglobulin A levels (IgA). Soluble ICAM-1 levels didn't change considerably in HIV-infected children in stable clinical conditions, independently of their clinical stage of the disease, during a follow-up period of 9-12 months. Conversely, s-ICAM-1 levels increased simultaneously with the appearance of new well-defined clinical disorders or decreased during the improvement of clinical conditions. A significant negative correlation was recorded between the titers of the s-ICAM-1 and the CD4(+) T-cell levels. These results suggest that the s-ICAM-1 might be another useful tool to evaluate disease progression.

[Soluble intercellular adhesion molecule-1 (ICAM-1) levels in HIV infected children]. / Niveles séricos de la forma soluble de la molécula de adhesión intercelular 1 (s-ICAM-1) en la infección por HIV en niños.

Intercellular adhesion molecule-1 (ICAM-1) is a membrane bound molecule that is involved in cell to cell adhesive interactions within the immune system. The aim of this study was to measure the concentrations of soluble ICAM-1 (s-ICAM-1) in 25 HIV-1 infected pediatric patients. We compared s-ICAM-1 values to parameters of immune activation--such as IgA and beta 2 microglobulin (beta 2 m) and viral replication such as adenosine deaminase (ADA). s-ICAM-1 levels were found to be significantly increased in HIV-1 infected children when compared with healthy controls. Levels of s-ICAM-1 were higher in patients with severe forms of HIV-1 infection in comparison with those with a mild form of the disease or non symptomatic infection. No differences in titers of s-ICAM-1 were recorded between seroreverters and healthy controls. A positive correlation between levels of s-ICAM-1 and IgA, beta 2 m or ADA concentrations was detected. Similarly, there was statistically significant correlation between levels of IgA, beta 2 m or ADA. In conclusion, increased s-ICAM-1 levels in HIV-1 pediatric patients appeared to be another important feature among the immune disturbances triggered by HIV-1 infection. s-ICAM-1 might be involved in the development of the immunologic dysfunction during the progression of the disease.

Niveles séricos de la forma soluble de la molécula de adhesión intercelular 1 (s-ICAM-1) en la infección por HIV en niños. / [Soluble intercellular adhesion molecule-1 (ICAM-1) levels in HIV infected children]

Intercellular adhesion molecule-1 (ICAM-1) is a membrane bound molecule that is involved in cell to cell adhesive interactions within the immune system. The aim of this study was to measure the concentrations of soluble ICAM-1 (s-ICAM-1) in 25 HIV-1 infected pediatric patients. We compared s-ICAM-1 values to parameters of immune activation--such as IgA and beta 2 microglobulin (beta 2 m) and viral replication such as adenosine deaminase (ADA). s-ICAM-1 levels were found to be significantly increased in HIV-1 infected children when compared with healthy controls. Levels of s-ICAM-1 were higher in patients with severe forms of HIV-1 infection in comparison with those with a mild form of the disease or non symptomatic infection. No differences in titers of s-ICAM-1 were recorded between seroreverters and healthy controls. A positive correlation between levels of s-ICAM-1 and IgA, beta 2 m or ADA concentrations was detected. Similarly, there was statistically significant correlation between levels of IgA, beta 2 m or ADA. In conclusion, increased s-ICAM-1 levels in HIV-1 pediatric patients appeared to be another important feature among the immune disturbances triggered by HIV-1 infection. s-ICAM-1 might be involved in the development of the immunologic dysfunction during the progression of the disease.

Haptoglobina y a1-antitripsina: proteínas de valor predictivo en la progresión del SIDA pediátrico / Haptoglobin and A1-antitrypsin: prognosis value in pediatric AIDS

El propósito de este trabajo fue determinar la utilidad de la heptoglobina (HP), a1-antitripsina (a1-AT), transferrina (TRF) y pre-albúmina (PA) en el SIDA pediátrico como marcadores de progresión de enfermedad. En este estudio, se utilizó la clasificación del Centro de Control y Prevención de Enfermedades (CDC), 1994. Para evaluar el comportamiento de estas proteínas en relación a los principales parámetros usados en esta clasificación, es decir la sintomatología clínica y el grado de compromiso inmunológico, los pacientes se reagruparon de acuerdo a estos parámetros en dos categorías: considerando la sintomatología clínica (N-A-B-C), y de acuerdo al grado de compromiso inmunológico (EI 1- EI 2- EI 3). Hp, a1-AT, TRF y PA son proteínas sintetizadas en el hígado. La HP y la a1-AT, pertenecientes a las proteínas reactantes de fase aguda, aumentan significativamente sus niveles plasmáticos en la inflamación e infección mientras que la TRF y la PA, proteínas de vida media corta, disminuyen sus niveles en diversas enfermedades hepáticas. Se estudiaron 53 niños infectados por el virus HIV, 27 niños y 26 niñas con edades comprendidas entre 2 meses y 10 años y 30 niños sanos como controles (Co). Dentro de la categoría clínica, los niveles de todas las proteínas estudiadas fueron similares (p > 0,05) entre los distintos grupos de pacientes HIV y los controles. Sin embargo, de acuerdo al grado de compromiso inmunológico, se observó una disminución significativa (p < 0,05) en los niveles plasmáticos de HP en pacientes HIV con evidencias de inmunosupresión severa (EI 3) con respecto a pacientes HIV con evidencia de inmunosupresión moderada (EI 2) y a los controles (EI 3: n = 8 x ñ ES = 77 ñ 25; EI 2: n = 23, x ñ ES = 193 ñ 19; Co: n = 30, x ñ ES = 193 ñ 90 mg por ciento). Por otro lado, se observó un aumento significativo (p < 0,05) en los niveles de a1-AT en EI 2 con respecto a los pacientes HIV- sin compromiso inmunológico (EI 1) y a los controles, manteniéndose dichos niveles en EI 3 (EI 3: n = 8, x ñ ES = 404 + 34; EI 2: n = 23, x ñ ES = 353 ñ 24; EI 1: n = 22, x ñ ES = 277 ñ 33; Co: n = 30, x ñ ES = 260 ñ 80 mg por ciento). Contrariamente, los niveles plasmáticos de TRF y PA fueron similares entre los distintos grupos de la categoría inmunológica...

Haptoglobina y a1-antitripsina: proteínas de valor predictivo en la progresión del SIDA pediátrico / Haptoglobin and A1-antitrypsin: prognosis value in pediatric AIDS

El propósito de este trabajo fue determinar la utilidad de la heptoglobina (HP), a1-antitripsina (a1-AT), transferrina (TRF) y pre-albúmina (PA) en el SIDA pediátrico como marcadores de progresión de enfermedad. En este estudio, se utilizó la clasificación del Centro de Control y Prevención de Enfermedades (CDC), 1994. Para evaluar el comportamiento de estas proteínas en relación a los principales parámetros usados en esta clasificación, es decir la sintomatología clínica y el grado de compromiso inmunológico, los pacientes se reagruparon de acuerdo a estos parámetros en dos categorías: considerando la sintomatología clínica (N-A-B-C), y de acuerdo al grado de compromiso inmunológico (EI 1- EI 2- EI 3). Hp, a1-AT, TRF y PA son proteínas sintetizadas en el hígado. La HP y la a1-AT, pertenecientes a las proteínas reactantes de fase aguda, aumentan significativamente sus niveles plasmáticos en la inflamación e infección mientras que la TRF y la PA, proteínas de vida media corta, disminuyen sus niveles en diversas enfermedades hepáticas. Se estudiaron 53 niños infectados por el virus HIV, 27 niños y 26 niñas con edades comprendidas entre 2 meses y 10 años y 30 niños sanos como controles (Co). Dentro de la categoría clínica, los niveles de todas las proteínas estudiadas fueron similares (p > 0,05) entre los distintos grupos de pacientes HIV y los controles. Sin embargo, de acuerdo al grado de compromiso inmunológico, se observó una disminución significativa (p < 0,05) en los niveles plasmáticos de HP en pacientes HIV con evidencias de inmunosupresión severa (EI 3) con respecto a pacientes HIV con evidencia de inmunosupresión moderada (EI 2) y a los controles (EI 3: n = 8 x ñ ES = 77 ñ 25; EI 2: n = 23, x ñ ES = 193 ñ 19; Co: n = 30, x ñ ES = 193 ñ 90 mg por ciento). Por otro lado, se observó un aumento significativo (p < 0,05) en los niveles de a1-AT en EI 2 con respecto a los pacientes HIV- sin compromiso inmunológico (EI 1) y a los controles, manteniéndose dichos niveles en EI 3 (EI 3: n = 8, x ñ ES = 404 + 34; EI 2: n = 23, x ñ ES = 353 ñ 24; EI 1: n = 22, x ñ ES = 277 ñ 33; Co: n = 30, x ñ ES = 260 ñ 80 mg por ciento). Contrariamente, los niveles plasmáticos de TRF y PA fueron similares entre los distintos grupos de la categoría inmunológica... (AU)

[Tuberculosis and immigrants. A study of its prevalence in the Umbria region]. / Tubercolosi ed immigrati. Uno studio di prevalenza nella Regione Umbria.

In 1995, 463 patients were admitted in the medical service of Perugia (Sanitary District n. 6). Only 20% of them were enrolled in the TBC programme. Mantoux was: < 10 mm in 35%, 10-15 mm in 25%, > 15 mm in 40%. Chest Rx in 30 subjects demonstrated: normality in 19; old TBC in 7, active TBC in 4 (miliary, bilateral upper lobe pneumonitis, left subapical upper lobe pneumonitis and right lobitis of the upper lobe). All patients were admitted in hospital and showed positive sputum culture for Mycobacterium Tuberculosis. They were treated with isoniazid, rifampin, pyrazinamide, ethambutol/streptomycin for 2 months and with isoniazid, rifampin for other 4-8 months. Two patients showed Mycobacterium tuberculosis with isoniazid resistance. Seven patients were treated with isoniazid chemoprophylaxis without side effects. Migrants should receive information about health care service and be encourage to register themselves with a general practitioner. Skin test screening and chest radiographs for those with positive results should be provided at a convenient location.

X-linked mental retardation, microcephaly, and growth delay associated with hereditary bullous dystrophy macular type: report of a second family.

We report on 2 patients with mental retardation and bullous dystrophy, macular type. The observation of the condition in a male and his maternal uncle is consistent with recessive X-linkage. Due to the rarity of the condition, nosologic definition was difficult before the birth of the propositus. The clinical picture in the two patients described, characterized by mental retardation, dwarfism, microcephaly, alopecia, bullous dystrophy macular type, hypogenitalism, is very much like the one observed in the patients, all males, belonging to the only other family reported to date. The recent localization of the bullous dystrophy gene in the Xq24-qter segment opens the possibility of prenatal diagnosis.

[The Chernobyl accident. Evaluation of the doses absorbed by the thyroid gland in children of a mountain community from the measurement of I131 retained activity]. / Incidente di Chernobyl. Valutazione della dose assorbita dall tiroide nei bambini di una Comunità Montana a partire dalle misure di attività ritenuta di I131.

I131 thyroid uptake after the Chernobyl's accident was sampled in a Val Pellice school. Children were grouped according to sex, age and area of residence. The procedure used in collecting data and calculating the transformation coefficients from activity counts by computer simulation is analysed, as are the errors and sensitivity of the method. The activities were then converted into doses using an intake model. The dose levels identified are lower than the estimates based on the measurement of environmental matrices. Statistical analysis revealed certain subgroups with significantly different levels of absorption: particularly groups accustomed to a different diet or living in particular areas.

[Reduction of doses in teleradiography of the spine. Criteria of radiation protection and studies of dosimetry]. / Riduzione della dose nella teleradiografia del rachide. Criteri radioprotezionistici e ricerche dosimetriche.

To reduce the radiation exposure during full spine X-ray examinations, the following techniques were instituted: 72" tube to film distance; X-ray beam collimation; fast screen-film combination (rare earth gradual screens with high speed films); additional compensation filters; shielding of the most radiation-sensitive organs. Dosimetric measurements are reported. A very high reduction in exposure, above all of breasts and gonads, was obtained, without significant loss in the quality of radiographs.

[Experimental dosimetric comparison between single tomography and multiple simultaneous tomography with Synchroplan in clinical practice]. / Confronto dosimetrico sperimentale tra tomografia singola e tomografia multipla simultanea con Synchroplan nella pratica clinica.

Reference is made to a dosimetric comparison between single tomography and simultaneous multiple tomography with Synchroplan in 10 patients subjected to nefroangiotomography. Data from several thermoluminescence dosimeters placed on different parts of the body were used in a careful statistical analysis that showed the absence of significant differences in absorbed dose in function of constitutional habitus. It was also found that the dose absorbed for 6 tomograms of the renal cavities in single tomography was about 4 times higher than with the Synchroplan (using a previously experimented set of high-sensitivity intensifying screens), which provides 6 tomograms in the same dynamic phase at different levels for the same exposure.

[A method of quality control in thermoluminescent dosimetry]. / Un metodo di controllo di qualità in dosimetria a termoluminescenza.

This work suggests a quality control method for thermoluminescent dosimetry. For each set of dosemeters, read-out has been made at increasing values of dose, on the base of predetermined conditions in different read-out techniques and from different operators. The statistical analysis of each possible group of T.L.D. permitted us to draw the error-response curves and the relative precision profiles and to select the best evaluation techniques and the best operator on the base of precision, sensitivity and useful range.