Changes in admissions, and hospitalization outcomes of IBD patients in an Italian tertiary referral center over a 13-year period.

OBJECTIVE: The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center. PATIENTS AND METHODS: Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed. RESULTS: Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions. CONCLUSIONS: Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

Assessing graduate perioperative education.

You may be one of many perioperative nurses who are considering graduate education. Although there are some obstacles to this goal, they are not insurmountable. This article examines the motivators and obstacles to master's-level nursing education. The educational options, assessment criteria, and admission process are described.

[Smoking in a sample of nursing students in Genoa. Reflections on the role of professional educators]. / Abitudine al fumo di un campione di allievi infermieri genovesi. Riflessioni sul ruolo educativo della professione.

Of all European Union member states, Italy has one of the highest rates of smokers among health care personnel. One important step towards the development of a "prevention-oriented culture" is the raising of the awareness of professional working in health care structures in order to involve them in preventive actions, this making these more effective. Before undertaking measures of this kind, it is imperative to first assess the extent of the smoking habit, even at the local level, so as to target actions as precisely as possible. We herein present the results of a study carried out in two professional nursing schools of the Province of Genoa (I). In all, 341 subjects, aged between 18 and 34, were interviewed. Findings show a high percentage of smokers among both sexes, with 50.0% of males and 40.0% of females claiming to be smokers. These figures are well above national averages (32% of males and 26% of females in the national population). The age at which most interviewees began smoking ranged from 15 to 18 years; however, a rather high percentage of respondents (25.1% for males and 26.1% for females) began after 18 years of age. Our results confirm the importance of school age oriented health education programs, but highlight as well the usefulness of similar awareness initiatives for future professionals. The Italian League for the Fight Against Cancer and the Italian Association of Cancer Nurses propose to vocational training schools a collaborative effort aiming to promote healthy lifestyles among nursing students and to re-assess the role of trainers.

Osteoblastic cells from rat long bone. II: Adhesion to substrata and integrin expression in primary and propagated cultures.

Propagation in vitro of rat tibial osteoblasts (ROB) is accompanied by increased expression of the early osteogenic marker alkaline phosphatase (AP) and maturation of the osteogenic phenotype. In order to establish the pattern of the integrin expressed in ROB during progression to the mature osteoblastic phenotype, we have used biosynthetic, immunoblotting and immunohistochemical assays. We immunoprecipitated from osteoblasts, expanded for 1.5- and 7.5-doubling, alpha 5 beta 1, alpha v beta 3, alpha 3 beta 1, alpha 6 beta 1 and alpha 1 beta 1 integrin heterodimers; furthermore beta 5, alpha 2 and alpha 4 chains were detected by immunoblots and indirect immunofluorescence. alpha v, alpha 1, alpha 6 subunits in most cells, and beta 3 and beta 1 subunits in a minority, were found to be associated with adhesion plaques in osteoblasts of 1.5-, 4.5- and 7.5-doubling grown in the presence of FCS, while all other subunits stained diffusely all the cells. Adhesion to fibronectin (FN), laminin (LN), collagen type I (COL I) and III(COL III) by ROB at different doubling (1.5-11) was dependent on substratum concentration, and after 2.5 h at 55 nM 60% of the cells adhered to all substrata. Arg-Gly-Asp-Ser (RGDS) containing peptides inhibited adhesion of cells differentially, according to substratum; no dependence on extent of progation in vitro was observed. In conclusion, ROB cultured in vitro for 1.5- to 11-doubling had an unchanged pattern of expression of integrin subunits, heterodimer association and cellular distribution. Adhesion specificity and affinity were also unchanged. These results suggest that the phenotypic maturation, detected as an increase in AP expression, is not accompanied by major changes in the potential for cell-matrix interactions, and does not correspond to changes in the type of integrin subunits expressed by osteoblasts.

Integrin synthesis and utilization in cultured human osteoblasts.

This study describes the adhesion of human osteoblasts, cultured in vitro, to proteins of the extracellular matrix, the biosynthesis of integrins, their topography and organization in focal contacts. The adhesion of osteoblasts to laminin, type I collagen, vitronectin and fibronectin was 77-100%, in 2 h and at 55 nM substrata concentration, and it was accompanied by spreading of the cells. Adhesion to fibronectin (FN), laminin (LN) and type I collagen (COL) was inhibited by antibodies to the beta 1 integrin and antibodies to the alpha 5 chain affected adhesion only to fibronectin. Using a panel of polyclonal antibodies against alpha 2, alpha 3, alpha 5, alpha v, beta 1 and beta 3 integrins we detected synthesis of alpha 3 beta 1, alpha 5 beta 1, alpha v beta 3, and an alpha v beta 1-like dimer by immunoprecipitation of metabolically labelled cell lysates. Studies of immunolocalization demonstrated the presence of the same integrins identified in lysates, plus alpha 4, alpha 1 and beta 5 subunits. In cells adhering in the presence of serum we showed organization of beta 3 and alpha v integrins in focal contacts. In cells adhering to fibronectin alpha 5 and beta 1 integrins were localized in focal contacts. In cells spread on laminin or type I collagen none of the integrins investigated was localized in focal contacts.

Ten years of anti-smoking programs in Italy: a review.

A diverse anti-smoking program for the prevention of cancer and cardiovascular diseases has been ongoing in Italy since 1981, coordinated by the National Cancer Institute of Genoa and the Italian League Against Cancer of Genoa. The program includes several initiatives addressed to different target groups; schoolchildren and teachers, military personnel, doctors and nurses, and women. A preliminary inquiry on the attitudes and habits towards smoking was implemented by the distribution of questionnaires to the various groups involved in the program. An annual school-based anti-smoking program involves about 10,000 students aged four to 18 and their teachers. Meetings are delivered by experts to groups of 20 to 40 students with the aid of specific audiovisual material, which are periodically updated. Additional informative material, leaflets, and posters are distributed to both schoolchildren and teachers. Another educational program on primary prevention of smoking-related health hazards is addressed to military recruits, career soldiers, and medical officers. It consists of several initiatives: training of military doctors and nurses, lectures to military recruits, and distribution of informative material in the barracks. An annual meeting is organized to discuss program implementation and results. Surveys are carried out by distributing an anonymous questionnaire to health professionals in several Italian hospitals to assess the smoking habits of doctors and their attitudes and practices towards counseling patients against smoking. The results show marked differences in smoking habits in the cities under study. Annually since 1983, an updated course is organized and addressed to teachers of primary and secondary schools in Genoa. The aim of the course is to train school personnel and to help them to implement prevention programs in the schools, with the aid of experts in the field of prevention. A series of initiatives are addressed to women at different ages to sensitize them not only to the more common tobacco risks but also those regarding pregnancy, oral contraception, and so on. The survey was conducted on a representative sample of 12- to 65-year-old female population groups. It is the first of this kind in Italy to ascertain trends in smoking behavior among Italian women in relation to age, educational achievement, and occupation.

Campaigns against smoking: compliance and results.

Smoking has become a true epidemic that interests a lot of people in the world. The antismoking programmes are at these moments the most important strategy to prevent lung cancer and cardiovascular diseases. This article analyses the compliance and the results of the antismoking campaigns in the world. Data show the long term efficacy of school based smoking prevention programmes and underline their importance even if the methodologies can be different in the various countries. Other data show that the percentage of young smokers is increasing during the last three years; for this reason it is necessary to implement everywhere new programmes against smoking.

[Correlations between membrane integrins and granulocyte defects in myelodysplastic syndromes]. / Correlazione tra integrine di membrana e difetti dei granulociti nelle sindromi mielodisplastiche.

The aim of the present study was to evaluate some functions of neutrophil granulocytes (PMNs), such as aggregation, superoxide production, chemotaxis and adhesion molecules involved in these processes, in 22 patients suffering from Myelodysplastic Syndrome (MDS), to clarify if granulocytes alterations described in this syndrome is really correlated with the expression of surface membrane integrins. Several patients suffering from MDS present granulocytopenia and/or absolute monocytoses; neutrophil granulocytes can have typical nuclear and cytoplasmatic alterations. These granulocytic anomalies are valuable in about 90% of patients suffering from MDS. The granulocytes showed a significant deficit in chemotaxis stimulated by serum activated with E. Coli, casein and formyl-methionyl-leucylphenylalanine (fMLP) (p < 0.01) and in superoxide production stimulated by phorbol-myristate-acetate (PMA). We also studied the role of membrane integrin CD11/CD18 using specific monoclonal antibodies (MoAb). The cytofluorimetric analysis demonstrated a significant inhibition in expression of CD11b/CD18 receptors in patients suffering from MDS (p < 0.001), while the expression of CD11a/CD18 and CD11c/CD18 receptors was normal. In conclusion we found specific alterations in PMNs functions in MDS and a correlation of these anomalies with membrane integrins of PMNs is therefore possible.

Modulation of integrins expression during human osteoblasts "in vitro" differentiation.

We here report the modulation of the adhesion of cultured human osteoblasts on Laminin during the acquisition of differentiated phenotype. We also show that interference with the differentiation program caused by treatment with Retinoic acid of the cultures, causes changes of the capability to adhere to Laminin and type I Collagen. The younger or dedifferentiated cells have lower capability to bind to Laminin or Collagen. The maturation associated changes are specific for the adhesion to the above substrata and do not involve the adhesion to FN or plastic. The alpha subunit(s) of the integrin receptor(s) for these proteins is likely to be responsible for the modulation adhesion to Laminin and Collagen.

Differential expression of alkaline phosphatase in clones of human osteoblast-like cells.

We established cultures of cells growing out from adult bone chips and maintained them through 12 passages in culture. The cultures showed osteoblastic phenotype accompanied by synthesis of collagen type I, osteonectin, alkaline phosphatase, and osteocalcin. We report the characterization of 21 clones obtained from three different individual primary cultures. We studied the expression of osteonectin, alkaline phosphatase, collagen, and osteocalcin in the clones. Metabolic labeling showed production of type I collagen and of osteonectin in all clones studied. In two-thirds of the clones and in mass cultures alkaline phosphatase was not detected at passage 2, but it was detected in increasing amounts at later passages in culture. The clones attained different but detectable levels of expression of this marker by passage 8. The different levels in the expression of alkaline phosphatase in positive clones may be because they were derived from cells at different stages of osteoblastic maturation or due to small changes in microenvironment. The alkaline phosphatase-positive clones were tested for osteocalcin, and they showed measurable expression only at passage 10. A third of the clones obtained were negative for alkaline phosphatase during 12 passages in culture. The obtainment of clones unable to produce alkaline phosphatase may be due to loss of differentiating potential under the in vitro culture conditions. The growth rate and potential of all clones studied were similar through 12 passages in culture, regardless of their potential for expression of alkaline phosphatase.

Immunologic cell markers of peripheral blood and lymph node lymphocytes in chronic lymphocytic leukemia.

The immunologic phenotype of the lymphocytes of 100 patients with chronic lymphocytic leukaemia (CLL) was investigated. Peripheral blood lymphocytes (PBL) were examined in all cases; in 46 patients with lymphadenopathy, a lymph node was biopsied and the histologic and immunologic patterns were assessed: 24 had a lymphocytic-lymphoplasmocytoid histology and 22 the follicular variant of lymphocytic lymphoma (mantle zone lymphoma, MZL). For comparison, lymph node suspensions from 19 patients with non-leukemic centrocytic lymphoma (CCL) were also studied. Significant differences in the PBL immunologic features were found between stage O and stage I patients. The phenotype of the lymphocytes of patients with lymphocytic histology was similar to that of stage 0 CLL patients, whereas major differences were found between these patients and those with mantle zone histology. This enables these patients to be recognized easily on immunologic grounds.

[Bone marrow culture in patients treated with Ticlopidine]. / Culture de moelle chez les sujets traités par la Ticlopidine.

Bone marrow cells obtained from 15 patients treated with Ticlopidine (500 mg/day) for a month, and from 20 matched controls were cultured in agar. GM colonies and clusters were counted after 7 and 14 days of culture. CFU GM were slightly decreased in the patients treated by Ticlopidine. In 8 patients, in which the bone marrow was cultured on a second occasion 3 months latter, a slight increase in the inhibition of CFU GM was observed. It could be due to the mechanism of action of the drug (by an increased synthesis of PGE1) and not to a toxic side effect. The few cases of reversible agranulocytosis reported in the literature might be due to the inhibition of myelopoiesis in patients with medullary reserves already impaired.

PHA-induced human T cell colony formation: enhancing effect of large granular lymphocytes.

The capacity of phytohemagglutinin (PHA)-stimulated human T cells to develop into colonies in agar has been evaluated in the presence or absence of a variety of peripheral blood mononuclear cell subsets. A subpopulation of non-T, non-B cells with receptors for the Fc portion of IgG (i.e. third population cells or TPC) was found to enhance considerably the T cell colony forming capacity. Since TPC have been previously shown to be highly enriched for large granular lymphocytes (LGL, i.e. cells with cytoplasmic azurophilic granules and acid hydrolases), LGL were purified on Percoll density gradients and tested for their T cell colony enhancing capacity. It was shown that LGL were indeed the cells capable of enhancing the T cell colony formation.

Polyclonal lymphadenopathy presenting as plasma cell leukemia with reversible renal insufficiency.

A case is reported of an elderly patient with generalized lymphadenopathy who, at presentation, showed a blood and bone marrow picture suggestive of plasma cell leukemia, polyclonal hypergammaglobulinemia restricted almost exclusively to IgA, and severe renal insufficiency. Treatment with melphalan and prednisone produced a complete remission that lasted only 1 month. A second partial remission was obtained, but the patient eventually died of heart failure. The pathological picture of the lymph nodes and spleen was intermediate between that of angioimmunoblastic lymphadenopathy (AIL) and of the plasma cell type of giant lymph node hyperplasia (Castleman's disease). The hypothesis is presented that AIL, Castleman's disease and many other polyclonal lymphadenopathies recently described in immunodeficient or elderly patients, including the present case, represent a continuous spectrum of lymphoproliferative disorders due to abnormal responses to various stimuli.

[Immunopathological characteristics of the lymphocytes of chronic lymphocytic leukemia, fractionated on gradients of various densities]. / Caratteristiche immunopatologiche dei linfociti di LLC frazionati su gradienti di varia densità.

Spontaneous rosettes and membrane immunofluorescence for the various classes of heavy and light immune globulin have been determined on lymphocyte subfractions obtained from the blood of 6 normal subjects and 16 patients with CLL by separation on gradients of various density. Whereas in the normal subject lymphocyte immunological features proved similar in all fractions, in CLL they presented significant differences from fraction to fraction, with the presence only in certain fractions of the lymphocyte peak with monoclonal membrane immune globulin and without peak coincidence for IgD and IgM, probably as a result of changes in the physico-chemical features of the lymphocytes occurring during maturation. All fractions presented a sizeable complement of lymphocytes not forming rosettes and without demonstrable membrane immune globulins. The correlation between the behaviour of membrane labels and lymphocyte morphology, stage, duration and course of the disease has been analysed. The variability in lymphocyte subfraction characteristics separable at different densities may explain discrepancies of findings in researches carried out in lymphocytes that separate only at gradient of density 1077.

Inferior venacavography for the staging of lymphomas.

Inferior venacavography was used for revealing enlarged retro- or paracaval lymph nodes, some of which are not visualized by lymphography as they lay above L 2. As criteria for involvement of lymph nodes the dislocation or narrowing of the vena cava and the reflux of contrast medium in the lumbar veins were studied. Venacavography was carried out in 48 consecutive patients with lymphomas: 23 Hodgkin's disease and 25 non-Hodgkin's lymphoma. Signs of enlargement of paracaval lymph nodes were seen in 52% of patients with Hodgkin's disease and in 80% of the cases of non-Hodgkin's lymphoma. A fairly good agreement was found to between lymphograms and cavograms. Cavography proved to be an easy, inexpensive and minimally invasive technique that can be repeated several times without inconveniencing the patients too much, thus enabling restaging of patients after therapy; moreover, it produced fairly good urograms as the contrast medium is promptly eliminated through the kidney, thus eliminating the need for intravenous pyelography.