Postmenopausal vulvovaginal atrophy (VVA) is positively improved by topical hyaluronic acid application. A prospective, observational study.

OBJECTIVE: To evaluate the effectiveness of a topical vaginal preparation containing hyaluronic acid in controlling signs and symptoms correlated with postmenopausal vulvovaginal atrophy (VVA). PATIENTS AND METHODS: A prospective, observational study has been performed at the Obstetrics and Gynecology Department of the Vita Salute San Raffaele University of Milan, Italy. Forty-six (46) consecutive postmenopausal women complaining of genital discomfort due to postmenopausal estrogen lack have been enrolled. All patients have been investigated by the use of the Vaginal Health Index (VHI) and of a Visual Analogic Scale (VAS) of symptoms at baseline and one month after the end of the study. The treatment protocol consisted of the administration of a hyaluronic acid-based liquid preparation for vaginal use (Justgin®, Just Pharma, Rome, Italy) three times a week, for a total of 8 weeks. Statistical analysis of VHI and VAS scores has been performed by the use of the Wilcoxon signed-rank test for repeated values, assuming a p-value < 0.05 as significant. RESULTS: Both Vaginal Health Index (VHI) and Visual Analogic Scale (VAS) of genital symptoms showed statistically significant (p < 0.0001) improvements at the end of the study protocol. Patients' degree of satisfaction at the end of treatment was reported as high. CONCLUSIONS: Conventional treatment of the postmenopausal syndrome, either in terms of systemic and genital symptoms, is based on hormonal replacement therapy (HRT). The limitations to this approach are represented by the need to discontinue the treatment after some years and the contraindications that some women present about the estrogens. For these reasons, alternative approaches have been recently investigated and indicate promising perspectives. Hyaluronic acid topical approach with a liquid preparation for vaginal use (Justgin®, Just Pharma, Roma, Italy) to control signs and symptoms of vulvovaginal atrophy (VVA) in postmenopausal women demonstrated significant effectiveness both in terms of objective and subjective improvement.

Prevalence of Borrelia Burgdorferi sensu lato genomospecies and of the human granulocytic ehrlichiosis (HGE) agent in Ixodes ricinus ticks collected in the area of Monti Lepini, Italy.

Ticks are obligate hematophagous arthropods that are parasites in every class of vertebrates in most regions of the world. They are also considered to be important vectors for the transmission of human infectious diseases. In the present study we used polymer chain reaction (PCR) amplification analysis to determine the prevalence of Borrelia burgdorferi and Ehrlichia phagocytophila, the agents of, respectively, Lyme borreliosis and human granulocytic ehrlichiosis, among ticks inhabiting the area of Monti Lepini, a wild area located in the Latium Region of Italy. A total of 141 I. ricinus ticks (125 nymphs and 16 adults) were collected in the studied area. Total DNAs were extracted from I. ricinus nymphs (pooled in groups of five) and from individual adults. The DNA samples were examined for the presence of B. burgdorferi sensu lato and E. phagocytophila by PCR using two specific pairs of oligonucleotides that specifically amplify distinct DNA regions of the 16S rRNA genes of the two species. The prevalence of vectors infected with B. burgdorferi s. l. was 16% in pooled nymphs samples, and 12.5% in adult ticks, while E. phagocytophila was found only in pooled nymphs samples (8%). Three genomospecies were identified, namely Borrelia afzelii, Borrelia garinii, and Borrelia valaisiana, in samples found positive for B. burgdorferi s. l. No sample was found positive for Borrelia burgdorferi sensu stricto.

Can breast-feeding protect against schizophrenia? Case-control Study.

BACKGROUND: Human milk, unlike formula feeds, contains long-chain polyunsatured fatty acids, such as docosahexaenoic acid and arachidonic acid which are essential in the development of the central nervous system. If human milk is the optimal food for brain development, and if schizophrenia is a neurodevelopment disorder, might people who become schizophrenic in adult life be less likely to have been breast-fed? AIMS: To compare the incidence and length of breast-feeding in patients, siblings and normal controls and to examine the relationship between the duration of breast-feeding and age at onset of schizophrenia. METHOD: 113 schizophrenic patients were recruited, as were 140 siblings of the patients and 113 nonschizophrenic controls. The breast-feeding history of the patients, their siblings and controls was obtained through interviews with the mothers of the patients and controls. RESULTS: There were no significant differences between groups in the incidence of breast- feeding. The duration of breast-feeding was positively correlated with the age at onset of illness (r = +0.25, p < 0.02). CONCLUSION: Breast-feeding is no less common in those who develop schizophrenia in later life. However, breast milk might postpone the onset of the illness in schizophrenic patients.

Helicobacter pylori: a eubacterium lacking the stringent response.

Accumulation of 16S rRNA and production of guanosine polyphosphates (pppGpp and ppGpp) were studied during amino acid starvation in three wild-type strains of Helicobacter pylori. All strains exhibit a relaxed phenotype with respect to accumulation of 16S rRNA. This constitutes the first example of a wild-type eubacterium showing a relaxed phenotype. The guanosine polyphosphate levels do not rise as a result of amino acid starvation, as expected for relaxed organisms. However, in both growing and starved cells, basal levels of the two polyphosphates appeared to be present, demonstrating that the enzymatic machinery for guanosine polyphosphate production is present in this organism. These findings are discussed within the framework of the hypothesis that stringent control is a physiological control mechanism more important for the fitness of prokaryotes growing in the general environment than for those that inhabit protected niches.

Benefits of direct glomerular filtration rate (GFR) determination versus creatinine-based tests for evaluating renal function.

To diagnose renal disease earlier and thereby reduce the number of patients with endstage renal disease, accurate, specific diagnostic tests are necessary. The author explains the benefits of using tests that rely on the glomerular filtration rate measurement rather than on traditional creatinine-based diagnostic tests.

Antigenic profiles for the differentiation of Mobiluncus curtisii and Mobiluncus mulieris by immunoblotting technique.

The antigenic profile of 30 vaginal isolates of Mobiluncus strains (22 M. curtisii and 8 M. mulieris) was determined by immunoblotting technique using mouse immune ascitic fluids containing polyclonal antibodies against the type strains M. curtisii subsp. holmesii (ATCC 35242) and M. mulieris (ATCC 35243). Two antigenic profiles were identified within M. curtisii isolates, whereas a certain variability was observed among M. mulieris strains where at least three antigens were constantly recognized. The detection of antigenic profiles of Mobiluncus strains by immunoblotting technique provided a simple method to identify Mobiluncus isolates at the species level.

Ligation of nonmatching DNA molecule ends.

T4 DNA ligase can promote the in vitro ligation of blunt DNA ends to ends bearing a 2-nucleotide single-stranded protrusion. This was shown by digestion of plasmids pBR322 and pSP71 with the appropriate restriction enzymes followed by recircularization of the plasmids and transformation of Escherichia coli. It could be ruled out that such nonmatching ligations are due to the presence of contaminating nucleases. The efficiency of ligation is of the same order of magnitude as that obtained with blunt end ligations. The interaction of a number of different combinations of blunt and sticky ends, the latter bearing both 3' and 5' protrusions, was investigated. Ligation of nonmatching ends was shown to take place in all cases. Several ligation junctions were sequenced, showing that during the ligation process the 2-nucleotide protrusion is trimmed away. In two instances the ligation event was accompanied by the specific loss of either 3 or 15 nucleotide pairs as well as the protrusion. An intermolecular ligation involving nonmatching ends was also performed, demonstrating that this form of ligation can be usefully employed in molecular cloning experiments.

Lack of production of (p)ppGpp in Halobacterium volcanii under conditions that are effective in the eubacteria.

The stringent halobacterial strain Haloferax volcanii was subjected to a set of physiological conditions different from amino acid starvation that are known to cause production of guanosine polyphosphates [(p)pp Gpp] in eubacteria via the relA-independent (spoT) pathway. The conditions used were temperature upshift, treatment with cyanide, and total starvation. Under none of these conditions were detectable levels of (p)ppGpp observed. This result, in conjunction with our previous finding that (p)ppGpp synthesis does not occur under amino acid starvation, leads to the conclusion that in halobacteria both growth rate control and stringency are probably governed by mechanisms that operate in the absence of ppGpp. During exponential growth, a low level of phosphorylated compounds with electrophoretic mobilities similar, but not identical, to that of (p)ppGpp were observed. The intracellular concentration of these compounds increased considerably during the stationary phase of growth and with all of the treatments used. The compounds were identified as short-chain polyphosphates identical to those found under similar conditions in Saccharomyces cerevisiae.

Stringency and relaxation among the halobacteria.

Accumulation of stable RNA and production of guanosine polyphosphates (ppGpp and pppGpp) were studied during amino acid starvation in four species of halobacteria. In two of the four species, stable RNA was under stringent control, whereas one of the remaining two species was relaxed and the other gave an intermediate phenotype. The stringent reaction was reversed by anisomycin, an effect analogous to the chloroamphenicol-induced reversal of stringency in the eubacteria. During the stringent response, neither ppGpp nor pppGpp accumulation took place during starvation. In both growing and starved cells a very low basal level of the two polyphosphates appeared to be present. In the stringent species the intracellular concentration of GTP did not diminish but actually increased during the course of the stringent response. These data demonstrate that (i) wild-type halobacteria can have either the stringent or the relaxed phenotype (all wild-type eubacteria tested have been shown to be stringent); (ii) stringency in the halobacteria is dependent on the deaminoacylation of tRNA, as in the eubacteria; and (iii) in the halobacteria, ppGpp is not an effector of stringent control over stable-RNA synthesis.

Dog-transmitted zoonoses: a serological survey in the province of Bologna.

Eight hundred and two sera of owned dogs from four small towns north-west of Bologna were examined for the presence of antibodies against Coxiella burnetii and Leishmania infantum. At the same time, 149 sera of 69 dog owners from the same area were tested for the presence of antibodies to Q fever, leishmaniasis, echinococcosis/hydatidosis and toxocarosis. Of the 802 dog sera, 7 (0.87%) were positive for Q fever. Of the 69 dog owners, 24 (35%) were positive for Q fever, 4 (6%) for echinococcosis/hydatidosis and 3 (4%) for toxocarosis. Some epidemiological evaluations are made on the possible role played by the dog in spreading the zoonoses considered, at least in the area examined.

Annulus fibrosus calcification in the cervical spine: radiologic-pathologic correlation.

Intervertebral disc calcification can be secondary to a variety of pathologic processes including some of the arthritides, metabolic diseases, and trauma. The annulus fibrosus is the most commonly calcified component and may mimic vertebral body fracture, limbus vertebra, or a persistent ring apophysis. We describe two young patients who developed calcification in the anterior annulus fibrosus and present radiologic-pathologic correlation in this condition in another case. This calcification may actually be secondary to subclinical or chronic stress on the involved intervertebral disc.

The esophageal-pleural stripe: an update.

Observations on the esophageal-pleural stripe were amplified by computed tomography. The relationship of the esophagus to the trachea is variable and, at times, the two may be side by side, the esophagus to the left. Under this condition, the naturally air-filled esophagus may mimic mediastinal emphysema or tracheomegaly; the barium-filled esophagus may mimic displacement by a mediastinal tumor.

A general radiologist looks at congestive heart failure.

Congestive heart failure may be difficult to detect. Determination of cardiac size is untrustworthy. Changes in the hili (vessels, bronchi) are reliable. Pulmonary edema may be atypical. Vascular redistribution must be interpreted accurately. Congestive changes with chronic obstructive lung disease may be difficult or impossible to detect. Pleural fluid may present atypically. Changes in pleural surfaces other than in bases produce "new" signs.

Let us not lose echocardiography.

Despite the unquestioned value of echocardiography in the diagnosis of valvular disease, pericardial effusion, cardiomyopathy and many other cardiac conditions, few residency programs in radiology are offering training in echocardiography. Echocardiograms of the last 100 consecutive patients in a small community hospital demonstrated a surprising breadth of clinical material. Echocardiography should be included in every residency program lest our role in this technique is lost altogether.

Further refinements in the plain radiologic diagnosis of splenic rupture: the air enema.

Plain film radiography, by appraisal of the soft tissues of the descending colon and left paracolonic gutter, comprises a safe, accurate, and quick determination of the presence of free fluid, which, in the proper clinical setting, indicates splenic rupture. The air enema, introduced under fluoroscopic control, is a valuable aid in eliminating false negatives and false positives, and also in distinguishing intraperitoneal clots from subserosal hematoma. The preoperative diagnosis was correct in 27 of 28 cases. The one error occurred in a case in which the interpretation of paravesical fluid (dog ears) was faulty, and in which the air enema had not been used.