Tethering of soluble immune effectors to mucin and chitin reflects a convergent and dynamic role in gut immunity.

The immune system employs soluble effectors to shape luminal spaces. Antibodies are soluble molecules that effect immunological responses, including neutralization, opsonization, antibody-dependent cytotoxicity and complement activation. These molecules are comprised of immunoglobulin (Ig) domains. The N-terminal Ig domains recognize antigen, and the C-terminal domains facilitate their elimination through phagocytosis (opsonization). A less-recognized function mediated by the C-terminal Ig domains of the IgG class of antibodies (Fc region) involves the formation of multiple low-affinity bonds with the mucus matrix. This association anchors the antibody molecule to the matrix to entrap potential pathogens. Even though invertebrates are not known to have antibodies, protochordates have a class of secreted molecules containing Ig domains that can bind bacteria and potentially serve a similar purpose. The VCBPs (V region-containing chitin-binding proteins) possess a C-terminal chitin-binding domain that helps tether them to chitin-rich mucus gels, mimicking the IgG-mediated Fc trapping of microbes in mucus. The broad functional similarity of these structurally divergent, Ig-containing, secreted effectors makes a case for a unique form of convergent evolution within chordates. This opinion essay highlights emerging evidence that divergent secreted immune effectors with Ig-like domains evolved to manage immune recognition at mucosal surfaces in strikingly similar ways. This article is part of the theme issue 'Sculpting the microbiome: how host factors determine and respond to microbial colonization'.

Ciprofloxacin versus chloramphenicol in the treatment of salmonella infection.

Strains of Salmonella typhi resistant to chloramphenicol and ampicillin have been isolated in several countries. This study compares treatment of Salmonella infection using ciprofloxacin (500 mg twice daily) for 10 days with chloramphenicol (50 mg/kg per day divided into four doses) for 14 days. The pathogen eradication rates for patients receiving ciprofloxacin was 18/20 (90%), compared with 25/28 (89%) for those who received chloramphenicol. Signs and symptoms in patients receiving chloramphenicol lasted longer and sometimes twice as long as patients treated with ciprofloxacin. In this study, ciprofloxacin was superior to cloramphenicol in the treatment of S. typhi infection and also had fewer side-effects and the convenience of a twice-a-day dosing

[Plasma HIV-1 RNA viral load up to one year of follow-up in 64 patients treated with HAART] / Follow up ad un anno della carica virale plasmatica di HIV in 64 soggetti trattati con HAART.

The aim of this study was to evaluate efficacy of highly active antiretroviral therapy (HAART) in 64 HIV-1 positive treatment-naive and previously treated patients, with different viral load at baseline. The HAART regimen consisted of one protease inhibitor and two reverse-transcriptase inhibitors. Plasma RNA viral load was measured by RT-PCR (Roche Amplicor Monitor kit) at enrolment and at months 3, 6, 9, and 12 of follow-up. The viral load fell below the threshold of 200 copies/ml in 46.9% of patients at month 6 and this result lasted up to month 12 of follow-up in 42.2% of patients. In these patients the CD4+ cell count increased from a baseline with a median of 194 cells/mmc at month 12. Treatment failure occurred in 35.9% of patients and the proportion was higher among previously treated patients. 7 patients stopped therapy because of poor compliance and 5 because of adverse drug effects. Also in our cases the HAART regimen showed more efficacy in treatment-naive patients, whereas baseline viral load >1x105 was the cause of less efficacy of therapy.

[Three sets of twins in three successive generations through the maternal line]. / Tre coppie di gemelle in tre generazioni successive nate da madri gemelle.

It is generally held that there are genetic factors for dizygotic (DZ) twinning, but the pattern of inheritance is far from clear. We report on a rare pedigree with three sets of spontaneous DZ female twin births in three successive generations. To our knowledge no similar pedigrees have been reported in literature. Zygosity determination in three pairs of twins was performed with ABO, MN and Rh blood groups from erythrocytes and with STR analysis from samples of saliva. In our pedigree, the direct transmission of the DZ twinning through the maternal line seems show an autosomal dominant pattern of inheritance. We believe that the inheritance of DZ twinning appears to be recessive in most case and autosomal dominant only in rare instances. It is plausible with the hypothesis that the expression of the dizygotic twinning trait in a mother shows a genetic heterogeneity.

24 hour monitoring of blood pressure in premature and full-term new born babies.

Using a 24 hour monitoring of the systo-diastolic blood pressure, 127 new born babies were studied in the first five days of life. 45 of these new born babies were premature (35 +/- 1 week) and 82 full-term. The results showed an overlap in the systo-diastolic blood pressure in the 2 groups of subjects with a rise and fall in pressure in the 24 hour period and no fall in pressure during the night typical to a healthy adult.

Efficacy of pneumatic dilatation for pyloric stenosis: an 18-month survey.

The efficacy of pneumatic dilatation with Rigiflex balloons as a treatment for pyloric peptic stenosis was tested in 18 patients. The patients underwent endoscopic dilatation in one sitting, the size of the balloons being gradually increased for a total of 3 minutes. Patients were also treated with omeprazole in the follow-up period. Pneumatic dilatation of upper digestive tract strictures has proved to be an effective and safe technique, showing remarkable advantages over the traditional surgical treatment. It could represent the first step in a therapeutic approach.

[Dietetic counseling of obese school child. Study in an elementary school]. / Suggerimenti dietetici per lo scolaro obeso. Indagine nella scuola elementare.

We controlled, after nine months, 29 obese children, who attended the primary school, and to whom it was advised a good balanced base diet of 1200 kcal. One child wasn't obese anymore, and in 13 cases there was a sensible reduction of overweight percentage. We consider these results positively, because our aim was to obtain a gradual resolution of the overweight, trying to avoid some very dangerous relapses for the young's future. Finally, we underline the necessity to begin some conferences about the young's and family's alimentary education, as soon as possible. These conferences have to be addressed to all the teachers, parents and pupils, from the primary school.

[Obesity and hypercholesterolemia in a primary school in Rome]. / Obesità ed ipercolesterolemia in una scuola elementare romana.

The research in particular the incidence of obesity, hypertension and hyperlipemia was evaluated involved 201 primary school children. The results show an obesity percentage equal to 28%; 23% of the young were hypercholesterolic and 21% had hypertriglyceridemia. Nobody was hypertensioned. The high percentage of obese and hjperlipemic subjects suggest the immediate needs of Courses of alimentary education in schools, as well as to resort to sound daily sporting activity.

Twelve-month omeprazole vs ranitidine in the treatment of Helicobacter pylori positive patients with healed duodenal ulcer.

We evaluated the results of a 12-month treatment using different regimens of omeprazole at the dose of 20 mg daily (three day week-end treatments and every other day) and of 150 mg nocte of ranitidine on Helicobacter pylori status and on preventing duodenal ulcer relapses in 140 Helicobacter pylori positive patients with healed duodenal ulcer. Only every-other-day omeprazole suppresses Helicobacter pylori after 3 month therapy (p < 0.001), after 6 months (p < 0.001) and 12 months (p < 0.05). After 3 months (T1) no significant effectiveness was found in the prevention of ulcer relapses by omeprazole and ranitidine. After 6 months (T2) a significant reduction of relapses (p < 0.05) was recorded when comparing every- other-day omeprazole to the weekend regimen. After 12 months every-other-day omeprazole treatment significantly reduced the relapses compared with the week-end therapy (p = 0.05) and with ranitidine (p < 0.05).

Octreotide treatment in secretory and cyrptosporidial diarrhea in patients with acquired immunodeficiency syndrome (AIDS): clinical evaluation.

Our objective was to evaluate the efficacy of octreotide in the treatment of AIDS patients with persistent diarrhea refractory to conventional therapy. We have treated 11 patients with AIDS related diarrhea (M/F-5/2, mean age 28 +/- 3 yr). The stool volume was in all pts > or = 21/24h. In 4 pts the diarrhea was secondary to cryptosporidium infection (Group A); in 7 pts the reason for the diarrhea could not be identified (Group B). Octreotide was administered in subcutaneous escalation doses, from 50 micrograms q8h to a maximum dose of 500 micrograms q8h. The minimal dose controlling symptoms was maintained for 21 days. In all patients stool volume and frequency decreased significantly. Group A pts were "partial responders" (stool 50% of initial daily volume); group B patients were "complete responders" (stools < 250-300 ml/day). Drug suspension resulted in a prompt return of diarrhea, especially in group A and in these patients, the cryptosporidium was continuously eliminated in the stool. With octreotide therapy there was a reduction in stool volume and frequency; whether this treatment is effective as long-term therapy for this AIDS manifestation is unknown.

Cerebrospinal fluid beta-2-microglobulin in multiple sclerosis and AIDS dementia complex.

Cerebrospinal fluid (CSF) and serum concentrations of beta-2-microglobulin (beta-2-m) were evaluated in 19 patients with clinically definite multiple sclerosis (MS), in 21 with AIDS dementia complex (ADC), and in 20 subjects with other neurological diseases (OND). CSF beta-2-m and CSF/serum beta-2-m ratio were significantly higher in the patients with ADC than in the MS and OND patients. The CSF and serum levels of beta-2-m in MS patients were not significantly different from those of OND patients. These findings indicate that CSF beta-2-m and CSF/serum ratio may be a useful marker in the diagnosis of ADC. In MS patients the beta-2-m CSF determinations are of no value.

[Clinical-echocardiography of 210 HIV-Ab positive patients: retrospective study]. / Indagine clinica-ecocardiografica su 210 pazienti HIV Ab positivi: studio retrospettivo.

Through the retrospective study of 210 HIV Ab+ patients in different disease's stages, recovered in the "D. Cotugno-Naples" hospital during the period February 1989-February 1991, the authors have valued the prevalence of cardiological alterations underlined by ecocardiograph. Pericardial pouring has been observed in four patients out of thirty, belonged to stages II, III and ARC. Ventricles' movement alterations have been observed in twenty patients out of thirty (66%), belonged prevalently to the fourth group. Kaposi's sarcoma has been observed in two patients out of thirty (6.6%), belonged to the fourth group. In the patients showing alterations, the authors have also noticed a correlation among the observed cardiological alterations and the immunital outline and the frequent homosexuality's presence. The follow up between the alterations' observation and the possible patient's death is on an average 4.3 months (range 1-12). They suggest that a wider and more precocious ecocardiographical research of HIV Ab+ patients is the only way, at the moment, to underline and follow the cardiac alterations' evolution, also in relation to a precocious antiretroviral therapy.

Cerebrospinal fluid beta-2-microglobulin in HIV-1 infection, as a marker of neurological involvement.

Cerebrospinal fluid (CSF) and serum concentration of beta-2-microglobulin (beta-2-m) were evaluated in 30 patients in various stages of HIV-1 infection. CSF beta-2-m and CSF/serum ratio were significantly higher in patients with neurological complications respect to asymptomatic subjects. These findings indicate that CSF beta-2-m and CSF/serum ratio may be a useful marker of neurological involvement in HIV-1 infection.

[Clinical description of three cases of cerebral cryptococcosis in patients with AIDS treated with fluconazole]. / Descrizione clinica di tre casi di criptococcosi cerebrale in pazienti con AIDS trattati con Fluconazolo.

The authors have evaluated the efficacy of Fluconazole (400 mg/iv/die for three days and after 200 mg/iv/die for 18 days) in three AIDS and SNC Cryptococcal infection patients. Two patients have shown healing of meningeal syndrome and negative isolation after 21 days of therapy; one patient, however, died because of Cytomegalovirus pneumonia. It is of note that early spinal puncture in AIDS patients with neurological symptoms enables an early diagnosis and immediate therapy. Fluconazole treatment has been well tolerated and immediately effective to resolve two of the cases observed; the oral prophylaxis with 100 mg/die of Fluconazole after 6 months has been effective to prevent the relapses of the disease.

[Serologic evaluation of circulating immune complexes in patients with HIV infections]. / Valutazione sierologica degli immunocomplessi circolanti (CIC) in pazienti con infezione da HIV.

In AIDS, immunitary system dysfunctions are manifold and regard both T and B-lymphocytes. The increased levels of circulating immune complexes (CIC) in HIV-Ab positive patients, immune complexes abnormalities, should be considered as an epiphenomenon of humoral immunity altered function; therefore, they are devoid of any diagnostic value.

[Seroepidemiologic and behavioral characteristics of a group of HIV-Ab positive homosexuals]. / Indagine sieroepidemiologica e del comportamento di un gruppo di omosessuali HIV ab positivi.

The present study was designed to demonstrate the role of homosexuality in transmission of HIV infection. The results, in cases showed by authors, suggest that the homosexuality is not significative for transmission in HIV infection. Whereas it is significative (56.52%) in transmission of syphilis. The study has demonstrated that homosexuals are not disposed very much to the use of sexual prevention.

[A method for identification of liver cirrhosis of alcoholic etiology]. / Metodo di identificazione della etiologia alcoolica della cirrosi epatica.

There is a significant association between the pro capita alcohol consumption and cirrhosis mortality rate. Cirrhosis usually develops after years of excessive drinking, although in many alcoholic men it never develops, even after decades of drinking. The admission of large amounts of alcohol beverages is very difficult for many patients. This is a serious problem. In order to make easier the diagnosis in those patients, the authors have studied a composed, arbitrary score for alcoholism risk. The diagnosis with only laboratory findings was worse than that with an additional alcoholism risk score, in 48 cirrhotic patients with doubtful history of alcoholic etiology. The alcoholic risk score was based on presence/absence of: 1) car driving or working accidents; 2) familiar or love problems; 3) alcoholic relatives; 4) other alcohol-correlate disease; 5) job type.

[Serum concentration of bile acids and portal hypertension in cirrhotic patients. Possible correlations]. / Concentrazione sierica degli acidi biliari e ipertensione portale di pazienti cirrotici. Possibile correlazione.

For the detection of mild liver disease (acute viral hepatitis, chronic persistent hepatitis, fatty liver) serum bile acids levels have not proved to be superior to transaminases or other common liver tests with almost similar sensitivity and/or specificity. Indeed it has been possible to show in patients with compensated cirrhosis of the liver that the serum bile acids concentration is related to the degree of intrahepatic shunts and that there was a significant relationship between the fasting serum bile acids and the intrinsic clearance of ICG. Measurement of serum bile acids appear to be more sensitive for detection of cirrhosis than commonly used tests. The elevation of bile acids concentration in cirrhotic patients is thought to result from a reduced hepatic clearance and/or from portosystemic shunting. In order to determine the role of serum bile acid estimation in the indirect assessment of portal hypertension, fasting and two-hour postprandial serum bile acids concentration were measured in 36 patients with liver cirrhosis, classified according to Child-Pugh's criteria. Real time ultrasonography, esophagogastroscopy and static liver scintigraphy of the liver were carried out in all patients. The size of esophageal varices, the portal vein and its related structure, the nuclear criteria were graded according to the common methods. Between the clinical findings, splenomegaly, was noted and graded, though the size of spleen does not correlate well with the level of portal pressure. In our patients a good correlation (p less than 0.001) existed between the two hour postprandial bile acids concentration and ultrasonographic findings of portal hypertension. Fasting serum bile acids (SBA) were significantly higher in severe than in mild liver cirrhosis according to Pugh's criteria (p less than 0.001). In conclusion we think that SBA concentrations have a great prognostic value in assessment of major complications (upper gastrointestinal hemorrhage particularly). The reduced liver blood flow, for intra-and extrahepatic porto-systemic shuntings, is probably the main cause of reduced hepatic clearance of bile acids.

Determination of indican and tryptophan in normal and uraemic patients by high-performance liquid chromatography with a new electrochemical detector.

A simple analytical procedure has been developed for the determination of indican and tryptophan in biological fluids by reversed-phase liquid chromatography using a new electrochemical detector consisting of a tubular anode obtained by moulding graphitized carbon black and polyethylene. The hydrodynamic voltammetry of these compounds has been carried out and it has been found that, by operating in isocratic conditions with phosphate buffer (pH 4.0)-methanol (93:7), the reported compounds can be determined directly. The procedure can be applied for the determination of the free compounds on ultrafiltered serum as well as of their total content on serum deproteinized with methanol. Levels of both compounds in normal and uraemic patients have been measured and the relative ratios between free and total content yield a useful marker for patients with renal disease. The limits of quantitation of indican and tryptophan in serum were 5 and 10 ng/ml, respectively. The within-day assay coefficient of variation for total indican and tryptophan ranged from 3.0 to 3.6% and from 3.8 to 4.1%, respectively. The day-to-day assay coefficient of variation for total indican and tryptophan ranged from 3.4 to 3.7% and from 4.6 to 5.0%, respectively.