Risk of fracture prevention in spina bifida patients: correlation between bone mineral density, vitamin D, and electrolyte values.

PURPOSE: The aim of our study was to investigate the relationship between bone mineral density (BMD), vitamin D, and electrolyte blood values in patients with spina bifida, to find a possible therapeutic regimen and an intervention to reduce the risk of fractures in this population. METHODS: BMD values were measured in 49 patients (32 females, 17 males; aged 14.1 ± 3.86 years; range 5-20 years) using dual-energy X-ray absorptiometry (DEXA) and were analyzed based on sex, the level of spinal involvement, vitamin D, and electrolyte values, physical activity, body mass index (BMI), and ambulatory status [patients were divided into three subgroups: full-time wheelchair (FTWC), limited ambulator (LA), and full-time ambulator (FTA)]. These data were analyzed considering sex-, age-, and BMD-matched values and compared with those of normal population. RESULTS: BMD was significantly lower in these patients compared with that in the general healthy population (Z-score: -1.2 ± 1.8); in particular, females had Z-score values significantly lower that of the males (Z-score: -2.43 ± 2.02; P < 0.0004). In FTWC subgroup, Z-score was lower than that of the other two subgroups (P < 0.009). Vitamin D values were significantly lower compared with those in the general healthy population (vitamin D spina bifida group: 14.6 ± 8.7 mg/dL; normal subjects: 35 ± 9.8 mg/dL; P < 0.001). Subjects with spina bifida showed hypophosphatemia (<3 mg/dL) because of the lower levels of vitamin D (3.1 ± 0.9 mg/dL; P < 0.001). CONCLUSIONS: Spina bifida patients showed lower BMD, vitamin D, and electrolyte values than the healthy population; hence, they have an increase risk of developing pathological fractures. Vitamin D supplementation for a longer time period could reduce this risk.

Lentinus (Panus) tigrinus augmentation of a historically contaminated soil: matrix decontamination and structure and function of the resident bacterial community.

The ability of Lentinus tigrinus to grow and to degrade persistent aromatic hydrocarbons in aged contaminated soil was assessed in this study. L. tigrinus extensively colonized the soil; its degradation activity after 60 d incubation at 28°C, however, was mostly limited to dichloroaniline isomers, polychlorinated benzenes and diphenyl ether while the fungus was unable to deplete 9,10-anthracenedione and 7-H-benz[DE]anthracene-7-one which were the major soil contaminants. Although clean-up levels were limited, both density of cultivable heterotrophic bacteria and richness of the resident bacterial community in L. tigrinus microcosms (LtM) increased over time to a significantly larger extent than the respective amended incubation controls (1.9×10(9) CFU g(-1) vs. 1.0×10(9) CFU g(-1) and 37 vs. 16, respectively). Naphthalene- and catechol 2,3-dioxygenase gene copy numbers, however, decreased over time at a higher rate in LtM than in incubation controls likely due to a higher stimulation on heterotrophs than xenobiotics-degrading community members.

Mobilizing agents enhance fungal degradation of polycyclic aromatic hydrocarbons and affect diversity of indigenous bacteria in soil.

The impact of several mobilizing agents (MAs) (i.e., soybean oil, Tween-20, Tween-80, olive-oil mill wastewaters, and randomly methylated beta-cyclodextrins) on the degradation performances of the white-rot fungi Irpex lacteus and Pleurotus ostreatus was comparatively assessed in a soil spiked with a mixture of seven polycyclic aromatic hydrocarbons (PAHs). Among the different MAs, soybean oil best supported the growth of both fungi that was twice that observed in soil in the absence of MAs. In addition, soybean oil positively affected PAH degradation by both fungi. In this case, the total weight of organic contaminants (TWOC) was lower than that in the absence of MAs (57.7 vs. 201.3 and 26.3 vs. 160.4 mg kg(-1) with I. lacteus and P. ostreatus, respectively). On the other hand, the number of cultivable heterotrophic bacteria was significantly lower in the soil with soybean oil augmented with either one of the two fungi (5.21 vs. 8.71 and 0.22 vs. 0.51 x 10(7) CFU g(-1) soil with I. lacteus and P. ostreatus, respectively). The effect of soybean oil was confirmed by denaturing gradient gel electrophoresis (DGGE) analysis of PCR-amplified 16S rRNA genes that showed a general decrease in biodiversity. The impact of the other MAs on bacterial diversity was either slightly negative or positive in incubation controls. Both richness and Shannon-Weaver index decreased upon treatment with P. ostreatus. Moreover, with this fungus the composition of the indigenous bacteria was not significantly affected by the type of MA used. By contrast, both indices increased in soil with I. lacteus in the presence of randomly methylated beta-cyclodextrins (39 vs. 33 and 1.43 vs. 1.26, respectively) and soybean oil (19 vs. 5 and 1.01 vs. 0.65, respectively).

Autophagy-mediated chemosensitizing effect of the plant alkaloid voacamine on multidrug resistant cells.

In our previous studies, voacamine, a bisindolic alkaloid extracted from Peschiera fuchsiaefolia, was examined for its possible capability of enhancing the cytotoxic effect of doxorubicin (DOX) on multidrug resistant (MDR) human osteosarcoma cells (U-2 OS-R). Voacamine induced in resistant cells a significant increase of drug retention and intranuclear location which became comparable to those observed in the parental sensitive counterparts (U-2 OS-WT). In the present study, the cell survival analysis and the electron microscopic observations confirmed the evident cytotoxicity of DOX on MDR cells after pre-treatment with the plant extract. Moreover, an increase of the reactivity of P-glycoprotein (P-gp) with the monoclonal antibody UIC2, which recognizes an epitope of the drug transporter in its functional conformation, was revealed, demonstrating that voacamine is a substrate of P-gp, thus acting as a competitive antagonist of the cytotoxic agent. Moreover, to investigate if the enhancement of the cytotoxic effect induced by voacamine could be due to an apoptotic process, we carried out the analysis of cell morphology after Hoechst staining and the quantification of apoptosis by Annexin V-FITC assay. These evaluations showed a very low rate of apoptosis in U-2 OS-R cells treated with voacamine and DOX given in association. In addition, the combined treatment induced ultrastructural modifications suggestive of autophagic cell death. In particular, transmission electron microscopy observations revealed the presence of numerous lysosomes and the formation of a large number of autophagosomes containing residual digested material. In conclusion, these findings seem to indicate that voacamine is capable of enhancing the cytotoxic effect of DOX on MDR cells by favouring a lethal autophagic process.

Voacamine, an alkaloid extracted from Peschiera fuchsiaefolia, inhibits P-glycoprotein action in multidrug-resistant tumor cells.

Multidrug resistance (MDR) in tumor cells is generally associated with increased efflux of the cytotoxic compounds, due to the activation of mechanisms of intracellular transport and to the overexpression of surface proteins, such as P-glycoprotein (Pgp), which act as ATP-dependent molecular pumps. In a previous study, voacamine, a bisindolic alkaloid from Peschiera fuchsiaefolia, was examined for its possible capability of enhancing the cytotoxic effect of doxorubicin (DOX) on resistant human osteosarcoma cells. The effects of voacamine on the cell survival and on accumulation of DOX were investigated on both the parental cell line, U-2 OS-WT, and its resistant counterpart, U-2 OS-R. A differential effect between sensitive and resistant cells on the intracellular DOX concentration and distribution was revealed. In particular, voacamine induced a significant increase of drug retention and intranuclear location in resistant cells. Moreover, the cell survival analysis and the electron microscopic observations revealed an enhancement of the cytotoxic effect of DOX induced by the plant extract. In the present study, a panel of monoclonal antibodies (MAbs), recognizing different and specific structural and functional state of Pgp, was used. By flow cytometry and immunofluorescence confocal microscopy, a dose-dependent increase of the reactivity of Pgp with MAb UIC2, which specifically recognizes an epitope of the drug transporter in its functional conformation, was detected in voacamine-treated U-2 OS-R cells. Conversely, the expression of the epitope recognized by MAb MC57 was downregulated while MAb MM4.17 did not change its binding level to treated and untreated MDR cells. These data suggest that the plant extract reacts with Pgp producing conformational changes with consequent epitope modulation. Taken together, our observations seem to demonstrate that voacamine is a substrate for Pgp and, therefore, interferes with the Pgp-mediated drug export, acting as a competitive antagonist of cytotoxic agents.

Voacamine, a bisindolic alkaloid from Peschiera fuchsiaefolia, enhances the cytotoxic effect of doxorubicin on multidrug-resistant tumor cells.

Multidrug-resistance (MDR) is largely caused by the efflux of therapeutics from the tumor cell by means of P-glycoprotein (P-gp), resulting in reduced efficacy of the chemotherapy. In order to overcome MDR, substances, such as verapamil and cyclosporin A (CsA), were employed. As these P-gp modulating agents did not seem promising in clinical practice, new compounds with a low degree of undesirable side effects, were introduced. In this study, bisindolic alkaloid voacamine was examined for its possible capability of enhancing the cytotoxic effect of doxorubicin (DOX) on drug resistant cells. Two different pairs of tumor cell lines were analyzed: the parental lymphoblastoid cell line CEM-WT and its MDR derivative CEM-R, the parental osteosarcoma cell line U-2 OS-WT and its resistant counterpart U-2 OS-R. These cell lines were characterized for their morphological features by scanning electron microscopy (SEM) and for the expression of the main drug transporters by flow cytometric analysis. The effects of voacamine on the cell survival and on both accumulation and efflux of DOX were then investigated. The intracellular distribution of DOX, given alone or in association with CsA or voacamine, was observed by laser scanning confocal microscopy. A differential effect of voacamine between sensitive and resistant cells on the intracellular DOX concentration and distribution was shown. In particular, voacamine induced a significant increase of drug retention and intranuclear location in resistant cells. The results of cell survival experiments revealed an enhancement of the cytotoxic effect of DOX induced by voacamine, confirmed by evident morphological changes observed by SEM. These findings suggest promising applications of this natural substance against MDR tumors.

7-Epimer oxindole alkaloids of Cabucala cryptophlebia: their (13)C-NMR and CD data.

The isolation, (13)C-NMR and CD data of two 7-epimer oxindole alkaloids, 10,11-dimethoxyisomitraphylline (1) and 10,11-dimethoxymitraphylline (2) from Cabucala cryptophlebia are reported.

Biological activities of the plant-derived bisindole voacamine with reference to malaria.

The in vivo antiplasmodial activity of voacamine was assessed in a 4-day test. It was shown to exhibit in vivo activity with 25.4% and 43.4% inhibition of parasitaemia with 2.5 and 10 mg/kg, respectively. In synchronized cultures, it was found to act on trophozoite and schizont stages of Plasmodium falciparum. Using the FMC29 strain of Plasmodium falciparum as parasite and the isobologram curve as a method to assess interaction in drug combination, it was shown to lack any chloroquine-enhancing activity and its in vitro antiplasmodial effect was not potentiated by the chemosensitizer malagashanine.

Antiplasmodial activity of the alkaloids of Peschiera fuchsiaefolia.

The tertiary and quaternary alkaloids isolated from the stem bark, root bark and seeds of Peschiera fuchsiaefolia are reported. The tertiary alkaloid crude extract from the stem bark was tested in vitro against Plasmodium falciparum on the basis of the antimalarial use of the plant. It showed good activity against both the D6 strain (IC50 = 495 ng/ml) and chloroquine-resistant W2 strain (IC50 = 817 ng/ml) and voacamine was the most active of the tested alkaloids (IC50 = 238 ng/ml for D6 and 290 ng/ml for W2). The tertiary alkaloid crude extract from the root bark of the same plant is more active than voacamine (IC50 = 179 ng/ml for D6 and 282 ng/ml for W2 strain), and is particularly rich in dimeric alkaloids (0.22% of the vegetable material).

Benzylbenzoate and norlignan glucosides from Curculigo pilosa: structural analysis and in vitro vascular activity.

From the rhizomes of Curculigo pilosa, two benzylbenzoate diglucosides, piloside A and piloside B, and a glucosyl-fused norlignan, pilosidine, previously obtained only as the tetra-O-methyl derivative, were isolated. Pilosidine showed facilitating effect on adrenaline evoked contractions in rabbit aorta isolated preparations.

Role of platelet age in assessment of coagulation.

There are two important reasons why most platelet function studies can be inaccurate. First, platelet function deteriorates when blood is taken out of the vascular tree. Second, tests performed on platelets removed from the blood do not incorporate the role of other cellular and chemical components that may alter platelet activity. This article demonstrates that a coagulation test developed in our laboratory can accurately assess the role of platelet age on the speed of the coagulation of blood. Samples (5.0 mL) of citrated venous blood from 15 volunteers were divided into two groups. One group (n = 6), comprised of subgroups A, B, C, and D of 950 microL aliquots each, was tested within 3 hours. The second group (n = 9), comprised of subgroups E, F, G, and H of 950 microL aliquots each, was tested at 24 hours. The aliquots were added to 50 microL saline without collagen (subgroups A and E), 50 microL saline with 10 micrograms collagen (subgroups B and F), 50 microL saline with 50 micrograms collagen (subgroups C and G), and 50 microL saline with 100 micrograms collagen (subgroups D and H). All collagen-incubated fresh blood samples were significantly more hypercoagulable (shorter recalcification times) compared with the control (no collagen) blood. In the 24-hour-old blood, changes were significant only in the sample with 50 micrograms/mL collagen. We conclude that these data authenticate the role of platelet age in the assessment of the coagulation process.

Expansile subchondral degenerative bone cyst secondary to osteoarthritis.

A 53-year-old man known to have osteoarthritis of the left knee was examined because of a soft-tissue swelling overlying the pes anserinus tendon. Plain radiography and computed tomography revealed an expansile subchondral cyst of the proximal tibia. The cyst was multiloculated, had a sclerotic margin and an extraosseous soft-tissue component, and interrupted the cortex. Proof of a degenerative cyst was obtained by open biopsy. Such presentation in the knee is rare. Awareness of the possible aggressive behaviour of such degenerative cysts should help avoid confusion with neoplasm.

[Blood levels of cortisol and prolactin. Are they indices of the degree of protection against surgical stress?]. / Livelli ematici di cortisolo e prolattina. Indici del grado di protezione dallo stress chirurgico?

The paper evaluates the level of analgesic protection by assaying cortisol and prolactin levels in two groups of 20 patients each undergoing general anesthesia using two different techniques: TIVA with propofol and fentanyl, and BPN-nitrous oxide. The results showed that TIVA caused a very slight increase in residue cortisol which was, however, within normal limits. With BPN-nitrous oxide anesthesia there was a greater increase in cortisol, reaching a statistically significant level in blood collected one hour after the end of surgery. With regard to prolactin, there was a marked increase in this hormone using both techniques although in percentage terms this increase was lower in TIVA. These results show that plasma prolactin is a more sensitive test than cortisol assay in evaluating antalgic protection and that, of the two anesthetic techniques used, the most protective appears to be TIVA with propofol and fentanyl.

[The heterotopic autograft of spleen fragments following splenectomy for trauma in the healthy subject]. / L'autotrapianto eterotopico di frammenti di milza dopo splenectomia per trauma, nel soggetto sano.

Authors report their experience on self-grafting of the spleen on 3 patients, among which a 9-year-old child. The surgical method is easy and quick and in their opinion it has given satisfactory results. In fact, basing themselves on the computation of the platelets values close to normality have been observed.

[Methylprednisolone sodium succinate in the profile of respiratory complications after thoracic surgical intervention]. / Il metilprednisolone sodio succinato nella profilassi delle complicanze respiratorie dopo interventi di chirurgia toracica.

Methylprednisolone sodium succinate (MPSS) was compared in a randomized double blind study to placebo in the prevention of respiratory complications in 40 patients submitted to thoracic surgery. The results indicate that the patients who received MPSS showed a lower incidence of respiratory complications, adverse reactions, chest pain and metabolic acidosis.

Unilateral os hamuli proprium simulating a fracture of the hook of the hamate: a case report.

The authors present a case of os hamuli proprium, a congenital anomaly of the hook of the hamate. A unilateral presentation of this anomaly is rare--this is the first to be reported in the literature. The lesion could easily be mistaken for a fracture of the hook of the hamate. Radiologists and orthopaedists should be aware of the possibility of such a misdiagnosis.

[Mandibular dysfunction syndrome: relation to orthodontics]. / Sindrome disfunzionale della mandibola: rapporti con l'ortodonzia.

The authors, on the basis of a neuro-muscular and occlusal examination of the mandibular dysfunctional syndrome, take in account the malocclusions which may favour the uprisal of such a syndrome. The authors then describe their own therapeutic approach through the use of an occlusal splint which takes advantage of the periodontium started inhibitory reflexes.