Expected and paradoxical effects of obesity on cancer treatment response.

Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. Furthermore, epidemiological studies have shown that obesity is a negative independent prognostic factor for several oncological outcomes, including overall and cancer-specific survival, for several site-specific cancers as well as for all cancers combined. Yet, a recently growing body of evidence suggests that sometimes overweight and obesity may associate with better outcomes, and that immunotherapy may show improved response among obese patients compared with patients with a normal weight. The so-called 'obesity paradox' has been reported in several advanced cancer as well as in other diseases, albeit the mechanisms behind this unexpected relationship are still not clear. Aim of this review is to explore the expected as well as the paradoxical relationship between obesity and cancer prognosis, with a particular emphasis on the effects of cancer therapies in obese people.

Enhanced fluorescence detection of miRNA-16 on a photonic crystal.

We report a novel sensing method for fluorescence-labelled microRNAs (miRNAs) spotted on an all-dielectric photonic structure. Such a photonic structure provides an enhanced excitation and a directional beaming of the emitted fluorescence, resulting in a significant improvement of the overall signal collected. As a result, the Limit of Detection (LoD) is demonstrated to decrease by a factor of about 50. A compact read-out system allows a wide-field imaging-based detection, with little or no optical alignment issues, which makes this approach particularly interesting for further development for example in microarray-type bioassays.

In-plane 2D focusing of surface waves by ultrathin refractive structures.

In an attempt to provide a fully dielectric platform for two-dimensional optical circuitry, we report on the focusing features of an ultrathin polymeric lens fabricated on a planar multilayer. The radiation coupled to surface modes sustained by the multilayer can be focused or waveguide-injected into linear ridges by exploiting a dielectric-loading mechanism successfully exploited for plasmons. The low losses of this photonic system also allow long propagation lengths in the visible spectral range. Experimental observations made by fluorescence imaging of the multilayer surface are well supported by computational data obtained through an effective index approach.

First measurement of the form factors in the decays D0 → ρ- e+ ν(e) and D+ → ρ0 e+ ν(e).

The beauty to up quark coupling constant |V(ub)| can be extracted from B → ρ e+ ν(e) combined with the form factors for D → K* e+ ν(e) and B → V ℓ+ ℓ- and D → ρ e+ ν(e). Using the entire CLEO-c ψ(3770) → DD event sample, corresponding to an integrated luminosity of 818 pb(-1) and approximately 5.4×10(6) DD events, we measure the form factors for the decays D0 → ρ- e+ ν(e) and D+ → ρ0 e+ ν(e) for the first time and the branching fractions with improved precision. A four-dimensional unbinned maximum likelihood fit determines the form factor ratios to be V(0)/A1(0)=1.48±0.15±0.05 and A2(0)/A1(0)=0.83±0.11±0.04. Assuming Cabibbo-Kobayashi-Maskawa unitarity, the known D meson lifetimes, and our measured branching fractions we obtain the form factor normalizations A1(0), A2(0), and V(0). We also present a measurement of the branching fraction for D+ → ω e+ ν(e) with improved precision.

Sorafenib in combination with erlotinib or with gemcitabine in elderly patients with advanced non-small-cell lung cancer: a randomized phase II study.

BACKGROUND: Sorafenib is a small-molecule multitargeted kinase inhibitor that blocks the activation of C-RAF, B-RAF, c-KIT, FLT-3, RET, vascular endothelial growth factor receptor 2 (VEGFR-2), VEGFR-3 and platelet-derived growth factor receptor ß. The aim of this multicenter, randomized phase II study was to evaluate clinical activity and safety of sorafenib in combination with erlotinib or gemcitabine in unselected untreated elderly patients with non-small-cell lung cancer (NSCLC). METHODS: The trial was designed to select the most promising sorafenib-containing combination in previously untreated elderly (≥70 years) stage IIIB or IV NSCLC patients, with performance status of zero to two. Patients were randomly assigned to one of the following combinations: gemcitabine, 1200 mg/m(2) days 1 and 8, every 21 days, for a maximum of six cycles, plus sorafenib, 800 mg/day, until disease progression or unacceptable toxicity (arm 1); or erlotinib, 150 mg/day, plus sorafenib, 800 mg/day, until disease progression or unacceptable toxicity (arm 2). A selection design was applied with 1-year survival rate as the primary end point of the study, requiring 58 patients. RESULTS: Sixty patients were randomly allocated to the study (31 patients in arm 1 and 29 patients in arm 2). After a median follow-up of 15 months, 10 patients [32%, 95% confidence interval (CI) 16% to 49%] in arm 1 and 13 patients (45%, 95% CI 27% to 63%) in arm 2 were alive at 1 year. Median overall survival was 6.6 and 12.6 months in arm 1 and arm 2, respectively. Observed toxic effects were consistent with the expected drug profiles. CONCLUSIONS: The combination of erlotinib and sorafenib was feasible in elderly patients with advanced NSCLC and was associated with a higher 1-year survival rate than the other arm. According to the selection design, this combination warrants further investigation in phase III trials.

Observation of the h(c)(1P) Using e+ e- collisions above the DD threshold.

Using 586 pb(-1) of e+ e- collision data at E(c.m.) = 4170 MeV, produced at the Cornell Electron Storage Ring collider and collected with the CLEO-c detector, we observe the process e+ e- → π+ π- h(c)(1P). We measure its cross section to be 15.6±2.3±1.9±3.0 pb, where the third error is due to the external uncertainty on the branching fraction of ψ(2S) → π0 h(c)(1P), which we use for normalization. We also find evidence for e+ e- → ηh(c)(1P) at 4170 MeV at the 3σ level and see hints of a rise in the e+ e- → π+ π- h(c)(1P) cross section at 4260 MeV.

Life-threatening biliary complications after percutaneous nephro-lithotomy: a case report.

Percutaneous nephrolithotomy is an option for the management of kidney stones. Rarely, life-threatening complications occur. A case of severe necrosis of the extrahepatic biliary tree after percutaneous neprolithotomy is hereby reported. A 55 years old woman underwent an emergency nephrectomy for bleeding the day after this procedure. One week later she developed an acute abdomen due to biliary peritonitis originating from necrosis of the choledochus and associated duodenal perforation. External biliary derivation, duodenal exclusion and gastro-jejunal anastomosis were carried out. Putative risk factors are in the following discussed.

Infections and immunosuppression as specific problems in a HIV + patient transplanted for end-stage alcoholic cirrhosis.

We report the case of a 54-year old man with decompensated alcoholic liver cirrhosis and HIV infection who underwent liver transplantation (LT). Due to relatively well preserved cellular immunity until 2003, no antiretroviral therapy (HAART) needed to be instituted. However, deterioration of his clinical state indicated LT. At that time, the viral load was of 4.84 Log and the CD4 count was more than 250 cells/mm(3). The posttransplant course was complicated by several infection episodes and one episode of acute cellular rejection grade 2. HAART consisted of Lamivudine, Stavudine, Lopinavir and Ritonavir. One week after beginning of HAART, tacrolimus was discontinued during 18 days due Ritonavir interaction. CD3/CD4 T-helper lymphocyte count showed a significant decrease immediately after LT which rapidly recovered after initiation of HAART. The patient was discharged on the 8th postoperative week in good conditions. This report encourages the institution of HAART once the liver graft regains normal function. Drug interactions between Ritonavir and Tacrolimus should be anticipated. A study protocol to manage these patients within a multidisciplinary team including also specialists in infectious diseases and virologists is mandatory.

A flow-through holed PDMS membrane as a reusable microarray spotter for biomedical assays.

We propose the exploitation of a holed-designed poly(dimethyl)siloxane (PDMS) membrane as an innovative microarray spotter. The membrane is fabricated by a simple technological approach and can be reused several times. A good level of reproducibility is found upon spotting fluorescent proteins at different concentrations over large areas.

Eukaryotic translation initiation factor 6 is a novel regulator of reactive oxygen species-dependent megakaryocyte maturation.

BACKGROUND: Ribosomopathies constitute a class of inherited disorders characterized by defects in ribosome biogenesis and function. Classically, bone marrow (BM) failure is a clinical symptom shared between these syndromes, including Shwachman-Bodian-Diamond syndrome (SBDS). Eukaryotic translation initiation factor 6 (eIF6) is a critical translation factor that rescues the quasilethal effect of the loss of the SBDS protein. OBJECTIVES: To determine whether eIF6 activity is necessary for BM development. METHODS: We used eIF6(+/-) mice and primary BM megakaryocytes to investigate the involvement of eIF6 in the regulation of hematopoiesis. RESULTS: We provide evidence that reduced eIF6 expression negatively impacts on megakaryopoiesis. We show that inhibition of eIF6 leads to a reduction in cell size and mean ploidy level of megakaryocytes and a delay in megakaryocyte maturation by blocking the G1 /S transition. Consistent with this phenotype, only few megakaryocyte-forming proplatelets were found in eIF6(+/-) cells. We also discovered that, in eIF6(+/-) cells, the steady-state abundance of mitochondrial respiratory chain complex I-encoding mRNAs is decreased, resulting in decreased reactive oxygen species (ROS) production. Intriguingly, connectivity map analysis showed that eIF6-mediated changes overlap with specific translational inhibitors. eIF6 is a translation factor acting downstream of insulin/phorbol 12-myristate 13-acetate (PMA) stimulation. PMA treatment significantly restored eIF6(+/-) megakaryocyte maturation, indicating that activation of eIF6 is essential for the rescue of the phenotype. CONCLUSIONS: Taken together, our results show a role for eIF6-driven translation in megakaryocyte development, and unveil the novel connection between translational control and ROS production in this cell subset.

Tolerance to some behavioural effects of lisuride, a dopamine receptor agonist, and reverse tolerance to others, after repeated administration.

To investigate whether prolonged pretreatment with the dopamine (DA) agonist lisuride would result in modification of some of its behavioural effects, food intake, locomotor activity, body temperature or stereotyped and mounting behaviour were evaluated after acute injections of different doses of lisuride into rats, pretreated daily for four weeks with either saline or lisuride. Rats pretreated with lisuride developed tolerance to its anorexigenic and hypothermic effects, and reverse tolerance to its effects on locomotor activity, stereotyped and mounting behaviour. Pretreatment with lisuride did not modify the activity of drug-metabolizing enzymes in the liver. These results, in addition to revealing the pattern of the changes in the behavioural effects of a DA agonist drug, after repeated administration, may be taken as evidence for the existence of different DA receptor systems in different areas of the brain, that mediate different behavioural effects, and that differ markedly in their reactions to prolonged stimulation with an agonist drug.

Hepatitis C infection-related liver disease: patterns of recurrence and outcome in cadaveric and living-donor liver transplantation in adults.

BACKGROUND: Preliminary data demonstrate that the recurrence of hepatitis C is more severe in patients undergoing adult-to-adult living liver (AAL) transplantation (Tx) in comparison with cadaveric liver (CL) Tx. The authors report on the 1-year follow-up of their cohort of hepatitis C virus (HCV) patients undergoing AALTx or CLTx. METHODS: Twenty-six patients with HCV end-stage liver cirrhosis underwent CLTx and 17 underwent AALTx. The diagnosis of recurrent HCV was made on the basis of increased transaminases, detectable HCV RNA levels, and histologic findings on liver biopsy. Liver biopsies were performed on the basis of clinical indications. Bilirubin concentration, partial thromboplastin time, and alanine aminotransferase activity were compared between the two groups at different time intervals. RESULTS: HCV recurrence was seen in 10 of 26 CLTx patients versus 6 of 17 AALTx patients (P=0.1). Time until recurrence was longer in AALTx patients (158+/-114 days vs. 227+/-154 days, P=0.4). Of the biochemical parameters, only bilirubin concentration at week 4 was significantly different between AALTx and CLTx patients (3.1+/-4.3 mg/dL vs. 1.26+/-0.83 mg/dL, P=0.04). Overall survival and the number of patients needing retransplantation were similar in both groups. CONCLUSIONS: At a follow-up period of 1 year, there is no difference in outcome between end-stage HCV patients undergoing AALTx or CLTx.

Diffuse alveolar hemorrhage and pulmonary capillaritis due to propylthiouracil.

Propylthiouracil (PTU) has recently been observed to be associated with antineutrophil cytoplasmic antibody (ANCA)-positive small vessel vasculitis, resulting in crescentic glomerulonephritis and, infrequently, diffuse alveolar hemorrhage (DAH). We describe a case of a 23-year-old pregnant woman who developed a perinuclear ANCA and antimyeloperoxidase-positive small vessel vasculitis manifesting as DAH and crescentic glomerulonephritis after she began taking PTU. An open lung biopsy was consistent with pulmonary capillaritis. She responded to corticosteroid therapy and discontinuation of PTU. DAH can be caused by pulmonary capillaritis, bland hemorrhage, or diffuse alveolar damage. To our knowledge, this represents the first documentation of an underlying pulmonary capillaritis in a case of PTU-induced DAH.

Effects of lisuride on body temperature of rats and rabbits: relation to microsomal biotransformation and dopaminergic receptor stimulation.

In rats, lisuride, either administered systemically or intracerebroventricularly induced a dose-related hypothermia. This effect was selectively antagonized by blockade of DA receptors in the CNS but not by inhibition of catecholamine synthesis or blockade of serotoninergic receptors. Also a blocker of "peripheral" DA receptors failed to antagonize the hypothermic effect of lisuride in rats. Induction of rat liver microsomal drug-metabolizing enzymes by phenobarbital counteracted lisuride-induced hypothermia. In rabbits lisuride induced a hyperthermic response which was sensitive to both pimozide and metergoline pretreatment. These findings indicate that stimulation of brain DA receptors involved in thermoregulation is responsible for the changes in body temperature indiced by lisuride in rats and rabbits and that these effects are caused by the drug itself and do not require previous biotransformation into an active metabolite.

n-hexane induces parkinsonism in rodents.

A case of human parkinsonism, due to n-hexane exposure, was recently described. On the basis of this observation, we treated mice and rats with n-hexane and its principle toxic metabolite 2,5-hexanedione. The mice underwent a chronic treatment intraperitoneum, the rats were treated stereotaxically into the substantia nigra. At biochemical analysis of the striata, dopamine and homovanillic acid levels were significantly lower compared with control animals; norepinephrine, serotonin, 5-hydroxindolacetic acid levels were unchanged. The rats treated with 2,5-hexanedione showed an apomorphine-induced rotational behavior significantly higher compared to controls. Since n-hexane and its metabolites are environmental contaminants and by-products of endogenous metabolic pathways, we propose that they may play a role in inducing parkinsonism in humans.

Anorectic effect of lisuride and other ergot derivatives in the rat.

Three ergot derivatives, lisuride, lergotrile and bromocriptine, given to rats trained to eat 4 h a day, induced a dose- and time-related anorexia. They were more potent in this context than either amphetamine or fenfluramine. Lisuride and lergotrile failed to increase locomotor activity or to induce stereotyped behaviour at doses corresponding to the ID50 on food intake. At this dose, bromocriptine slightly stimulated motor activity. The anorectic effect of the three compounds was selectively antagonized by blockers of dopamine (DA) receptors in the central nervous system but not by either inhibiton of catecholamine synthesis or blockade of alpha- or beta-adrenoceptors or of serotonergic receptors. Also two blockers of 'peripheral' DA receptors failed to antagonize ergoline-induced anorexia. These findings indicate that stimulation of DA receptors involved in feeding behaviour was responsible for the anorexigenic effect of the ergot derivatives investigated. In most instances this effect occurred at dose levels which failed to induce central stimulant effects.

Effects of acute n-hexane and 2,5-hexanedione treatment on the striatal dopaminergic system in mice.

In order to investigate the effect of n-hexane and its metabolites on the Central Nervous System (CNS), we treated mice with n-hexane and 2,5-hexanedione (2,5-HD) by intraperitoneal (i.p.) administration. Gascromatographic mass spectrometric (GCMS) analyses of striatum and cerebellum revealed a consistent increase of 2,5-HD concentration at 0.5 and 2 hours after treatment and a decline to baseline levels at 24 hours. Traces of 2,5-HD were detected in the brain of control animals. Biochemical analyses revealed a precocious, short lasting, significant increase of striatal dopamine (DA) and homovanillic acid (HVA) levels. A significant increase of striatal synaptosomal DA uptake, suggesting a DA releasing effect on the dopaminergic terminals, was also observed. These results support the hypothesis of a possible role of n-hexane and its metabolites in inducing parkinsonism in humans and animals.

Dopaminergic and serotoninergic anorectics differentially antagonize insulin- and 2-DG-induced hyperphagia.

The efficacy of anorectic drugs has been studied in rats made hyperphagic by injection of insulin or of 2-deoxy-d-glucose (2-DG). It was found that anorectics that act through a serotoninergic mechanism, i.e., d- and d-l-fenfluramine, p-chloroamphetamine, quipazine and fluoxetine antagonize both insulin- and 2-DG-induced overeating, while anorectics acting through the dopaminergic system, i.e., d-amphetamine, diethylpropion, lisuride, bromocriptine and mazindol, antagonize the hyperphagia induced by 2-DG but not that induced by insulin. Neither serotoninergic nor dopaminergic anorectics modified insulin-induced hypoglycaemia. The serotonin (5-HT) receptor blocker metergoline did not modify the hyperphagic response to insulin or 2-DG. The present results indicate that there are different neuronal or humoral circuits underlying the hyperphagic responses to insulin and 2-DG. In addition, these results, which show different effectiveness of anorectic drugs depending on what has provoked the hyperphagia, suggest that differences in the etiology of the hyperphagia of obese subjects must be taken into consideration when choosing therapy.

POEMS and Crow-Fukase syndrome: two cases giving rise to more questions about plasma cell dyscrasias.

Two cases of POEMS and Crow-Fukase syndrome are reported. We focused our attention on the problems recently debated in the literature regarding POEMS and osteosclerotic myeloma, the pathogenetic mechanisms of the clinical symptoms in these syndromes and the problems of their classification among plasma cell dyscrasias with polyneuropathy.

[Use of glucagon in the treatment of severe contractile insufficiency of the myocardium]. / L'impiego del glucagone nel trattamento della grave insufficienza contrattile del miocardio

Glucagon hydrochloride has been used to treat severe contractile insufficiency of the myocardium. The drug was administered to cardiopathic patients who had been admitted to the intensive care unit. Results in the various groups examined were satisfactory, particularly in cases of patients with valve diseases and with chronic pulmonary heart and cardiac insufficiency recalcitrant to digitalis therapy. No important side-effects were noted.