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The Saharan Air Layer is a mass of hot, dry air laden with dust that forms over the Sahara and moves towards the Atlantic Ocean. This air mass contains soil dust particles emitted by the action of winds on the African continent. Between June and August, the large-scale patterns of wind circulation transport dust from the Sahara across the tropical North Atlantic Ocean,affecting parts of the Caribbean, Central America, Mexico, even some regions of the United States, and the Mediterranean and Southern Europe. Between December and April, wind circulation patterns facilitate dust transportation from the Sahara to the northern parts of South America and the Amazon. This dust transportation a phenomenon of interest to geosciencesand public health because of the potential health impacts of dust dispersion and circulation in the atmosphere. Thus, we assessed the relationship between exposure to Saharan dust (SahD) and its implications for human health in the Americas. We performed a nonsystematic review in the PubMed, Google Scholar, EMBASE, and Scielo databases of studies published between 2000 and 2020 in Portuguese, English, French, or Spanish using the search words “Saharan dust,” or “mineral dust,” or “desert dust,” and “human health.” The available direct air pollutants measurements indicate that the pollution level in the cities affected on a constant and prolonged basis is high versus acceptable standards. Further, this review also showed that the negative health effects of SahD are sparsely studied in the Americas.

Summary Background Currently no national standards exist for the prevention of surgical site infection (SSI) in cardiac surgery. SSI rates range from 1% to 8% between centres. Aim The aim of this study was to explore and characterize variation in approaches to SSI prevention in the UK and the Republic of Ireland (ROI). Methods Cardiac surgery centres were surveyed using electronic web-based questionnaires to identify variation in SSI prevention at the level of both institution and consultant teams. Surveys were developed and undertaken through collaboration between the Cardiothoracic Interdisciplinary Research Network (CIRN), Public Health England (PHE) and the National Cardiac Benchmarking Collaborative (NCBC) to encompass routine pre-, intra- and postoperative practice. Findings Nineteen of 38 centres who were approached provided data and included responses from 139 consultant teams. There was no missing data from those centres that responded. The results demonstrated substantial variation in over 40 aspects of SSI prevention. These included variation in SSI surveillance, reporting of SSI infection rates to external bodies, utilization of SSI risk prediction tools, and the use of interventions such as sternal support devices and gentamicin impregnated sponges. Conclusion Measured variation in SSI prevention in cardiac centres across the UK and ROI is evidence of clinical uncertainty as to best practice, and has identified areas for quality improvement as well as knowledge gaps to be addressed by future research.

This review study aimed to determine the relationship between exposure to smoke from biomass burning in the Amazon rain forest and its implications on human health in that region in Brazil. A nonsystematic review was carried out by searching PubMed, Google Scholar, SciELO, and EMBASE databases for articles published between 2005 and 2021, either in Portuguese or in English, using the search terms “biomass burning” OR “Amazon” OR “burned” AND “human health.” The review showed that the negative health effects of exposure to smoke from biomass burning in the Amazon have been poorly studied in that region. There is an urgent need to identify effective public health interventions that can help improve the behavior of vulnerable populations exposed to smoke from biomass burning, reducing morbidity and mortality related to that exposure. RESUMO Este estudo de revisão teve como objetivo determinar a relação entre a exposição à fumaça da queima de biomassa na Floresta Amazônica e suas implicações para a saúde humana nessa região do Brasil. Foi realizada uma revisão não sistemática por meio de buscas nas bases de dados PubMed, Google Scholar, SciELO e EMBASE de artigos publicados entre 2005 e 2021, em português ou inglês, utilizando os termos de busca “biomass burning” OU “Amazon” OU “burned” E “human health”. A revisão mostrou que os efeitos negativos para a saúde resultantes da exposição à fumaça da queima de biomassa na Amazônia foram pouco estudados na região. Há uma necessidade urgente de identificar intervenções efetivas de saúde pública que possam ajudar a melhorar o comportamento das populações vulneráveis expostas à fumaça da queima de biomassa, reduzindo a morbimortalidade relacionada a essa exposição.

With the mass adoption of data analysis in several scientific fields such as climatology, medicine, astronomy and astrophysics, the availability of an appropriate analytics infrastructure has becom...

In this paper we describe how an accurate urinary sediment examination, which revealed the presence of a severe 2,8-dihydroxyadenine crystalluria, opened the way to an articulate and successful diagnostic and therapeutic roadmap for a rare and potentially severe renal disease.

10 p., Myasthenia gravis is a paradigmatic muscle disorder characterized by abnormal fatigue and muscle weakness that worsens with activities and improves with rest. Clinical and research studies done on nicotinic acetylcholine receptors have advanced our knowledge of the muscle involvement in myasthenia. Current views still state that sensory deficits are not “features of myasthenia gravis”. This article discusses the gap that exists on sensory neural transmission in myasthenia that has remained after > 300 years of research in this neurological disorder. We outline the neurobiological characteristics of sensory and motor synapses, reinterpret the nanocholinergic commonalities that exist in both sensory and motor pathways, discuss the clinical findings on altered sensory pathways in myasthenia, and propose a novel way to score anomalies resulting from multineuronal inability associated sensory troubles due to eugenic nanocholinergic instability and autoimmunity. This medicine-based evidence could serve as a template to further identify novel targets for studying new medications that may offer a better therapeutic benefit in both sensory and motor dysfunction for patients. Importantly, this review may help to re-orient current practices in myasthenia.

Parathyroid scintigraphy is superior to other imaging techniques in detecting hyperfunctioning parathyroid glands. It is mainly performed using double-phase or dual-tracer subtraction methods. Neither of the techniques is perfect and different protocols are being used. We aimed to evaluate the accuracy of double-phase and subtraction methods in detecting abnormal gland as well as the potential effects of coexisting thyroid disease and clinical-laboratory data. We considered patients with primary hyperparathyroidism who underwent parathyroid surgery, after a parathyroid scintigraphy between April 2015 and February 2017. Sixty-eight patients were included; in 45 cases (66.2%), a thyroid disease was coexistent. Diagnostic performances of the two techniques were compared. The effect of thyroid disease and clinical-pathological data on examination interpretation was considered. Double-phase scintigraphy showed higher sensitivity and accuracy in detecting the exact abnormal gland compared to the digital subtraction (90% and 75% vs. 76% and 66%, respectively). For double-phase technique, sensitivity and accuracy were higher in cases with no thyroid disease when compared to those with thyroid disease (92% and 86% vs. 88% and 69%, respectively). Similarly, for digital subtraction, sensitivity and accuracy were higher in the absence of thyroid disease compared to their presence (84% and 79% vs. 70% and 58%, respectively). There was no significant variation in the performance of both techniques, considering clinical-laboratory data. Double-phase scintigraphy has been more accurate than digital subtraction. The presence of thyroid disease could be a possible limit, affecting the subtraction more than the double-phase technique. Clinical data did not influence the scintigraphic outcome.

Introduction Pulmonary benign metastasizing leiomyoma (BML) is a rare and often asymptomatic presentation of smooth muscle tumour of uterine origin, occurring within the lung. Just over a hundred individual cases have been described in the literature; with two series of ten patients each, from continental Europe and North America. Objectives We sought to present the first comprehensive descriptive series from a contemporary U.K. population. Methodology Patients at a single U.K. thoracic surgical centre, between 2003 and 2017, were identified from prospective histology databases. Retrospective data was collected from physical and electronic data sources, and cross-referenced for accuracy. Results 6 patients – all postmenopausal females – were identified over a 15 year period. Average age was 44±8 years (mean ±SD). Half of the patients were asymptomatic with an incidental finding of pulmonary nodules, whilst the remaining 50% complained of nonspecific respiratory symptomatology. Plain imaging of the chest failed to reveal any abnormality in 2 (33.3%) patients. 5 (88.3%) patients had multiple lesions – median of 9 (range 2 to 12) – with bilateral distribution; measuring a median 11 mm (range 7 to 27) in size on cross-sectional imaging. All patients underwent diagnostic surgical wedge biopsy, with 5 (88.3%) procedures completed thoracoscopically; and no perioperative morbidity. 4 (66.7%) patients had a history of previous hysterectomy, and a further patient underwent a hysterectomy following the diagnosis of BML – all for uterine leiomyomata. 4 (66.7%) patients underwent oophorectomy, whilst one patient required hormonal suppression therapy. Survival was 100% at a median follow up of 37 months (range 4 to 150). Conclusion BML is a rare clinical entity accounting for a small proportion of patients presenting with pulmonary nodules. Following successful tissue diagnosis, outcomes with conservative or medical management are excellent.

The use of epoxy bonded fibre reinforced polymer (FRP) materials as strengthening technique for existing masonry structures is becoming in the last years more and more widespread, but some topics, as the effect of the mortar joints on the bond performance at the reinforcement/masonry substrate interface, still represents an open question. This paper is focused on studying in detail the effect of the mortar joints on the bond performance of FRP materials made of different type of fibres (carbon, glass, basalt, steel) externally bonded by means of epoxy resin to three different masonry substrates, very common in Italy: tuff stones, Lecce stones, and clay bricks. Firstly, the experimental results of bond tests carried out by three laboratories on three different masonry substrates were discussed in detail in order to highlight the effect of the mortar joints as the masonry typology changes. Successively, statistical analysis were performed on a more extended database of bond tests coming from literature and carried out on similar masonry substrates. The analysis were aimed to define design formulations for calculating the debonding load of FRP materials bonded to different masonry substrates with and without mortar joints.

The Mediterranean small-sized "long-storage" tomato, which allows an extended shelf life due to its textural properties, provides a delightful product that combines good taste with excellent nutritional properties. Due to the high drought tolerance of the plant, long-storage tomato is traditionally cultivated with no water supply once established, indicating an interesting genetic source in breeding programmes for water stress tolerance in both fresh and processing tomatoes. Recently, the feasibility of obtaining a new minimally processed product from local landraces of long-storage tomato has been considered. A study was conducted to assess the quality of fresh-cut long-storage tomato during storage at 4°C compared to a commercial cultivar of grape-shaped tomato, and also the efficacy of some dipping treatments on shelf-life extension. All fruits were disinfected for 10 min in a sodium hypochlorite solution before cutting in half. Dipping consisted of a 1 h dip in 1% citric acid or 2.4% calcium chloride solutions (w/v) after cutting. Long-storage tomato exhibited higher quality than commercial tomato throughout 13 days of storage, e.g. in terms of total solids (>8 g 100 g-1), total polyphenols (>0.12 mg g-1 fresh weight), soluble solids (>5 °Brix), and antioxidant activity [>80% 2,2-diphenyl-1-picrylhydrazyl (DPPH) inhibition]. The calcium chloride dip resulted in greater cut fruit quality compared to the citric acid dip. Both treatments were beneficial for microbial quality (mesophiles, Enterobacteriaceae, lactic acid bacteria, yeasts and moulds) when compared to the control (distilled water dip), but not when compared to the untreated control (no dip), in which microbial load was the lowest.

We investigated the influence of acute inflammation in skin isograft acceptance.Two mouse lines selected for maximal (AIRMAX) or minimal inflammatory response (AIRMIN) were transplanted with syngeneic skin. Cellular infiltrates and cytokine production were measured 1, 3, 7 or 14 days post-transplantation. The percentage of CD4+CD25+Foxp3+ cells in the lymph nodes was also evaluated.Grafts were totally accepted in 100% of AIRMAX and in 26% of AIRMIN mice. In the latter, partial acceptance was observed in 74% of the animals. Emigrated cells were basically PMN and were enhanced in AIRMAX transplants. IL-10 production by graft infiltrating cells showed no interline differences. IFN-gamma was increased in AIRMIN grafts at day 14 and lower percentages of CD4+CD25+Foxp3+ cells in the lymph nodes were observed in these mice.Our data suggest that differences in graft acceptance might be due to a lack of appropriate regulation of the inflammatory response in AIRMIN mice compromising the self/non-self recognition.

Introduction: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. Objective: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. Methods: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. Results: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. Conclusion: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group.

Background Arrhythmic patterns and left ventricular geometric adaptations to pressure overload were investigated in 76 patients with untreated borderline-to-moderate sustained essential hypertension studied by 2-dimensional and M-mode echocardiography, 12-lead, Halter, and signal-averaged electrocardiography, and ambulatory blood pressure monitoring. Methods and Results Sixty-two age- and sex-matched normal adults were chosen for data comparison. Hypertrophic hypertensive patients were subdivided into 2 subgroups: 44 patients with nocturnal blood pressure reduction (dippers) and 32 patients without it (nondippers). Common afterload and diastolic function indexes were found to be lower in combined nondipper and dipper groups, but only fractional shortening decreased in nondippers. The number of premature atrial and ventricular contractions per hour was high in dippers and nondippers, with no statistically significant differences between them; atrial and ventricular complex dysrhythmias were similar. Signal-averaged electrocardiography showed a prolonged P-wave duration in dipper and nondipper patients with high atrial volumes but no late ventricular potentials and no difference in quantitative P-wave analysis. Left atrial volumes, P-wave duration, and premature atrial contractions were found to be positively linked to left ventricular hypertrophy. In nondipper patients a linear correlation was observed between left atrial volume and P-wave duration, although supraventricular ectopic activity was connected to left atrial volume enlargement both in dipper and nondipper patients. Conclusions These data suggest that the nondipper pattern is not linked to a worse arrhythmogenic substrate; only atrial volume increase may be related to significant supraventricular activity and prolonged atrial activation in nondipper patients, but late ventricular potentials are uncommon in hypertrophic hypertensive patients.

Toxoplasmosis, a worldwide zoonosis caused by a coccidian parasite Toxoplasma gondii, is more often asymptomatic in immunocompetent patients. We report the case of a 38-year-old immunocompetent male with a polymyositis as the presenting manifestation of T. gondii infection. The patient was hospitalized for a 30-day history of fever (T max 39.5°C), muscle pain, and progressive weakness of the muscles. A diagnosis of polymyositis was made, and he was started on corticosteroid treatment, which caused no reduction of symptoms. After finding a positive polymerase chain reaction (PCR) assay for T. gondii, together with additional clinical findings, a diagnosis of acute toxoplasmosis was made. Specific treatment with pyrimethamine and sulfadiazine was started, with a progressive reduction of symptoms and normalization of laboratory tests.

A sonar based device with tactile feedback was developed to improve the mobility and independence of visually impaired individuals. It features a transceiver/receiver, a potentiometer, a microcontroller, a rechargeable polymer lithium ion battery, and a Nokia Cell phone vibrator. All components are commercially available and housed in a custom acrylic package with 86 mm × 34 mm × 12 mm in dimension, and 120 grms in weight. Additionally, the device features an adjustable detection scheme for user customization of distance range, and a tactile feedback system that avoids interference with auditory sensory information. The device was tested for its navigational efficacy in an artificial indoor environment, and in a live outdoor setting. Ten subjects (9 males and 1 female), with a mean age of 35 years-old (range: 17 to 52) were presented with a series of navigational tasks resulting in considerable reduction of head, shoulder, chest, and arms collisions during their locomotion. We conclude that this device greatly improves the mobility and safety of visually impaired individuals.

A photochemical method using the Rose Bengal dye as thrombogenic agent was employed to induce focal cerebral ischemia in frontoparietal cortex of rats. A transcerebral microdialysis probe was used to collect samples from ischemic cortical area. An increase in glutamate (6-fold) and in taurine (4-fold) within the first hour occurred. Neuropathological investigations demonstrate a reproducible damaged area surrounded by a thin peripheral area showing neuronal apoptotic phenomena. The method represents a reproducible model of focal cerebral ischemia with neuropathological aspects superimposable to those characteristic of thrombogenic stroke in man. This method could also be relevant in the study of neurotransmitters during the evolution of ischemia. Furthermore, the presence of apoptotic phenomena in the perilesional halo confirms an ischemic penumbra suggesting the significance of preclinical pharmacological trials.

Background and Aims The motor-evoked potential (MEP) induced by transcranial magnetic stimulation (TMS), its recruitment and the conditioning effects of weak stimuli in Parkinson's disease (PD) have shown contradictory results. The aim of this study is to definitively establish the influences of PD on the TMS-evoked MEP. Methods We investigated resting and active motor thresholds, resting and active recruitment curves, and short interval intracortical inhibition (ICI) and facilitation (ICF) in 39 PD patients and 40 age-matched healthy controls. The Unified Parkinson's Disease Rating Scale (UPDRS) motor score was used as a clinical measure. Results MEPs to single pulses were slightly, but significantly, larger in the PD patients at rest, but increased much less than controls with voluntary muscle activation. PD patients also showed clearly and consistently less ICI and ICF by the conditioning pulse. Both ICI and ICF correlated with MEP threshold in healthy subjects, but not in PD patients. None of the TMS measures correlated with the UPDRS. Conclusions This study strongly supports the view that PD-related MEPs reflect a disturbed signal-noise ratio of pyramidal neuron responses. Such disturbance may be due to a complex combination of altered presynaptic and surround inhibition that results in unbalanced excitatory/inhibitory input at the brain motor cortex level.

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Dear Editor: In an article recently published in this journal, a finite genopsycho-somatotyping model, which combined Ayurvedic genomics, constitutional psychology, and endocrinology, was proposed in males. In them, the high rate of muscle growth and leadership characteristics are considered to be part of the ‘‘andrus’’ constitution due to the androgen effects. Since androgen and testes do not represent the female characteristics, we consider that such a model must be adjusted to current findings since women behave differently than the model proposed. Even though androgens are commonly seen as the ‘‘male’’ hormones and estrogens are considered to be the ‘‘female’’ hormones, they participate in a complex interplay in both sexes. Interestingly enough, estrogens are produced from androgens in both sexes. Moreover, testosterone, a wellknown hormone involved in male dominance, is considered an unlikely candidate for biologic underpinning of dominance motivation in females. Instead of this, a positive association between estradiol and dominance motivation was found in women. Furthermore, levels of circulating androgens are positively associated with body mass index. Such correlation has been found only in women with polycystic ovary syndrome or with simple obesity. Moreover, high circulating levels of dehydroepiandrosterone sulphate, the sulphate ester of the androgen precursor dehydroepiandrosterone, does correlate with truncal fat in women but not in men. The aforementioned hormone actions strongly support the concept that gender differences have to be considered from now on in the mesomorphic or andrus (pitta) basic constitution discussed elsewhere. Also, the constitutional model referred to as ‘‘andrus’’ for males should be referred as ‘‘estrus’’ in females. Likewise, the associated organ to the latter somatotype should be the ovaries, since they constitute the main place of estrogen synthesis in premenopausal nonpregnant women. Therefore, the genopsycho-somatotyping model for humans must consider the effects of hormone-to-hormone differences as well as their interaction, as a key point in male and female alternative and complementary psychophysiology in order to better understand the human mind–body–spirit homeostasis.

Background: Growth hormone (GH) treatment has been proven to have a beneficial effect on growth in children with Russell-Silver syndrome (RSS). Methods: We describe 7 prepubertal children with RSS and lower limb asymmetry treated with GH for 3 years. Results: There was a significant increase in height without any significant change in the asymmetry. Conclusions: We conclude that the rapid growth acceleration to GH treatment does not alter the lower limb asymmetry in children with RSS.

Susceptibility to experimental autoimmune uveitis (EAU) in inbred mice has been associated with a dominant Th1 response. Elevated anti-inter-photoreceptor retinoid-binding protein (anti-IRBP) IgG2a/IgG1 antibody ratios have been implicated as candidate markers to predict disease severity. In the present study, both the anti-IRBP antibody isotype and severity of EAU phenotypes were examined in 4 non-isogenic genetically selected mouse lines to determine if they can be used as general markers of disease. Mice between 8 and 12 weeks old selected for high (H(III)) or low (L(III)) antibody response and for maximum (AIR(MAX)) or minimum (AIR(MIN)) acute inflammatory reaction (AIR) were immunized with IRBP. Each experiment was performed with at least 5 mice per group. EAU was evaluated by histopathology 21 days after immunization and the minimal criterion was inflammatory cell infiltration of the ciliary body, choroid and retina. Serum IgG1- and IgG2a-specific antibodies were determined by ELISA. EAU was graded by histological examination of the enucleated eyes. The incidence of EAU was lower in AIR(MIN) mice whereas in the other strains approximately 40% of the animals developed the disease. Low responder animals did not produce anti-IRBP IgG2a antibodies or interferon-gamma. No correlation was observed between susceptibility to EAU and anti-IRBP isotype profiles. Susceptibility to EAU is related to the intrinsic capacity to mount higher inflammatory reactions and increased production of anti-IRBP IgG2a isotype is not necessarily a marker of this immunologic profile.

The development of microchimerism was evaluated at different time points after infusion of a mixed population of bone marrow and spleen cells from (BALB/c × C57Bl/6)F1 mice in the presence or absence of a cardiac transplant. Microchimerism was observed in the spleen, bone marrow and thymus of transplanted BALB/c mice even after graft rejection. In the absence of transplantation, donor cells persisted especially in the thymus. The results show that despite augmentation of graft survival after donor cell infusion compared to nontreated controls, the development of microchimerism did not sustain cardiac semihistocompatible grafts. Moreover, the persistence of donor cells in the thymus in both situations suggests a role for this organ in the increased graft survival in our model.

The ability of trimetazidine (2,3,4, trimethoxybenzylpiperazine dihydrochloride, TMZ) to protect the myocardium against anthracycline (ANT)-induced cardiotoxicity during chemotherapy has been evaluated in female patients with breast cancer. A clinical trial was conducted in 61 patients subdivided into three groups: group 1 (n = 15, G1) treated with standard ANT protocol and cardioprotection by dexrazoxane (DEX) plus TMZ (60 mg, daily dose); group 2 (n = 22, G2) treated with ANT and cardioprotection by TMZ only; and group 3 (n = 24, G3) scheduled to receive ANT therapy and DEX. All the patients submitted to an echocardiographic evaluation of diastolic function (E wave velocity, A wave velocity, isovolumetric relaxation time [IVRT], deceleration time [DT]) at enrollment (TO), at T1 time, at T2 time, and at T3 time. After a 12- month follow-up period, the patients showed a good conservation of diastolic function both in G1 and G2 groups. No statistically significant difference was observed in E wave and A wave velocity and E/A ratio after ANT treatment. TMZ produced a cardioprotective effect, compa rable to DEX protection, against subacute and chronic subclinical cardiotoxicity with no signif icant changes in diastolic function after 1 year of follow-up.

Cardiac rehabilitation (CR) can improve cardiac hemodynamic performance in patients after myocardial infarction (MI). Little evidence is provided concerning the consequences of CR on atrial wave duration, and less is known about the link between pre-arrhythmogenic patterns and the cardiovascular performance improvement in these subjects. Twenty-six patients, post- MI 0 to 7 days, underwent a complete CR cycle and a signal-averaged electrocardiogram (SAECG) for the evaluation of atrial activation parameters (group 1) to appreciate if physical training can promote parallel improvement in cardiovascular and intra-atrial conduction para meters. A control group of 24 well-matched nonischemic subjects (group 2) was chosen for data comparison. Resting heart rate (p

Objective To assess the incidence and associated risk factors of adverse reactions of DDAVP treatment of children with diabetes insipidus, comparing different routes of administration. Design We retrospectively studied 103 children (44 females, 59 males) with cranial diabetes insipidus (mean age 6.9 years at diagnosis) treated with intramuscular (59), intranasal (84) and/or oral (64) DDAVP, over a mean follow-up period of 5.2 years. Results Eight patients died. For at least two children death was related to water intoxication. Major complications (symptomatic water overload with or without seizures) or asymptomatic hyponatraemia were observed in 33 patients. The incidence of total complications was significantly higher in cortisol deficient patients than in those with normal cortisol reserve (36% vs 6%). In patients on concomitant carbamazapine treatment major complications were more frequent in comparison to the remaining patients (33% vs 10%). Although not achieving significance, there were fewer complications using the oral route. Conclusions Caution is needed in managing patients with DI, especially if risk factors such as cortisol deficiency or concomitant carbamazepine treatment are present. The oral route of administration seems to be preferred for both convenience and safety. Major changes in dose and formulation should be undertaken in hospital.

We reviewed the hospital records of 45 boys, followed in 13 pediatric departments throughout Italy, who had undergone computed tomography and/or magnetic resonance imaging for central precocious puberty (CPP). Twenty-seven patients (60%) had idiopathic CPP and 18 (40%) neurogenic CPP. A hamartoma of the tuber cinereum was found in six patients (33%). All patients with hypothalamic hamartoma had earlier onset of symptoms than patients with idiopathic CPP. Five patients (27%) were affected by type 1 neurofibromatosis, two had ependymoma and five patients had an intracranial anomaly. Basal LH and basal and peak LH/FSH ratio were greater, but not significantly, in boys with neurogenic CPP than in boys with idiopathic CPP. The highest LH peak levels were observed in patients with hamartoma; however, no correlation was observed between LH peak and the size of the hamartomas. In addition, bone age at diagnosis was more advanced in patients with hamartoma than in patients with other conditions. In conclusion, gonadotrophin-dependent precocious puberty may be of idiopathic origin or may occur in association with any CNS disorder. Further studies are needed in order to evaluate the effects of nutritional, environmental and psychosocial factors on the timing of sexual maturation, to explain the high incidence of idiopathic CPP in our male patients.

Gonadotrophin-releasing hormone agonists (GnRHa) have been demonstrated as the therapy of choice for central precocious puberty (CPP). Few studies have provided male patients' adult height data. In our multicenter study we evaluated long-term effects of different GnRHa preparations and final/near-final height (FH) in 12 boys with CPP and analyzed the factors influencing FH. Patients' mean chronological age at the time of diagnosis was 7.6 +/- 0.9 yr. Three patients were treated only with triptorelin at a mean dose of 90 microg/kg i.m. every 28 days. Nine patients initially received buserelin (at a mean initial dose of 53.4 microg/kg/day i.n. divided into 3-6 equal doses) or buserelin (at a mean dose of 36.7 microg/kg/day s.c.) and were subsequently switched to triptorelin. The GnRHa therapy was continued for 4.1 +/- 0.6 yr (range 2.9-5.4). The mean predicted adult height increased from 169.9 +/- 4.2 cm at diagnosis to 180.7 +/- 6.0 cm at the end of treatment. Mean FH was 176.1 +/- 6.1 cm (170.1-190.7), corresponding to mean SDS(CA) 0.4 +/- 0.8 (-0.6/2.5), mean SDSBA 0.2 +/- 0.9 (-0.6/2.4) and mean corrected SDS for target height of 0.4 +/- 0.6 (-0.8/1.2). Multiple regression analysis revealed that FH was mainly influenced by target height and height at discontinuation of GnRHa therapy. The present data indicate that GnRHa therapy significantly improves growth prognosis in boys with CPP and fully restores genetic height potential.

Myocardial uptake of 99Tcm-tetrofosmin in vivo is determined by a combination of flow and metabolic status of myocytes. The accumulation of tetrofosmin in the mitochondria is related to their ability to transduce metabolic energy into electronegative membrane potential. Trimetazidine (TMZ), an anti-ischaemic drug, appears to have a metabolic cytoprotective effect related to mitochondrial function, since it does not induce systemic or coronary haemodynamic changes. In this study, we evaluated the effects of TMZ on tetrofosmin uptake in hypoperfused myocardial regions in patients with coronary artery disease (CAD). Twenty-two patients, 14 with previous myocardial infarction (group A) and eight with a history of angina (group B), with angiographically documented CAD were studied. All patients underwent two tetrofosmin SPET studies at rest, before (baseline) and 1 week after TMZ administration (post-TMZ). On quantitative analysis, 131 segments showed less tetrofosmin uptake at baseline. In these segments, tetrofosmin uptake was 51 +/- 13% at baseline and 55 +/- 15% post-TMZ (P < 0.001 vs control). In the 86 hypoperfused segments of group A, tetrofosmin uptake was 48 +/- 14% at baseline and 52 +/- 17% post-TMZ (P < 0.001 vs control). In the 45 hypoperfused segments of group B, tetrofosmin uptake was 56 +/- 9% at baseline and 60 +/- 10% post-TMZ (P < 0.001 vs control). In the remaining 309 segments, no significant difference in tetrofosmin uptake before and after TMZ was observed. In conclusion, our results suggest that TMZ administration may increase myocardial uptake of tetrofosmin in hypoperfused regions at rest in patients with CAD, based on its metabolic effect.

To assess by autoregressive model the frequency domain heart rate variability (HRV) during clinostatism and after passive orthostatic load (head-up tilt), 81 hypertensive and normotensive subjects (42 men and 39 women) were subdivided into four groups: 20 adult normotensive subjects (Group 1); 21 elderly normotensive subjects (Group 2); 20 elderly hypertensive subjects with nocturnal blood pressure (BP) falls (Group 3); and 20 elderly hypertensive subjects without nocturnal BP falls (Group 4). They were chosen to assess the influence of aging and arterial hypertension on sympathetic-parasympathetic balance. The age-related decrease observed in nearly all HRV spectral frequency components (normalised units [NUs], high frequency [HF] and low frequency [LF]) was reported in elderly patients in rest conditions. LF indexes resulted in decreases in Group 3 and these data seemed to be emphasised in Group 4. After passive tilt, spectral data were recorded as follows: 25.3 ± 1.8 vs17.8 ± 2.2 HF, Group 2 vs Group 1, P

Obesity is a metabolic condition, related to abnormalities of the glyco-insulinaemic metabolism, and plays a substantial role in the development of cardiovascular disease. The aim of this study was to establish a correlation among left ventricular mass, evaluated echocardiographically according to Penn Convention criteria, blood pressure, evaluated by ambulatory blood pressure monitoring, anthropometric indices for evaluation of body mass index and waist to hip ratio circumference, regional adipose tissue distribution, evaluated by ultrasound measurements of visceral adipose tissue, and insulin resistance, evaluated by hyperinsulinaemia by oral glucose tolerance test. We selected two groups of elderly male subjects well matched for age (68.5 +/- 6.4 years): 29 obese and 20 lean, with a body mass index, respectively, of 34.6 +/- 2.9 and 23.4 +/- 2.3. Statistical analysis was carried out by Student's t-test and linear regression analysis. In spite of the fact that statistical analysis showed a higher, though not statistically significant, systolic and diastolic mean blood pressure in the lean subjects, we found an increased left ventricular mass in obese subjects (P0.0001). The area under the insulin curve was higher in obese than in lean subjects (P0.0001) while the area under the glucose curve was not significantly different in the two groups. Furthermore, linear regression analysis showed that in obese subjects left ventricular mass was strictly correlated with visceral adipose tissue (r = 0.607; P0.0001) and hyperinsulinaemia (r = 0.615; P0.0001). In conclusion, our data suggest that centripetal adipose tissue distribution and hyperinsulinaemia, independent of blood pressure values, are closely correlated with left ventricular mass.

In this study we show that antigen-specific lymphocyte proliferation and interleukin (IL)-2 production by peripheral blood lymphocytes from patients under thiopental anesthesia are significantly depressed. In contrast, mitogen-induced lymphocyte proliferation and IL-2 secretion are not depressed. We have also shown that tetanus toxoid (TT) specific CD4+ T cell clones, with a known cytokine production profile, were sensitive to the inhibitory effects of thiopental and exhibited decreased proliferation to TT as well as decreased secretion of IL-2. We observed no difference regarding IL-4 production by these clones. The data suggest that the immunosuppressive effect of thiopental is confined to antigen-specific responses. In addition, we have shown that whereas IL-2 and interferon-γ production is dramatically impaired by the drug, IL-4 production is not significantly altered. This last finding has important implications regarding the type of immune response that is most affected by this anesthetic agent. In spite of the transient decrease in antigen-driven IL-2 synthesis, no clinical evidence of infection was noted in any healthy patient.

Obesity is a physical condition, related to abnormalities of glucose and insulin metabolism; it plays a substantial role in development of cardiovascular disease. The aim of this study was to establish the correlations among cardiac mass determined by echography according to the PENN Convention criteria (Devereux Index), blood pressure measured by ambulatory blood pressure monitoring (ABPM), and anthropometric indexes such as body mass index (BMI) and local adipose tissue distribution expressed as the waist to hip ratio (WHR). Two groups of subjects were selected, matched for age (67 +/- 2.5 years): 10 obese subjects with BMI = 34.5 +/- 2.8 and WHR = 1.02 +/- 0.004; and 10 non-obese subjects with BMI = 26.8 +/- 2.1 and WHR = 0.088 +/- 0.003. Statistical analysis was carried out by the Mann-Whitney U-Test, and linear regression analysis. The statistical analysis revealed a higher mean blood pressure (MBP) in the nonobese group (138.5 +/- 16.9 / 82.2 +/- 5.09 mmHg) compared to the obese subjects (131 +/- 15.3 / 84.29 +/- 11.72 mmHg), the difference was not significant (p0.05). Nevertheless, a significant difference was found in the left ventricular mass (LVM) and the LVM index (LVMI) of the two groups (p0.005) as follows: LVM(norm) = 224.55 +/- 50.59; LVM(ob) = 295.02 +/- 43.54; LVMI(norm) = 127.56 +/- 18.58; LVMI(ob) = 172.48 +/- 15.44. These results represent an evidence showing that obesity and blood pressure are two independent risk factors in the determination of the ventricular cardiac mass.