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This study aimed to enhance solar disinfection (SODIS) by the photo-Fenton process, operated at natural pH, through the re-utilization of fruit wastes. For this purpose, pure organic acids present in fruits and alimentary wastes were tested and compared with synthetic complexing agents. Owing to solar light, complexes between iron and artificial or natural chelators can be regenerated through ligand-to-metal charge transfer (LMCT) during disinfection. The target complexes were photoactive under solar light, and the Fe:Ligand ratios for ex situ prepared iron complexes were assessed, achieving a balance between iron solubilization and competition with bacteria as a target for oxidizing species. In addition, waste extracts containing natural acidic ligands were an excellent raw material for our disinfection enhancement purposes. Indeed, lemon and orange juice or their peel infusions turned out to be more efficient than commercially available organic acids, leading to complete inactivation in less than 1 h by this novel "fruto-Fenton" process, i.e. in the presence of a fruit-derived ligand, Fe(II) and H 2 O 2 . Finally, its application in Lake Leman water and in situ complex generation led to effective bacterial inactivation, even in mildly alkaline surface waters. This work proposes interesting SODIS and fruit-mediated photo-Fenton enhancements for bacterial inactivation in resource-poor contexts and/or under the prism of circular economy., Competing Interests: Declaration of competing interest The authors declare no financial/personal relationships which may be considered as potential competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Great advances have been made in the knowledge of development and regulatory approval of medicinal product containing genetically modified cells. Although a guideline has been available in the EU since 2012, the current updated version provides a useful guide to developers and professionals involved in the regulatory process of these medicines. This article presents the main issues communicated in that guidance, the regulators' insights and a commentary from the academic developers' point of view., (© 2024 British Pharmacological Society.)

Advanced oxidation processes are the most efficient tool to thwart the overaccumulation of harmful organic compounds in the environment. In this direction bioinspired metal complexes may be a viable solution for oxidative degradations in water. However, their synthesis is often elaborated and their scalability consequently low. This study presents alternative easy-to-synthesize bioinspired metal complexes to promote degradations in water. The metals employed were iron and manganese ions, hence cheap and highly accessible ions. The complexes were tested toward Phenol, Estrone, Triclosan, Oxybenzone, Diclofenac, Carbamazepine, Erythromycin, Aspartame, Acesulfame K, Anisole and 2,4-Dinitrotoluene. The reaction favoured electron-rich compounds reaching a removal efficiency of over 90%. The central ion plays a crucial role. Specifically, Mn(II) induces a non-radical pathway while iron ions a predominant radical one ( ⋅ OH is predominant). The iron systems resulted more versatile toward contaminants, while the manganese ones showed a higher turn-over number, hence higher catalytic behaviour., (© 2024. The Author(s).)

In recent years, several bacterial strains have acquired significant antibiotic resistance and can, therefore, become difficult to contain. To counteract such trends, relational databases can be a powerful tool for supporting the decision-making process. The case of Klebsiella pneumoniae diffusion in a central region of Italy was analyzed as a case study. A specific relational database is shown to provide very detailed and timely information about the spatial-temporal diffusion of the contagion, together with a clear assessment of the multidrug resistance of the strains. The analysis is particularized for both internal and external patients. Tools such as the one proposed can, therefore, be considered important elements in the identification of infection hotspots, a key ingredient of any strategy to reduce the diffusion of an infectious disease at the community level and in hospitals. These types of tools are also very valuable in the decision-making process related to antibiotic prescription and to the management of stockpiles. The application of this processing technology to viral diseases such as COVID-19 is under investigation.

X-linked chronic granulomatous disease is a rare disease caused by mutations in the CYBB gene. While more extensive knowledge is available on genetics, pathogenesis, and possible therapeutic options, mitochondrial activity and its implications on patient monitoring are still not well-characterized. We have developed a novel protocol to study mitochondrial activity on whole blood of XCGD patients before and after transplantation, as well as on XCGD carriers. Here we present results of these analyses and of the restoration of mitochondrial activity in hyperinflamed X-linked Chronic Granulomatous Disease after hematopoietic stem cell transplantation. Moreover, we show a strong direct correlation between mitochondrial activity, chimerism, and DHR monitored before and after transplantation and in XCGD carriers. In conclusion, based on these findings, we suggest testing this new ready-to-use marker to better characterize patients before and after treatment and to investigate disease expression in carriers., (© 2022. The Author(s).)

Peracetic acid has quickly gained ground in water treatment over the last decade. Specifically, its disinfection efficacy toward a wide spectrum of microorganisms in wastewater is accompanied by the simplicity of its handling and use. Moreover, peracetic acid represents a promising option to achieve disinfection while reducing the concentration of typical chlorination byproducts in the final effluent. However, its chemical behavior is still amply debated. In this study, the reactivity of peracetic acid in the presence of halides, namely, chloride and bromide, was investigated in both synthetic waters and in a real contaminated water. While previous studies focused on the ability of this disinfectant to form halogenated byproducts in the presence of dissolved organic matter and halides, this work indicates that peracetic acid also contributes itself as a primary source in the formation of these potentially carcinogenic compounds. Specifically, this study suggests that 1.5 mM peracetic acid may form around 1-10 μg/L of bromoform when bromide is present. Bromoform formation reaches a maximum at near neutral pH, which is highly relevant for wastewater management.

Background: Effective treatment for metachromatic leukodystrophy (MLD) remains a substantial unmet medical need. In this study we investigated the safety and efficacy of atidarsagene autotemcel (arsa-cel) in patients with MLD., Methods: This study is an integrated analysis of results from a prospective, non-randomised, phase 1/2 clinical study and expanded-access frameworks. 29 paediatric patients with pre-symptomatic or early-symptomatic early-onset MLD with biochemical and molecular confirmation of diagnosis were treated with arsa-cel, a gene therapy containing an autologous haematopoietic stem and progenitor cell (HSPC) population transduced ex vivo with a lentiviral vector encoding human arylsulfatase A (ARSA) cDNA, and compared with an untreated natural history (NHx) cohort of 31 patients with early-onset MLD, matched by age and disease subtype. Patients were treated and followed up at Ospedale San Raffaele, Milan, Italy. The coprimary efficacy endpoints were an improvement of more than 10% in total gross motor function measure score at 2 years after treatment in treated patients compared with controls, and change from baseline of total peripheral blood mononuclear cell (PBMC) ARSA activity at 2 years after treatment compared with values before treatment. This phase 1/2 study is registered with ClinicalTrials.gov, NCT01560182., Findings: At the time of analyses, 26 patients treated with arsa-cel were alive with median follow-up of 3·16 years (range 0·64-7·51). Two patients died due to disease progression and one due to a sudden event deemed unlikely to be related to treatment. After busulfan conditioning, all arsa-cel treated patients showed sustained multilineage engraftment of genetically modified HSPCs. ARSA activity in PBMCs was significantly increased above baseline 2 years after treatment by a mean 18·7-fold (95% CI 8·3-42·2; p<0·0001) in patients with the late-infantile variant and 5·7-fold (2·6-12·4; p<0·0001) in patients with the early-juvenile variant. Mean differences in total scores for gross motor function measure between treated patients and age-matched and disease subtype-matched NHx patients 2 years after treatment were significant for both patients with late-infantile MLD (66% [95% CI 48·9-82·3]) and early-juvenile MLD (42% [12·3-71·8]). Most treated patients progressively acquired motor skills within the predicted range of healthy children or had stabilised motor performance (maintaining the ability to walk). Further, most displayed normal cognitive development and prevention or delay of central and peripheral demyelination and brain atrophy throughout follow-up; treatment benefits were particularly apparent in patients treated before symptom onset. The infusion was well tolerated and there was no evidence of abnormal clonal proliferation or replication-competent lentivirus. All patients had at least one grade 3 or higher adverse event; most were related to conditioning or to background disease. The only adverse event related to arsa-cel was the transient development of anti-ARSA antibodies in four patients, which did not affect clinical outcomes., Interpretation: Treatment with arsa-cel resulted in sustained, clinically relevant benefits in children with early-onset MLD by preserving cognitive function and motor development in most patients, and slowing demyelination and brain atrophy., Funding: Orchard Therapeutics, Fondazione Telethon, and GlaxoSmithKline., Competing Interests: Declaration of interests FFu, VC, MGNS, AA, CB, FB, FFe, MM, FT, VG, SR, ESF, MPC, and MEB are investigators of gene therapy clinical trials for MLD sponsored by Orchard Therapeutics, the licence holder of investigational medicinal product arsa-cel. FFu and VC have acted as ad-hoc consultants for an Orchard Therapeutics advisory board. The MLD gene therapy was licensed to GlaxoSmithKline in 2014, and then to Orchard Therapeutics in 2018. Telethon and Ospedale San Raffaele are entitled to receive milestone payments and royalties for such a therapy. MSe and AB left San Raffaele Hospital and their role as principal investigators of the pivotal study on November, 2014, and September, 2015, respectively. AA subsequently became study principal investigator and responsible physician for treatment under expanded access frameworks. AB is currently a member of the scientific advisory board of Orchard Therapeutics and holds stock in Orchard Therapeutics. PMVR and CDS have a contract with Orchard Therapeutics to perform statistical analyses of gene therapy clinical trials for MLD. SMa and FM have a service contract with Ospedale San Raffaele. SMa has a contract with Orchard Therapeutics to perform ARSA activity on CSF in the clinical trial NCT03392987. JG-S, LCS, and GFD are former employees and hold stock in Orchard Therapeutics, which sponsored the clinical trial. All other authors declare that they have no financial interest related to the work described in the manuscript., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Polymer flooding is an enhanced oil recovery technique to extract the large portion of leftover subsurface oil following conventional extraction methods. In the flooding process, a long-chain polymer, such as partially hydrolyzed polyacrylamide (HPAM), is added to the displacing fluid to increase the mobility and extraction of the oil phase. Nevertheless, the challenge of managing produced water from polymer flooding operations is high because residual HPAM results in significantly high viscosity and organic content in the stream. Commonly used methods for produced water treatment, such as gravity settling and flotation, cannot be applied to obtain a purified stream efficiently, while innovative techniques are not yet feasible in practical operations. In this work, a simple method of polymer precipitation prompted by divalent ions is evaluated, optimized, and compared to membrane ultrafiltration. The physico-chemical properties of the HPAM are investigated and polymer precipitation tests are conducted by varying the main operational parameters, including pH, salinity, temperature, calcium and/or magnesium concentration, and polymer concentration. Response surface developed by central composite design method is used to optimize the process and identify the correct dosage of divalent cations coagulants and pH, the two main factors promoting HPAM separation. The removal of HPAM is well-described and maximized (>85%) by the model, which is also validated on three synthetic samples representing real wastewaters from polymer flooding applications. Optimized ultrafiltration, using ceramic membranes with surface pore size of 15 kDa, also shows the ability to remove HPAM effectively from water, but the precipitation method seems to be more versatile and easier to apply. The two processes, precipitation and ultrafiltration, may potentially be used in sequence as they complement each other in several ways., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Membrane distillation is a promising technology to desalinate hypersaline produced waters. However, the organic content can foul and wet the membrane, while some fractions may pass into the distillate and impair its quality. In this study, the applicability of the traditional Fenton process was investigated and preliminarily optimized as a pre-treatment of a synthetic hypersaline produced water for the following step of membrane distillation. The Fenton process was also compared to a modified Fenton system, whereby safe iron ligands, i.e., ethylenediamine-N,N'-disuccinate and citrate, were used to overcome practical limitations of the traditional reaction. The oxidation pre-treatments achieved up to 55% removal of the dissolved organic carbon and almost complete degradation of the low molecular weight toxic organic contaminants. The pre-treatment steps did not improve the productivity of the membrane distillation process, but they allowed for obtaining a final effluent with significantly higher quality in terms of organic content and reduced Vibrio fischeri inhibition, with half maximal effective concentration (EC 50 ) values up to 25 times those measured for the raw produced water. The addition of iron ligands during the oxidation step simplified the process, but resulted in an effluent of slightly lower quality in terms of toxicity compared to the use of traditional Fenton., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Versatile and ecofriendly methods to perform oxidations at near-neutral pH are of crucial importance for processes aimed at purifying water. Chitosan, a deacetylated form of chitin, is a promising starting material owing to its biocompatibility and ability to form stable films and complexes with metals. Here, we report a novel chitosan-based organometallic complex that was tested both as homogeneous and heterogeneous catalyst in the degradation of contaminants of emerging concern in water. The stoichiometry of the complex was experimentally verified with different metals, namely, Cu(II), Fe(III), Fe(II), Co(II), Pd(II), and Mn(II), and we identified the chitosan-Fe(III) complex as the most efficient catalyst. This complex effectively degraded phenol, triclosan, and 3-chlorophenol in the presence of hydrogen peroxide. A putative ferryl-mediated reaction mechanism is proposed based on experimental data, density functional theory calculations, and kinetic modeling. Finally, a film of the chitosan-Fe(III) complex was synthesized and proven a promising supported heterogeneous catalyst for water purification., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

This study evaluates 9 biocides as disinfectants against microbiological contaminants, specifically, microalgae and E. coli, while assessing their safety and environmental impact. Specifically, the biocide effectiveness and corresponding generation of halogenated compounds is assessed in a real contaminated groundwater receiving acidic leachate from a phosphogypsum landfill. Oxidizing agents are investigated, namely, hypochlorite, peracetic acid, hydrogen peroxide, chlorine dioxide, and persulfate, together with electrophilic biocides, namely, 2,2-dibromo-2-cyanoacetamide and (chloro-) methylisothiazolinone. In addition, a novel disinfection approach is assessed by applying reducing agents, namely, sulfite and metabisulfite. The disinfection mechanism and the formation of halogenated compounds are discussed on the basis of the mode of action and of the molecular structure of each biocide. Overall, the results show that an optimal dosage of the biocides exists to minimize the formation of harmful compounds in water while maximizing disinfection, especially for hypochlorite and peracetic acid. This dosage was between 0.03 mM and 0.15 mM depending on the biocide. The safety of electrophilic biocides is found to be associated to their molecular structure rather than their mode of action. Hydrogen peroxide, MIT, and metabisulfite are the most promising disinfectants in the contaminated groundwater matrix of interest since no halogenated by-products are detected upon successful disinfection, while they are able to completely inactivate bacteria and remove over the 80% of microalgae in the selected matrix. In particular, metabisulfite represents a highly promising biocide, owing to its low environmental and health impacts, as well as economic feasibility (estimated reagent cost ~0.002 € per cubic meter of treated water)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Chronic granulomatous disease (CGD) is a rare inherited disorder due to loss-of-function mutations in genes encoding the NADPH oxidase subunits. Hematopoietic stem and progenitor cell (HSPC) gene therapy (GT) using regulated lentiviral vectors (LVs) has emerged as a promising therapeutic option for CGD patients. We performed non-clinical Good Laboratory Practice (GLP) and laboratory-grade studies to assess the safety and genotoxicity of LV targeting myeloid-specific Gp91 phox expression in X-linked chronic granulomatous disease (XCGD) mice. We found persistence of gene-corrected cells for up to 1 year, restoration of Gp91 phox expression and NADPH oxidase activity in XCGD phagocytes, and reduced tissue inflammation after LV-mediated HSPC GT. Although most of the mice showed no hematological or biochemical toxicity, a small subset of XCGD GT mice developed T cell lymphoblastic lymphoma (2.94%) and myeloid leukemia (5.88%). No hematological malignancies were identified in C57BL/6 mice transplanted with transduced XCGD HSPCs. Integration pattern analysis revealed an oligoclonal composition with rare dominant clones harboring vector insertions near oncogenes in mice with tumors. Collectively, our data support the long-term efficacy of LV-mediated HSPC GT in XCGD mice and provide a safety warning because the chronic inflammatory XCGD background may contribute to oncogenesis., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

The Fenton reaction is an effective advanced oxidation process occurring in nature and applied in engineering processes toward the degradation of harmful substances, including contaminants of emerging concern. The traditional Fenton application can be remarkably improved by using iron complexes with organic ligands, which allow for the degradation of contaminants at near-neutral pH and for the reduction of sludge production. This work discusses the mechanisms involved both in the classic Fenton process and in the presence of ligands that coordinate iron. Cyclohexane was selected as mechanistic probe, by following the formation of the relevant products, namely, cyclohexanol (A) and cyclohexanone (K). As expected, the classic Fenton process was associated with an A/K ratio of approximately 1, evidence of a dominant free radical behavior. Significantly, the presence of widely common natural and synthetic carboxyl ligands selectively produced mostly the alcoholic species in the first oxidation step. A ferryl-based mechanism was thus preferred when iron complexes were formed. Common iron ligands are here proven to direct the reaction pathway towards a selective metal-based catalysis. Such a system may be more easily engineered than a free radical-based one to safely remove hazardous contaminants from water and minimize the production of harmful intermediates., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In this work, contaminants of emerging concern were catalytically degraded in the homogeneous phase with the use of unconventional green reagents. Three reagents, namely, sulfite, metabisulfite, and persulfate, were tested and compared with conventional hydrogen peroxide in the degradation process activated by Fe-TAML. The latter is a biodegradable, homogeneous tetra-amido macrocyclic ligand catalyst containing iron(III). Metabisulfite showed the highest efficiency among the three tested reagents, and its reactivity was similar to that of H 2 O 2 . However, metabisulfite is a safer and cleaner reagent compared to H 2 O 2 . A comprehensive study of the activity of metabisulfite with Fe-TAML was carried out toward the oxidative degradation of eight contaminants of emerging concern. The catalytic process was tested at different pH values (7, 9, and 11). Metabisulfite showed the highest activity at pH 11, completely degrading some of the tested micropollutants, but in several cases, the system was active at pH 9 as well. In particular, metabisulfite showed the best efficiency toward phenolic compounds. A preliminary study on the reaction mechanism and the nature of the active species in the Fe-TAML/metabisulfite system was also conducted, highlighting that a high-valent iron-oxo species might be involved in the degradation pathways., Competing Interests: The authors declare no competing financial interest., (Copyright © 2019 American Chemical Society.)

The treatment of produced waters (by-products of oil and gas extraction) with the innovative process of membrane distillation is challenging, because these highly saline streams contain high concentrations of organic compounds and hydrocarbons that cause membrane wetting and impairment of performance. To design the most compact treatment scheme and with the aim of obtaining an easier management of produced water for reuse purposes, Fenton oxidation is here investigated as a feed pre-treatment that may produce an effluent easily handled by membrane distillation. In high-recovery membrane distillation tests, we systematically investigate the detrimental effects of individual contaminants in a synthetic produced water mimicking the composition of a real sample. The recovery rate depends strongly on the initial salinity, which eventually causes scaling and pore blocking. Surfactants are found to be mainly responsible for membrane wetting, but volatile and hydrophobic organics also spoil the quality of the product water. A Fenton oxidation pre-treatment is thus performed to degrade the target organics, with the aim of enhancing the effectiveness of the following membrane distillation and to improve the quality of the final product. The combined oxidation-membrane distillation scheme has both advantages and limitations, which need to be carefully evaluated and further investigated.

Site-selective C-H functionalization of aliphatic alkyl chains is a longstanding challenge in oxidation catalysis, given the comparable relative reactivity of the different methylenes. A supramolecular, bioinspired approach is described to address this challenge. A Mn complex able to catalyze C(sp 3 )-H hydroxylation with H 2 O 2 is equipped with 18-benzocrown-6 ether receptors that bind ammonium substrates via hydrogen bonding. Reversible pre-association of protonated primary aliphatic amines with the crown ether selectively exposes remote positions (C8 and C9) to the oxidizing unit, resulting in a site-selective oxidation. Remarkably, such control of selectivity retains its efficiency for a whole series of linear amines, overriding the intrinsic reactivity of C-H bonds, no matter the chain length., (© 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

H 2 O 2 acts as a second messenger in key signaling circuits, transiently modulating tyrosine phosphatases and kinases. We investigated its origin, membrane transport, and functional role during B cell activation and differentiation. Our data identified NADPH-oxidase 2 as the main source of H 2 O 2 and aquaporin 8 as a transport facilitator across the plasma membrane. On aquaporin 8 silencing, inducible B lymphoma cells responded poorly to TLR and BCR stimulation. Their differentiation was severely impaired, as demonstrated by retarded onset of IgM polymerization, low amounts of IgM secretion, and prolonged BCR expression on the cell surface. A silencing-resistant aquaporin 8 rescued responsiveness, confirming that the import of H 2 O 2 across the membrane is essential for B cell activation. The addition of exogenous catalase to primary B splenocytes severely impaired the tyrosine phosphorylation induced by BCR cross-linking, as did the absence of NOX2 in a murine model of chronic granulomatous disease. Importantly, re-expression of gp91 phox through gene therapy restored the specific B cell signaling deficiency in NOX2 -/- cells. Thus, efficient induction of B cell activation and differentiation requires intact H 2 O 2 fluxes across the plasma membrane for signal amplification., (© Society for Leukocyte Biology.)

Regulated transgene expression may improve the safety and efficacy of hematopoietic stem cell (HSC) gene therapy. Clinical trials for X-linked chronic granulomatous disease (X-CGD) employing gammaretroviral vectors were limited by insertional oncogenesis or lack of persistent engraftment. Our novel strategy, based on regulated lentiviral vectors (LV), targets gp91(phox) expression to the differentiated myeloid compartment while sparing HSC, to reduce the risk of genotoxicity and potential perturbation of reactive oxygen species levels. Targeting was obtained by a myeloid-specific promoter (MSP) and posttranscriptional, microRNA-mediated regulation. We optimized both components in human bone marrow (BM) HSC and their differentiated progeny in vitro and in a xenotransplantation model, and generated therapeutic gp91(phox) expressing LVs for CGD gene therapy. All vectors restored gp91(phox) expression and function in human X-CGD myeloid cell lines, primary monocytes, and differentiated myeloid cells. While unregulated LVs ectopically expressed gp91(phox) in CD34(+) cells, transcriptionally and posttranscriptionally regulated LVs substantially reduced this off-target expression. X-CGD mice transplanted with transduced HSC restored gp91(phox) expression, and MSP-driven vectors maintained regulation during BM development. Combining transcriptional (SP146.gp91-driven) and posttranscriptional (miR-126-restricted) targeting, we achieved high levels of myeloid-specific transgene expression, entirely sparing the CD34(+) HSC compartment. This dual-targeted LV construct represents a promising candidate for further clinical development.

In the last years important progress has been made in the treatment of several primary immunodeficiency disorders (PIDs) with gene therapy. Hematopoietic stem cell (HSC) gene therapy indeed represents a valid alternative to conventional transplantation when a compatible donor is not available and recent success confirmed the great potential of this approach. First clinical trials performed with gamma retroviral vectors were promising and guaranteed clinical benefits to the patients. On the other hand, the outcome of severe adverse events as the development of hematological abnormalities highlighted the necessity to develop a safer platform to deliver the therapeutic gene. Self-inactivating (SIN) lentiviral vectors (LVVs) were studied to overcome this hurdle through their preferable integration pattern into the host genome. In this review, we describe the recent advancements achieved both in vitro and at preclinical level with LVVs for the treatment of Wiskott-Aldrich syndrome (WAS), chronic granulomatous disease (CGD), ADA deficiency (ADA-SCID), Artemis deficiency, RAG1/2 deficiency, X-linked severe combined immunodeficiency (γchain deficiency, SCIDX1), X-linked lymphoproliferative disease (XLP) and immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome.

Idiopathic pulmonary fibrosis has been associated with emphysema in cigarette smokers as a new clinical entity: combined pulmonary fibrosis and emphysema (CPFE). In order to compare histomorphometrical, roentgenological and immunohistochemical aspects of usual interstitial pneumonia (UIP) with and without associated pulmonary emphysema, 17 patients with biopsy-proven UIP were evaluated. Morphometrical evaluation of lung parenchyma destruction was used to divide patients in two subgroups: emphysema/UIP (n=9) and UIP alone (n=8); four patients with biopsy-proven emphysema without fibrosis were also evaluated. At HRTC scan, emphysematous lesions were prevalent in the upper fields of both emphysema/UIP and emphysema groups and the distribution of fibrotic lesions was similar in emphysema/UIP compared to UIP alone. The semiquantitative histopathological fibrotic score was also similar in emphysema/UIP and UIP alone. In addition, the expression of tumor necrosis factor (TNF)-alpha, matrix metalloproteinase (MMP)-2, MMP-9, MMP-7 and membrane type 1-metalloproteinase (MT1-MMP) by fibroblasts of myofibroblastic foci was similar in emphysema/UIP and UIP alone patients. In contrast, fibroblasts in areas of parenchymal destruction of emphysema/UIP expressed MMP-2, MMP-9, MMP-7 and MT1-MMP at variable but significantly higher levels when compared to emphysema subjects, in the presence of similar levels of TIMP-1, TIMP-2 and TNF-alpha. Fibrotic and emphysematous lesions in emphysema/UIP patients appear to follow the roentgenological and histopathological patterns expected for either UIP or emphysema. Interstitial fibroblast activation is more pronounced in the areas of lung destruction in emphysema/UIP compared to those with emphysema alone, as for exaggerated tissue remodeling.

In the present study we evaluated the 3-month follow-up of 14 subjects with phenobarbital-induced shoulder-hand syndrome after discontinuation of their previous pharmacological treatment (group 1: gabapentin 100 mg/day; group 2: acetaminophen 3 g/day for 3 months). The aim of this study was to evaluate pain and joint function in each group after cessation of treatment and to compare the results in the two groups. The result for pain and joint function was better in the seven patients previously treated with gabapentin.