Atraso na busca por serviço de saúde para o diagnóstico da tuberculose em Ribeirão Preto (SP)

Foi analisado o atraso na busca por serviço de saúde para o diagnóstico da Tuberculose (TB) em Ribeirão Preto, 2009, em um estudo epidemiológico, transversal, realizado com 94 doentes. Utilizou-se questionário baseado no Primary Care Assessment Tool, adaptado para avaliar a atenção à TB. Estabeleceu-se a mediana (15 dias ou mais) para caracterizar atraso na busca pelo primeiro atendimento. Através da Razão de Prevalência, identificaram-se as variáveis relacionadas ao maior atraso. O primeiro serviço de saúde procurado foi o de pronto atendimento (57,4%). Verificou-se um maior tempo na procura pelos serviços de saúde entre os doentes: do sexo masculino; com idade entre 50 a 59 anos; com renda familiar inferior a cinco salários mínimos; forma pulmonar; casos novos; não coinfecção TB/HIV; não consumiam bebida alcoólica, conhecimento satisfatório sobre TB (apresentou significância estatística na associação com o atraso) e que não procuravam o serviço de saúde próximo do domicílio antes de ter TB. Verificou-se a necessidade de capacitação para os profissionais de saúde quanto aos sinais e sintomas da doença, reduzindo as barreiras de acesso ao diagnóstico oportuno da TB e divulgação ampla para a comunidade em geral.

Postpartum depression and child development in first year of life

The aim of the study was to investigate the characteristics of infant development at four, eight and twelve months of age, as result of postpartum depression. The prevalence of Postpartum Depression - measured by the Edinburgh Postnatal Depression Scale - at four months after delivery was 30.3%; at eight months, 26.4%; and at 12 months, 25.0%. Chi-square tests were used to compare children of mothers with and without Postpartum Depression in relation to developmental milestones. It was found developmental delay in infants of mothers with Postpartum Depression in: two interactional indicators at four months, two motor indicators at eight months and one gross motor indicator at twelve months. However, children of mothers with Postpartum Depression showed better results in one fine motor and in two language items at 12 months. The results point to the necessity of considering external and internal factors of mother and infant in the study of the effects of maternal depression on child development.

UVB-induced cell death signaling is associated with G1-S progression and transcription inhibition in primary human fibroblasts

DNA damage induced by ultraviolet (UV) radiation can be removed by nucleotide excision repair through two sub-pathways, one general (GGR) and the other specific for transcribed DNA (TCR), and the processing of unrepaired lesions trigger signals that may lead to cell death. These signals involve the tumor suppressor p53 protein, a central regulator of cell responses to DNA damage, and the E3 ubiquitin ligase Mdm2, that forms a feedback regulatory loop with p53. The involvement of cell cycle and transcription on the signaling to apoptosis was investigated in UVB-irradiated synchronized, DNA repair proficient, CS-B (TCR-deficient) and XP-C (GGR-deficient) primary human fibroblasts. Cells were irradiated in the G1 phase of the cell cycle, with two doses with equivalent levels of apoptosis (low and high), defined for each cell line. In the three cell lines, the low doses of UVB caused only a transient delay in progression to the S phase, whereas the high doses induced permanent cell cycle arrest. However, while accumulation of Mdm2 correlated well with the recovery from transcription inhibition at the low doses for normal and CS-B fibroblasts, for XP-C cells this protein was shown to be accumulated even at UVB doses that induced high levels of apoptosis. Thus, UVB-induced accumulation of Mdm2 is critical for counteracting p53 activation and apoptosis avoidance, but its effect is limited due to transcription inhibition. However, in the case of XP-C cells, an excess of unrepaired DNA damage would be sufficient to block S phase progression, which would signal to apoptosis, independent of Mdm2 accumulation. The data clearly discriminate DNA damage signals that lead to cell death, depending on the presence of UVB-induced DNA damage in replicating or transcribing regions.

Photodynamic therapy for the treatment of induced mammary tumor in rats

The objective of this work was to evaluate photodynamic therapy (PDT) by using a hematoporphyrin derivative as a photosensitizer and light-emitting diodes (LEDs) as light source in induced mammary tumors of Sprague–Dawley (SD) rats. Twenty SD rats with mammary tumors induced by DMBAwere used. Animals were divided into four groups: control (G1), PDT only (G2), surgical removal of tumor (G3), and submitted to PDT immediately after surgical removal of tumor (G4). Tumors were measured over 6 weeks. Lesions and surgical were LEDs lighted up (200 J/cm2 dose). The light distribution in vivo study used two additional animals without mammary tumors. In the control group, the average growth of tumor diameter was approximately 0.40 cm/week. While for PDT group, a growth of less than 0.15 cm/week was observed, suggesting significant delay in tumor growth. Therefore, only partial irradiation of the tumors occurred with a reduction in development, but without elimination. Animals in G4 had no tumor recurrence during the 12 weeks, after chemical induction, when compared with G3 animals that showed 60 % recurrence rate after 12 weeks of chemical induction. PDT used in the experimental model of mammary tumor as a single therapy was effective in reducing tumor development, so the surgery associated with PDT is a safe and efficient destruction of residual tumor, preventing recurrence of the tumor.

Salt stress responses in pear and quince: physiological and molecular aspects

The productivity of agricultural crops is seriously limited by salinity. This problem is rapidly increasing, particularly in irrigated lands. Like almost all the fruit tree species, Pyrus communis is generally considered a salt sensitive species, but only little information is available on its behavior under saline conditions. Previous studies, carried out in the Department of Fruit Tree and Woody Plant Science (University of Bologna), focused their attention on pear and quince salt stress responses to understand which rootstock would be the most suitable for pear in order to tolerate a salt stress condition. It has been reported that pear and quince have different ability in the uptake, translocation and accumulation of chloride (Cl-) and sodium (Na+) ions, when plants were irrigated for one season with saline water (5 dS/m). The aim of the present work was to deepen these aspects and investigate salt stress responses in pear and quince. Two different experiments have been performed: a “short-term” trial in a growth chamber and a “long-term” experiment in the open field. In the short-term experiment, three different genotypes usually adopted as pear rootstocks (MC, BA29 and Farold®40) and the pear variety Abbé Fétel own rooted have been compared under salt stress conditions. The trial was performed in a hydroponic culture system, applying a 90 mM NaCl stress to half of the plants, after five weeks of normal growth in Hoagland’s solution. During the three-weeks of salt stress treatment, physiological, mineral and molecular analyses were performed in order to monitor, for each genotype, the development of the salt stress responses in comparison with the corresponding “unstressed” plants. Farold®40 and Abbé Fétel own rooted showed the onset of leaf necrosis, due to salt toxicity, one week before quinces. Moreover, quinces displayed a significant delay in premature senescence of old leaves, while pears emerged for their ability to regenerate new leaves from apparently dead foliage with the salt stress still running. Physiological measurements, such as shoots length, chlorophyll (Chl) content, and photosynthesis, have been carried out and revealed that pears exhibited a significant reduction in water content and a wilting aspect, while for quinces a decrease in Chl content and a growth slowdown were observed. At the end of the trial, all plants were collected and organs separated for dry weight estimation and mineral analyses (Cu, Fe, Mn, Zn Mg, Ca, K, Na and Cl). Mineral contents have been affected by salinity; same macro/micro nutrients were altered in some organs or relocated within the plant. This plant response could have partially contributed to face the salt stress. Leaves and roots have been harvested for molecular analyses at four different times during stress conditions. Molecular analyses consisted of the gene expression study of three main ion transporters, well known in Arabidopsis thaliana as salt-tolerance determinants in the “SOS” pathway: NHX1 (tonoplast Na+/H+ antiporter), SOS1 (plasmalemma Na+/H+ antiporter) and HKT1 (K+ high-affinity and Na+ low-affinity transporter). These studies showed that two quince rootstocks adopted different responsive mechanisms to NaCl stress. BA29 increased its Na+ sequestration activity into leaf vacuoles, while MC enhanced temporarily the same ability, but in roots. Farold®40, instead, exhibited increases in SOS1 and HKT1 expression mainly at leaf level in the attempt to retrieve Na+ from xylem, while Abbé Fétel differently altered the expression of these genes in roots. Finally, each genotype showed a peculiar response to salt stress that was the sum of its ability in Na+ exclusion, osmotic tolerance and tissue tolerance. In the long-term experiment, potted trees of the pear variety Abbé Fétel grafted on different rootstocks (MC, BA29 and Farold®40), or own rooted and also rootstocks only were subjected to a salt stress through saline water irrigation with an electrical conductivity of 5 dS/m for two years. The purposes of this study were to evaluate salinity effects on physiological (shoot length, number of buds, photosynthesis, etc.) and yield parameters of cultivar Abbé Fétel in the different combinations and to determine the salt amount that pear is able to tolerate over the years. With this work, we confirmed the previous hypothesis that pear, despite being classified as a salt-sensitive fruit tree, can be cultivated for two years under saline water irrigation, without showing any salt toxicity symptoms or severe drawbacks on plant development and production. Among different combinations, Abbé Fétel grafted on MC resulted interesting for its peculiar behaviors under salt stress conditions. In the near future, further investigations on physiological and molecular aspects will be necessary to enrich and broaden the knowledge of salt stress responses in pear.

Molekulardynamiksimulationen zur Untersuchung des Mischalkali-Effektes in silikatischen Gläsern

In der vorliegenden Arbeit wird mittels Molekulardynamik(MD)-Computersimulationen die Dynamik von verschiedenen Alkalisilikaten in der Schmelze und im Glas untersucht. Es ist bekannt, daß diese Systeme ionenleitend sind, was auf eine hohe Mobilität der Alkaliionen im Vergleich zu den glasbildenden Komponenten Si und O zurückzuführen ist. Im Mittelpunkt des Interesses steht der sog. Mischalkalieffekt (MAE), der in ternären Mischungen aus Siliziumdioxid mit zwei Alkalioxiden auftritt. Gegenüber Mischungen mit nur einer Alkaliionensorte weisen letztere Systeme eine signifikante Verlangsamung der Alkaliionendiffusion auf. Zunächst werden zwei binäre Alkalisilikate simuliert, nämlich Lithiumdisilikat (LS2) und Kaliumdisilikat (KS2). Die Simulationen zeigen, daß der Ursprung der hohen Mobilität der Alkaliionen in der Struktur begründet ist. KS2 und LS2 weisen auf intermediären Längenskalen Ordnung auf, die in partiellen statischen Strukturfaktoren durch Prepeaks reflektiert ist. Die den Prepeaks zugrundeliegende Struktur erklärt sich durch perkolierende Netzwerke aus alkalioxidreichen Kanälen, die als Diffusionskanäle für die mobilen Alkaliionen fungieren. In diesen Kanälen bewegen sich die Ionen mittels Sprüngen (Hopping) zwischen ausgezeichneten Plätzen. In der Simulation beobachtet man für die hohen Temperaturen (4000K>=1500K) eine ähnliche Aktivierungsenergie wie im Experiment. Im Experiment findet allerdings unterhalb von ca.1200K ein Crossover in ein Arrheniusverhalten mit höherer Aktivierungsenergie statt, welches von der Simulation nicht nachvollzogen wird. Das kann mit der in der Simulation nicht im Gleichgewicht befindlichen Si-O-Matrix erklärt werden, bei der Alterungseffekte beobachtet werden. Am stärksten ist der MAE für eine Alkalikomponente, wenn deren Konzentrationsanteil in einem ternären Mischalkalisystem gegen 0 geht. Daher wird ein LS2-System untersucht, in dem ein Li-Ion gegen ein K-Ion getauscht wird. Der Einfluß des K-Ions ist sowohl lokal in den charakteristischen Abständen zu den ersten nächsten Nachbarn (NN) zu sehen, als auch in der ortsaufgelösten Koordinationszahlverteilung bis zu Längenskalen von ca. 8,5 Angstrom. Die Untersuchung der Dynamik des eingesetzten K-Ions zeigt, daß die Sprungwahrscheinlichkeit nicht mit der Lokalisierung, einem Maß für die Bewegung eines Teilchens um seine Ruheposition, korreliert ist, aber daß eine chemische Umgebung mit wenig Li- und vielen O-NN oder vielen Li- und wenig O-NN ein Sprungereignis begünstigt. Zuletzt wird ein ternäres Alkalisilikat (LKS2) untersucht, dessen Struktur alle charakteristischen Längenskalen von LS2 und KS2 aufweist. Es stellt sich also eine komplexe Struktur mit zwei perkolierenden Subnetzwerken für Alkaliionen ein. Die Untersuchung der Dynamik zeigt eine geringe Wahrscheinlichkeit dafür auf, daß Ionen in ein Subnetzwerk andersnamiger Ionen springen. Auch kann gezeigt werden, daß das Modellpotential den MAE reproduzieren kann, daß also die Diffusionskonstanten in LKS2 bei bis zu einer Größenordnung langsamer sind als in KS2 bzw. LS2. Der beobachtete Effekt stellt sich zudem vom funktionalen Verlauf her so dar, wie er beim MAE erwartet wird. Es wurde auch festgestellt, daß trotz der zeitlichen Verzögerung in den dynamischen Größen die Anzahl der Sprünge pro Zeit nicht geringer ist und daß für niedrige Temperaturen (d.h.im Glas) Sprünge auf den Nachbarplatz mit anschließendem Rücksprung auf die vorherige Position deutlich wahrscheinlicher sind als bei hohen Temperaturen (also in der Schmelze). Die vorliegenden Resultate geben Aufschluß über die Details der Mechanismen mikroskopischer Ionenleitung in binären und ternären Alkalisilikaten sowie dem MAE.

Intrazelluläre Lokalisation und synaptische Ausschüttung der Neurotrophine in hippokampalen Neuronen und die Bedeutung von BDNF bei hippokampaler synaptischer Plastizität

Die Mitglieder der Neurotrophin-Familie (NGF, BDNF, NT-3 und NT-4) sind sekretierte Neuropeptide, die eine bedeutende Rolle bei der Entwicklung von Nervenzellen und bei der Modulation der synaptischen Transmission spielen. Wenngleich eine aktivitätsabhängige Sekretion von BDNF bereits gezeigt werden konnte, wurden die subzelluläre Expression und die Ausschüttung der anderen Neurotrophine bislang nur unzureichend charakterisiert. Um die Expression und die Ausschüttung aller Neurotrophine unter identischen Bedingungen untersuchen zu können, wurde in der vorliegenden Arbeit das Expressionsmuster und die synaptische Ausschüttung GFP-markierter Neurotrophine in dissoziierten hippokampalen Neuronen mit Hilfe der konfokalen Fluoreszenz-Videomikroskopie zeitaufgelöst untersucht. Zwei Phänotypen konnten unterschieden werden: der distale vesikuläre Expressionstyp mit Neurotrophin-beinhaltenden Vesikeln in distalen Neuriten, und der proximale Expressionstyp mit einer diffusen Neurotrophin-Verteilung in den Neuriten und Neurotrophin-beinhaltenden Vesikeln im Soma des Neurons und in den proximalen Dendriten. Der distale vesikuläre Phänotyp entsprach einer Verteilung des entsprechenden Neurotrophins in die sekretorischen Granula des aktivitätsabhängigen Sekretionsweges, während der proximale Phänotyp den Transport eines Neurotrophins in den konstitutiven Sekretionsweg widerspiegelte. Alle Neurotrophine erreichten in hippokampalen Neuronen prinzipiell beide Sekretionswege. Jedoch gelangten BDNF und NT-3 mit einer größeren Effizienz in den regulierten Sekretionsweg als NT-4 und NGF (BDNF: in 98% aller Zellen, NT-3: 85%, NT-4: 23% und NGF: 46%). Neurotrophine besitzen, wie es für sekretorische Peptide üblich ist, eine Vorläufersequenz, die während der Reifung des Proteins proteolytisch abgespalten wird. Die Fusion dieser Präpro-Sequenz von BDNF mit der Sequenz des maturen NT-4 bewirkte einen effizienteren Transport von NT-4 in die sekretorischen Granula des regulierten Sekretionsweges, und zeigte die große Bedeutung der Präpro-Sequenz für das zelluläre Verteilungsmuster von Neurotrophinen. In Neuronen, in denen die Neurotrophine in den regulierten Sekretionsweg transportiert wurden, konnte eine aktivitätsabhängige Sekretion der Neurotrophine an postsynaptische Strukturen glutamaterger Synapsen beobachtet werden. Die aktivitätsabhängige postsynaptische Ausschüttung der Neurotrophine zeigte eine Heterogenität in der Kinetik der Sekretion (exponentieller Abfall des Neurotrophin-Signals mit Zeitkonstanten von tau = 121 bis 307s). Die Präinkubtion mit dem Protonen-Ionophor Monensin, welcher die Neutralisation des intragranulären pH-Wertes und somit die Solubilisierung der dicht gepackten Proteinstrukturen in den Vesikeln erzwingt, erhöhte die Geschwindigkeit der Neurotrophin-Ausschüttung auf den Wert des unter physiologischen Bedingungen schnellsten Neurotrophins NT-4. Dennoch blieb die Geschwindigkeit der Neurotrophin-Ausschüttung im Vergleich zur Neurotransmitter-Ausschüttung langsam (tau = 13 ± 2 s). Diese Daten belegen eindeutig, dass die Neutralisation der sekretorischen Granula die Geschwindigkeit der Neurotrophin-Ausschüttung kritisch determiniert und die Geschwindigkeit der Neurotrophin-Ausschüttung im Vergleich zur konventionellen Neurotransmitter-Ausschüttung langsam erfolgt. Des Weiteren konnte gezeigt werden, dass das Neurotrophin BDNF effizient in distale vesikuläre Strukturen von CA1 Pyramidenzellen organotypischer Schnittkulturen des Hippokampus sortiert wird. Die basalen elektrischen Eigenschaften von CA1 Pyramidenzellen BDNF-defizienter Mäuse sind vergleichbar zu den Eigenschaften von Wildtyp Mäusen. Sowohl das Eigenpotential der CA1 Pyramidenzellen, die Form der Aktionspotentiale als auch die evozierten Antworten der CA1 Pyramdenzellen auf eine gepaarte präsynaptische Stimulation der Schaffer-Kollateralen zeigten bei BDNF-/- -, BDNF+/- - und BDNF+/+ -Mäusen keine signifikanten Unterschiede. Die Fähigkeit der CA1 Pyramidenzellen auf eine hochfrequente Reizung mit einer Langzeitpotenzierung (LTP) der postsynaptischen Ströme zu reagieren ist jedoch bei den BDNF-defizienten Mäusen beinträchtigt. Eine verminderte Induktion von LTP war in den BDNF-defizienten Mäusen nach tetanischer Stimulation der präsynaptischen Schaffer-Kollateralen und simultaner postsynaptischer Depolarisation der CA1 Pyramidenzelle zu beobachten.

Spin-crossover in metallomesogens of iron(II)

Covalent grafting mesogenic groups to the coordination cores of the parent mononuclear low-spin and spin-crossover compounds afforded metallomesogenic complexes of iron(II). In comparison with the parent complexes the spin-crossover properties of the alkylated derivatives are substantially modified. The type of the modification was found to be dependent on the properties of the parent system and the nature of the used anion, however, the general tendency is the destabilization of the low-spin state at the favor of spin-crossover or high-spin behavior below 400 K. The structural insight revealed the micro-segregated layered organization. The effect of the alkylation of the parent compounds consists first of all in the change of the lattice to a two-dimensional lamellar one retaining significant intermolecular contacts only within the ionic bilayers. The comprehensive analysis of the structural and thermodynamic data in the homologous series pointed at the mechanism of the interplay between the structural modification on melting and the induced anomalous change of the magnetic properties. A family of one-dimensional spin-crossover polymers was synthesized and characterized using a series of spectroscopic methods, X-ray powder diffraction, magnetic susceptibility measurements and differential scanning calorimetry. The copper analogue of was also synthesized and its crystal structure solved. In comparison with the mononuclear systems, the polymeric mesogens of iron(II) are less sensitive to the glass transition, which was attributed to the moderate concomitant variation of the structure. Nevertheless, the observed increase of the magnetic hysteresis with lengthening of the alkyl substituents was ascribed to the interplay of the structural reorganization of the coordination core due to spin-crossover with the structural delay in the spatial reorganization of the mesogenic substituents. The classification of mononuclear and polymeric metallomesogens according to the interactions between the structural- and the spin-transition and analysis of the data on the reported spin-crossover metallomesogens led to the separation of three types, namely: Type i: systems with coupling between the electronic structure of the iron(II) ions and the mesomorphic behavior of the substance; Type ii: systems where both transitions coexist in the same temperature region but are not coupled due to competition with the dehydration or due to negligible structural transformation; Type iii: systems where both transitions occur in different temperature regions and therefore are uncoupled. Fine-tuning, in particular regarding the temperature at which the spin-transition occurs with hysteresis properties responsible for the memory effect, are still a major challenge towards practical implementation of spin-crossover materials. A possible answer to the problem could be materials in which the spin-crossover transition is coupled with another transition easily controllable by external stimuli. In the present thesis we have shown the viability of the approach realized in the mesogenic systems with coupled phase- and spin-transitions.

Glykolytische Aktivität von Ovarialkarzinomzelllinien in vitro und in vivo und die Bedeutung von HIF-1alpha

Ovarialkarzinome stellen eine schwer zu therapierende onkologische Erkrankung mit im Durchschnitt sehr schlechter Prognose dar. Die Notwendigkeit einer weiteren Verbesserung der Therapie dieser Erkrankung ist sehr offensichtlich. Studien an anderen Tumorentitäten haben die große Bedeutung des Glukosestoffwechsels, speziell des Laktats, in der Erken- nung, Kategorisierung und Therapie von onkologischen Erkrankungen gezeigt. In der Kon- trolle des Glukosestoffwechsels, aber auch vieler anderer Funktionen, wie z. B. des Tumor- wachstums und des Zellüberlebens, hat sich der Hypoxia Inducible Factor (HIF) als beson- ders wichtig herausgestellt. In der vorliegenden Arbeit wurde daher der Glukosestoffwechsel in Ovarialkarzinomen und seine Beeinflussung durch eine Herunterregulierung von HIF-1α untersucht. Hierzu wurden die Ovarialkarzinomzelllinien OC 316 und IGROV1 (Wildtyp) und die Zelllinie OC 316 mit einem lentiviralen Vektor zur Herunterregulierung von HIF-1α ver- wendet. Das Wachstumsverhalten, die Laktatproduktion und der Glukoseverbrauch wurden bei diesen Zelllinien in vitro untersucht. Darüber hinaus wurden mithilfe der bildgebenden Biolumineszenz ATP, Laktat, Pyruvat und Glukose in Xenotransplantaten dieser Zelllinien gemessen. Diese in unserer Arbeitsgruppe entwickelte Methode erlaubt die quantitative Er- fassung von Metaboliten in selektiven Gewebsarealen, wie z. B. in vitalen Tumorregionen, in stomatösen Arealen oder im tumornahen Normalgewebe.rnIn dieser Arbeit kann gezeigt werden, dass die glykolytische Aktivität von Ovarialkarzinom- zelllinien mit dem Wachstumsverhalten positiv korreliert ist. Eine Herunterregulierung von HIF-1α führt zu einer deutlichen Verlangsamung des Zellwachstums, wobei allerdings alle HIF-Zielgene betroffen sein können. Des Weiteren wird mit den hier gezeigten Daten die prognostische Bedeutung des Laktats bestätigt. Hohe Laktatwerte in vitro waren mit schnel- lerem Wachstum korreliert. Zusätzlich zeigen die vorliegenden Daten, dass die gewonnenen Befunde in vitro nur näherungsweise auf die in vivo Situation übertragbar sind. Eine Herun- terregulierung von HIF-1α zeigt keine signifikant unterschiedlichen Laktatwerte in den Xe- notransplantaten. Allerdings spiegeln sich zelllinienspezifische Unterschiede in der metabo- lischen Aktivität in vitro im metabolischen Verhalten der entsprechenden Xenografttumoren recht gut wider.rnDie gewonnenen Ergebnisse weisen zum einen auf die prognostische Bedeutung einer Bestimmung von Laktatkonzentrationen aus Tumorbiopsien hin und bestätigen zum anderen die klinische Aussagekraft metabolischer Aktivitätsmessungen mittels PET. Solche Daten könnten dazu dienen Patienten einer individualisierten Therapie zuzuführen. Außerdem wur- de die Effektivität, aber auch die Komplexität einer gegen HIF-1α gerichteten Therapie auf Protein- und Genebene bestätigt. Somit zeigen die erzielten Resultate einerseits Möglichkei- ten einer individualisierten Therapie auf, andererseits unterstreichen sie die große Notwen- digkeit weiterer Grundlagenforschung auf diesem Gebiet.

I Fondi Strutturali europei 2007-2013 in Italia: un'analisi delle criticità

A 7 anni dall’avvio dell’ attuazione della Politica di Coesione dell’Unione Europea 2007- 2013, l’Italia ha il tasso di assorbimento dei Fondi Strutturali più basso d’Europa, insieme alla Romania, e rischia di subire un disimpegno delle risorse, che rappresenterebbe un gravissimo fallimento economico e politico. Il contributo di questo lavoro al dibattito sull’uso dei Fondi strutturali in Italia è duplice. Da una parte, per la prima volta, si propone uno studio sistematico delle criticità nella gestione del periodo 2007-2013, che hanno causato l’attuale ritardo nella spesa. Dall’altra, si affronta il problema italiano sia da una prospettiva europea sia nella sua dimensione nazionale, indagando le differenze regionali nella performance di spesa e proponendo un’analisi basata su tre dimensioni principali delle criticità: finanziaria, politica, amministrativa. L’approccio della ricerca consiste nella convergenza di dati quantitativi e qualitativi, raccolti durante un periodo di ricerca a Bruxelles e presso le Autorità di Gestione dei Programmi Operativi cofinanziati dal FESR. La questione dell’assorbimento finanziario e del ritardo nell’attuazione è stata indagata da tre punti di vista. Una prospettiva “storica”, che ha raccontato il ritardo strutturale nell’utilizzo dei Fondi Strutturali in Italia e che ha chiarito come il problema italiano, prima dell’attuale ciclo 2007-2013, sia stato non di quantità, ma di qualità della spesa. La seconda prospettiva è stata di respiro europeo, ed è servita a indagare le cause del basso livello di assorbimento finanziario dell’Italia suggerendo alcuni elementi utili a comprendere le ragioni di un simile divario con gli altri Paesi. Infine, la prospettiva nazionale e regionale ha svelato l’esistenza di un mix complesso, e micidiale, che ha letteralmente paralizzato la spesa italiana dei Fondi. Un mix di fattori finanziari, politici e amministrativi che non ha avuto eguali negli altri Paesi, e che si è concentrato soprattutto, ma non esclusivamente, nelle regioni dell’Obiettivo Convergenza.

Characterization of West Nile virus strains isolated in Italy

West Nile virus (WNV) is a neurotropic flavivirus that is maintained in an enzootic cycle between mosquitoes and birds, but can also infect and cause disease in humans and other vertebrate species. Most of WNV infections in humans are asymptomatic, but approximately 20% of infected people develop clinical symptoms, although severe neurological diseases are observed in less than 1% of them. WNV is the most widely distributed arbovirus in the world and has been recently associated with outbreaks of meningo-encephalitis in Europe, including Italy, caused by different viral strains belonging to distinct lineages 1 and 2. The hypothesis is that genetic divergence among viral strains currently circulating in Italy might reflect on their pathogenic potential and that the rapid spread of WNV with increased pathogenicity within naïve population suggest that epidemic forms of the virus may encode mechanisms to evade host immunity. Infection with WNV triggers a delayed host response that includes a delay in the production of interferon-α (IFN-α). IFNs are a family of immuno-modulatory cytokines that are produced in response to virus infection and serve as integral signal initiators of host intracellular defenses. The increased number of human cases and the lack of data about virulence of European WNV isolates highlight the importance to achieve a better knowledge on this emerging viral infection. In the present study, we investigate the phenotypic and IFN-α-regulatory properties of different WNV lineage 1 and 2 strains that are circulating in Europe/Italy in two cell lines: Vero and 1321N1. We demonstrate that: Vero and 1321N1 cells are capable of supporting WNV replication where different WNV strains show similar growth kinetics; WNV lineage 2 strain replicated in Vero and 1321N1 cells as efficiently as WNV lineage 1 strains; and both lineages 1 and 2 were highly susceptible to the antiviral actions of IFN-α.

Occurrence and types of associated injuries in patients with fractures of the facial bones

PURPOSE: To identify the occurrence, types, and severity of associated injuries outside the facial region among patients diagnosed with facial fractures, and to analyze whether there are any factors related to associated injuries. MATERIALS AND METHODS: This was a cross-sectional study of 401 patients diagnosed with facial fractures during the 2-year period from 2003 to 2004. RESULTS: Associated injuries were observed in 101 patients (25.2%). The most common type of injury was a limb injury (13.5%), followed by brain (11.0%), chest (5.5%), spine (2.7%), and abdominal (0.8%) injuries. Multiple associated injuries were observed in 10% and polytrauma in 7.5%. The mortality rate was 0.2%. The occurrence of associated injury correlated significantly with trauma mechanism and fracture type; high-speed accidents and severe facial fractures were significant predictors of associated injury. CONCLUSIONS: Associated injuries are frequent among patients who have sustained facial fractures. The results underscore the importance of multiprofessional collaboration in diagnosis and sequencing of treatment, but also the importance of arranging appropriate clinical rotations for maxillofacial residents in training.

Delayed osteoblast differentiation and altered inflammatory response around implants placed in incisor sockets of type 2 diabetic rats

Objective: Central to the process of osseointegration is the recruitment of mesenchymal progenitor cells to the healing site, their proliferation and differentiation to bone synthesising osteoblasts. The process is under the control of pro-inflammatory cytokines and growth factors. The aim of this study was to monitor these key stages of osseointegration and the signalling milieu during bone healing around implants placed in healthy and diabetic bone. Methods: Implants were placed into the sockets of incisors extracted from the mandibles of normal Wistar and diabetic Goto-Kakizaki rats. Mandibles 1-12 weeks post-insertion of the implant were examined by histochemistry and immunocytochemistry to localise the presence of Stro-1- positive mesenchymal progenitor cells, proliferating cellular nuclear antigen proliferative cells, osteopontin and osteocalcin, macrophages, pro-inflammatory cytokines interleukin (IL)-1 , IL-6, tumour necrosis factor (TNF)- and tumour growth factor (TGF)- 1. Image analysis provided a semi-quantification of positively expressing cells. Results: Histological staining identified a delay in the formation of mineralised bone around implants placed in diabetic animals. Within the diabetic bone, the migration of Stro-1 mesenchymal cells in the healing tissue appeared to be unaffected. However, in the diabetic healing bone, the onset of cell proliferation and osteoblast differentiation were delayed and subsequently prolonged compared with normal bone. Similar patterns of change were observed in diabetic bone for the presence of IL-1 , TNF- , macrophages and TGF- 1. Conclusion: The observed alterations in the extracellular presence of pro-inflammatory cytokines, macrophages and growth factors within diabetic tissues that correlate to changes in the signalling milieu, may affect the proliferation and differentiation of mesenchymal progenitor cells in the osseointegration process. To cite this article: Colombo JS, Balani D, Sloan AJ, St Crean J, Okazaki J, Waddington RJ. Delayed osteoblast differentiation and altered inflammatory response around implants placed in incisor sockets of type 2 diabetic rats Clin. Oral Impl. Res22, 2011; 578-586 doi: 10.1111/j.1600-0501.2010.01992.x.

Nerve excitability studies characterize Kv1.1 fast potassium channel dysfunction in patients with episodic ataxia type 1

Episodic ataxia type 1 is a neuronal channelopathy caused by mutations in the KCNA1 gene encoding the fast K(+) channel subunit K(v)1.1. Episodic ataxia type 1 presents with brief episodes of cerebellar dysfunction and persistent neuromyotonia and is associated with an increased incidence of epilepsy. In myelinated peripheral nerve, K(v)1.1 is highly expressed in the juxtaparanodal axon, where potassium channels limit the depolarizing afterpotential and the effects of depolarizing currents. Axonal excitability studies were performed on patients with genetically confirmed episodic ataxia type 1 to characterize the effects of K(v)1.1 dysfunction on motor axons in vivo. The median nerve was stimulated at the wrist and compound muscle action potentials were recorded from abductor pollicis brevis. Threshold tracking techniques were used to record strength-duration time constant, threshold electrotonus, current/threshold relationship and the recovery cycle. Recordings from 20 patients from eight kindreds with different KCNA1 point mutations were compared with those from 30 normal controls. All 20 patients had a history of episodic ataxia and 19 had neuromyotonia. All patients had similar, distinctive abnormalities: superexcitability was on average 100% higher in the patients than in controls (P < 0.00001) and, in threshold electrotonus, the increase in excitability due to a depolarizing current (20% of threshold) was 31% higher (P < 0.00001). Using these two parameters, the patients with episodic ataxia type 1 and controls could be clearly separated into two non-overlapping groups. Differences between the different KCNA1 mutations were not statistically significant. Studies of nerve excitability can identify K(v)1.1 dysfunction in patients with episodic ataxia type 1. The simple 15 min test may be useful in diagnosis, since it can differentiate patients with episodic ataxia type 1 from normal controls with high sensitivity and specificity.

Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.