Variazione dei markers di attivata coagulazione indotta dalla terapia infusionale con Infliximab in pazienti affetti da malattie infiammatorie croniche intestinali

INTRODUCTION: A relationship between inflammatory response and coagulation is suggested by many observations. In particular, pro-inflammatory cytokines, such as TNFalpha, promote the activation of coagulation and reduce the production of anticoagulant molecules. It is known that inflammatory bowel diseases show a prothrombotic state and a condition of hypercoagulability. Aim of our study was to evaluate whether anti-TNFalpha therapy induces changes in the levels of coagulation activation markers in IBD patients. MATERIALS AND METHODS: We analyzed 48 plasma samples obtained before and 1 hour after 24 infliximab infusions (5 mg/kg) in 9 IBD patients (5 men and 4 women; mean age: 47.6+17.6 years; 4 Crohn's disease, 4 Ulcerative Colitis,1 Indeterminate Colitis). F1+2 and D-dymer levels were measured in each sample using ELISA methods.The data were statistically analyzed by means of Wilcoxon matched paired test. RESULTS: Median F1+2 levels were markdely reduced 1 hour after anti-TNFα infusion (median pre-infusion levels were 247.0 pmol/L and median post-infusion levels were 185.3 pmol/L) (p<0.002). Median D-dymer levels were also significantly reduced, from 485.2 ng/mL to 427.6 ng/mL (p< 0.001). These modifications were more evident in patients naive for infliximab therapy (p<0.02 for F1+2 and p<0.02 for D-dymer) and in Crohn's disease compared with Ulcerative Colitis patients (p=0.01 for F1+2 and p<0.007 for D-dymer).CONCLUSIONS: Infusion of infliximab significantly reduces the activation of coagulation cascade in IBD patients. This effect is early enough to suggest a direct effect of infliximab on the coagulation cascade and a possible new anti-inflammatory mechanism of action of this molecule.

La lattatemia nel puledro neonato sottoposto a terapia intensiva

Admission blood lactate concentration has been shown to be a useful indicator of disease severity in human medicine and numerous studies have associated hyperlactatemia with patients at high risk of death who should be treated aggressively regardless of the cause of the lactate generation. The degree and duration of hyperlactacidaemia also have been correlated with the subsequent development of organ failure. Similarly, in a small number of studies about equine colic, blood lactate concentration has been investigated as a useful prognostic variable . In neonatal foals blood lactate was studied first by Magdesian (2003) who described venous blood lactate concentration in 14 normal foals during the initial 48 hours post-partum. A preliminary study about lactate concentration in foals presenting to a neonatal intensive care unit reported that surviving foals had earlier lactate clearance. The measurement of blood lactate concentration is traditionally available with a wet chemistry laboratory method or with blood-gas analyzers, for clinicians working at university or large private hospital. But this methods may not be easily accessible to many practitioners in field conditions. Several relatively inexpensive, easy to use and rapid pocket size monitors to measure lactate concentration have been validated in human patients and athletes. None of these portable lactate analyzer have been evaluated in clinically normal neonatal foals or in foals referred to a neonatal intensive care unit. The aims of this study were to validate the Lactate Scout analyzer in neonatal foals, investigating the correlation between lactate concentration in whole blood measured with the portable monitor and measured in plasma with the reference laboratory analyzer. The effect of hematocrit (Hct) on the accuracy of Lactate Scout was also evaluated. Further, we determined the utility of venous lactate measurement in critically-ill foals, describing lactate values in the most frequent neonatal pathologies, evaluating serial blood lactate measurements during hospitalization and investigating its prognostic value. The study also describes normal range for lactate in healthy neonatal foals during the first 72 hours of life.

La sorpresa come fattore critico indicatore di sintonizzazione emotiva in bambini normali e con disturbi pervasivi dello sviluppo

The topic of this study is surprise, re gard as an evolutionary complex process, with manifold implication in different fields, from neurological, since aspecific correlate of surprise exist more or less at every level of neuronal processes (e.g. Rao e Ballard, 1999.), to behavioral , inasmuch a s our ability to quickly valuate(assess), recognize and learn from surprising events, are be regarded as pivotal for survival (e.g. Ranganath e Rainer, 2003). In particular this work, going from belief that surprise is really a psychoevolutive mechanism of primary relevance, has the objective to investigate if there may be a substantial connection between development of surprise' emotion and specific developmental problems, or, if in subjects with pervasive developmental disorders surprise may embody (represent) a essential mechanism of emotional tuning, and consequently if abnormalities in such process may be at the base of at least a part of cognitive and behavioural problems that determine (describe) this pathology. Theoretical reasons lead us to conside r this particular pathologic condition, recall to a broad area of research concern the comprehension of belief as marker of ability to reasons about mental states of others (i.e. Theory of Mind), and in addition, at the detection of specific subjects' diff iculty in this field. On the experimental side, as well as limited of this work, we have to compare comprehension and expression of surprise in a sample of 21 children with pervasive developmental disorders (PDD), with a sample of 35 children without deve lopmental problems, in a range of age 3-12. Method After the customary approach to become friendly with the child, an experimenter and an accomplice showed three boxes of nuts, easily to distinguish one from the other because of their different colours an d , working together with the child, the contents of one of the boxes were replaced and a different material (macaroni, pebbles) was put in the box. for the purpose of preparing a surprise for someone. At this stage, the accomplice excused himself/herself and left and the experimenter suggested to the child that he prepare another surprise, replacing the contents in the second box. When the accomplice came back, the child was asked to prepare a surprise for him by picking out the box that he thought was the right one for the purpose. After, and the child doesn't know it, the accomplice change the content of one of the boxes with candies and asked out to the children to open the box, in order to see if he show surprise. Result Date have obtain a significant difference between autistic and normal group, in all four tests. The expression of surprise too, is present in significantly lower degree in autistic group than in control group. Moreover, autistic children do not provide appropriate metarappresentative explanations. Conclusion Our outcome, with knowledge of the limit of our investigation at an experimental level (low number of the champions, no possibility of video registration to firm the expressions ) orient to consider eventuality that surprise, may be seen as relevant component, or indicative, in autistic spectrum disorders.

Implantes endomedulares hidráulicos para la terapia reconstructiva de miembros

Programa de doctorado: Avances en Traumatología, Medicina del Deporte, Cuidados de Heridas (interdepartamental)

Rilascio dei biomarkers di danno miocardico dopo iniezione diretta per via percutanea di cellule staminali e terapia genica

Aims: We aimed to quantify the release of bio-markers of myocardial damage in relation to direct intramyocardial injections of genes and stem cells in patients with severe coronary artery disease. Methods and Results: We studied 71 patients with “no-option” coronary artery disease. Patients had, via the percutaneous transluminal route, a total of 11±1 (mean ± SD) intramyocardial injections of vascular endothelial growth factor genes (n=56) or mesenchymal stromal cells (n=15). Injections were guided to an ischemic area by electromechanical mapping, using the NOGA™/Myostar™ catheter system. ECG was monitored continuously until discharge. Plasma CKMB (upper normal laboratory limit=5 μg/l) was 2 μg/l (2-3) at baseline; increased to 6 (5-9) after 8 hours (p < 0.0001) and normalized to 4 (3-5) after 24 hours. A total of 8 patients (17%), receiving a volume of 0.3 ml per injection, had CKMB rises exceeding 3 times the upper limit, whereas no patient in the group receiving 0.2 ml had a more than two fold CKMB increase. No patient developed new ECG changes. There were no clinically important ventricular arrhythmias and no death. Conclusion: Direct Intramyocardial injections of stem cells or genes lead to measurable release of cardiac bio-markers, which was related to the injected volume.

Validazione e applicazioni cliniche della metodica NIRA (Near Infrared Reflectance Analysis) per la valutazione del contenuto nutrizionale del latte materno in terapia intensiva neonatale

Phase 1: To validate Near-Infrared Reflectance Analysis (NIRA) as a fast, reliable and suitable method for routine evaluation of human milk’s nitrogen and fat content. Phase 2: To determine whether fat content, protein content and osmolality of HM before and after fortification may affect gastroesophageal reflux (GER) in symptomatic preterm infants. Patients and Methods: Phase 1: 124 samples of expressed human milk (55 from preterm mothers and 69 from term mothers) were used to validate NIRA against traditional methods (Gerber method for fat and Kjeldhal method for nitrogen). Phase 2: GER was evaluated in 17 symptomatic preterm newborns fed naïve and fortified HM by combined pH/intraluminal-impedance monitoring (pH-MII). HM fat and protein content was analysed by a Near-Infrared-Reflectance-Analysis (NIRA). HM osmolality was tested before and after fortification. GER indexes measured before and after fortification were compared, and were also related with HM fat and protein content and osmolality before and after fortification. Results: Phase 1: · A strong agreement was found between traditional methods’ and NIRA’s results (expressed as g/100 g of milk), both for fat and nitrogen content in term (mean fat content: NIRA=2.76; Gerber=2.76; mean nitrogen content: NIRA=1.88; Kjeldhal =1.92) and preterm (mean fat content: NIRA=3.56; Kjeldhal=3.52; mean nitrogen content: NIRA=1.91; Kjeldhal =1.89) mother’s milk. · Nitrogen content of the milk samples, measured by NIRA, ranged from 1.18 to 2.71 g/100 g of milk in preterm milk and from 1.48 to 2.47 in term milk; fat content ranged from 1.27 to 6.23 g/100 g of milk in preterm milk and from 1.01 to 6.01 g/100 g of milk in term milk. Phase 2: · An inverse correlation was found between naïve HM protein content and acid reflux index (RIpH: p=0.041, rho=-0.501). · After fortification, osmolality often exceeded the values recommended for infant feeds; furthermore, a statistically significant (p<.05) increase in non acid reflux indexes was observed. Conclusions: NIRA can be used as a fast, reliable and suitable tool for routine monitoring of macronutrient content of human milk. Protein content of naïve HM may influence acid GER in preterm infants. A standard fortification of HM may worsen non acid GER indexes and, due to the extreme variability in HM composition, may overcome both recommended protein intake and HM osmolality. Thus, an individualized fortification, based on the analysis of the composition of naïve HM, could optimize both nutrient intake and feeding tolerance.

Studio immunologico per l'individuazione di pazienti trapiantati per cirrosi HBV relata che potrebbero sospedere la terapia con immunoglobine specifiche (HBIG)

Hepatitis B virus (HBV) recurrence after orthotopic liver transplantation (OLT) is associated with poor graft and patient survival. Treatment with HBV-specific immunoglobulins (HBIG) in combination with nucleos(t)ide analogs is effective in preventing HBV reinfection of the graft and improving OLT outcome. However, the combined immunoprophylaxis has several limitations, mainly the high cost and the lack of standard schedules about duration. So far, the identification of markers able to predict the reinfection risk is needed. Although the HBV-specific immune response is believed to play an essential role in disease outcome, HBV-specific cellular immunity in viral containment in OLT recipients is unclear. To test whether or not OLT recipients maintain robust HBV-specific cellular immunity, the cellular immune response against viral nucleocapsid and envelope-protein of HBV was assessed in 15 OLT recipients and 27 individuals with chronic and 24 subjects with self-limited HBV infection, respectively. The data demonstrate that OLT recipients mounted fewer but stronger clusters of differentiation (CD)8 T cell responses than subjects with self-limited HBV infection and showed a preferential targeting of the nucleocapsid antigen. This focused response pattern was similar to responses seen in chronically infected subjects with undetectable viremia, but significantly different from patients who presented with elevated HBV viremia and who mounted mainly immune responses against the envelope protein. In conclusion, virus-specific CD4 T cell–mediated responses were only detected in subjects with self-limited HBV infection. Thus, the profile of the cellular immunity against HBV was in immune suppressed patients similar to subjects with chronic HBV infection with suppressed HBV-DNA.