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BackgroundThe proinflammatory cytokines have been implicated in the pathogenesis of heart failure. Recent studies have shown that @b-adrenergic blockade can modulate cytokine production. This study investigates the different impact of different degrees of sympathetic antagonism on circulating levels of cytokines in patients with heart failure resulting from ischemic dilated cardiomyopathy (IDC).Methods and ResultsThirty-five patients with IDC were randomly assigned to receive metoprolol or carvedilol in an open-label study. Echocardiographic measurements and circulating levels of tumor necrosis (TNF)-@a and interleukin (IL)-1@b and IL-6 were obtained at baseline and after 3 months of treatment. The 2 @b-blockers significantly improved the left ventricular ejection fraction and reduced end-diastolic and end-systolic volume. The magnitude of these changes was greater with carvedilol than with metoprolol (respectively P < .001, P < .05, and P < .05). Both treatments induced a significant decrease in the levels of cytokines (for all P < .01), but the decrease in TNF-@a and IL-1@b was more consistent in the carvedilol group (P < .01).ConclusionOur results support the hypothesis that a more complete block of sympathetic activity by carvedilol induces a greater decrease in the circulating levels of proinflammatory cytokines that could explain, at least in part, the better improvement in the left ventricular remodelling and systolic function in patients with IDC.

The aim of this study was to compare glucose measurements between fingertip and forearm using the blood glucose (BG) monitoring system One Touch® Ultra™ (LifeScan), an electrochemical sensor that requires only a very small drop of blood (1 μL). Patients with type 1 or type 2 diabetes were identified in five outpatient diabetes clinics. Participants were requested to use the One Touch Ultra at home for 1 week for the measurement of BG levels from both sites. Patients filled in a questionnaire about their experience with testing blood samples from fingertip and forearm. The agreement between the measurements from the two sites was assessed using linear regression analysis, mean absolute relative error (MARE), the Bland-Altman method, and Error Grid Analysis (EGA). Overall, 112 patients were recruited, of whom 58% had type 1 diabetes. Linear regression analysis showed an intercept of 17.7, statistically different from 0 (p < 0.0001). The slope was 0.956, and the Pearson correlation coefficient was 0.95. A MARE of 12.1% (SD = 11.8%) was obtained, with a greater deviation of the forearm values from the fingertip ones in the hypoglycemic range (MARE = 22.3%; SD = 21.7%). The Bland-Altman bias plot showed a mean bias of 10.2 mg/dL (SD = 23.1), with no correlation between mean difference and average BG levels (r = 0.02). The EGA showed that 89.2% of the values fell in zone A, 10.4% in zone B, and 0.4% in zone C. The vast majority of patients (71%) declared that the collection of blood from the forearm caused no pain or less pain than the traditional site. Only 17% of the patients declared that it was impossible to obtain any blood from the forearm, while 63% reported with satisfaction that the quantity requested was small. At the end of the study period, 32% of the participants indicated the forearm as the preferred test site. Alternative site testing on the arm, with a BG meter that requires only a very small drop of blood, is feasible and reliable under routine clinical conditions. When testing with the express purpose of detecting hypoglycemia, the finger still remains the recommended test site.

Background: Since March 1998, 143 BioEnterics� Intragastric Balloons (BIB) were placed in 132 obese and morbidly obese patients, to study the clinical possibilities of a new system, both from the point of view of the materials used and the application method. Methods: 36 patients were male and 96 female; mean age was 43 years (21-70); mean weight was 115.4 kg (67-229), and mean BMI was 41.0 (29-81). 8 patients were affected by severe respiratory insufficiency. We placed and removed the balloon endoscopically under conscious sedation or general anesthesia. BIB was removed in the majority of patients 4 months after insertion. The patients were given a balanced diet of 800-1000 kcal/day; follow-up involved a monthly check-up (routine blood tests, weight control) and a visit every 15 days with the dietitian. Results: Mean weight loss was 14.4 kg; mean reduction in BMI was 5.2.Weight loss was much better in males. The weight loss produced an improvement of the complications associated with the obesity. Complications observed were: balloon intolerance (9 early removals), 1 balloon deflated and passed, 2 cases of gastric ulcer at balloon removal. Conclusions:The most correct indications for BIB should be: extremely obese patients (BMI>40) in preparation for a bariatric operation; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI< 30 in a multidisciplinary approach.

Aims/hypothesis. To evaluate the relation between the incidence of childhood Type I (insulin-dependent) diabetes mellitus and the degree of urbanization in the central-southern part of Italy. Methods. The incidence was determined in two areas: area A encompasses 3 regions of central-eastern Italy (Marche, Abruzzo, Umbria), whereas area B encompasses one southern region (Campania). During 1990–1995, 706 children aged 14 or under with insulin-dependent diabetes mellitus of recent onset were registered. The completeness of the case ascertainment in the registries analysed separately for each region was high, ranging from 96.3 % to 99 %. Results. The age-standardized incidence was higher in area A (9.6 per 100 000 person per year; 95 % confidence interval: 8.5–10.8) than in area B (5.4 per 100 000 person per year; 95 % confidence interval: 4.9–6.0). In both areas the standardized incidence ratios increased with the degree of urbanization (chi-squared for trend: area A = 140, p< 0.0001; area B = 79, p< 0.0001). The highest standardized incidence ratios were in the most urban communities. Conclusion/interpretation. This study showed a statistically significant difference in incidence of childhood insulin-dependent diabetes mellitus among different areas of the continental peninsula of Italy. People living in the rural communities appear to have a lower risk. [Diabetologia (1999) 42: 789–792]Aims/hypothesis. To evaluate the relation between the incidence of childhood Type I (insulin-dependent) diabetes mellitus and the degree of urbanization in the central-southern part of Italy. Methods. The incidence was determined in two areas: area A encompasses 3 regions of central-eastern Italy (Marche, Abruzzo, Umbria), whereas area B encompasses one southern region (Campania). During 1990–1995, 706 children aged 14 or under with insulin-dependent diabetes mellitus of recent onset were registered. The completeness of the case ascertainment in the registries analysed separately for each region was high, ranging from 96.3 % to 99 %. Results. The age-standardized incidence was higher in area A (9.6 per 100 000 person per year; 95 % confidence interval: 8.5–10.8) than in area B (5.4 per 100 000 person per year; 95 % confidence interval: 4.9–6.0). In both areas the standardized incidence ratios increased with the degree of urbanization (chi-squared for trend: area A = 140, p< 0.0001; area B = 79, p< 0.0001). The highest standardized incidence ratios were in the most urban communities. Conclusion/interpretation. This study showed a statistically significant difference in incidence of childhood insulin-dependent diabetes mellitus among different areas of the continental peninsula of Italy. People living in the rural communities appear to have a lower risk. [Diabetologia (1999) 42: 789–792]

In the present study, we investigated the effect of a 50-Hz sinusoidal magnetic field at 1 mT rms field intensity on cell proliferation and micro-nucleus frequency in peripheral blood lymphocytes exposed for 72 h. Lymphocyte cultures from 5 subjects affected by Turner's syndrome were tested; cultures from 5 healthy donors were also studied to make a comparison with a control group. No statistically significant differences in micronucleus frequency and cell proliferation were found between control and exposed cultures from healthy and TS donors. The results obtained indicate that the field tested does not exert any genotoxic effect nor interfere with cell cycle.

The objective and electroretinographic modifications that occurred during a 12-year follow-up in a girl suffering from gyrate atrophy of the choroid and retina are described. the disease was treated by reducing the patient's protein intake. This approach resulted in a reduction of ornithine levels and arrested the progression of the disease, but did not prevent the central vision damage, which occurred during early puberty.

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