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Purpose The anatomical proximity of the styloid process (SP) to the ipsilateral internal carotid artery (ICA) has been recently recognized as a possible risk factor for carotid artery dissection (CAD). We aimed to verify this hypothesis by comparing the minimum distance between SP and ICA in young adult patients ( Methods Thirty-one CAD patients (cases) were compared with 41 sex-matched patients without dissection, group one of control (G1), and with 16 sex-matched patients with vertebral artery dissection (VAD), group two of control (G2). Two independent observers measured, on CT angiography images, the minimum distance on the axial plane between the SP and ICA in cases and controls. They evaluated both the intercentric and the marginal distance. Differences between groups were estimated by Student t-test. Results SP-ICA intercentric distance ipsilateral to dissection was significantly shorter compared to that of the contralateral side of cases (p p p p p Conclusion A short SP-ICA distance appears to be a risk factor for CAD as it likely induces a continuous microtraumatism of the vessel wall during normal head and neck movements.

Um dos caminhos para estímulo ao engajamento e a participação na vida pública é o uso de educação a distância para aproximação do debate entre governo e cidadãos. Todavia, como as estratégias utilizadas, pelo TCE-MT e UFMT, no curso de formação de cidadãos para o exercício da cidadania e do controle social, elevam o número de capacitados e melhoram a efetividade do curso? Para responder tal questão, esta pesquisa analisa dados dos últimos sete anos do curso de extensão "Cidadania e controle social", oferecido como produto de uma parceria entre diferentes instituições governamentais, como ação do Tribunal de Contas do Estado de Mato Grosso – TCE-MT. Os dados mostram não apenas o interesse dos cidadãos, mas também a capilaridade dessa estratégia, que atinge pessoas de diferentes estados, grupos sociais e áreas. Assim, o governo e a sociedade são beneficiados, à medida que os cidadãos se tornam mais bem informados e engajados na vida pública.

Gli Autori riportano un caso clinico in cui la diagnosi di tumore bruno dell'osso mascellare ha condotto alla definizione del processo patologico primitivo causato da un iperparatiroidismo sostenuto da adenoma primitivo della paratiroide. Il paziente, portatore di insufficienza renale cronica e nefrolitiasi ha eseguito biopsia e TC del mascellare, con diagnosi di tumore bruno associato ad altre aree di osteolisi a carico dell'osso mandibolare. Il profilo ematochimico ha rivelato una ipercalcemia con ipofosforemia associata a aumento del dosaggio sierico del paratormone, pertanto è stata eseguita una scintigrafia delle paratiroidi che ha mostrato la presenza di tessuto iperfunzionante in corrispondenza del terzo inferiore del lobo sinistro della tiroide. Il quadro eco-color-Doppler, ha confermato la presenza di un adenoma paratiroideo di 4,5 cm alla base del lobo sinistro della tiroide. Il paziente è stato sottoposto a terapia con cinacalcet in attesa dell'intervento chirurgico.

Results-based management as an administrative paradigm can be thought of as a way for private and public organizations to manage their resources with a focus on organizational results. Thus, a multi-stage study is proposed with the aim of examining a public project of results-based management, which is part of a program called Integrated Institutional Development Program (IDP) of the Court of Auditors of the State of Mato Grosso, by means of the analysis of 24 strategic plans of municipalities in the state of Mato Grosso. For methodology, a theoretical framework with 10 dimensions and 63 sub-dimensions was developed, allowing the investigation of 1094 indicators and subsequent analysis of a group of 498 univocal indicators of Public Management. These were obtained through the Strategic Planning System (GPE), which stores and operates multiple Performance Measurement Systems (SMD). As a technical and academic contribution, this work proposes a set of 68 municipal public indicators that could be used in the aforementioned project and in similar cases.

The present document describes a nutritional approach that is nested in the European Innovation Partnership for Active and Healthy Aging (EIP-AHA) and aims to provide the first common European program translating an integrated approach to nutritional frailty in terms of a multidimensional and transnational methodology. The document has been developed by the A3 Nutrition Action Area of the EIP-AHA and aims at providing a stepwise approach to malnutrition in older citizens, identifying adequate interventions based on a unified assessment and ICT-supported solutions. “NutriLive” is an integrated nutritional approach, represented by a structured Screening-Assessment-Monitoring-Action-Pyramid-Model (SAM-AP). Its core concept is the stratification of the nutritional needs, considered by the working group as the key for targeted, effective, and sustainable interventions. “NutriLive” tries to close gaps in epidemiological data within an aging population, creating a unified language to deal with the topic of nutrition and malnutrition in Europe. By assembling all the validated screening, assessment, and monitoring tools on malnutrition in a first pyramid, which is interrelated to a second intervention pyramid, the A3 Nutrition WG identifies a common, integrated vision on the nutritional approach to frailty, which applies to the various health care settings.

The objective of this study is to investigate bone metabolism, density, and quality in patients with diabetes type 2 using DEXA and spinal deformity index (SDI), a surrogate index of bone quality. Fifty-six patients with type 2 diabetes were studied; exclusion criteria were diseases and medications that affect bone and mineral metabolism. Mean age was 65 ± 7 years. Mean diabetes duration was 10 ± 7 years and mean HbA1C was 6.6 ± 0.5 %. BMI was 30 ± 4. Fifty-six sex, age, and BMI matched served as controls. All subjects underwent a clinical and biochemical examination. Spinal and femoral neck BMD were measured by DEXA, and a spine radiography was performed to assess vertebral fractures and to calculate SDI. Mean serum 25-OH vitamin D levels were 19.6 ± 3.7 ng/ml in patients and 30 ± 14 ng/ml in controls (p < 0.01). PTH serum levels were 47.9 ± 40 pg/ml in patients versus 37 ± 5.3 pg/ml in controls (p < 0.01). At lumbar spine there was a significant difference between patients and controls only for T-score (p =

Purpose: The aim of this study is to investigate in a population of adolescents living in Regione Campania, undergoing sun exposure at least 9 months per year the prevalence of severe deficiency (

Hypovitaminosis D represent an environmental risk factors for cardiovascular (CV) disease. To investigate the prevalence of hypovitaminosis D and the correlation between GH/IGF-I deficiency and hypovitaminosis D with CV risk in GH deficiency (GHD) patients. A link between these hormones has been shown. Forty-one hypopituitaric patients with GHD (22 males, age 18-84 years) and 41 controls were enrolled in the study. Anthropometric parameters, blood pressure, glucose and lipid profile, parathyroid hormone (PTH), 25(OH) vitamin D (vitamin D), metabolic syndrome (MS), GH peak after GHRH + ARG, IGF-I, and standard deviation score (SDS) of IGF-I (zIGF-I) were assessed. Vitamin D levels were lower in patients than in controls (21.3 ± 12.3 vs. 28.2 ± 9.4, p = 0.006). Deficiency was found in 51 % of patients versus 14.6 % of controls (p < 0.01), insufficiency in 26.8 versus 41.4 % (p = 0.269) and normal vitamin D levels in 21.9 versus 43.9 % (p = 0.060). The prevalence of dyslipidemia was 51.2 % in patients versus 12.1 % in controls (p < 0.001), type 2 diabetes mellitus (DM) was 7.3 versus 17 % (p = 0.292), hypertension was 44 versus 22 % (p = 0.060), and MS was 17 versus 14.6 % (p = 0.957). In patients, an association was found between the presence of hypovitaminosis D and the prevalence of dyslipidemia, hypertension and MS and between zIGF-I and the prevalence of hypertension. Hypovitaminosis D was the most powerful predictor of the prevalence of dyslipidemia and hypertension. GHD patients have an increased prevalence of hypovitaminosis D compared with controls. The presence of hypovitaminosis D was the most powerful predictor of the prevalence of dyslipidemia and hypertension in GHD patients, suggesting the involvement of both factors in the CV risk in these patients.

La elevata complessità dei meccanismi neuroendocrini e metabolici di regolazione del peso corporeo e la loro stretta interazione con fattori genetici, ambientali, nutrizionali e psicologici, rendono allo stato attuale l’approccio farmacologico dell’obesità poco soddisfacente alla necessità di ridurre il peso corporeo ed i fattori rischio di malattia cardiovascolare correlati all’obesità, nonché di mantenere stabilmente la riduzione del peso. Secondo le Linee Guida Italiane (LiGIO'99), la terapia farmacologica dell’obesità può essere prescritta con BMI 30 kg/m2 oppure  27 kg/m2 con associati fattori di rischio (per esempio diabete mellito, coronaropatia, ipertensione e apnea ostruttiva del sonno), dopo almeno 3 mesi di dieta controllata, esercizio fisico e modificazioni del comportamento. Il farmaco ideale per la terapia dell’obesità dovrebbe essere in grado di indurre perdita esclusiva di grasso corporeo senza causare effetti collaterali. Studi clinici controllati con placebo, randomizzati, che hanno valutato i 2 farmaci attualmente registrati in Italia ed in Europa (Sibutramina e Orlistat) con indicazione al trattamento del’obesità, dopo la recente sospensione del Rimonabant, hanno mostrato una perdita di peso media

Osteoporosis is a multifactorial skeletal disorder characterized by reduced bone mass and deterioration of the micro-architecture of bone. These features predispose affected subjects to increased susceptibility to fractures. According to the World Health Organization, osteoporosis is diagnosed if the bone mineral density (BMD) is 2.5 standard-deviations below the mean peak value in young adults of the same ethnicity and sex (T-score less than −2.5). The “gold standard” for measuring BMD is dual-energy X-ray absorptiometry (DEXA). Other diagnostic modalities include computed tomography (CT), peripheral quantitative CT, and ultrasonography (which has not been shown to provide additional information about bone quality).

Vitamin D system is a complex pathway that includes precursors, active metabolites, enzymes and receptors activating several molecular pathways and mediating a multitude of functions. In addition to the classical role of vitamin D metabolites in calcium and bone homeostasis, many in vitro and in vivo studies recognized several "non calcemic" effects involved in host defence, inflammation, immunity and cancer processes. The aim of this review is to highlight the relationship between vitamin D and cancer, summarizing several mechanisms proposed to explain the potential protective effect of vitamin D against the development and progression of cancer. Vitamin D acts like a transcription factor that influences central mechanisms of tumorigenesis: growth, cell differentiation and apoptosis. In addition to cellular and molecular studies, epidemiological surveys have shown that sunlight exposure and consequent increased circulating levels of vitamin D are associated not only with reduced occurrence but also with reduced mortality for different histological types of cancer. Another recent field of interest concerns polymorphisms of vitamin D receptor: in this context, preliminary data suggest that vitamin D receptor polymorphisms more frequently associated with tumorigenesis are Fok1, Bsm1, Taq1, Apa1, EcoRV, Cdx2, although further studies are needed to clarify any discrepancies. In this review, the relationship between vitamin D and cancer is discussed.

Neuroendocrine tumors (NETs) can be sporadic or they can arise in complex hereditary syndromes. Patients with hereditary NETs can be identified before the development of tumors by performing genetic screenings. The aim of the study was to evaluate the clinical and prognostic impact of a preclinical genetic screening in subjects with hereditary NET syndromes. 46 subjects referred for hereditary NET syndrome [22 MEN1, 12 MEN2, 12 Familial Paragangliomatosis (FPGL)] were enrolled and divided in 2 groups (group A, 20 subjects with clinical appearance of NET before the genetic diagnosis; group B, 26 subjects with genetic diagnosis of hereditary NET syndromes before the clinical appearance of NETs). The main outcome measures were severity of disease, prognosis, and survival. The rate of surgery for MEN1-, MEN2-, FPGL4-related tumors was 90% in group A and 35% in group B (p

Cinacalcet is effective in controlling the biochemical abnormalities in patients with primary hyperparathyroidism (PHPT) but it seems to be less effective on bone mineral density (BMD). In the same patients, bisphosphonates are reported to be effective on bone resorption but less effective on calcium and PTH excess. In this study, the efficacy of cinacalcet in combination with alendronate has been retrospectively evaluated in patients with PHPT. Twenty-three patients with PHPT who had not been operated were retrospectively investigated. Cinacalcet was evaluated in combination with alendronate in 10 of the 23 patients, and in monotherapy in 13 other patients. Serum calcium, phosphorus and PTH, 24 h urine calcium and phosphorus as well as BMD, evaluated by DXA and expressed as T-score, were measured before and after treatment. In all patients serum calcium and phosphorus and urinary calcium excretion were effectively and stably controlled and PTH was significantly decreased after treatment. There was no difference in the rate of serum calcium and PTH decrease between subjects treated with cinacalcet plus alendronate and those treated with cinacalcet alone. T-score increased by 9.6% at lumbar spine and 3.9% at femur level in the cinacalcet plus alendronate subgroup and was unchanged in the cinacalcet subgroup (P < 0.01). In patients with PHPT, the biochemical abnormalities are rapidly improved by cinacalcet regardless from the administration in monotherapy or in combination with alendronate. BMD is significantly improved in patients receiving cinacalcet plus alendronate and stable in those receiving cinacalcet in monotherapy.

BACKGROUND We investigated whether several different inflammatory markers including C-reactive protein (CRP) and fibrinogen and white blood cells (WBCs) count, are associated with maximal oxygen consumption (VO(2 max)) in women with polycystic ovary syndrome (PCOS). METHODS In PCOS women (n = 124, 24.1 +/- 4.5 year-old) VO(2 max) was measured during symptom-limited cardiopulmonary exercise test. Abdominal fat distribution was determined by ultrasound. Physical activity level was assessed by a standardized questionnaire. CRP was measured by immunoassays, fibrinogen by the Clauss method, and WBCs count with a Coulter counter. RESULTS Pearson's analysis showed a significant correlation between VO(2 max) and logCRP (r = -0.437, P < 0.001), fibrinogen (r = -0.479, P < 0.001), and WBCs count (r = -0.438, P < 0.001). Multivariable logistic regression model showed that age (beta = -0.127, P = 0.005), AUC(INS )(beta = -0.335, P < 0.001), HDL-C (beta = 0.390, P < 0.001), physical activity score (beta = 0.238, P = 0.002), visceral fat (beta =-0.184), P = 0.023), FAI (beta = -0.291, P = 0.028); CRP (beta = -0.216, P = 0.011), fibrinogen (beta = -0.113, P = 0.008) and WBCs count (beta = -0.177, P < 0.001) were significantly associated with VO(2 max). CONCLUSIONS Acute-phase reactants, such as CRP and fibrinogen, and WBCs count were independently and inversely associated with a direct measure of cardiorespiratory fitness (VO(2 max)) in women with PCOS, even after adjustment for physical activity level and other potential confounding factors. These findings add to the growing body of evidence linking inflammation to cardiorespiratory fitness in PCOS women.

BACKGROUND Polycystic ovary syndrome (PCOS) is a common female reproductive-age endocrine disease predominantly characterized by chronic anovulation, hyperandrogenism, insulin-resistance and low-grade inflammatory status. Exercise training (ET) favourably modulates cardiopulmonary function and insulin-sensitivity markers in PCOS women. The present study investigated the effects of ET on autonomic function and inflammatory pattern in PCOS women. STUDY DESIGN Prospective baseline uncontrolled clinical study. METHODS One-hundred and eighty five PCOS women referred to our department were screened for the inclusion into the study protocol from March 2004 to July 2007. One-hundred and twenty four PCOS women met the criteria for the inclusion into the study protocol and were subdivided into two groups each composed of 62 patients: PCOS-T (trained) group underwent 3-month ET program, whereas PCOS-UnT (untrained) group did not. At baseline and at 3-month follow-up, hormonal and metabolic profile, cardiopulmonary parameters, autonomic function (as expressed by heart rate recovery, HRR) and inflammatory pattern [as expressed by C-reactive protein (CRP) and white blood cells (WBCs) count] were evaluated. RESULTS PCOS-T showed a significant (P < 0.05) improvement in maximal oxygen consumption (VO(2max)) and in post-exercise HRR, and a significant (P < 0.001) decrease in CRP and WBCs; whereas no statistically significant changes of the same parameters were observed in PCOS-UnT. Multiple linear regression analysis showed that 3-month HRR is linearly related to the inclusion in training group (beta = 0.316, P < 0.001), VO(2max) (beta = 0.151, P = 0.032) and the ratio between glucose and insulin area under curve (AUC) (beta = 0.207, P = 0.003), and inversely related to body mass index (beta = -0.146, P = 0.046), insulin AUC (beta = -0.152, P = 0.032), CRP (beta = -0.165, P < 0.021), and WBCs count (beta = -0.175, P = 0.039). CONCLUSIONS Exercise training improves autonomic function and inflammatory pattern in PCOS women.

OBJECTIVE: The aim of the present study was to investigate the potential alterations in electrocardiographic (ECG) pattern in patients with polycystic ovary syndrome (PCOS). PATIENTS: Fifty PCOS patients and 50 age- and body mass index-matched healthy women were studied. METHODS: We assessed hormonal and metabolic pattern, and performed ECG analysis for evaluating PQ interval, QRS duration, minimum and maximum QT interval corrected for heart rate (QT(c)min and QT(c)max, respectively), corrected QT dispersion (QT(c)d), corrected J point/T-wave interval (JTend(c)), corrected JTmax interval (JTmax(c)), and corrected Tmax-end interval (Tmax-end(c)). RESULTS: QT(c)min (399 +/- 21 vs. 396 +/- 25 ms, P = 0.51); QT(c) max (445 +/- 25 vs. 443 +/- 27 ms, P = 0.70); and QT(c)d (46 +/- 13 vs. 47 +/- 15 ms, P = 0.72); JTend(c) (337 +/- 14 vs. 336 +/- 16 ms(1/2), P = 0.74); and JTmax(c) (256 +/- 22 vs. 258 +/- 21 ms(1/2), P = 0.64); Tmax-end(c) (81 +/- 18 vs. 78 +/- 19 ms(1/2), P = 0.42) were not significantly different between PCOS and healthy women. CONCLUSION: Despite profound differences in hormonal and metabolic pattern, our data demonstrate no significant difference in ECG pattern in PCOS compared to healthy controls.

CONTEXT: Insulin resistance is a feature of polycystic ovary syndrome (PCOS), and it is related to mitochondrial function, particularly with maximal oxygen consumption (VO(2max)). At the moment, no evaluation of cardiopulmonary functional capacity in young patients with PCOS has been performed. OBJECTIVE: Our objective was to assess cardiopulmonary functional capacity in young PCOS overweight patients. DESIGN AND SETTING: We conducted a prospective baseline-controlled clinical study at University Federico II of Naples, School of Medicine (Naples, Italy). PATIENTS: Forty-five PCOS patients were matched with 45 healthy women for age (mean +/- sd, 21.3 +/- 2.0 vs. 21.6 +/- 1.9 yr, respectively) and body mass index (29.4 +/- 3.6 vs. 29.0 +/- 3.4 kg/m(2), respectively). MEAN OUTCOME MEASURES: We assessed hormonal and metabolic pattern and functional capacity by cardiopulmonary exercise testing to evaluate maximal oxygen consumption (VO(2max)), oxygen consumption at anaerobic threshold (VO(2AT)), and the maximal workload at peak exercise. RESULTS: VO(2max) (17.0 +/- 3.7 vs. 26.8 +/- 3.5 ml/kg.min), oxygen consumption at anaerobic threshold (13.9 +/- 3.0 vs. 21.2 +/- 3.8 ml/kg.min), and maximal workload at peak exercise (101.3 +/- 25.2 vs. 135 +/- 22.6 W) were significantly (P < 0.001) reduced in PCOS subjects compared with healthy women. The multiple linear regression analysis showed that only homeostasis model assessment appears to have a strong negative linear relation with VO(2max) in PCOS. No relation was found in controls. CONCLUSIONS: Our data demonstrate a reduced cardiopulmonary functional capacity in young PCOS patients.

Cooking beef patties results in the formation of mutagens detectable by Salmonella typhimurium TA98 with metabolic activation. We now show that the amount of fat in beef affects the quantity of mutagens formed. While char increases with increasing fat, over the range of 5-309% of added fat content, mutagenicity reaches a peak at 10% added fat and subsequently decreases. Thus, char formation is not an accurate measure of mutagenicity. These results suggest that fat plays an important role in mutagen formation in fried beef.

Cooking beef patties results in the formation of mutagens detectable by Salmonella typhimurium TA98 with metabolic activation. Decreased mutagenic activity results when frying beef with added soy protein concentrates (SPC). The reduction in mutagenicity takes place during the cooking process. Whereas fried beef hamburgers show high mutagenic activity, by comparison, similarly fried soy-hamburgers have much less mutagenic activity. Volumetric effects are responsible partly for the reduction of mutagenicity by SPC. Naturally occurring antioxidants in SPC, such as chlorogenic acid, also play a role. Also, a commonly used antioxidant, butylated hydroxyanisole (BHA), has been found effective in reducing the mutagenicity of fried beef. Thus, the addition of SPC or BHA in beef patties may provide a practical way of reducing mutagen formation during frying of beef.

Diet and nutrition may be responsible for 60% of the total cancer incidence for women and greater than 40% for men. Fat, animal protein, and meat consumption are highly correlated with colon cancer incidence. The charcoal broiling of meat and fish yield mutagenic substances. Many findings support the hypothesis that the predominant mutagens are formed by the Maillard reaction. A number of mutagenic compounds have been identified both from cooked foods and from protein pyrolysates. The identified compounds are N-heterocyclic primary amine derivatives of either carbolines, imidazoquinolines, or imidazoquinoxalines. The carboline-type mutagens are structurally related to the known carcinogens 2-acetylaminofluorene (AAF) and 2-aminofluorene (AF), while the imidazoquinoline and imidazoquinoxaline types are believed to resemble 3,2′-dimethyl-4-aminobiphenyl (DMAB). Studies support the theory that these compounds require metabolic activation and are carcinogenic. The major metabolites of several compounds have been identified as the N-hydroxy derivatives. DNA binding was found to be a necessary but not a sufficient condition for mutagenesis. The modified base products have been identified as C-8-guanyl derivatives, resembling adducts formed by the carcinogenic aromatic amines.

The major mutagenic component of fried beef has been isolated using a series of chromatographic steps. The pure compound has been analyzed by low and high resolution mass spectroscopy and nuclear magnetic resonance spectroscopy. The results indicate that the molecular weight of this extremely mutagenic compound is 198, with an elemental composition of C11H10N4. The compound is different from the known mutagenic pyrolysis products of amino acids or proteins.

Diet and nutrition may be responsible for 60% of the total cancer incidence for women and greater than 40% for men. Fat, animal protein, and meat consumption are highly correlated with colon cancer incidence. The charcoal broiling of meat and fish yield mutagenic substances. Many findings support the hypothesis that the predominant mutagens are formed by the Maillard reaction. A number of mutagenic compounds have been identified both from cooked foods and from protein pyrolysates. The identified compounds are N-heterocyclic primary amine derivatives of either carbolines, imidazoquinolines, or imidazoquinoxalines. The carboline-type mutagens are structurally related to the known carcinogens 2-acetylaminofluorene (AAF) and 2-aminofluorene (AF), while the imidazoquinoline and imidazoquinoxaline types are believed to resemble 3,2'-dimethyl-4-aminobiphenyl (DMAB). Studies support the theory that these compounds require metabolic activation and are carcinogenic. The major metabolites of several compounds have been identified as the N-hydroxy derivatives. DNA binding was found to be a necessary but not a sufficient condition for mutagenesis. The modified base products have been identified as C-8-guanyl derivatives, resembling adducts formed by the carcinogenic aromatic amines.

The effects of highly purified human immune interferon (IFN-gamma) on the differentiation of human promyelocytic HL-60 leukemic cells have been studied. The addition of 100 units/ml interferon to HL-60 cells for 5 days results in morphological changes characteristic of macrophages. At the biochemical level, there is a 3-fold increase in the specific activity of the enzyme NADase. Kinetic analysis shows that IFN-gamma causes an increase in the Vmax of NADase without affecting the apparent Km. Pulse labeling experiments with [35S] methionine show a marked change in the de novo synthesis of several proteins in the course of interferon treatment. Chromatography on DNA-agarose show that after treatment with interferon for 24 or 48 h, there is a 60-70% decrease in newly synthesized proteins which bind DNA-agarose and can be subsequently displaced from the column with 2% SDS containing buffer (from 7.7-8.7% bound in control cell extracts to 2.6-3.1% bound in interferon treated cell extract).