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Background: Prevalence of mobile device addiction has increased over the years; both women and men have assimilated the mobile phone as a central component of their personal existence: integrating it into their lifestyle or becoming so dependent on it that life without it has become unimaginable. Smartphones generate radio-frequency electromagnetic fields. While short-term exposure in adults was considered quite safe, effects of long-term exposure or exposure during pregnancy on fetuses or during breastfeeding on newborns are not well studied yet. The objective of the present study was to investigate the prevalence and usage characteristics of smartphones among a sample of pregnant women, and promote the correct and conscious use of the smartphone. Methods: A cross-sectional study was conducted, with a questionnaire administered during childbirth classes and - after the questionnaire administration - an educational intervention focused on promoting the correct and conscious use of smartphones was carried out by psychologists and psychotherapists. Results: The findings of our study suggest that a significant number of the participants suffered addiction to mobile phone usage, but were not aware of it. More than two third of the sample (67.2%) have not changed their smartphone use habits since the beginning of their pregnancy and even more significant data shows that almost all future moms (98.3%) never speak with their doctor about smartphone use during pregnancy. Conclusions: Data collected suggest a lack of attention to the proposed topic, especially in relation to pregnancy. It seems necessary to sensitize future mothers on this topic. The promotion of a more conscious and controlled use of electronic devices can help reduce the radiation to which the unborn child may be exposed, but has a fundamental role even after birth, to ensure an adequate psychomotor and relational development of the child and do not affect, due to uncontrolled use of smartphones, the mother-child relationship.

A cross-sectional single-center study was conducted to assess cytokine levels in aqueous humor (AH) and plasma of three different uveitis entities: definite ocular sarcoidosis (OS), definite OS associated with QuantiFERON®-TB Gold test positivity (Q + OS) and presumed tubercular uveitis (TBU).Thirty-two patients (15 OS, 5 Q + OS, 12 TBU) were included.Quantification of selected cytokines was performed on blood and AH samples collected before starting any treatment. Statistical analysis was conducted using the Kruskal-Wallis test, the Mann-Whitney or Fisher test and the Principal Component Analysis (PCA).IL-6, IL-8 and IP-10 levels were higher in AH samples than in peripheral blood. In AH samples, BLC, IL-8 and IP-10 were significantly higher in definite OS than in presumptive TBU. There were no statistically significant differences in terms of cytokine levels between Q + OS and presumptive TBU. PCA showed a similar cytokine pattern in the latter two groups (IFNγ, IL-15, IL-2, IP-10, MIG), while the prevalent expression of BLC, IL-10 and MIP-3 α was seen in definite OS.The different AH and plasma cytokine profiles observed in OS compared to Q + OS and TBU may help to differentiate OS from TBU in overlapping clinical phenotypes of granulomatous uveitis (Q + OS).

To develop an effective Pseudomonas aeruginosa outer-membrane-vesicle (OMV) vaccine, we eliminated multiple virulence factors from a wild-type (WT) P. aeruginosa strain, PA103, to generate a recombinant strain, PA-m14. Strain PA-m14 was tailored with a pSMV83 plasmid carrying the pcrV-hitAT fusion gene to produce OMVs. The recombinant OMVs (termed OMV-PH) enclosed increased amounts of the PcrV-HitAT bivalent antigen (PH) and exhibited lower toxicity than did the OMVs from PA103. Intramuscular vaccination with OMV-PH from PA-m14(pSMV83) afforded 70% protection against intranasal challenge with 6.5 × 106 CFU (∼30 50% lethal doses [LD50]) of PA103, while immunization using OMVs without the PH antigen (termed OMV-NA) or the PH antigen alone failed to offer effective protection against the same challenge. Further immune analysis showed that OMV-PH immunization significantly stimulated potent antigen-specific humoral and T-cell (Th1/Th17) responses over those with PH or OMV-NA immunization in mice and that these more-potent responses can effectively hinder P. aeruginosa infection. Undiluted antisera from OMV-PH-immunized mice displayed significantly more opsonophagocytic killing of WT PA103 than antisera from PH antigen- or OMV-NA-immunized mice. Moreover, OMV-PH immunization afforded significant antibody-independent cross-protection to mice against PAO1 and the AMC-PA10 clinical isolate. Taking our findings together, the recombinant P. aeruginosa OMV delivering the bivalent PH antigen exhibits high immunogenicity and may be a promising next-generation vaccine candidate against P. aeruginosa infection.

BackgroundMusculoskeletal pain is an important feature in patients (pts) with anterior acute uveitis (AAU), as a symptom of spondyloarthritis (SpA). Fibromyalgia (FM), which is more prevalent in pts with chronic inflammatory diseases, has a widely recognized effect on both differential diagnosis and evaluation of outcome measures in SpA.ObjectivesTo estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of pts with AAU, and to compare clinical and ultrasonographic findings in SpA pts with (SpAFM+) and without (SpAFM-) concurrent FM and SpA.Methods152 consecutive pts affected by AAU from the Immunology Eye Unit (AUSL-IRCCS Reggio Emilia, Italy) were enrolled.A complete rheumatological assessment, including 68/66 peripheral joint count, Leeds Enthesitis Index (LEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Fibromyalgia Impact Questionnaire (FIQ) was performed.Using an Esaote MyLabClass, 18-6MHz linear multifrequency transducer, 6 entheses (lateral epicondyle, distal quadriceps insertion, proximal and distal patellar tendon insertions, calcaneal insertion of Achilles tendon and plantar fascia) were evaluated bilaterally for the presence of any elementary lesion, structural damage and active enthesitis, according to OMERACT definitions2.Pts were classified as having SpA and/or FM according to ASAS criteria and 2010 ACR diagnostic criteria for FM, respectively.Results103 pts were diagnosed with anterior acute non granulomatous uveitis (AANGU) and 49 with anterior acute granulomatous uveitis (AAGU) (F/M 93/59, age 46.2±12.3 years, BMI 25±5.1, disease duration 43.8±85.2 months).14 pts (9.2%) met the ACR criteria for FM, of whom 8 pts had concomitant FM and SpA. All FM pts had AANGU. FM pts showed significantly higher enthesitis count and report worse disease activity and function scores (Table 1). Fulfillment of ASAS criteria was associated with FM (p=0.004).Table 1.Demographic and clinical data of FM patients (results for continuous variables expressed as mean ± standard deviations, for discrete variables as n° and percentage)FM + (14)FM - (138)pOR (95%CI)Age48 ± 11.746.1 ± 12.40.569Female10 (71.4%)83 (60%)0.409BMI24.7 ± 5.525 ± 5.20.831AANGU14 (100%)89 (64.5%)0.005SpA8 (57%)30 (22%)0.0044.8 (1.6 – 14.9)ax-SpA6 (43%)18 (13%)0.0045 (1.6 – 16.1)Psoriasis2 (14.3%)9 (6.5%)0.268IBP7 (50%)19 (14%)0.0016.3 (2 – 19.9)Buttock pain9 (64%)24 (17%)8.6 (2.63 – 27.8)History of enthesitis7 (50%)20 (14.5%)0.0015.8 (1.9 – 18.6)TJC2.6 ± 3.80.6 ± 1.80.072LEI1.9 ± 1.20.5 ± 1MASES3.8 ± 3.40.8 ± 20.07BASDAI5.1 ± 1.71.8 ± 1.7BASFI2 ± 1.40.6 ± 1.2FIQa0.6 ± 0.60.3 ± 0.80.176FIQb4.2 ± 2.31.1 ± 1.8FIQc1.9 ± 2.40.4 ± 1.30.044FIQd38.9 ± 13.516.2 ± 13.9SpAFM+ pts more frequently reported an history of enthesitis [75% vs 23.3% p=0.011 OR 9.9 (95% CI 1.6 – 60.2) and buttock pain [75% vs 33.3% p=0.034 OR 6 (95% CI 1.02 – 35.3)] when compared with SpAFM-, whereas no significant differences in LEI, MASES, joint count, and inflammatory back pain (IBP), as well as in sex, age and BMI were observed.BASDAI, FIQb and FIQd were increased in SpAFM+ (6±1.1 vs 3.4±1.8 pAbnormal US findings were detected in 35/38 SpA pts (92.1%), without significant differences in elementary lesions and structural damage between SpAFM+ and SpAFM-. At patient-level, a significantly higher percentage of SpAFM+ pts had at least one active enthesitis, as compared with SpAFM- (25% vs 3.4%, p = 0.048).ConclusionComorbid FM was frequent in SpA associated with AANGU, affecting both clinical presentation and outcome measures, whereas no FM patients were found in the AAGU group. In our cohort the role of ultrasonography in discriminate SpAFM- from SpAFM+ is not clear.References[1]Balint PV et al. Ann Rheum Dis 2018;77(12):1730-35.Disclosure of InterestsNone declared

Vogt–Koyanagi–Harada (VKH) is an autoimmune disease characterized by inflammation in tissues that contain melanocytes. We aimed to increase the knowledge regarding immunological pathways deregulated in VKH disease. We compared the percentages of circulating natural killer (NK), NK T and T cells expressing the activatory markers: CD16, CD69, NK group 2D (NKG2D), natural cytotoxicity triggering receptor 3 (Nkp30), natural cytotoxicity triggering receptor 1 (Nkp46) and the inhibitory marker: NK group 2 member A (NKG2A) in 10 active VKH patients, 20 control subjects (CTR) and seven patients with Behçet disease (BD) by flow cytometry. Cytotoxic potential of NK cells was determined through the degranulation marker CD107a expression after contact with K562 cells by flow cytometry. Moreover, plasmatic levels of 27 cytokines were determined with a multiplex bead‐based assay. VKH patients showed higher percentages of NKG2D(pos) NK and NK T cells versus CTR. The cytotoxic potential of NK cells induced by K562 cells was comparable between VKH patients and CTR. Finally, higher concentrations of interleukin (IL)‐4, IL‐5, IL‐7, IL‐17 and platelet‐derived growth factor‐subunits B (PDGF‐bb) were detected in plasma of VKH patients versus CTR. The immune profile of VKH patients was similar to that of BD patients.

Nucleic acid amplification tests, such as PCR, are the method of choice for respiratory virus testing, due to their superior diagnostic accuracy and fast turnaround time. The Panther Fusion (Fusion; Hologic) system has an array of highly sensitive in vitro diagnostic (IVD) real-time PCR assays for respiratory viruses, including an assay for influenza A (FluA) virus, influenza B (FluB) virus, and respiratory syncytial virus (RSV) (FFABR assay). The Fusion system has Open Access functionality to perform laboratory-developed tests (LDTs) alongside IVD assays., Nucleic acid amplification tests, such as PCR, are the method of choice for respiratory virus testing, due to their superior diagnostic accuracy and fast turnaround time. The Panther Fusion (Fusion; Hologic) system has an array of highly sensitive in vitro diagnostic (IVD) real-time PCR assays for respiratory viruses, including an assay for influenza A (FluA) virus, influenza B (FluB) virus, and respiratory syncytial virus (RSV) (FFABR assay). The Fusion system has Open Access functionality to perform laboratory-developed tests (LDTs) alongside IVD assays. We developed two LDTs for FluA virus strain typing on the Panther Fusion instrument, enabling side-by-side testing with the FFABR assay. The LDT-FAST assay uses proprietary primers and probes designed by Hologic for the Prodesse ProFAST+ (PFAST) assay. The exWHO-FAST assay is an expanded redesign of the WHO-recommended reverse transcriptase PCRs (RT-PCRs). To evaluate the performance of these two LDTs, 110 FluA virus-positive samples were tested. Of these, 104 had been subtyped previously; 54 were H3, 46 were 09H1, and 4 were fsH1. All were appropriately subtyped by both LDTs. Of the untyped FluA virus samples, three were subtyped as H3 by both LDTs and two were subtyped as H3 by the LDT-FAST assay only. The sample not subtyped by either LDT was retested with the FFABR assay and was now negative. Limit-of-detection (LOD) analyses were performed with five FluA virus strains. The LDT-FAST LODs were similar to the FFABR assay LODs, while the exWHO-FAST LODs were higher for two H3N2 strains, findings that were explained by analysis of primer/probe homology. In conclusion, either FluA virus typing assay would be a valuable complement to the Panther Fusion respiratory menu given the performance of these LDTs, the system’s full automation, and the ability to split eluates for both IVD and LDT testing.

Background Many CpGs become hyper or hypo-methylated with age. Multiple methods have been developed by Horvath et al. to estimate DNA methylation (DNAm) age including Pan-tissue, Skin & Blood, PhenoAge, and GrimAge. Pan-tissue and Skin & Blood try to estimate chronological age in the normal population whereas PhenoAge and GrimAge use surrogate markers associated with mortality to estimate biological age and its departure from chronological age. Here, we applied Horvath’s four methods to calculate and compare DNAm age in 499 subjects with type 1 diabetes (T1D) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study using DNAm data measured by Illumina EPIC array in the whole blood. Association of the four DNAm ages with development of diabetic complications including cardiovascular diseases (CVD), nephropathy, retinopathy, and neuropathy, and their risk factors were investigated. Results Pan-tissue and GrimAge were higher whereas Skin & Blood and PhenoAge were lower than chronological age (p < 0.0001). DNAm age was not associated with the risk of CVD or retinopathy over 18–20 years after DNAm measurement. However, higher PhenoAge (β = 0.023, p = 0.007) and GrimAge (β = 0.029, p = 0.002) were associated with higher albumin excretion rate (AER), an indicator of diabetic renal disease, measured over time. GrimAge was also associated with development of both diabetic peripheral neuropathy (OR = 1.07, p = 9.24E−3) and cardiovascular autonomic neuropathy (OR = 1.06, p = 0.011). Both HbA1c (β = 0.38, p = 0.026) and T1D duration (β = 0.01, p = 0.043) were associated with higher PhenoAge. Employment (β = − 1.99, p = 0.045) and leisure time (β = − 0.81, p = 0.022) physical activity were associated with lower Pan-tissue and Skin & Blood, respectively. BMI (β = 0.09, p = 0.048) and current smoking (β = 7.13, p = 9.03E−50) were positively associated with Skin & Blood and GrimAge, respectively. Blood pressure, lipid levels, pulse rate, and alcohol consumption were not associated with DNAm age regardless of the method used. Conclusions Various methods of measuring DNAm age are sub-optimal in detecting people at higher risk of developing diabetic complications although some work better than the others.

I pazienti affetti da Artrite Idiopatica Giovanile (AIG) presentano capacità funzionali articolari e muscolari, tolleranza all’esercizio aerobico e anaerobico ridotti con una limitazione della fitness rispetto ai loro coetanei. In periodi di remissione, l’attività motoria è una strategia di follow-up sicura, con risvolti terapeutici positivi, in grado di migliorare non solo la fitness, ma anche l’escursione articolare, la forza muscolare, la qualità di vita. E’ stato recentemente dimostrato che lo svolgimento regolare di attività motoria riduce il dolore e l’uso di FANS. L’obiettivo dello studio è stato di valutare i deficit di equilibrio e di postura e la fitness di bambini e adolescenti affetti da AIG, utilizzando test specifici. Abbiamo inserito 30 pazienti con AIG (13 M; 17 F; età: 8-18 anni); tra questi pazienti, 7 sono stati valutati longitudinalmente negli anni 2016-2018, valutando i test in fasi diverse dell’artrite. Il test di posturografia è stato somministrato utilizzando il “FreeMed posturography system” (la piattaforma abaropodometrica FreeMed ed il software FreeStep v.1.0.3). E’ stata utilizzata una batteria specifica per valutare la fitness dei pazienti (Abalakov test, backsaver sit and reach, the toe touch test, sit-up test, hand grip test). La patologia era in fase acuta in 7 pazienti (2 M; 5 F), dei quali 1 con AIG Sistemica; 5 con AIG poliarticolare; 1 con AIG psoriasica). La valutazione posturale ha evidenziato una distribuzione patologica del carico fra piede destro e sinistro in 15 pazienti (4 con AIG sistemica; 9 con AIG poliarticolare; 2 con AIG oligoarticolare). La distribuzione del carico fra avampiede e retropiede è risultata patologica in tutti i pazienti, con un maggior ipercarico nei pazienti con AIG poliarticolare. Il test “hand grip” era

Highlights • Panther Fusion RV Assays evaluated using 275 consecutive NP specimens previously used to analyze 5 PCR, as well as 225 archived specimens. • Fusion’s overall sensitivity was 100% despite multiple freeze/thaws of these samples, which were previously used in multiple studies. • Limit of detection with a variety of FluA isolates ranged from 2.69–2.96 log copies/ml and demonstrated superior as compared to six other commercial tests., Background Nucleic acid amplification tests (NAATs), such as PCR, are preferred for respiratory virus testing, due to superior diagnostic accuracy and faster turnaround time. Panther Fusion® Respiratory Assays (Fusion), which includes FluA/B/RSV (FFABR), Paraflu and AdV/hMPV/RV, offers a modular approach to syndromic testing on a fully automated platform while improving gene targets and expanding the test menu. Objectives and study design We evaluated Fusion using 275 consecutive nasopharyngeal specimens previously used in an analysis of five PCRs, as well as 225 archived specimens. Results Of the combined 500 specimens, 134 were positive for influenza A (FluA), 54 for FluB, 65 for RSV, 64 for parainfluenza (PIV), 24 for adenovirus (AdV), 21 for humanmetapneumovirus (hMPV), and 40 for rhinovirus (RV) with Fusion. Of the positive samples Fusion correlated with historical results for all but one, despite multiple freeze-thaws cycles of this collection. Fusion was positive for an additional 33 samples, including 11 FluAs, 7 RSVs, 3 PIV3s, 3 AdV, 6 hMPV and 3 RVs. These samples were retested with corresponding Prodesse (Pro) assays using quadruple sample volume. This resolver test confirmed Fusion results for an additional 4 FluAs, 4 RSVs, 1 PIV3 and 3 AdVs. The sensitivity and specificity ranges of Fusion were 99–100% and 98–100%. Limit of detection (LOD) analyses were performed on a variety of Flu isolates. The LODs ranged from 2.69 to 2.99 log copies/ml and demonstrated superior LOD as compared to previously published data for some assays or to concurrent analyses with two new commercial tests.

Background Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus. Methods and Results A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments. Conclusions Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Infants and children with special refractive needs can benefit greatly from contact lens correction. Ocular conditions that may particularly require contact lens correction include infantile/childhood aphakia, high refractive error including high anisometropia, and posttraumatic or infectious corneal scarring. Careful clinical evaluation and proper education of the patient and parents for the use and care of contact lenses is crucial to a successful contact lens regimen. This chapter will provide a guide to recognize the medical indications for contact lens wear in children, to understand the contact lens design options that meet specific patient needs, and to develop a working knowledge of the basic concepts required to achieve a proper contact lens fit. Emphasis will be placed on the aphakic infant since this is a common application for the medical use of contact lenses in childhood.

This clinical care update describes a variety of viruses that can lead to respiratory illness. The viruses discussed include Influenza, Parainfluenza, Respiratory Syncytical Virus, Human Metapneumovirus, Rhinovirus, Adenovirus, and Enterovirus. These viruses are responsible for many unscheduled office visits and hospitalizations in both immunocompetent and immunocompromised individuals; people with asthma are often affected. Details presented in the article include viral characteristics, signs and symptoms, complications, diagnosis, treatment, and educational recommendations for asthma educators.

Implementation of multicenter and/or longitudinal studies requires an effective quality assurance program to identify trends, data inconsistencies and process variability of results over time. The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study represent over 30 years of data collection among a cohort of participants across 27 clinical centers. The quality assurance plan is overseen by the Data Coordinating Center and is implemented across the clinical centers and central reading units. Each central unit incorporates specific DCCT/EDIC quality monitoring activities into their routine quality assurance plan. The results are reviewed by a data quality assurance committee whose function is to identify variances in quality that may impact study results from the central units as well as within and across clinical centers, and to recommend implementation of corrective procedures when necessary. Over the 30-year period, changes to the methods, equipment, or clinical procedures have been required to keep procedures current and ensure continued collection of scientifically valid and clinically relevant results. Pilot testing to compare historic processes with contemporary alternatives is performed and comparability is validated prior to incorporation of new procedures into the study. Details of the quality assurance plan across and within the clinical and central reading units are described, and quality outcomes for core measures analyzed by the central reading units (e.g. biochemical samples, fundus photographs, ECGs) are presented.

We applied a multivariate analysis to a large series of serum biochemical tests in an attempt to identify a function that could efficiently discriminate cirrhosis from hepatocellular carcinoma (HC). We analyzed two successive temporal cohorts (1987-90; 1991-94) of HC and cirrhotic patients, all histologically classified (first cohort: 69 cirrhosis and 39 HC; second cohort: 66 cirrhosis and 38 HC). Using data from the first temporal cohort of patients, we obtained a discriminant function based on seven serum analytes: alpha-fetoprotein, the hepatic isoenzyme of alkaline phosphatase, lactate dehydrogenase isoenzyme 5, total gamma-glutamyltransferase (GGT), GGT isoforms complexed with low-density lipoprotein, aspartate aminotransferase, and copper. The same panel of analytes emerged when the second cohort was tested and also when both cohorts were tested together. In the two successive cohorts (total, 212 patients) with a prevalence of cirrhosis vs HC of approximately 2:1, the discriminant function correctly classified 93% of cases, the highest percentage of correct classification of the two diseases obtained so far by laboratory approaches. Validation with the jackknife reallocation statistical algorithm confirmed these results. In addition, of six patients with liver cirrhosis for whom we had the opportunity of following up and observing the evolution to HC, five were classified as HC at diagnosis by the multivariate discriminant analysis; i.e., discriminant analysis provided a diagnostic lead time of 6-12 months over histology. This discriminant function, based on easy-to-perform serum biochemical tests, may help solve a fundamental problem of differential diagnosis in the evolution of chronic liver diseases from cirrhosis to HC.

Background & Aims: Although numerous non-invasive tests are currently available to explore liver function and disease activity in patients with HCV-related chronic diseases, none of these indicate the likelihood of disease progression in the individual patient. We aimed at assessing the prognostic ability of C-13(2)-aminopyrine breath test (C-13-ABT) in the prediction of liver fibrosis progression in patients with HCV chronic hepatitis who prospectively entered a long-term follow-up. Methods: Fifty patients with HCV-related chronic disease who underwent paired liver biopsy (at baseline and after a mean period of 86 months) were included in the study. C-13-ABT was carried out at baseline and every 3 years. Histological progression was defined as increase of at least 2 fibrosis units according to Ishak score. Results: Fourteen patients progressed of at least 2 fibrosis units during the follow-up. These patients were more frequently infected with a HCV-1b genotype and had, at baseline, a significantly older age, higher BMI, AST levels, and AST to platelet ratio index (APRI). C-13-ABT was altered in 57% of cases at baseline and in 100% of the cases at 3-year follow-up. In the univariate analysis, age (p = 0.005), BMI (p = 0.006), platelet count (p = 0.03), AST (p = 0.012) and ALT (p = 0.04) levels, APRI (p = 0.03), and baseline C-13-ABT results (p

Background/Aims : Studies on non-alcoholic fatty liver disease (NAFLD) have included chronic liver damage attributed to various causes. Our investigation was held to observe the main clinical, histological, and pathophysiological aspects of NAFLD in patients not exposed to any known cause of chronic liver disease. Methods : We evaluated, in 84 in-patients (male/female, 66/18; median age, 36 years), the clinical and biochemical characteristics of NAFLD, and particularly its association with diabetes, dyslipidemia, hyperinsulinemia and/or with the increase of parameters of oxidative stress (blood levels of malonyldialdehyde, 4-hydroxynonenal and total plasma antioxidant capacity). Results : Ninety percent of patients had an increased body mass index (BMI), 35% had dyslipidemia, 40% had sub-clinical diabetes (only 3% had overt diabetes), 60% had hyperinsulinemia, and more than 90% had enhanced levels of lipid peroxidation markers. In 48 patients who had consented to liver biopsy, we found: 14 with simple steatosis, 32 with steatohepatitis, and two with cirrhosis. Conclusions : Our data indicate that in our country, NAFLD may occur in young males with an increased BMI, with or without hyperinsulinemia, dyslipidemia and diabetes, generally associated with disorders of redox status, and that it may be differentiated from steatosis to steatohepatitis or cirrhosis only with a liver biopsy.

BACKGROUND, OBJECTIVES: Pancreatic cancer ranks fourth for cancer mortality for men and women in the United States. This is a particularly devastating cancer since the case-fatality proportion approaches 90% within 12 months following diagnosis. Therefore, understanding the etiology and identifying the risk factors are essential for the primary prevention of this deadly disease. Of the few potentially modifiable risk factors that have been identified, cigarette smoking, history of diabetes mellitus, and obesity seem to be among the most consistent, but the effect of dietary factors is still unclear. The aim of our study is to review of the literature examining the potential role of carbohydrates, fatty acids, meat, fruit and vegetables, alcohol.Although large prospective cohort studies with questionnaire based analyses will continue to have much to offer in defining predisposing factors for difficult diseases, such as pancreatic cancer, unfortunately dietary questionnaires do not reflect the bioavailability of the nutrients from various foods, the level of absorption from the digestive tract, or individual differences in metabolism.Greater use of participant-derived biological samples, banked plasma, germline DNA, and tumour tissue samples may help to the understanding of pancreatic cancer pathogenesis.

The most frequent defect of the male urogenital tract at birth is cryptorchidism. Cryptorchidism causes primitive testicular pathology responsible for infertility. Men with Down's syndrome (DS) have an increased risk of cryptorchidism. The spermatid perinuclear RNA-binding protein (STRBP) gene codifies a microtubule-associated RNA-binding protein and it is high- ly expressed in the testis as well as in the brain. At both levels, this gene seems to play a relevant role in the regular development of these organs. These observations prompted us to evaluate the expression of STRBP mRNA in 5 DS men with cryptorchidism and 5 normal healthy men (controls) by quantitative Real Time PCR in peripheral blood leukocytes. We found a decreased ex- pression of the STRBP gene in men with DS and cryptorchidism compared with controls. This finding suggests that the im- paired expression of this gene in DS may play a pathogenetic role in the altered brain and testicular development in subjects with DS and cryptorchidism. (J. Endocrinol. Invest. 35: 5-7, 2012) ©2012, Editrice Kurtis

No laboratory test completely distinguishes malignant ascites (MA) from ascites associated with cirrhosis and (or) hepatocellular carcinoma (A/C-HC). Ascitic cytology is highly specific but has a diagnostic sensitivity of only 40-60%. We determined 11 ascitic analytes and cytology in 58 patients with cirrhosis, 15 with hepatocellular carcinoma, and 21 with MA (10 ovarian cancers, 4 mesotheliomas, 6 gastrointestinal neoplasias, 1 leukemia). Ascitic total protein, cholesterol, pseudouridine, and lactate dehydrogenase (LD), and the ascitic:serum ratios of total protein and of LD showed the most significant differences between the two groups of patients. Stepwise multiple linear discriminant analysis (applying the Wilks' lambda criterion) of several variables, corroborated by the "jack-knife" reallocation procedure, showed that the ascitic cholesterol and ascitic LD association correctly identified 100% of MA and A/C-HC; cytology had a diagnostic specificity of 100%, but identified only 48% of MA. This association may represent a primary tool for the discrimination of ascites of unknown origin, particularly in the presence of negative cytology findings.

This paper proposes an intelligent system for solving the fault diagnosis problem in electrical power transmission system, involving substation equipments and transmission lines. The proposed methodology is based on Bayesian Networks and this paper is focusing only on the failures related to transmission lines. The fault diagnosis in power transmission systems is a complex problem and its solution usually needs a great deal of expertise and experience related to equipments, transmission systems and failures modes. The developed system allows not only the definition of the most probable cause of a detected failure, but also the prognosis of possible failures, when some evidences of equipment status or causes are known. Validation tests were performed with this computational model, considering realistic data from a Brazilian transmission utility. The tests have demonstrated the effectiveness of this approach, confirming it as a promising computational tool to the maintenance engineers.

The optimal therapy for patients with chronic hepatitis C who have not responded to interferon (IFN) is still an unsolved issue. The aim of this study was to evaluate the efficacy and tolerability of a high dose of IFN-alpha2a plus amantadine for chronic hepatitis C patients who were non-responders to a previous course of IFN. Forty consecutive patients with chronic hepatitis C, genotype 1b, who had not responded to IFN-alpha, were randomized to receive: (i) IFN 4.5 MU daily plus amantadine 200 mg/day for 4 weeks and then IFN 6 MU thrice weekly plus amantadine 200 mg/day for an additional 5 months (group A) or (ii) IFN alone at the same dosage and duration (group B). After 1 month of therapy, normal alanine aminotransferase (ALT) values were observed in three of 21 (14.3%) patients in group A and in three of 19 (15.8%) in group B; serum hepatitis C virus (HCV)-RNA clearance was observed in one patient (4.8%) in group A and in six (31.6%) in group B. At the end of treatment, six patients (28.6%) in group A and three (15.8%) in group B had normal ALT levels; however, HCV-RNA in serum was detectable in all of them at levels comparable to the basal values; an ALT relapse occurred within 3 months of stopping therapy. The combination of daily IFN plus amantadine was ineffective in this setting.

In France, the Afssaps/HAS 2006 guidelines for insulin-treated type 2 diabetic patients recommend a target glycated haemoglobin level (HbA(1c)) of less than 7%, achieved by optimalizing the insulin dose or increasing the number of daily injections. The present study investigated to what extent these recommendations are followed in clinical practice by general practitioners (GPs) and diabetologists (DTs).The ADHOC study (observational, transversal) was a survey of 267 GPs and 180 DTs prescribing insulin in France (participation rate: 4.45% and 11.6% of GPs and DTs, respectively). Physicians answered a questionnaire focused on aspects of insulin therapy in type 2 diabetic patients receiving oral antidiabetic drugs (OADs) and insulin for at least six months.A total of 1874 patients were included in the study (959 from GPs and 915 from DTs). Insulin was initiated about 10 years after the diagnosis of diabetes, when patients had high HbA(1c) levels (mean value: 9.2%). At the time of the survey, patients had been treated with insulin for 3.4 ± 3.5 years (mean ± SD), and the mean HbA(1c) was significantly reduced (P0.05) to 7.8% and 7.9% in patients treated by GPs and DTs, respectively. However, almost 80% of patients had HbA(1c) levels greater than 7%, and 35% had levels greater than 8%. The last fasting blood glucose level was 144 ± 45 mg/dL. More than 60% of patients with HbA(1c) greater than 8% were using single daily injection therapy. On consultation day, insulin treatment (dose, number of injections and type of insulin) was not optimalized in more than 40% of the latter patients. Differences in data between patients treated by GPs and DTs were small and often not statistically significant.In this study, the main therapeutic goals of insulin therapy, as defined by the Afssaps/HAS 2006 guidelines, were only attained in around 20% of type 2 diabetic patients, irrespective of follow-up by a GP or DT. During consultation, insulin therapy was not optimalized in a large proportion of inadequately controlled patients.

A cyclic electron accelerator Microtron MT-25 will be installed in Havana, Cuba. Electrons, neutrons and gamma radiation up to 25 MeV can be produced in the MT-25. A detailed shielding analysis for the bunker is carried out using two ways: the NCRP-51 Report and the Monte Carlo Method (MCNP-4C Code). The walls and ceiling thicknesses are estimated with dose constraints of 0.5 and 20 mSv y(-1), respectively, and an area occupancy factor of 1/16. Both results are compared and a preliminary bunker design is shown. Language: en

BACKGROUND Birdshot chorioretinopathy is characterised by dual unrelated inflammatory involvement of the retina and the choroid. Indocyanine green angiography made it possible to assess and follow choroidal disease with the same precision as retinal involvement was followed so far. The aim of this study was to analyse the severity, progression and response to therapy of both retinal involvement using fluorescein angiography and choroidal involvement using indocyanine green angiography. PATIENTS AND METHODS Patients with birdshot retinochoroidopathy followed at La Source Eye Centre in Lausanne, Switzerland from January 1995 to December 2002 were subdivided into three subgroups according to the duration of evolution of the disease: untreated patients with no more than one year duration of the disease (group 1, n = 6); treated patients with disease duration of 1 - 7 years duration (group 2, n = 5) and patients with disease lasting for more than 7 years (group 3, n = 4). Fluorescein and indocyanine green angiographic signs (angiographic scores given by a masked observer) were analysed in the 3 groups and compared to the "cream-coloured" fundus lesions. RESULTS Fifteen out of the 742 patients (2.0 %) seen at La Source Eye Centre during the time period considered presented BC and were included in the study. In the "early disease group" fluorescein and ICG angiography showed more severe choroidal than retinal involvement with respective scores of 3 +/- 0.79 (ICG) and 2 +/- 1.17 (FA) while there were few depigmented fundus lesions to be seen (score 1 +/- 0.27). The choroidal involvement responded well to systemic corticosteroids +/- immunosuppressive therapy (scores in groups 2 and 3 = 1.2 and 0.75), while retinal disease was stabilised at best (scores in groups 2 and 3 = 2.2. and 2.4) and depigmented fundus lesions increased (scores in groups 2 and 3 = 2.8 and 3). CONCLUSION The evolution and response to therapy of retinal and choroidal disease in birdshot chorioretinopathy have a different course with choroidal disease responding well to therapy while retinal disease is more resistant, possibly explaining the slow deterioration of functional parameters despite therapy. The increase of "cream-coloured" fundus lesions despite good choroidal response to therapy could be explained by depigmentation left behind after resolution of choroidal stromal granulomas, a hypothesis recently confirmed by an autopsy case of birdshot chorioretinopathy.

We investigated whether there are differences between the natural history of B and C chronic hepatitis in a southern Italian population, and whether the chronic viral hepatitis population was modified by the introduction of the anti-HCV test in 1989. We examined clinical charts of 1120 patients consecutively admitted to our division from January 1979 to December 1998 with the histological diagnosis of chronic viral hepatitis (304 from 1979 to 1988; 816 from 1989 to 1998). We found significant differences only in age at diagnosis (higher in the second decade, P=0·001), and in aetiology (HBV decreased in the second decade, P

Purpose Beta-blockers have been used since the late 1970's as ‘first-choice’ in the treatment for glaucoma. Since the introduction of new molecules in clinical routine, the current role of beta-blockers in glaucoma therapy has been rediscussed. In particular, concerns have been raised regarding their actual safety profile. Methods This review will focus on the latest advances on the efficacy and safety profiles of non-selective beta-blockers. Conclusions The data provided will help to trace a more appropriate role for beta-blockers in glaucoma therapy.

A 42.2 m firn core was collected at the Hercules Névé plateau (100 km inland and 2960 m a.s.L), northern Victoria Land, during the 1994-95 Italian Antarctic Expedition. Chemical (Cl–, NO3–, SO42–’; δ18O δ18O δ18O; m-2a-1) and isotope (5180) analyses were performed to evaluate the snow-accumulation rate at this site. Tritium measurements were performed in the upper part of the core to narrow down the dating of the core.High nssSO42- concentrations seem to be related to some explosive volcanic eruptions, such as Tambora (AD 1815) and the preceding event called "Unknown" (AD 1809), Coseguina (AD 1835), Makjan (AD 1861), Krakatoa (AD 1883) and Tarawera (AD 1886).A comparison between the seasonal variations observed in the isotope and chemical profiles was carried out in order to reduce the dating uncertainty, using the tritium and the volcanic markers as time constraints. A deposition period of 222 years was determined.The 3 year smoothed «5180 profile shows more negative values from the bottom of the core (dated AD 1770) throughout the 19th century, suggesting "cooler" conditions, in agreement with other East Antarctic ice-core records! Subsequently, a general increase in δ180-values is observed.The calculated average snow-accumulation rates between the above-mentioned time markers are 111-129 kg m-2a-1.

Much controversy exists concerning effect of N-acetyl-cysteine, a precursor of glutathione, on the response to interferon treatment in patients with C-virus chronic hepatitis. The aim of this study was to evaluate the efficacy of interferon therapy with and without oral N-acetyl-cysteine. We also measured glutathione concentrations in lymphomonocytes of 25 patients with chronic C-virus hepatitis before and after interferon treatment and correlated the results with treatment response.Glutathione was extracted from lymphomonocytes and measured with a modified high performance liquid chromatographic method in the 25 hepatitis patients and 12 healthy controls.1) Hepatitis patients and controls had similar basal concentrations of lymphomonocytic glutathione; 2) neither interferon nor N-acetyl-cysteine significantly affected glutathione concentrations in patients; and 3) N-acetyl-cysteine did not affect response to interferon.

The study correlated reslts of spleen size measurement performed on the planar spleen scintigraphy performed with 99mTc- Sulphur (Re) Coll

Organization and expression of the gene coding for beta 4 integrin subunit were investigated in murine carcinoma lines endowed with low and high metastatic potential maintained both in vivo and in vitro. Probes corresponding to either the extracellular or the cytoplasmic domains of the protein were generated and employed for Southern and Northern blot hybridization experiments. Southern blot analysis demonstrates a restriction fragment-length polymorphism between BALB/c and C57BI/6J DNAs. The different genomic organization of the beta 4 gene apparently does not generate variation in mRNA length. Northern blot analysis reveals a 7-kb transcript encoding full-length beta 4 protein and shorter transcripts that apparently correspond to nonfunctional mRNAs. In carcinoma cells endowed with low metastatic capacity, the 7-kb mRNA cannot be revealed in spite of the presence of shorter transcripts. In contrast, the 7-kb transcript is always present in tumor cells endowed with high metastatic capacity. Accordingly, the beta 4 protein is detectable, either by immunofluorescence or by Western blot analyses, only in highly metastatic carcinoma cells. In conclusion, the data presented show that in these murine carcinoma cell lines (i) the 7-kb mRNA is associated with a more invasive phenotype, and (ii) missing expression of the beta 4 integrin subunit in low metastatic carcinoma cells depends, at least in part, on mechanisms acting at a post-transcriptional level. The possibility that beta 4 subunit expression is a consequence of specific differentiation stages of lung carcinoma cells is discussed.

Introduction The Rorschach is a projective test frequently used in the forensic ambit for the information it can give in both the cognitive and affective areas. The purpose of our work is to identify the traits recurring in perpetrators of the “crime of impetus” through the examination of the psychometric indices of the Rorschach. Method 15 male subjects between 22 and 60 years (mean age = 43.2 ± 10.96 years) authors of murders, without previous psychiatric disorders, were tested; the control group was represented by 15 subjects without history of crimes. All protocols were collected and signed through the method “Scuola Romana Rorschach” and the scores of psychometric indices were compared between and within groups by Student's t-test. Results From the cognitive point of view there were no significant differences concerning the sense of reality between the murderers and control samples (R+% = 75,87 vs 70,73; p = 0,241. F+% = 75,47 vs 76,93; p = 0,653), but the number of responses was lower than average (16,67 vs 25,27; p Conclusions According to the most recent literature the Rorschach indices showed in the perpetrators of the “crime of impetus” the absence of mental disorders; however, the disproportion of the Index G/M and Impulsivity Index may indicate a “vulnerable anthropology” as a risk factor for impulsive crime in the presence of emotional stress.

Hepatocellular carcinoma (HC) is often difficult to distinguish from secondary liver neoplasia (SLN) by physical and imaging diagnostic procedures alone. To this aim we have extended and improved a laboratory approach based on a serum lactate dehydrogenase isoenzyme ratio (LD4:LD5) by adding the carcinoembryonic antigen: alpha-fetoprotein ratio, alkaline phosphatase, and serum iron concentrations to obtain a highly efficient discriminant function. In two successive cohorts, for a total of 102 patients, all histologically diagnosed, with a prevalence of HC vs SLN of 3:1, we correctly classified 96% of cases (100% of SLN cases). Subsequent verification with the jackknife reallocation statistical algorithm confirmed these results. In conclusion, this discriminant function based on simple laboratory assays of a few analytes is an important tool in solving a diagnostic dilemma in cases of liver neoplasia.

Introduction Erectile dysfunction (ED) and premature ejaculation (PE) are common disorders among italian male population aged between 18 and 65 years old (prevalence rate: 20–25%). Several studies demonstrate that the early treatment of the psychological conditions, frequently associated to ED and PE, can positively influence the prognosis. Aim To evaluate the psychological correlates of sexual dysfunction using a standardized instruments.Methods. 46 male patients aged between 18 and 65 years old affected by EP (60,87%) and DE (47,83%) were administered the Cognitive Behavioural Assessment (CBA 2.0). Analysis of data was carried out using an automatic scoring and creating a graphic profile. Results The 28,26% of the participants showed an high score (> 95th percentile) at the STAI X-1 suggesting the presence of trait anxiety; the 39.16% of the subjects reported experiences of social and emotional maladjustment and concomitant introversive personality traits at EPQ schedule (85–@95th percentile at subscales E and P) and depressive mood at scale 8 (questionnaire D). Finally, the 32.60% did not present psychological conditions. Conclusions According to the literature, our findings demonstrates an high frequency of psychological distress in patients affected by sexual dysfunction (67%). The use of CBA 2.0 migth represent an useful tool for the diagnosis and early treatment of this kind of population.

Introduction The Rorschach is a projective test frequently used in the forensic ambit for the information it can give in both the cognitive and affective area. The purpose of our work is to identify the personality traits recurring in killings through the examination of the psychometric major indices of the Rorschach. Method 20 male subjects, authors of murders, between 20 and 50 years were tested (average age, 29); the control group was represented by 20 male subjects aged between 20 and 50 years without history of crimes. All protocols were collected and signed through the method “Scuola Romana Rorschach” and processed by information systems RORCOMP. Results From the cognitive point of view there were no significant differences concerning the sense of reality between the murderers and control samples (R +%, F +%: 70–80), but the number of responses was lower than average (80% of subjects R = 20) as well as the number of M (75% of subjects M FC; then 78% of the subjects showed an average value of the Impulsivity Index equivalent to 0.85. Conclusions Despite the availability of a limited number of cases, the Rorschach indices, in concordance with literature data, showed in the murderers the presence of affective lability and immature object relations, lack of interest in the object, impulsivity, egotism and mild empathy, that identify the cluster B personality traits.

No laboratory test completely distinguishes malignant ascites (MA) from ascites associated with cirrhosis and (or) hepatocellular carcinoma (A/C-HC). Ascitic cytology is highly specific but has a diagnostic sensitivity of only 40-60%. We determined 11 ascitic analytes and cytology in 58 patients with cirrhosis, 15 with hepatocellular carcinoma, and 21 with MA (10 ovarian cancers, 4 mesotheliomas, 6 gastrointestinal neoplasias, 1 leukemia). Ascitic total protein, cholesterol, pseudouridine, and lactate dehydrogenase (LD), and the ascitic:serum ratios of total protein and of LD showed the most significant differences between the two groups of patients. Stepwise multiple linear discriminant analysis (applying the Wilks' lambda criterion) of several variables, corroborated by the "jack-knife" reallocation procedure, showed that the ascitic cholesterol and ascitic LD association correctly identified 100% of MA and A/C-HC; cytology had a diagnostic specificity of 100%, but identified only 48% of MA. This association may represent a primary tool for the discrimination of ascites of unknown origin, particularly in the presence of negative cytology findings.

In a long-term study (27 months) of patients affected by C-virus active hepatitis we have evaluated the effect of decreasing the dose of interferon by 50% and by 75% with respect to the initial efficacious dose (6 MU tiw). Sixty patients received recombinant interferon alpha-2b(r-IFN- alpha-2b) 6 MU tiw for two months followed by 3 MU for seven months (Group A), and 60 patients received r-IFN alpha-2b 6 MU tiw for two months followed by 1.5 MU for seven months (Group B). Three patients in group B failed to return to follow-up and were not considered in subsequent evaluations. Side effects such as to cause suspension of treatment occurred only during the first two months of the study at 6 MU of interferon (3 patients in group A and 6 in group B). During the two months at 6 MU, transaminase values returned to normal in 94 patients (80%). At the end of follow-up, 49 of these patients (42% of the 117 patients examined; or 48.3% in group A and 35.1% in group B) had normal transaminase levels. In no case did the anti-HCV test become negative. On a reduced dose of interferon, relapses occurred more frequently in group B (21.4%) than in group A (9.6%), but the difference was not significant. No difference between responders and non-responders, including relapsing patients, was observed in relation to gender, age, presence of cirrhosis, presence of B-virus antibodies and initial levels of serum transaminase.

Structural and functional analyses of several integrin heterodimers were performed in non-small-cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cell lines. The expression of beta 1, beta 3, beta 4, and beta 5 heterodimers was evaluated at protein and mRNA levels. By flow cytometry and immunoprecipitation experiments we demonstrate that NSCLC cells (A549 adenocarcinoma and DG 3 large cell carcinoma) coexpress integrin heterodimers composed of beta 1, beta 3, beta 4, and beta 5 subunits, whereas SCLC cells (AE2 and H69) express only beta 1 integrin heterodimers. Northern blot experiments confirmed immunochemical analysis: SCLC cells in contrast to NSCLC cells express only the mRNA coding for the beta 1 subunit. These data indicate that in lung carcinoma cells the diversity in the integrin repertoire depends upon differential gene expression. The functionality of integrin receptors has been studied using antibody blocking experiments. Data reported demonstrate that the alpha 6 beta 1 integrin is a laminin receptor in either SCLC or NSCLC cells. An antibody to the beta 4 subunit partially inhibits the adhesion of adenocarcinoma cells to lamin but does not block lamin adhesion of large cell carcinoma cells, even though alpha 6 beta 4 complexes are expressed on both cell types. Two antisera to vitronectin receptors inhibit the adhesion of NSCLC cels to both vitronectin and fibronectin. The same antisera inhibit the adhesion of SCLC cells only to laminin, indicating that the alpha v beta 1 integrin might function in these cells as laminin receptor.

IntroductionThe use of standardized and objective instruments constitutes a support to the clinical observation in order to evaluate particular and general aspects of an individual's psychic life, and it can represent a valid aid in the evaluation and prediction of aggressivity. Our aim is the assessment of the MMPI-2 ‘s predictive capacity, a self-report personality test, constituted of 567 items, evaluating possible aggressive acts.Method20 subjects with a history of aggressivity, in the absence of major psychiatric disorders, were examined. The MMPI-2 test was administered to them, so as to assess their profile with reference to the aggressivity's indicators. It was also administered to a control group of subjects without a history of aggressivity.ResultsIn all the examined offenders, unlike the control group, were observed low T values in the K scale (< 40), an increase in the Pd base scale (>65) and supplemental scale O-H (>65); with respect to the derivative indexes, it was noticed a scarce adaptive capacity (Hy< Pa), a low tendency to the tolerance of frustrations and a negative value at T points in the PAI (Hy+100)-(Pd+2Pa).ConclusionIn concordance with the literature data, the MMPI-2 can be a useful support in evaluating the risk of aggressivity. Subjects at risk of acting out show low values in the K scale (< 40), high values in the Pd scale (>65). Other particularly important risk indicators are: code types 4/6, 4/8, 468, a scarce adaptive capacity (Hy< Pa) and a scarce tolerance to frustrations.

but 28% had reduced urinary phosphate absorption, as assessed by estimated TmPI/GFR, Overall, TDF dosing was reduced or discontinued in 3.3% of the patients because of renal toxicity or other adverse events. Two patients cleared HBsAg and discontinued TDF successfully. Conclusions: TDF suppressed HBV replication in most NUC-naive patients in field practice up to 21 months with few patients showing an impairment of renal function.

IntroductionThe delusional misidentification syndromes (syndromes of Frégoli, Intermetamorphosis, Subjective Doubles and Capgras) are characterized by delusions of misidentification of other persons or of one-self. Aggressive ideas or behaviours often go with these delusions, but the problem received relatively little attention. Capgras’ Syndrome is characterized by the delusional belief that a well-known person has been replaced by a double. The delusion frequently involves significant others and takes place in a paranoid atmosphere with feelings of strangeness and unreality. We stress the importance of considering the potential dangerousness and homicidal acts directed towards family members of patients with Capgras’ Syndrome.MethodsWe report a case with histories of paranoid schizophrenia and alcohol and cannabis intoxications who developed a Capgras’ Syndrome associated with homicidal behaviours toward his wife.ResultsOur case met DSM IV-TR diagnostic criteria for paranoid schizophrenia, according to previous studies which show that paranoid schizophrenia is the most frequent mental disorder associated with delusional misidentification. The psychopathological analysis show that homicidal acts are connected to anguish of the ego disintegration and failure of defense mechanisms.ConclusionsAccording to the most recent literature, our findings suggest that Capgras’ Syndrome may be linked to a genesis of aggressive behaviours; alcohol and substance intoxications facilitates impulsivity and dissociation. The patients’ acting out directed toward family members occurs during a psychotic breakdown. Capgras’ Syndrome should always be evaluated in order to prevent violent acts.

IntroductionThe longevity of population is an evidence over the past decades. Elderly physical and mental health are imperative. Despite anxiety is common and has adverse consequences, literature is meagre.ObjectivesTo estimate the prevalence of generalized anxiety disorder (GAD) in elderly and to investigate the association with physical comorbidity, depression, daily habits.Methods426 subjects from the population-based Faenza Community Aging Study (De Ronchi et al 2005), mean age 85,1 (Standard Deviation = 6,9). The Geriatric Anxiety Inventory short-form (GAI-sf) was utilized to define GAD (score ≥ 3). Logistic-regression were used to estimated odds ratio and 95%Confidence Intervals (CI).ResultSubjects with anxiety were 84 (21,2%), 63,1% were women. For age < 80 the prevalence of GAD was 38,1% while for age> 95 was 4,8%. When we compared elderly with GAD to elderly not affected we found the following results: no hobbies (83,3% vs 79,6%) p = 0,124, no friendship (21,8% vs 15,8%) p = 0,425, they don’t make physical activity (53,7% vs 45,6%) p = 0,214 than subjects without anxiety. To have comorbidity was associated with anxiety: one disease OR (CI95%) = 2,71 (1,15–6,24), two or three OR (CI95%) = 2,57 (1,07–6,16) and > three OR (CI95%) = 7,5 (1,81–31,05). Hypertension was positively associated with anxiety OR (CI95%) = 1,94 (1,04-3,62). Depression was highly correlated with anxiety OR (CI 95%) = 5,82 (3,39–9,98). Moderate alcohol consumption was negative associated with anxiety OR(CI 95%) = 0,49 (0,25–0,95).ConclusionAnxiety in elderly is frequent and should be actively investigated especially in elderly with comorbidity.

The aim of this study was to investigate whether there is a variable responsiveness of the hepatitis C virus and/or of the affected host to different types of interferon. We treated 21 patients affected by chronic hepatitis C who failed to respond to recombinant alpha interferon, after a four-month interval, with lymphoblastoid interferon. Alanine transaminase (ALT) serum level was normal in 9 patients (43%) at the end of treatment. At the end of a 12 months treatment-free follow-up serum ALT remained normal in 3 patients, 4 patients relapsed and 2 dropped-out. As yet there are no reports of differences in the therapeutic efficacy of the two types of interferon used in our study. The good response to the lymphoblastoid interferon in our non responders to recombinant alpha interferon may be due to the immune modulation induced by the four-month wash-out interval between the two therapies or to a different virus sensitivity to this interferon.