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Blue nevi are a heterogeneous group of lesions that can display a variety of different clinicopathological characteristics. Although attempts are made to classify each lesion into defined subtypes, there can be overlap between the subtypes. The clinical , dermoscopic and histolopathologic features of a case of proliferative nodule arising within blue nevus is discussed. Running title: Blue nevi are an heterogeneous group of melanocytic lesions blue tinctorial properties. Proliferative nodules are rare benign lesions often present at birth as a component of a large congenital melanocytic nevi, congenital or acquired nevi. We first report a case of proliferative nodule arising within blue nevus.

Background and Purpose: Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patients. The aims of this prospective, multicenter, multinational, unmatched, case-control study were (1) to investigate for risk factors that could predict ICH occurring in patients with atrial fibrillation during NOAC treatment and (2) to evaluate the role of CHA2DS2-VASc and HAS-BLED scores in the same setting. Methods: Cases were consecutive patients with atrial fibrillation who had ICH during NOAC treatment. Controls were consecutive patients with atrial fibrillation who did not have ICH during NOAC treatment. As within the CHA2DS2-VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. Results: Four hundred nineteen cases (mean age, 78.8±8.1 years) and 1526 controls (mean age, 76.0±10.3 years) were included in the study. From the different models performed, independent predictors of ICH were increasing age, concomitant use of antiplatelet agents, active malignancy, high risk of fall, hyperlipidemia, low clearance of creatinine, peripheral artery disease, and white matter changes. Low doses of NOACs (given according to label or not) and congestive heart failure were inversely associated with the risk of ICH. HAS-BLED and CHA2DS2-VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468-0.525) and 0.530 (95% CI, 0.500-0.560), respectively. Conclusions: Several risk factors were associated to ICH in patients treated with NOACs for stroke prevention but not HAS-BLED and CHA2DS2-VASc scores. © 2021 Lippincott Williams and Wilkins. All rights reserved.

Introduction: The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing. Materials and Methods: Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results: A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39–2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16–1.80). Discussion: our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events. Conclusions: Patients with PS or AS and AF appear to have similar risks of ischaemic or haemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT. © European Stroke Organisation 2020.

An early identification of non-responders in oncology is of crucial importance to rapidly switch treatment regimens. Here we report a positron emission tomography, (PET)-guided switch from immunotherapy to targeted therapy in a patient affected by metastatic melanoma. We describe the case of a 78-years-old male patient diagnosed with nodular melanoma, submitted to baseline PET/CT with 18fluorodeoxyglucose (18F-FDG) that showed cutaneous and skeletal metastases (stage IV). The patients started immunotherapy with pembrolizumab. A PET/CT performed 3 months after the start of immunotherapy demonstrated progressive metabolic disease both at skeletal and cutaneous level, confirmed also by the biopsy. As patients resulted positive for BRAF V600k mutation, treatment regimen was rapidly switched to combined anti-BRAF/MEK targeted therapy. The PET/CT performed 3 months later, showed almost complete metabolic response. Ten months after the beginning of targeted therapy, the patient continues to present a durable metabolic response. PET/CT with 18F-FDG may help in monitoring the response to treatment in metastatic melanoma thus defining personalized therapeutic pathways.

Archaeological excavations carried out in Early Iron Age Vetulonia (northern Tuscany, Italy) brought to light a funerary urn particularly noteworthy for the presence of an unusual decoration obtained by plastering the vase surface with an organic dark grey substance, on which metal strips were originally fixed. In order to reveal the origin of such coating, it was chemically studied by gas chromatography coupled with mass spectrometry (GC/MS). Chemical analysis not only revealed that birch bark tar was used as coating/adhesive material for the manufacture of the urn, but also allowed us to discuss the significance of the vessel in terms of eco‐technological knowledge and possible cultural connections on a large geographical scale.

Urban land disturbance degrades physical, chemical, and biological soil properties by removing topsoil and compacting the remaining subsoil. Such practices create a soil environment that is unfavorable for vegetation establishment. A 3-year field study was conducted to compare the effects of various one-time compost application treatments on soil properties and re-vegetation of a disturbed soil. A disturbed urban soil received the following treatments: (1) inorganic fertilizer; (2) 2.5-cm-depth surface-applied compost; (3) 2.5-cm-depth incorporated compost; (4) 5.0-cm-depth incorporated compost; (5) inorganic fertilizer plus 0.6-cm compost blanket; and (6) inorganic fertilizer plus straw mat cover. The plots were seeded with a mixture of tall fescue Festuca arundinacea Shreb.: ‘Magellan,’ ‘Coronado Gold,’ ‘Regiment,’ and ‘Tomcat,’ perennial ryegrass Lolium perenne L. ‘Linn’, and Kentucky bluegrass Poa pratenis L. ‘Baron.’ Soil chemical and physical attributes and plant growth and quality parameter...

Resume Introduction Le regime cetogene est une strategie therapeutique qui a montre son efficacite dans les epilepsies pharmacoresistantes. Il est egalement le traitement de certaines maladies metaboliques. Il n’existe pas de consensus francais ou europeen sur la mise en place et l’utilisation du regime cetogene. Methode Nous avons mene par questionnaires une evaluation des pratiques sur trois periodes : 2001 a 2002, 2002 a 2003 (questionnaire de 2005) et 2005 a 2008 (questionnaire de 2008). Il s’agissait d’evaluer le degre de prescription, les indications et les modalites d’utilisation du regime cetogene aupres des services ou unites de neurologie pediatrique des centres hospitaliers universitaires francais. Resultats Le regime cetogene est utilise dans une majorite de centres avec une augmentation de son utilisation dans le temps. Les modalites d’initiation du regime ont egalement evolue en adequation avec les donnees de la litterature. Conclusion Cette strategie therapeutique semble bien connue des neuropediatres francais.

The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet that has been employed as a nonpharmacologic therapy for intractable epilepsy. Several multicenter or randomized studies have demonstrated the anticonvulsive properties of the ketogenic diet. The reports on the clinical efficacy have described a greater than 50% reduction in seizure frequency for about 60% of patients on a ketogenic diet. Efficacy has been reported both for child-teenager and adult patients. Patients who were responders to the ketogenic diet exhibited a decrease in seizure frequency within two months of treatment onset. Underlying mechanisms remain unknown. The current hypotheses are: anticonvulsive properties of ketone bodies, variation in excitatory or inhibitory brain neurotransmissions, modulation of cell excitability or implication of polyunsaturated fatty acids. Ketogenic diet is a fastidious and restrictive therapy. Moreover, side effects have been reported. In order to facilitate patient tolerability and palatability, the diet protocols are gradually modified including changes in ratios of the fat versus non fat components, initiation of the diet with or without fasting, fatty acids composition. A modified Atkins diet seems to be a possible alternative diet with a comparable efficacy on intractable epilepsy. This diet induces ketosis without fluid, calorie or protein restriction, nor the requirement for fasting and food weighing. Furthermore, 10 to 20 grams carbohydrates are allowed per day to increase patient tolerability and palatability. New data suggest that ketogenic diet and its variants should not be considered like a "last chance" treatment.

Resumen Introduccion Las enfermedades dermatologicas representan un porcentaje importante de los motivos de consulta en Atencion Primaria. En nuestro ambito la creciente demanda de consulta y la consecuente aparicion de listas de espera hace necesario establecer algun tipo de criterio para una adecuada derivacion. Pretendemos en este estudio describir las caracteristicas de la derivacion desde los centros de Atencion Primaria a las consultas de Dermatologia, asi como la correlacion existente entre el motivo de consulta y el diagnostico dermatologico final. Material y metodos Se recogen los datos de 3.164 pacientes atendidos por primera vez en nuestras consultas de Dermatologia, durante 1998, clasificandose segun el centro de Atencion Primaria de procedencia y el motivo de consulta. Se realiza un estudio de concordancia entre el motivo de consulta y el diagnostico dermatologico final, averiguando para cada caso el valor predictivo positivo, la sensibilidad diagnostica y el indice de concordancia kappa. Resultados La concordancia diagnostica global ha sido del 65,52 %. Se detecta por parte del medico de Atencion Primaria un sobrediagnostico de las enfermedades por papilomavirus y una sensibilidad diagnostica muy baja en patologias como el carcinoma basocelular y las queratosis seborreicas. Conclusiones Se hace necesario insistir en la formacion de los medicos de Atencion Primaria, en una adecuada derivacion desde los centros de Atencion Primaria y en potenciar un buen modelo de interconsulta con el especialista.

Resumen Introduccion Se ha observado en los ultimos anos un aumento en la poblacion inmigrante que acude a nuestras consultas. Pretendemos describir en el presente estudio las caracteristicas epidemiologicas dermatologicas de este grupo de poblacion en el area de salud del Hospital Miguel Servet de Zaragoza. Material y metodos Se han recogido los datos de los pacientes inmigrantes atendidos en nuestras consultas de Dermatologia durante el ano 2004. Los diagnosticos dermatologicos se han codificado segun el ICD-9-CM. El estudio estadistico se ha realizado con el programa SPSS, el gestor de base de datos Access y la hoja de calculo Excel. Resultados Se han atendido un total de 706 pacientes inmigrantes, lo que supone el 4% aproximado del total de primeras visitas, apreciandose una mayor frecuencia de mujeres, con diferencias significativas. La edad media es de 31 anos, sin que se aprecien diferencias significativas entre ambos sexos. Ecuador, Colombia, Rumania, Marruecos, Gambia, Guinea y Senegal son por este orden los paises de origen que con mas frecuencia se han detectado entre nuestros pacientes. Las enfermedades dermatologicas mas frecuentes en este grupo de poblacion han sido las de origen infeccioso, sobre todo micosis, siguiendo las de origen viral y las piodermitis asi como las enfermedades de transmision sexual, apreciandose en todas ellas una incidencia superior a la de la poblacion autoctona. Conclusiones Se hace necesario un adecuado conocimiento de la patologia dermatologica en este grupo de poblacion con el fin de realizar tanto un correcto diagnostico y tratamiento como de desarrollar medidas de prevencion de enfermedades importadas.

Introduction. In recent years there has been an increase in the size of the immigrant population consulting dermatology services in Spain. The aim of this study was to describe the epidemiological characteristics of this sector of the population in the health care area served by Miguel Servet Hospital in Saragossa, Spain. Material and methods. Data were collected on immigrant patients seen in the dermatology department of our hospital during 2004. Dermatological diagnoses were classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Statistical analysis was undertaken using the SPSS statistical package, Access database management software, and Excel spreadsheets. Results. A total of 706 patients were seen, corresponding to approximately 4% of all first appointments, and more women were seen than men, a difference that was statistically significant. The mean age of the patients was 31 years and there were no statistically significant differences in age between the sexes. In order of frequency, the most common countries of origin of the patients were Ecuador, Colombia, Romania, Morocco, Gambia, Guinea, and Senegal. The most common skin diseases in this population group were infectious diseases, in particular mycoses, followed by viral diseases and pyodermatitis, as well as sexually transmitted diseases. In all cases, the incidente of the disease was higher than in the Spanish population. Conclusions. An appropriate knowledge of dermatological diseases in this population group is necessary both to obtain correct diagnosis and to develop preventative measures for imported diseases.

Introduction Skin diseases account for a high proportion of presenting complaints in primary health care. In Spain, the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist. This study aimed to investigate the characteristics of referrals from primary care centers to dermatology specialists as well as the correlation between the presenting complaint and the final dermatologic diagnosis. Patients and methods We collected data from 3164 patients seen for the first time by dermatologists in our specialist service during 1998. Patients were stratified according to the referring primary health care center and the reason for referral. The agreement between the presenting complaint and the final dermatologic diagnosis was studied. For each dermatologic condition, the positive predictive value, diagnostic sensitivity, and κ statistic were calculated. Results The overall diagnostic agreement was 65.52%. Primary care physicians were found to overdiagnose diseases caused by papillomavirus and the diagnostic sensitivity was very low for diseases such as basal cellcarcinoma and seborrheic keratosis. Conclusions It is necessary to insist on training primary care physicians, ensuring appropriate referral from primary health care clinics, and promoting an effective dialogue with the specialist.

Resumen Existen pocos casos descritos de mucinosis folicular primaria en adultos. Dentro de esta rareza aun son menos frecuentes los casos cuya presentacion clinica no corresponde a papulas foliculares con areas de alopecia. Por ambos motivos presentamos aqui una paciente de 65 anos con una placa eritemato-descamativa en la region facial, sin enfermedades hematologicas ni dermatologicas concomitantes, cuyo estudio histologico revelo el diagnostico de mucinosis folicular. Con este caso pretendemos aportar mas evidencia sobre la potencial diversidad de expresividad clinica de la mucinosis folicular primaria.

[EN] Industrial maintenance is a key factor in ensuring the availability of the production systems of companies. Furthermore, it also has a significant impact on energy efficiency and on safety. The study of the status of the maintenance departments activity in the industrial sector in Spain (and probably in other European countries) shows negative aspects that indicate little innovation, lack of resources or personnel, poor planning and a downward trend in own staffing levels, while hiring with outside companies increases. Many companies perceive maintenance as an unavoidable cost. To change these negative trends it is necessary to make visible to the management staff the cost-benefit analysis of the maintenance activity and justify the investments to improve their results. This article highlights some of the threats that affect the activity of maintenance departments in industry, as perceived through statistics on industrial activity and sectoral surveys in Spain. Secondly, the article proposes the basis of a cost-benefit analysis, based on the avoided costs that maintenance department activity can generate. The authors propose this model as a simple tool to justify investments in the maintenance departments of companies.

Background & Aims: Oral immunization with Helicobacter pylori urease can cure Helicobacter infection in animals. As a step toward therapeutic immunization in humans, the safety and immunogenicity of oral immunization with recombinant H. pylori urease were tested in H. pylori –infected adults. Methods: Twenty-six H. pylori –infected volunteers were randomized in a double-blind study to four weekly oral doses of 180, 60, or 20 mg of urease with 5 μg heat-labile enterotoxin of Escherichia coli (LT), LT alone, or placebo. Side effects and immune responses were evaluated weekly after immunization, and gastric biopsy specimens were obtained after 1 month and 6 months for histology and quantitative cultures. Results: Diarrhea was noted in 16 of 24 (66%) of the volunteers who completed the study. Antiurease serum immunoglobulin A titers increased 1.58-fold ± 0.37-fold and 3.66-fold ± 1.5-fold (mean ± SEM) after immunization with 60 and 180 mg urease, respectively, whereas no change occurred in the placebo ± LT groups ( P = 0.005). Circulating antiurease immunoglobulin A–producing cells increased in volunteers exposed to urease compared with placebo (38.9 ± 13.6/10 6 vs. 5.4 ± 3.1; P = 0.018). Eradication of H. pylori infection was not observed, but urease immunization induced a significant decrease in gastric H. pylori density. Conclusions: H. pylori urease with LT is well tolerated and immunogenic in H. pylori –infected individuals. An improved vaccine formulation may induce curative immunity. GASTROENTEROLOGY 1999;116:804-812

Live Salmonella typhimurium phoP c bacteria were tested as mucosal vaccine vectors to deliver Helicobacter pylori antigens. The genes encoding the A and B subunits of H. pylori urease were introduced into S. typhimurium phoP c and expressed under the control of a constitutive tac promoter (tac- ureAB ) or a two-phase T7 expression system (cT7- ureAB ). Both recombinant Salmonella strains expressed the two urease subunits in vitro and were used to nasally immunize BALB/c mice. The plasmid carrying cT7- ureAB was stably inherited by bacteria growing or persisting in the spleen, lungs, mesenteric or cervical lymph nodes, and Peyer’s patches of immunized mice, while the plasmid carrying tac- ureAB was rapidly lost. Spleen and Peyer’s patch CD4 + lymphocytes from mice immunized with S. typhimurium phoP c cT7- ureAB proliferated in vitro in response to urease, whereas cells from mice given S. typhimurium phoP c alone did not. Splenic CD4 + cells from mice immunized with phoP c cT7- ureAB secreted gamma interferon and interleukin 10, while Peyer’s patch CD4 + cells did not secrete either cytokine. Specific H. pylori anti-urease immunoglobulin G1 (IgG1) and IgG2A antibodies were detected following immunization, confirming that both Th1- and Th2-type immune responses were generated by the live vaccine. Sixty percent of the mice (9 of 15) immunized with S. typhimurium phoP c cT7- ureAB were found to be resistant to infection by H. pylori , while all mice immunized with phoP c tac- ureAB (15 of 15) or phoP c (15 of 15) were infected. Our data demonstrate that H. pylori urease delivered nasally by using a vaccine strain of S. typhimurium can trigger Th1- and Th2-type responses and induce protective immunity against Helicobacter infection.

The ketogenic diet is an adequate treatment for drug-resistant epilepsy and certain inborn metabolic disorders. The efficacy of the ketogenic diet for the treatment of epilepsy is now well established. In France, and more widely in Europe, there is currently no consensus concerning appropriate initiation of the ketogenic diet and subsequent patient management.Using the same questionnaire in 2005 and 2008, we retrospectively recorded the practices of child neurology departments of the French university hospitals during three study periods (2001-2002, 2002-2003 and 2005-2008). The aim was to evaluate the number of ketogenic diets started and how the ketogenic diet was initiated.The ketogenic diet was widely used by pediatric neurologists. The number of patients on a ketogenic diet increased over time. Diet initiation protocols also changed over time, being modified adequately with advances in knowledge of the ketogenic diet.The French pediatric neurologists appear to have a good understanding of the ketogenic diet.

The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet that has been employed as a nonpharmacologic therapy for intractable epilepsy. Several multicenter or randomized studies have demonstrated the anticonvulsive properties of the ketogenic diet. The reports on the clinical efficacy have described a greater than 50% reduction in seizure frequency for about 60% of patients on a ketogenic diet. Efficacy has been reported both for child-teenager and adult patients. Patients who were responders to the ketogenic diet exhibited a decrease in seizure frequency within two months of treatment onset. Underlying mechanisms remain unknown. The current hypotheses are: anticonvulsive properties of ketone bodies, variation in excitatory or inhibitory brain neurotransmissions, modulation of cell excitability or implication of polyunsaturated fatty acids. Ketogenic diet is a fastidious and restrictive therapy. Moreover, side effects have been reported. In order to facilitate patient tolerability and palatability, the diet protocols are gradually modified including changes in ratios of the fat versus non fat components, initiation of the diet with or without fasting, fatty acids composition. A modified Atkins diet seems to be a possible alternative diet with a comparable efficacy on intractable epilepsy. This diet induces ketosis without fluid, calorie or protein restriction, nor the requirement for fasting and food weighing. Furthermore, 10 to 20 grams carbohydrates are allowed per day to increase patient tolerability and palatability. New data suggest that ketogenic diet and its variants should not be considered like a "last chance" treatment.

In recent years there has been an increase in the size of the immigrant population consulting dermatology services in Spain. The aim of this study was to describe the epidemiological characteristics of this sector of the population in the health care area served by Miguel Servet Hospital in Saragossa, Spain.Data were collected on immigrant patients seen in the dermatology department of our hospital during 2004. Dermatological diagnoses were classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Statistical analysis was undertaken using the SPSS statistical package, Access database management software, and Excel spreadsheets.A total of 706 patients were seen, corresponding to approximately 4 % of all first appointments, and more women were seen than men, a difference that was statistically significant. The mean age of the patients was 31 years and there were no statistically significant differences in age between the sexes. In order of frequency, the most common countries of origin of the patients were Ecuador, Colombia, Romania, Morocco, Gambia, Guinea, and Senegal. The most common skin diseases in this population group were infectious diseases, in particular mycoses, followed by viral diseases and pyodermatitis, as well as sexually transmitted diseases. In all cases, the incidence of the disease was higher than in the Spanish population.An appropriate knowledge of dermatological diseases in this population group is necessary both to obtain correct diagnosis and to develop preventative measures for imported diseases.

The axillopectoral muscle, usually called Langer’s axillary arch instead of Langer’s arm arch, is a supernumerary muscle and is the principal anatomic variation of the axilla. Three cases of the muscle were observed originating from latissimus dorsi crossing over the axillary neurovascular bundle and inserting deep to the insertion of pectoralis major or into the coracoid process. Clinicians should be aware of its existence as it can give rise to different pathologies. It should be recognised and excised to expose the axillary artery and vein in patients with trauma and to perform axillary lymphadenectomy or axillary bypass. It should be considered in the differential diagnosis of axillary masses or in a history of intermittent axillary vein obstruction. If the muscle causes problems its excision should be curative.

OBJECTIVE: To determine the prevalence of suspected ill treatment of the elderly (ITE) in the population cared for in a health district and to analyse the associated variables. DESIGN: Cross-sectional study. SETTING: Les Planes (Sant Joan Despí, Barcelona). Urban Health District. PATIENTS: 307 patients over 70 years old seen in the Health District. The study had 39 losses, 31 exclusions because of cognitive disorder and 18 because it was impossible to hold the interview. 219 completed the study. MEASUREMENTS AND RESULTS: The Pfeiffer test was administered through an interview, social and demographic variables were collected, a questionnaire on ill treatment was filled in (a positive reply was considered ITE), and physical dependence was evaluated (Katz index). Prevalence of ITE was 26 people or 11.9% (95% CI, 7.6-16.2), breaking down into 6 physically ill-treated, 20 psychologically, one sexually, 3 by negligence and 3 by neglect. Nine people suffered more than one kind of ill treatment. Significant associated variables were: being a woman 18% (p

Specific strains of Lactobacillus acidophilus are known to inhibit intestinal cell adhesion and invasion by enterovirulent bacteria. As L. acidophilus can survive transiently in the human stomach, it may downregulate Helicobacter pylori infection.The ability of L. acidophilus (johnsonii) La1 supernatant to interfere with H. pylori bacterial growth, urease activity, and adhesion to epithelial cells was tested in vitro. Its effect on H. pylori infection in volunteers was monitored in a randomized, double-blind, controlled clinical trial, using a drinkable, whey-based, La1 culture supernatant. H. pylori infected volunteers were treated 14 days with 50 ml of La1 supernatant four times a day combined with either omeprazole 20 mg four times a day or with placebo. Infection was assessed by breath test, endoscopy, and biopsy sampling, performed at inclusion, immediately at the end of the treatment (breath test only), and 4 weeks after the end of the treatment.La1 supernatant inhibited H. pylori growth in vitro, regardless of previous binding of H. pylori to epithelial cells. In 20 subjects (8 females, 12 males, mean age 33.1 years) a marked decrease in breath test values was observed immediately after treatment with La1 supernatant, both in the omeprazole and in the placebo group (median 12.3 vs. 28.8 and 9.4 vs. 20.4, respectively; p0.03). In both treatment groups, breath test values remained low 6 weeks after treatment (omeprazole treated 19.2, placebo treated 8. 3; p0.03 vs. pretreatment), but the persistence of H. pylori infection was confirmed in gastric biopsies.La1 culture supernatant shown to be effective in vitro has a partial, acid-independent long-term suppressive effect on H. pylori in humans.

Apnoea become a medical problem when associated with a symptomatology cohort characterized by skin colour modifications, muscular tone modifications and consciousness. This syndrome named ALTE, from the acronym Apparent Life Threatening Event, well describes the near death sensation in the witnesses. Only 60% of this events may be revealed in his etiopathogenesis, also even a strong diagnostic protocol is applied; the remaining part, called idiopathic represent a open doubt and stressing factor for the physicians. ALTE may be analyzed in his rising and resolving ways, throughout a complete and accurate report of the history and throughout his association with other several symptoms eventually associated, able to leading at diagnosis. The child must be investigated about his metabolic status near the crisis, particularly for each disease life threatening as cardiac arrhythmias, electrolytes alterations and hide or beginning infections. The use of instruments for domestic surveillance is based on old observations, denied by a lot of studies, there is an high relation between ALTE and SIDS. Really the monitoring has different rules in the management of child with ALTE: it is a useful tool to evaluate in continuous child's life parameters in order to be able to make a quick intervention in case of life threatening alterations for child. It also represents a diagnostic and prognostic way because it allows to evaluate respiratory and cardiac patterns and their modifications time related. There are some side effects as anxiety elicited in parents, cause of high frequency in false alarms. This allows the need of a strict relation between a SIDS Center and the family in order to increase the parents compliance.

Background & Aims: Infection with Helicobacter induces a T helper type 1 response in mice and humans. Mice can be cured or protected from infection with Helicobacter by mucosal immunization with recombinant H. pylori urease B subunit (rUreB). This study characterizes the immune response of infected mice immunized with rUreB. Methods: BALB/c mice were infected with H. felis. Two weeks later, they were orally immunized four times with rUreB and cholera toxin (CT) at weekly intervals. Controls were only infected or sham-immunized with CT. Animals were killed at various times after immunization. Splenic CD4 + cells were obtained and cultured in vitro with rUreB to evaluate antigen-specific proliferation and induction of interferon gamma and interleukin 4 secretion. Results: All rUreB-immunized mice (n = 8) were cured from infection 3 weeks after the fourth immunization. Immunization induced a proliferative response of splenic CD4 + cells, a progressive decrease in interferon gamma secretion, and a concomitant increase in interleukin 4 secretion after each immunization. A simultaneous increase in rUreB specific serum immunoglobulin G1 levels was observed in infected/immunized mice. Conclusions: In BALB/c mice, therapeutic mucosal immunization with rUreB induces progressively a Th2 CD4 + T cell response resulting in the elimination of the pathogen. GASTROENTEROLOGY 1998;115:891-897

Live Salmonella typhimurium phoPc bacteria were tested as mucosal vaccine vectors to deliver Helicobacter pylori antigens. The genes encoding the A and B subunits of H. pylori urease were introduced into S. typhimurium phoPc and expressed under the control of a constitutive tac promoter (tac-ureAB) or a two-phase T7 expression system (cT7-ureAB). Both recombinant Salmonella strains expressed the two urease subunits in vitro and were used to nasally immunize BALB/c mice. The plasmid carrying cT7-ureAB was stably inherited by bacteria growing or persisting in the spleen, lungs, mesenteric or cervical lymph nodes, and Peyer’s patches of immunized mice, while the plasmid carrying tac-ureAB was rapidly lost. Spleen and Peyer’s patch CD4+ lymphocytes from mice immunized with S. typhimurium phoPc cT7-ureAB proliferated in vitro in response to urease, whereas cells from mice given S. typhimurium phoPc alone did not. Splenic CD4+ cells from mice immunized with phoPc cT7-ureAB secreted gamma interferon and interleukin 10, while Peyer’s patch CD4+ cells did not secrete either cytokine. Specific H. pylori anti-urease immunoglobulin G1 (IgG1) and IgG2A antibodies were detected following immunization, confirming that both Th1- and Th2-type immune responses were generated by the live vaccine. Sixty percent of the mice (9 of 15) immunized with S. typhimurium phoPc cT7-ureAB were found to be resistant to infection by H. pylori, while all mice immunized with phoPc tac-ureAB (15 of 15) or phoPc (15 of 15) were infected. Our data demonstrate that H. pylori urease delivered nasally by using a vaccine strain of S. typhimurium can trigger Th1- and Th2-type responses and induce protective immunity against Helicobacter infection.

Background & Aims: Eradication of Helicobacter pylori infections in humans results in the healing of gastritis and gastric ulcers. This study used a mouse model to test whether oral vaccination can cure Helicobacter infection and gastritis. Methods: Mice were infected with Helicobacter felis . Three weeks after infection, the mice were orally immunized with H. pylori urease B subunit. Control mice were simultaneously infected but sham immunized. Results: Three to 8 weeks after oral immunization of H. felis —infected mice with recombinant H. pylori urease B subunit, the infection cleared and there was no evidence of gastritis. Vaccinated mice remained protected against two consecutive H. felis challenges. Conclusions: These results show that the lack of natural immunity against Helicobacter can be overcome by oral immunization and that vaccination offers a novel therapeutic approach to Helicobacter -induced gastritis.

Background/Aims: Invasion of the intestinal epithelium is considered a critical step in Salmonella pathogenesis. Infection by Salmonella of cultured monolayers of polarized Madin-Darby canine kidney (MDCK) cells has been established as a simple in vitro system that mimics the invasion of intestinal enterocytes in vivo. This study analyzes the protective role of secretory immunoglobulin (Ig) A antibodies against epithelial invasion. Methods: Salmonella typhimurium was applied to MDCK cell monolayers in the presence or absence of a monoclonal, polymeric IgA antibody (Sal4) directed against an antigenic determinant exposed on the surface of wild-type S. typhimurium . Results: In the presence of Sal4 IgA, confluent monolayers of MDCK cells were protected against apical invasion by wild-type S.typhlmurium but not against a mutant strain that lacks the Sal4 epitope. Protection was Sal4-specific, dependent on the concentration of Sal4 in the apical medium, and occurred at IgA concentrations at which agglutination of IgA-bacterial complexes was observed. When MDCK cell monolayers were formaldehyde-fixed before incubation with Salmonella to prevent bacterial invasion, adhesion of Salmonella occurred in the absence of IgA and in the presence of control IgA but not in the presence of Sal4 IgA. Conclusions: IgA alone can prevent bacterial adherence and invasion of epithelial cells in the absence of other immune or nonimmune protective mechanisms.

Werner syndrome or adult progeria is a very rare disease transmitted in a recessive autosomic way. It is characterized by a pathologic and premature aging in all organs and systems, which begins generally between 1st and 3rd decades of life. We discuss a new case with a very visible expression both clinical as well as analytical, highlighting the characteristic chromosomic study.

The aim of this research is focused on the biological effects of multi wall carbon nanotubes (MWCNTs) on three different human cell types, laboratory animals in vivo, and immunological effects. Large numbers of researchers are directly involved in the handling of nanostructured materials such as MWCNTs and nanoparticles. It is important to assess the potential health risks related to their daily exposure to carbon nanotubes. The administration of sterilized nanosamples has been performed on laboratory animals, in both acute and chronic administration, and the pathological effects on the parenchymal tissues have been investigated. We studied the serum immunological modifications after intraperitoneal administration of the MWCNTs. We did not observe any antigenic reaction; the screening of ANA, anti-ENA, anti-cardiolipin, C-ANCA and P-ANCA was negative. No quantitative modification of immunoglobulins was observed, hence no modification of humoral immunity was documented. We also studied the effects of MWCNTs on the proliferation of three different cell types. MCF-7 showed a significant inhibition of proliferation for all conditions studied, whereas hSMCs demonstrated a reduction of cell growth only for the highest MWCNTs concentrations after 72 h. Also, no growth modification was observed in the Caco-2 cell line. We observed that a low quantity of MWCNTs does not provoke any inflammatory reaction. However, for future medical applications, it is important to realize prosthesis based on MWCNTs, through studying the corresponding implantation effects. Moreover, it has to be emphasized that this investigation does not address, at the moment, the carcinogenicity of MWCNTs, which requires a detailed follow-up investigation on the specific topic. In view of the subsequent and more extensive use of MWCNTs, especially in applications where carbon nanotubes are injected into the human body for drug delivery, as a contrast agent carrying entities for MRI, or as the basic material of a new prosthesis generation, more extended tests and experiments are necessary.