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Aim This study aimed to investigate whether it is useful both for diagnostic purposes and for cost savings to associate a solid-phase monotest called CTD screen to the immunofluorescence (IIF) test, to detect anti-nuclear and anti-cytoplasmic antibodies (ANA). Methods Fifteen Italian laboratories participated in the study enrolling at least 250-each consecutive unselected samples from patients routinely referred for ANA testing. They all used the conventional IIF method on HEp-2 cells associated to a solid phase CTD screen method. Seven centers used the EliA FEIA CTD screen method on the Phadia 250 instrument (ThermoFisher), five centers used the QUANTAFlash CTD Screen method (Inova Diagnostics) on the BioFlash CLIA instrument, while three centers used both methods, albeit in two different series of patients. Results A total of 5043 samples were tested. We focused attention to the 1674 discrepant results: 106 (2%) were ANA-IIF negative/CTD screen positive and 1568 (31%) were ANA-IIF positive/CTD screen negative. Specific antibodies were detected in 87/106 (82%) of the ANA-IIF negative/CTD screen positive samples, mainly Ro52, Ro60, dsDNA, PM/Scl and Jo1. Thirty four of these patients were diagnosed with an ANA-associated autoimmune rheumatic disease (AARD) (seven SLE, 15 Sjӧgren's syndrome, nine autoimmune inflammatory myositis, three systemic sclerosis). Among 1568 ANA-IIF positive/CTD screen negative discrepant patients, a specific antibody was found in 94 (6%) samples (28 patients with AARD, 13 with undifferentiated connective tissue disease, two with undifferentiated arthritis, and 51 without a rheumatic disease). Conclusions This study is the first that compares the IIF method vs. solid-phase assays in the detection of ANA, on a very large sample size from the routine work-up (real-life approach). Results show that the association of solid-phase CTD screen tests to the ANA-IIF test increases the sensitivity (from 89.2% to 97.4%) and the specificity (from 64.6% to 98.4%) of serological tests for ANA screening. Analysis of costs demonstrated that combination of the two tests is also cost-effective, reducing global costs for the immunoserological diagnosis of AARD by 22%.

Cognitive functions display a progressive impairment with ageing, and this is thought to be due to the accumulation of neuronal loss or acute and/or repeated microvascular accidents. Chronic damage to the brain cortex lead to decreasing ability of elderly subjects to cope with daily events and ultimately result in loss of self-sufficiency. Since proinflammatory cytokines have been implicated both in cerebrovascular injury due to atherosclerosis and in Alzheimer's disease (AD), we investigated 70 elderly subjects with neurocognitive and functional impairment. Diagnosis was established in 54, the others were included in the "mixed" group. Sera were collected and stored at -70 degrees C until measurement of IL-1beta and TNF-alpha, performed by commercial ELISA kits. Data obtained were analysed with respect to other socio-demographic, psychoneurological and clinical variables. The results show that serum TNF-alpha was lower in mild-moderate AD compared to severe AD and dementias due to vascular disease, as well as the TNF-alpha/IL-1beta ratio. Both cytokines showed a significant relationship with age. Our study suggests that proinflammatory cytokines serum profiles seem to discriminate between mild-moderate AD and vascular or mixed forms of dementia. Furthermore, it offers new evidence of a strong implication of inflammatory mechanisms in atherosclerosis, more than in less severe AD.

In most childhood rheumatic diseases, specific diagnostic markers are not yet available. Therefore, a major emphasis in medical research today is directed to the discovery of new inflammation molecules, like calprotectin. Calprotectin (MRP8/MRP14) is a complex of calcium- and zinc-binding proteins that belong to the S100 protein family. This protein is directly released by leukocytes during the interaction with inflammatory activated endothelium at the site of inflammation. Increased plasma calprotectin levels have been found in inflammatory chronic diseases such as rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), inflammatory bowel diseases (IBD), multiple sclerosis, cystic fibrosis and systemic lupus erythematosus (SLE). In these diseases, serum calprotectin has been shown to correlate with disease activity and laboratory variables of inflammation such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). This review outlines the validity and the possible applications of calprotectin as a new inflammation marker in paediatric rheumatic diseases.

Background The assertion of a causal relationship between celiac disease and infertility is suggested by several lines of research. Nevertheless, robust evidence has not yet been provided. The present study evaluated, for the first time, the prevalence of celiac disease in women undergoing assisted reproduction techniques (ART). Methods Serum samples from 200 Italian women undergoing ART were evaluated for celiac disease by endomisium antibody (EMA) and transglutaminase antibody (t-TGA)-two highly sensitive and specific serological markers. Two hundred women not reporting reproductive problems and having delivered at least one child served as controls. In cases of positive serology, the diagnosis was confirmed by jejunal biopsy. Results Five (2.5%) women from the study group and two (1.0%) from the control group were found to have celiac disease (P = 0.44). The main indications for ART in women found to have celiac disease were tubal factor in two cases and male infertility in three cases. None of these women reported major gastrointestinal complaints. Extra intestinal signs linked to celiac disease were noted in four out of five patients. Conclusion This study raises the issue of celiac disease screening in ART programmes. Given the available evidence in the literature combined with our observations from this study, the value of serological testing for celiac disease in infertile women remains uncertain. Further studies to address this issue are required.