Promotion of healthy lifestyle: knowledge and attitudes of primary care physicians

Preretinal neovascularization and chronic retinal oedema are the two major sight-threatening complications that can occur during diabetic retinopathy. Ocular neovascularization is strongly associated with retinal ischaemia, and growth factors have been implicated in its pathogenesis. The ischaemic retina is assumed to secrete growth factors that stimulate residual vessels to proliferate. Interest has focused on basic fibroblast growth factor (bFGF), insulin-like growth factor-1 (IGF-1), platelet-derived growth factor (PDGF), transforming growth factor beta (TGF beta) and more recently vascular endothelial cell growth factor (VEGF). Histologic studies have demonstrated the presence of growth factor proteins and receptors and/or their mRNA, mainly VEGF, PDGF, and bFGF, in preretinal membranes of patients with proliferative diabetic retinopathy. Elevated intravitreal levels of IGF-1 and VEGF correlating with neovascular activity have been found in some patients. However, a direct causal relationship between ischaemia, growth factors and neovascularization has not been clearly demonstrated despite considerable research work. To date, the growth factor correlating most closely with neovascularization is VEGF. As many growth factors seem to be produced during the neovascular process, their specific inhibition probably will have limited effects. Laser photocoagulation of the retina has proved beneficial for regression of new vessels, probably through destruction of the ischaemic retina producing neovascular growth factors, and is currently the only treatment for proliferative diabetic retinopathy. Inhibition of IGF-1 by somatostatin analogs has produced unsatisfactory results. Other vascular inhibitors are currently being studied.     

Effect of rapeseed and dietary oils on the mean survival time of stroke-prone spontaneously hypertensive rats

Low-fat conventional diets supplemented with 5 or 10% vegetable oils were fed to stroke-prone spontaneously hypertensive rats (SHR-SP) from weaning and the mean survival times were determined. A 1% aqueous sodium chloride solution was used as drinking water throughout the experiments. In four separate experiments, the rapeseed oil group showed a significantly shorter mean survival time. The relative mean survival times were 50-59% (rapeseed oil group), 78-100% (soybean oil group) and 86% (microbial oil group) as compared with the group fed perilla oil (100%). The group which received 4-fold diluted rapeseed oil exhibited a significantly shorter survival time as compared with the group receiving soybean oil. Although the feeding experiments were performed under very simple and restricted conditions, these results suggest that the rapeseed oil prepared for human use contains a factor (s) which is toxic to SHR-SP rats.     

"Aggrecanase" activity is implicated in tumour necrosis factor alpha mediated cartilage aggrecan breakdown but is not detected by an in vitro assay

An accurate analysis of the morphological changes which take place during pathological processes of the posterior pole is important for a correct diagnosis and therapeutic approach. The purpose of the study was to determine the intraobserver and interobserver reproducibility of the Image-net system 100 (Topcon, Japan) to take measurements on the retina. The program 'Linear/Areal Measurement functions' of Image-net system 100 which is an image digitalization technique, was tested. Twelve patients were consecutively selected from the patients of the Retina Center of the Department of Ophthalmology, University of Genoa. Three images of each eye were taken from each subject and only the best image was used in this study. The intraobserver and interobserver reproducibility of both the distance between two pre-set points (linear measurement), and the perimeter and area of preselected retinal zones were calculated. The repeatability (or intraobserver reproducibility) of the linear sizes was measured by the coefficient of variation and ranged from 0.32% to 7.38%, while the interobserver reproducibility ranged from 0.46% to 5.22%. The repeatability and reproducibility of the perimeters ranged from 0.72% to 9.63% and from 0.6% to 5.7%, respectively, while the repeatability and reproducibility of the areas ranged from 0.72% to 9.63% and from 0.6% to 5.7%, respectively. Although the results were quite good, the quality of the image of the fundus and the number of observers influenced the coefficient of variation; furthermore, the anatomy of the areas to be measured and the computer 'mouse' could increase the value of the coefficient of variation.     

Primary malignant fibrous histiocytoma of spleen

We report a case of primary malignant fibrous histiocytoma of spleen, which also emphasizes the difficulties in diagnosing such a rare condition.     

Craniocervical junction tuberculosis: a rare but dangerous disease

BACKGROUND: Mycobacterium tuberculosis of the cervical spine is a rare but dangerous manifestation of extra-pulmonary tuberculosis. The clinical picture ranges from early, nonspecific, insidious symptoms to severe neurological complications and death, attributed to craniocervical junction instability and cervicomedullary compression. The different lines of management include antituberculous medication with traction and external fixation or adjunctive surgery (debridement and stabilization) in patients with severe or persistent neurological complications and/or vertebral instability. METHODS: We describe two patients with advanced craniocervical junction tuberculosis. The early clinical picture was nonspecific in Case 1 and obscured by psychiatric illness in Case 2. The detailed clinical and radiological findings, and the management, will be described. Involvement of the occipital condyles and foramen magnum, which has not been reported previously, will be demonstrated. RESULTS: Both cases underwent transoral biopsy, aspiration, and debridement of retropharyngeal abscess (granuloma). Histological and tissue culture studies proved the abscesses were tuberculous and anti-tuberculous medications were started. Case 1 showed complete resolution of the clinical and radiological findings. Case 2 developed cardiorespiratory arrest while in a halo jacket. He was resuscitated but remained quadriplegic and semiconscious; he developed nosocomial gram negative pneumonia. He was referred back to his local hospital where he died 1 year later. CONCLUSIONS: Tuberculosis is an infrequent but notable cause of cervicomedullary compression. It should be suspected in patients with infective spondylitis who are immunocompromised or reside in an area highly endemic for tuberculosis. Management strategies include antituberculosis medication, transoral biopsy and drainage of the abscess, traction and external fixation, posterior decompression, and internal fixation, according to the clinical and radiological findings.     

Role of mismatch repair in the Escherichia coli UVM response

Mutagenesis at 3,N4-ethenocytosine (epsilonC), a nonpairing mutagenic lesion, is significantly enhanced in Escherichia coli cells pretreated with UV, alkylating agents, or H2O2. This effect, termed UVM (for UV modulation of mutagenesis), is distinct from known DNA damage-inducible responses, such as the SOS response, the adaptive response to alkylating agents, or the oxyR-mediated response to oxidative agents. Here, we have addressed the hypothesis that UVM results from transient depletion of a mismatch repair activity that normally acts to reduce mutagenesis. To test whether the loss of mismatch repair activities results in the predicted constitutive UVM phenotype, E. coli cells defective for methyl-directed mismatch repair, for very-short-patch repair, or for the N-glycosylase activities MutY and MutM were treated with the UVM-inducing agent 1-methyl-3-nitro-1-nitrosoguanidine, with subsequent transfection of M13 viral single-stranded DNA bearing a site-specific epsilonC lesion. Survival of the M13 DNA was measured as transfection efficiency, and mutation fixation at the lesion was characterized by multiplex sequencing technology. The results showed normal UVM induction patterns in all the repair-defective strains tested. In addition, normal UVM induction was observed in cells overexpressing MutH, MutL, or MutS. All strains displayed UVM reactivation, the term used to describe the increased survival of epsilonC-containing DNA in UVM-induced cells. Taken together, these results indicate that the UVM response is independent of known mismatch repair systems in E. coli and may thus represent a previously unrecognized misrepair or misreplication pathway.