Multiplex staining depicts the immune infiltrate in colitis-induced colon cancer model

Assessment of the host immune response pattern is of increasing importance as highly prognostic and diagnostic, in immune-related diseases and in some types of cancer. Chronic inflammation is a major hallmark in colon cancer formation, but, despite the extent of local inflammatory infiltrate has been demonstrated to be extremely informative, its evaluation is not routinely assessed due to the complexity and limitations of classical immunohistochemistry (IHC). In the last years, technological advance helped in bypassing technical limits, setting up multiplex IHC (mIHC) based on tyramide signal amplification (TSA) method and designing software suited to aid pathologists in cell scoring analysis. Several studies verified the efficacy of this method, but they were restricted to the analysis of human samples. In the era of translational medicine the use of animal models to depict human pathologies, in a more complete and complex approach, is really crucial. Nevertheless, the optimization and validation of this method to species other than human is still poor. We took advantage of Multispectral Imaging System to identify the immunoprofile of Dextran Sulphate Sodium (DSS)-treated mouse colon. We optimized a protocol to sequentially stain formalin fixed paraffin embedded murine colon samples for CD3, CD8a, CD4, and CD4R5B0 antigens. With this approach we obtained a detailed lymphocyte profile, while preserving the morphological tissue context, generally lost with techniques like gene expression profiling or flow cytometry. This study, comparing the results obtained by mIHC with immunophenotyping performed with cytofluorimetric and standard IHC methods validates the potentiality and the applicability of this innovative approach

Long-term CD4+ T-cell count evolution after switching from regimens including HIV nucleoside reverse transcriptase inhibitors (NRTI) plus protease inhibitors to regimens containing NRTI plus non-NRTI or only NRTI

BACKGROUND: Data regarding CD4+ recovery after switching from protease inhibitor (PI)-based regimens to regimens not containing PI are scarce. METHODS: Subjects with virological success on first-PI-regimens who switched to NNRTI therapy (NNRTI group) or to nucleoside reverse transcriptase (NRTI)-only (NRTI group) were studied. The effect of the switch on the ongoing CD4+ trend was assessed by two-phase linear regression (TPLR), allowing us to evaluate whether a change in the CD4+ trend (hinge) occurred and the time of its occurrence. Furthermore, we described the evolution of the frequencies in CD4-count classes across four relevant time-points (baseline, before and immediately after the switch, and last visit). Finally, we explored whether the CD4+ counts evolved differently in patients who switched to NNRTI or NRTI-only regimens by considering: the overall CD4+ trends, the time to CD4+ 65 500/mm3 after the switch, and the area-under-the-curve (AUC) of the CD4+ after the switch. RESULTS: Eight hundred and ninety-six patients, followed for a median of 2,121 days, were included. At TPLR, hinges occurred in 581/844 (68.9%), but in only 40/581 (6.9%) within a time interval (180 days) compatible with a possible relationship to the switch; furthermore, in 19/40 cases, CD4+ counts appeared to decrease after the hinges. In comparison with the NNRTI group, the NRTI group showed CD4+ count greater at baseline (P = 0.0234) and before the switch (P 64 0.0001), superior CD4+ T-cell increases after HAART was started, lower probability of not achieving CD4+ 65 500/mm3 (P = 0.0024), and, finally, no significant differences in the CD4+ T-cell AUC after the switch after adjusting for possible confounders (propensity score and pre-switch AUC). Persistence at CD4+ < 200/mm3 was observed in 34/435 (7.5%) patients, and a decrease below this level was found in only 10/259 (3.9%) with baseline CD4+ 65 350/mm3. CONCLUSIONS: Switching from first-line PI to NNRTI- or NRTI-based regimens did not seem to impair CD4+ trend over long-term follow-up. Although the greater CD4+ increases in patients who switched to the NRTI-only regimen was due to higher CD4+ counts before the switch, several statistical analyses consistently showed that switching to this regimen did not damage the ongoing immune-reconstitution. Lastly, the observation that CD4+ T-cell counts remained low or decreased in the long term despite virological success merits further investigation

Inter-observer agreement in the assessment of endoscopic findings in ulcerative colitis

BACKGROUND: Endoscopic findings are essential in evaluating the disease activity in ulcerative colitis. The aim of this study was to evaluate how endoscopists assess individual endoscopic features of mucosal inflammation in ulcerative colitis, the inter-observer agreement, and the importance of the observers' experience. METHODS: Five video clips of ulcerative colitis were shown to a group of experienced and a group of inexperienced endoscopists. Both groups were asked to assess eight endoscopic features and the overall mucosal inflammation on a visual analogue scale. The following statistical analyses were used; Contingency tables analysis, kappa analysis, analysis of variance, Pearson linear correlation analysis, general linear models, and agreement analysis. All tests were carried out two-tailed, with a significance level of 5%. RESULTS: The inter-observer agreement ranged from very good to moderate in the experienced group and from very good to fair in the inexperienced group. There was a significantly better inter-observer agreement in the experienced group in the rating of 6 out of 9 features (p < 0.05). The experienced and inexperienced endoscopists scored the "ulcerations" significantly different. (p = 0.05). The inter-observer variation of the mean score of "erosions", "ulcerations" and endoscopic activity index in mild disease, and the scoring of "erythema" and "oedema" in moderate-severe disease was significantly higher in the inexperienced group. A correlation was seen between all the observed endoscopic features in both groups of endoscopists. Among experienced endoscopists, a set of four endoscopic variables ("Vascular pattern", "Erosions", "Ulcerations" and Friability") explained 92% of the variation in EAI. By including "Granularity" in these set 91% of the variation in EAI was explained in the group of inexperienced endoscopists. CONCLUSION: The inter-observer agreement in the rating of endoscopic features characterising ulcerative colitis is satisfactory in both groups of endoscopists but significantly higher in the experienced group. The difference in the mean score between the two groups is only significant for "ulcerations". The endoscopic variables "Vascular pattern", "Erosions", "Ulcerations" and Friability" explained the overall endoscopic activity index. Even though the present result is quite satisfactory, there is a potential of improvement. Improved grading systems might contribute to improve the consistency of endoscopic descriptions

Il trattamento con topiramato protegge i topi APOE-KO dall&#8217;insorgenza di danno renale senza modificare i livelli dei lipidi plasmatici

Il topiramato e\u300 un farmaco impiegato nel trattamento dell\u2019epilessia e prescritto anche nella profilassi dell\u2019emicrania che si caratterizza per i molteplici meccanismi d\u2019azione. Diversi studi indicano che il trattamento con topiramato promuove la riduzione del peso corporeo e riduce moderatamente i livelli dei lipidi plasmatici e la glicemia. In considerazione di questi effetti metabolici positivi si e\u300 deciso di valutare se il trattamento con topiramato potesse modulare lo sviluppo di aterosclerosi e al tempo stesso avere effetti protettivi sugli organi bersaglio di condizioni dismetaboliche. Trenta topi apoE-KO sono stati distribuiti in tre gruppi sperimentali e alimentati per 12 settimane con una dieta ad elevato contenuto lipidico (controllo), oppure con la stessa dieta addizionata con topiramato allo 0.125% o allo 0.25%. Il peso corporeo e il consumo di cibo e acqua sono stati monitorati durante tutto lo studio. E\u300 stata inoltre misurata la concentrazione dei lipidi plasmatici e la glicemia, ed e\u300 stato effettuato un test di tolleranza al glucosio. Lo sviluppo di aterosclerosi e\u300 stato valutato nell\u2019intera aorta e nel seno aortico. Sono state inoltre condotte indagini istologiche su fegato, rene e tessuto adiposo. Il trattamento con topiramato non ha influenzato l\u2019aumento di peso corporeo o il consumo di cibo. La tolleranza al glucosio e la concentrazione lipidica plasmatica sono risultati comparabili tra i gruppi, cosi\u300 come lo sviluppo di aterosclerosi. Il trattamento non ha inoltre alterato l\u2019istologia del fegato e del tessuto adiposo. A livello renale, il trattamento con topiramato ha invece ridotto l\u2019insorgenza di lipidosi glomerulare in modo dose-dipendente, riducendo l\u2019accumulo di cellule schiumose e l\u2019espressione di marcatori di infiammazione. Inoltre, anche i livelli plasmatici di urea sono risultati ridotti in seguito al trattamento. In conclusione, i risultati ottenuti indicano che il trattamento con topiramato non influenza lo sviluppo di aterosclerosi, ma preserva struttura e funzionalita\u300 renale. Il topiramato potrebbe pertanto essere preso in considerazione in studi di riposizionamento farmacologico per il trattamento della lipidosi glomerulare

Mitigation of NH3 emissions due to cattle slurry fertilisation.

Agriculture is known as the major source of atmospheric ammonia (NH3). The strategies to reduce the emissions of this gas have become an important focus in many countries to prevent environmental issues and to reduce the loss of nutrients and energy from cropping systems. Appropriate slurry application techniques are fundamental strategies to reduce nitrogen losses. This study presents an evaluation of the best agronomical practices for reducing NH3 emissions from cattle slurry spreading on arable lands. Two different application techniques with two incorporation procedures were assessed in four different field trials in the Po Valley. The NH3 concentration measurements were performed using passive samplers, while a dispersion model has been used for estimating NH3 fluxes at field scale. The best abatement strategy from slurry application has proved to be the direct injection into the soil, with a reduction of about 95% with respect to the surface spreading, while a contextual incorporation was able to reduce the emission of more than 85%

New coil concept for endoluminal MR imaging: Initial results in staging of gastric carcinoma in correlation with Histopathology

Our aim was to conduct a prospective study to evaluate staging accuracy of a new coil concept for endoluminal magnetic resonance imaging (MRI) on ex vivo gastric carcinomas. Twenty-eight consecutive patients referred to surgery with a clinically proven primary gastric malignancy were included. Surgical specimens were examined with a foldable and self-expanding loop coil (8-cm diameter) at 1.5 Tesla immediately after total gastrectomy. T1- and T2-weighted and opposed-phase sequences (axial, frontal sections; 3- to 4-mm slice thickness) were acquired. Investigators blinded to any patient information analyzed signal intensity of normal gastric wall, gastric tumor, and lymph nodes. Findings were compared with histopathological staging. On surgical specimens, 2–5 gastric wall layers could be visualized. All gastric tumors (26 carcinomas, two lymphomas) were identified on endoluminal MR data (100%). Overall accuracy for T staging was 75% (18/24); sensitivity to detect serosal involvement was 80% and specificity 89%. N staging correlated in 58% (14/24) with histopathology (N+ versus N−). The endoluminal coil concept is feasible and applicable for an ex vivo setting. Endoluminal MR data provided sufficient detail for gastric wall layer differentiation, and therefore, identification of T stages in gastric carcinoma is possible. Further investigations in in vivo settings should explore the potential of our coil concept for endoluminal MR imaging

Research Directions in the Clinical Implementation of Pharmacogenomics: An Overview of US Programs and Projects

Response to a drug often differs widely among individual patients. This variability is frequently observed not only with respect to effective responses but also with adverse drug reactions. Matching patients to the drugs that are most likely to be effective and least likely to cause harm is the goal of effective therapeutics. Pharmacogenomics (PGx) holds the promise of precision medicine through elucidating the genetic determinants responsible for pharmacological outcomes and using them to guide drug selection and dosing. Here we survey the US landscape of research programs in PGx implementation, review current advances and clinical applications of PGx, summarize the obstacles that have hindered PGx implementation, and identify the critical knowledge gaps and possible studies needed to help to address them