Studies on the Reactions of Polycyclic Aromatic Hydrocarbons With Nitrogen-Dioxide in Aprotic Solvents.

There is recent evidence that free radical nitration reactions occur in polluted urban air, and that the nitrated polycyclic aromatic hydrocarbons (NO\sb2-PAH) produced by this reaction pathway account for a substantial amount of the total NO\sb2-PAH found in ambient particulate organic matter. The nitration of PAH with nitrogen dioxide in solvents of low polarity has been studied as a model for the reactions occurring in the atmosphere (gas phase). While vast amounts of data are available for the electrophilic ionic nitration and its mechanism of reaction is considered well-established (and often included in sophomore Chemistry books), the literature documents relatively few reports on the mechanism of reaction of PAH with nitrogen dioxide. Our studies indicate that: (1) a free radical mechanism operates in solvents of low dielectric constant (e.g. CCl\sb4) and becomes less important as the dielectric constant is increased (CHCl\sb3, CH\sb2Cl\sb2, THF, CH\sb3CN, CH\sb3NO\sb2), (2) Bronsted and Lewis acids, and lower temperatures promote the electrophilic ionic reaction pathway, (3) the free radical mechanism involves metastable adducts of the PAH and two to four nitrogen dioxide equivalents, (4) the radical reaction yields nonconventional substitution patterns of dinitro-PAH even at low conversions (e.g. 1,2- and 1,3-dinitrofluoranthenes and, 1,3- and 2,3-dinitronaphthalenes), (5) the radical reaction of anthracene with nitrogen dioxide yields cis- and trans-9,10-dinitro,9,10-dihydroanthracene, which are isolable, (6) in radical nitration, the nitro-group does not have a strong deactivating effect towards further nitration as in electrophilic ionic nitration, in fact, its effect in radical nitration is frequently that of slight activation

Effectiveness of add-on Pegylated interferon alfa-2a therapy in a Lamivudine-treated patient with chronic hepatitis B

Hepatitis B virus (HBV) surface antigen (HBsAg) to anti-HBsAg (anti-HBs) antibody seroconversion is the best, final objective for all available chronic hepatitis B (CHB) treatments. Unfortunately, this goal is rarely obtained with the currently utilized therapeutic approaches. Here we describe the case of a CHB patient who was very successfully treated with a particular therapeutic schedule. The patient was initially treated with lamivudine for four years. Subsequently, pegylated interferon alpha-2a was introduced for a period of one year. During this period of combined therapies, the patient showed a flare of aminotransferase values followed by complete normalization of liver biochemistry parameters and HBsAg/anti-HBs seroconversion that persisted up to 24 months after all therapies had been stopped

Anti-obesity drug therapy in clinical practice: Evidence of a poor prescriptive attitude

Obesity is a worldwide growing problem for the health care systems and its treatment is strongly recommended. Orlistat, naltrexone/bupropion, and liraglutide are approved for weight loss in Italy in patients with a Body Mass Index (BMI) ≥ 30 kg/m2 or ≥ 27 kg/m2 with concomitant diseases. However, the prescription of these drugs is significantly low worldwide. General practitioners (GPs) play a key role in the early diagnosis and appropriate management of obesity. The aim of the study was to investigate the management of obesity and the prescriptive attitude of anti-obesity drugs in a general practice setting.All patients registered in lists of 8 GPs with a recorded diagnosis of obesity or BMI values ≥ 30 kg/m2 in the period 2017–2018, were recruited. A descriptive analysis of demographic and clinical characteristic was carried out. The Spearman's correlation rank test was applied to identify correlations between BMI and all the variables of interest.Among 1301 obese patients, only 66.1 % had been diagnosed and 29.4 % had no registered BMI value. Patients with recorded BMI, were overweight (7.8 %) or in the obesity class I (38.8 %), class II (14.1 %), and class III (7.1 %), respectively.The obese patients (class 1–3) were older [66 (55–76) vs 49 (32–59); p < 0.01], and had more concurrent diseases [5 (3−8) vs 4 (2–6); p < 0.01] than patients who reached a BMI < 30 Kg/m2. Moreover, most of obese were high cardiovascular risk (HCVr) patients (67.0 % vs 31.9 %; p < 0.01). The BMI was directly related to age (rs 0.14; p < 0.01), diabetes (rs 0.19; p < 0.01), hypertension (rs 0.14; p < 0.01), heart failure (rs 0.09; p < 0.01), HCVr (rs 0. 12; p < 0.01) and number of comorbidities (rs 0.08; p = 0.01). No prescriptions of orlistat or naltrexone/bupropion were found. Liraglutide was prescribed only in 7 patients because of the concomitant presence of diabetes.Our results suggest a low adherence to guide line recommendations for obesity management and confirm an under-prescription of anti-obesity drugs in Italy

High-molecular weight hyaluronan reduced renal PKC activation in genetically diabetic mice

AbstractThe cluster determinant (CD44) seems to play a key role in tissues injured by diabetes type 2. CD44 stimulation activates the protein kinase C (PKC) family which in turn activates the transcriptional nuclear factor kappa B (NF-κB) responsible for the expression of the inflammation mediators such as tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), interleukin-18 (IL-18), inducible nitric oxide synthase (iNOS), and matrix metalloproteinases (MMPs). Regulation of CD44 interaction with its ligands depends greatly upon PKC. We investigated the effect of the treatment with high-molecular weight hyaluronan (HA) on diabetic nephropathy in genetically diabetic mice.BKS.Cg-m+/+Leprdb mice had elevated plasma insulin from 15days of age and high blood sugar levels at 4weeks. The severe nephropathy that developed was characterized by a marked increased in CD44 receptors, protein kinase C betaI, betaII, and epsilon (PKCβI, PKCβII, and PKCε) mRNA expression and the related protein products in kidney tissue. High levels of mRNA and related protein levels were also detected in the damaged kidney for NF-κB, TNF-α, IL-6, IL-18, MMP-7, and iNOS.Chronic daily administration of high-molecular mass HA for 2weeks significantly reduced CD44, PKCβI, PKCβII, and PKCα gene expression and the related protein production in kidney tissue and TNF-α, IL-6, IL-18, MMP-7, and iNOS expression and levels also decreased. Histological analysis confirmed the biochemical data. However, blood parameters of diabetes were unchanged.These results suggest that the CD44 and PKC play an important role in diabetes and interaction of high-molecular weight HA with these proteins may reduce inflammation and secondary pathologies due to this disease

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The effects of recombinant human granulocyte-colony stimulating factor on vascular dysfunction and splanchnic ischaemia-reperfusion injury

1. The aim of our study was to investigate the effects of recombinant human granulocyte-colony stimulating factor in a rat model of splanchnic ischaemia-reperfusion injury. 2. Male anaesthetized rats were subjected to clamping of the splanchnic arteries for 45 min. This surgical procedure resulted in an irreversible state of shock (splanchnic artery occlusion shock; SAO shock). Sham operated animals were used as controls. Survival rate, serum tumour necrosis factor-α (TNF-α), neutrophil count, bone marrow myeloid precursor cells, myeloperoxidase activity (MPO; studied as a quantitative means to assess leukocyte accumulation), mean arterial blood pressure and the responsiveness of aortic rings to phenylephrine (PE, 1 nM–10 μM) were studied. 3. SAO shocked rats had a decreased survival rate (0% at 4 h of reperfusion, while sham shocked rats survived more than 4 h), increased serum levels of TNF-α (201±10 u ml(−1); sham shocked rats=undetectable), neutropenia, enhanced MPO activity in the ileum (0.11±0.06 u × 10(−3) g(−1) tissue; sham shocked rats=0.02±0.001 u × 10(−3) g(−1) tissue) and in the lung (1.5±0.2 u × 10(−3) g(−1) tissue; sham shocked rats=0.19±0.05 u × 10(−3) g(−1) tissue) and unchanged bone marrow myeloid precursor cells. Furthermore aortic rings from shocked rats showed a marked hyporeactivity to PE. 4. Administration of recombinant human granulocyte colony stimulating factor (rh G-CSF; 5, 10 and 20 μg kg(−1) 5 min following the release of occlusion) increased in a dose-dependent manner survival rate (90% at 4 h of reperfusion with the dose of 20 u × 10(−3) g kg(−1)), reduced serum TNF-α (13±5 u ml(−1)) and MPO activity in the ileum (0.065±0.002 u × 10(−3) g(−1) tissue) and in the lung (0.7±0.03 μ g  kg(−1) tissue), improved neutropenia and mean arterial blood pressure but did not modify bone marrow myeloid progenitor cells. Furthermore rh G-CSF, either in vivo or in vitro (200 nM for 1 h in the organ bath), restored to control values the hyporeactivity to PE. Finally rh G-CSF potently inhibited the activity of inducible nitric oxide synthase in peritoneal macrophages activated with endotoxin. 5. Our results suggest that rh G-CSF protects against splanchnic ischaemia reperfusion injury by a mechanism(s) that does not depend upon its haematopoietic effects

Protective effects of Cyclosporin-A in splanchnic artery occlusion shock

1. Cyclosporin A (CsA) is an immunosuppressant drug that inhibits nitric oxide (NO) synthase induction in vascular smooth muscle cells. Splanchnic artery occlusion (SAO) shock is a lethal type of shock characterized by a marked vascular dysfunction in which the L-arginine/nitric oxide pathway plays an important role. We investigated whether CsA exerts protective effects in SAO shock by interfering with the L-arginine/nitric oxide pathway. 2. Male anaesthetized rats (n=156) were subjected to clamping of the splanchnic arteries for 45 min. This surgical procedure resulted in an irreversible state of shock (SAO shock). Sham operated animals were used as controls. SAO shocked rats had a decreased survival (86±6 min, while sham shocked rats survived more than 240 min), marked hypotension, increased serum levels of TNF-α, enhanced plasma nitrite/nitrate concentrations (75±7.1 μM; sham shocked rats=1.6±0.5 μM) and enhanced inducible NO synthase (iNOS) protein induction and activity in the aorta. Moreover aortic rings from shocked rats showed a marked hyporeactivity to phenylephrine (PE, 1 nM–10 μM). 3. CsA (0.25, 0.5 and 1 mg kg(−1), 5 min after reperfusion) increased survival rate (SAO+CsA=236±9 min following the highest dose), reverted the marked hypotension, reduced plasma nitrite/nitrate concentration (11±5.2 μM following the highest dose), restored to control values the hyporeactivity to PE, and blunted iNOS protein induction and activity in aortic rings. 4. The present data indicate that in an experimental rat model CsA may have antishock properties related to inhibition of L-arginine/nitric oxide pathway