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Biomedical subjects

A Del Maschio

Publications and source records attributed to A Del Maschio.

At least 37 records · Page 2Linked to original sources

Regulation of cadherin function by Rho and Rac: modulation by junction maturation and cellular context.

Cadherins are cell-cell adhesion receptors whose adhesive function requires their association with the actin cytoskeleton via proteins called catenins. The small guanosine triphosphatases (GTPases), Rho and Rac, are intracellular proteins that regulate the formation of distinct actin structures in different cell types. In keratinocytes and in other epithelial cells, Rho and Rac activities are required for E-cadherin function. Here we show that the regulation of cadherin adhesiveness by the small GTPases is influenced by the maturation status of the junction and the cellular context. E-cadherin localization was disrupted in mature keratinocyte junctions after inhibition of Rho and Rac. However, an incubation of 2 h was required after GTPase inhibition, when compared with newly established E-cadherin contacts (30 min). Regarding other cadherin receptors, P-cadherin was effectively removed from mature keratinocytes junctions by blocking Rho or Rac. In contrast, VE-cadherin localization at endothelial junctions was independent of Rho/Rac activity. We demontrate that the insensitivity of VE-cadherin to inhibition of Rho and Rac was not due to the maturation status of endothelial junction, but rather the cellular background: when transfected into CHO cells, the localization of VE-cadherin was perturbed by inhibition of Rho proteins. Our results suggest that the same stimuli may have different activity in regulating the paracellular activity in endothelial and epithelial cells. In addition, we uncovered possible roles for the small GTPases during the establishment of E-cadherin-dependent contacts. In keratinocytes, Rac activation by itself cannot promote accumulation of actin at the cell periphery in the absence of cadherin-dependent contacts. Moreover, neither Rho nor Rac activation was sufficient to redistribute cadherin molecules to cell borders, indicating that redistribution results mostly from the homophilic binding of the receptors. Our results point out the complexity of the regulation of cadherin-mediated adhesion by the small GTPases, Rho and Rac.

Actins↗

Small hepatocellular carcinoma treated with percutaneous RF ablation: MR imaging follow-up.

OBJECTIVE: The purpose of our study was to determine the usefulness of MR imaging in the follow-up evaluation of small hepatocellular carcinoma lesions treated with RF ablation. SUBJECTS AND METHODS: The study group included 37 patients with a single hepatocellular carcinoma lesion less than 3 cm in diameter. A strict protocol required follow-up MR imaging every 6 months after RF treatment. At each follow-up visit, the findings on unenhanced and dynamic gadolinium-enhanced MR images were correlated with those on contrast-enhanced CT images and with results of fine-needle aspiration biopsy. In five patients who underwent surgical resection after the 6-month follow-up examination, comparison with histologic findings of surgical specimens was also performed. RESULTS: Correct diagnosis of complete or partial tumor necrosis was made in 32 (86%) of the 37 patients with the use of unenhanced and dynamic gadolinium-enhanced MR images. Hypointensity on T2-weighted images and loss of enhancement on dynamic MR images corresponded to completely necrotic lesions in all patients. Conversely, intratumoral regions of hyperintensity on T2-weighted images and enhancement on dynamic MR images did not always correlate to residual viable tumor. MR imaging and CT findings agreed in the evaluation of therapeutic response in all patients. CONCLUSION: Our experience confirms that MR imaging is useful for evaluating the effectiveness of RF therapy in achieving tumor regression.

Aged↗

Intramyocellular triglyceride content is a determinant of in vivo insulin resistance in humans: a 1H-13C nuclear magnetic resonance spectroscopy assessment in offspring of type 2 diabetic parents.

Insulin resistance is the best prediction factor for the clinical onset of type 2 diabetes. It was suggested that intramuscular triglyceride store may be a primary pathogenic factor for its development. To test this hypothesis, 14 young lean offspring of type 2 diabetic parents, a model of in vivo insulin resistance with increased risk to develop diabetes, and 14 healthy subjects matched for anthropomorphic parameters and life habits were studied with 1) euglycemic-hyperinsulinemic clamp to assess whole body insulin sensitivity, 2) localized 1H nuclear magnetic resonance (NMR) spectroscopy of the soleus (higher content of fiber type I, insulin sensitive) and tibialis anterior (higher content of fiber type IIb, less insulin sensitive) muscles to assess intramyocellular triglyceride content, 3) 13C NMR of the calf subcutaneous adipose tissue to assess composition in saturated/unsaturated carbons of triglyceride fatty acid chains, and 4) dual X-ray energy absorption to assess body composition. Offspring of diabetic parents, notwithstanding normal fat content and distribution, were characterized by insulin resistance and increased intramyocellular triglyceride content in the soleus (P < 0.01) but not in the tibialis anterior (P = 0.19), but showed a normal content of saturated/unsaturated carbons in the fatty acid chain of subcutaneous adipocytes. Stepwise regression analysis selected intramyocellular triglyceride soleus content and plasma free fatty acid levels as the main predictors of whole body insulin sensitivity. In conclusion, 1H and 13C NMR spectroscopy revealed intramyocellular abnormalities of lipid metabolism associated with whole body insulin resistance in subjects at high risk of developing diabetes, and might be useful tools for noninvasively monitoring these alterations in diabetes and prediabetic states.

Adult↗

Magnetic resonance contrast enhancement with gadolinium-DTPA in patients with angina and angiographically normal coronary arteries: effect of chronic beta-blockade.

BACKGROUND: The syndrome of angina and normal coronary arteries (syndrome X) comprises a heterogeneous group of patients with typical chest pain, a positive exercise test, angiographically smooth coronary arteries and no evidence of spasm. Magnetic resonance imaging (MRI) has been used to detect areas of myocardial ischemia and/or recent necrosis both in animal and human studies. Most of these studies have been conducted after intravenous administration of the paramagnetic contrast medium gadolinium-DTPA (Gd-DTPA), that is considered a sensitive marker of extracellular, probably ischemic in origin, edema. On the basis of these data, we used MRI to evaluate the possibility of myocardial Gd-DTPA deposition at rest in patients with syndrome X, and to assess the effects of oral treatment with atenolol. METHODS: We have studied 24 patients with syndrome X, 10 patients with coronary artery disease and 10 age-matched control subjects. The protocol was similar in all study subjects. Exercise testing and MRI were undertaken off therapy after coronary arteriography. Following MRI, patients underwent a 10 day treatment period with atenolol and repeated exercise stress test and MRI while on therapy. RESULTS: In all patients with syndrome X and coronary artery disease were observed effort diagnostic ST-segment changes that were associated with angina in 9 (37%) and 7 (70%) patients, respectively. Of 24 patients with syndrome X, 16 (66.6%) showed areas of myocardial enhancement after Gd-DTPA in comparison to the precontrast imaging. In 4 out of 10 patients with coronary artery disease (40%), Gd-DTPA accumulation was documented. Finally, focal Gd-DTPA myocardial enhancement was not observed in any normal control subject. After beta-blockade, 22 (92%) patients with syndrome X and 2 (20%) with coronary artery disease did not show any ischemic ST-segment changes on effort; 14 syndrome X patients (88%) and 2 coronary artery disease patients (50%) showed complete disappearance of the previously Gd-DTPA enhanced areas on MRI. CONCLUSIONS: Patients with syndrome X often exhibit regional accumulation of Gd-DTPA on MRI. The agent is believed to trace interstitial water accumulation as occurs during ischemia and its accumulation is reduced or abolished by treatment with atenolol, probably by different mechanisms. It is likely that an overactivation of the sympathetic outflow to the cardiovascular system can induce most of the abnormalities observed in syndrome X patients. In this context, beta-blockers probably represent the mainstay of the medical treatment of this condition.

Adrenergic beta-Antagonists↗

FDG/PET and spiral CT image fusion for medistinal lymph node assessment of non-small cell lung cancer patients.

BACKGROUND: To assess the potential usefulness of 18F-FDG/PET and spiral-CT images concurrent assessment and coregistration in staging mediastinal lymph node involvement in patients with non small cell lung cancer. METHODS: 28 patients waiting to undergo surgical treatment underwent spiral-CT and PET examinations on the same day. The results of the two studies were interpreted separately, together (CT&PET) and following their fusion in a single image (CT+PET). Results of spiral-CT, PET, CT&PET and CT+PET were assessed with respect to the histological diagnosis. RESULTS: A correct assessment of mediastinal lymph nodes was achieved by spiral-CT in 21 of the 28 patients, in 22 of the 28 patients by PET, in 24 patients by CT&PET and in 25 patients by CT+PET. CONCLUSIONS: CT+PET is more accurate than spiral-CT and PET alone in staging mediastinal lymph node involvement in lung cancer patients, with possible implications for their prognosis and therapy.

Aged↗

Endovascular treatment of aortic aneurysms of the abdominal aorta with covered stents.

Abdominal aortic aneurysms are common in the aging population; their surgical treatment is well established and allows good results in specialized centers. Endovascular exclusion of abdominal aortic aneurysms has been shown to be feasible since 1991 and nowadays commercially available bifurcated endografts allow safe exclusion in selected cases. In the last year 22 patients with an aorto-iliac aneurysm received endovascular treatment at our Institution. We included patients with favorable anatomic characteristics (i.e. neck > 15 mm length, and < 28 mm diameter, iliac neck < 12 mm diameter, absence of > 90 degrees iliac or aortic angulation) and, in particular, those with increased surgical risk for systemic pathology (12 patients), or hostile abdomen (9 patients). We employed Vanguard II (Boston Scientific) endovascular grafts introduced through a surgically exposed common femoral artery; the contralateral limb of bifurcated grafts was inserted percutaneously. The endograft was successfully implanted in all cases, requiring additional iliac cuffs for complete aneurysm exclusion in 3 cases. Periprocedural morbidity included one case of thrombosis and one case of pseudoaneurysm of the punctured femoral artery, which required surgical treatment. In one case surgical exposure of the iliac artery was required in order to advance the device into the aorta. In one patient who previously underwent hemicolectomy, postoperative colonic ischemia was observed, and pharmacological treatment was required. Moreover we also observed one case of groin infection that was treated successfully with local wound care and systemic antibiotics, and one late contralateral limb thrombosis that was successfully treated with loco-regional thrombolysis. The mean follow-up was 6.1 months: one patient died because of congestive heart failure. No further morbidity was recorded. A type-II endoleak was observed in one patient, originating from the inferior mesenteric artery with no sac enlargement; this patient is still under observation. In conclusion, with proper clinical selection, commercially available endovascular devices allow safe exclusion of abdominal aortic aneurysms. Long-term follow-up is needed to ascertain the durability of the procedure.

Aorta, Abdominal↗

Assessment of skeletal maturation in infants: comparison between two methods in hypothyroid patients.

BACKGROUND: Conventional skeletal radiography is the standard technique for assessing skeletal age. However, radiography cannot demonstrate cartilage and is therefore of lesser value in infancy when the ossification centres are composed mainly of cartilage. By comparison, US clearly demonstrates cartilage and bone. OBJECTIVE: In the present study, we compared radiography and sonography for the assessment of skeletal age in neonates and infants. MATERIALS AND METHODS: Because delayed skeletal maturation is a feature of congenital hypothyroidism and assessment of skeletal age is routinely performed in our centre, we studied 55 hypothyroid infants (aged 7-66 days). AP radiographs and sonograms, acquired using high-frequency scanners, were obtained and dimensions of the distal femoral epiphyseal ossification centre (DFE) were compared. RESULTS: Measurements of DFE by the two methods showed excellent correlation (R = 0.94, P = 0.0001). Radiographs did not demonstrate a DFE in 11 infants, and US did not show it in 6. In no infant did radiography demonstrate DFE not seen by US. Moreover, DFE dimensions on US were larger than those measured on radiographs. Infants with absent thyroid gland had a DFE significantly smaller than those infants with ectopic or normally placed glands (P < 0.001), on both radiographs and sonograms. CONCLUSION: Our data suggest that sonography is a valid alternative to standard radiography for the assessment of skeletal age in infants.

Age Determination by Skeleton↗

MR state of the art.

Magnetic resonance imaging is undergoing continual and progressive evolution. To make a high quality examination, some requirements are mandatory, such as high spatial and contrast resolution to identify lesions and high temporal resolution to characterize them. We review the most important new magnetic resonance technologies, both those which are already available and used in clinical practice and those which are still to be developed. We analyze such technologic and methodolgic features as magnetic field strength, gradients, surface coils, echoplanar imaging, fat suppression techniques and magnetization transfer, contrast agents, automatic injectors, image postprocessing, computer assisted diagnosis, magnetic resonance-guided biopsy and spectroscopy. All these factors are in continuous evolution and new technologies anticipate, in the near future, faster examinations with very high spatial and contrast resolution, with magnetic resonance-guided cytologic and histologic aspiration biopsies, as well as spectroscopic studies of previously identified lesions. To perform a correct, state-of-the-art magnetic resonance examination of the breast, we need high strength gradients with high slew rate and bilateral coils. Finally, we discuss new technologies and methods which will increase the accuracy of magnetic resonance studies of the breast, improving image quality and decreasing execution time. Thus, magnetic resonance spectroscopy, allowing in vivo biochemical tissue analysis, seems to have high potentials; even though they are still difficult to define, the technique is sure to have major diagnostic impact also in monitoring the results to different treatments.

Biopsy↗

Feto-neonatal ultrasonography to detect renal abnormalities: evaluation of 1-year screening program.

To determine the accuracy of antenatal renal pelvis measurement as a screening tool for renal anomalies we reviewed the antenatal ultrasounds performed at our institution over 1 year. Renal pelvis dilation was found in 3.8% of pregnancies followed by our obstetrics department. In nine (17.6%) infants renal anomalies were detected after birth, the remaining cases remained unchanged or resolved over a 1-year postnatal follow-up. In our series dilations of less than 10 mm in utero resolved in the first months after birth while dilations greater than 15 mm were all associated with malformations of the genitourinary tract. The choice of the most appropriate follow-up for dilations between 10 and 15 mm remains an issue because these dilations can herald renal anomalies.

Dilatation, Pathologic↗

Body composition assessed on the basis of arm circumference and triceps skinfold thickness: a new index validated in children by magnetic resonance imaging.

Fat and muscle areas can be calculated from equations on the basis of upper arm circumference (C) and triceps skinfold thickness (TS). These equations assume a circular limb and muscle compartment and a symmetrically distributed fat rim: total upper arm area (TUA) = C2/(4 pi), upper arm muscle area (UMA) = [C - (TS x pi)2]/(4 pi), and upper arm fat area (UFA) = TUA - UMA. This traditional method underestimates the degree of adiposity. We propose that the unrolled fat rim is a rectangle whose length = C and width = TS/2. The following new indexes are based on this assumption: upper arm fat area estimate (UFE) = C x (TS/2), and upper arm muscle area estimate (UME) = TUA - UFE. To validate these equations, areas were measured with magnetic resonance imaging (MRI) in 28 children aged 9-15 y (17 control subjects and 11 obese subjects). Correlations between MRI and UFA and MRI and UFE were similar (r = 0.96 for both correlations in the control group and r = 0.84 and 0.82, respectively, in the obese group), but the areas assessed by MRI (13.8 cm2) were closer to UFE (12.4 cm2) than to UFA (11.2 cm2) in the control group as well as in the obese group (MRI = 48.7 cm2, UFE = 46.6 cm2, and UFA = 38.5 cm2). The limits of agreement between MRI and anthropometry were 5.7 +/- 5.8 cm2 for UFA and 0.6 +/- 5.0 cm2 for UFE, showing that UFA is not acceptable in most cases, whereas UFE measurements are close to MRI measurements. In conclusion, UFE and UME are simple and accurate indexes to assess body composition. French reference values are available from 1 mo to 17 y of age.

Adipose Tissue↗

Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients.

PURPOSE: To determine the potential efficacy of radio-frequency (RF) ablation of liver metastases during long-term follow-up. MATERIALS AND METHODS: Sixteen patients with 31 hepatic metastases were treated with percutaneous, ultrasound-guided RF ablation. RF was applied to monopolar electrodes (2-3-cm tip exposure) either individually or within a multiprobe array (two to four probes) for 6 minutes at 90 degrees C over one to four treatment sessions per metastasis. RESULTS: In only one of 75 sessions, a moderate complication, self-limited intraperitoneal hemorrhage, was observed. Four patients (four lesions) underwent surgical resection 15-60 days after RF treatment. Residual, viable tumor was seen in all of these patients. The remaining 12 patients were followed up for 9-29 months (mean, 18.1 months). In these patients, 18 of 27 lesions remained stable or decreased in size and showed no enhancement at computed tomography and/or magnetic resonance imaging for at least 9 months. Two patients died of disseminated disease at 13 months and one at 16 months. Disease-free survival was achieved in eight patients. CONCLUSIONS: RF ablation appears to be a simple, safe, and potentially effective treatment for selected patients with liver metastases and may become a less invasive alternative to surgical therapy.

Aged↗

Renal artery stenosis: evaluation with breath-hold, three-dimensional, dynamic, gadolinium-enhanced versus three-dimensional, phase-contrast MR angiography.

PURPOSE: To compare breath-hold, three-dimensional, gadolinium-enhanced magnetic resonance (MR) angiography with three-dimensional, phase-contrast MR angiography in the evaluation of renal artery stenosis. MATERIALS AND METHODS: Fifty-five consecutive adult patients with clinical suspicion of renovascular disease were prospectively examined with three-dimensional, phase-contrast MR angiography and breath-hold, three-dimensional MR angiography with injection of a standard dose of gadopentetate dimeglumine to evaluate the number of renal arteries and the presence and degree of stenosis. The standard of reference was intraarterial digital subtraction angiography. RESULTS: Gadolinium-enhanced MR angiography depicted all 105 main renal arteries, whereas phase-contrast MR angiography depicted 104. The number of accessory renal arteries depicted was significantly higher with gadolinium-enhanced (17 of 18) than with phase-contrast (11 of 18) studies (P = .04). Both techniques depicted 27 of the 29 stenoses (sensitivity, 93%; P > .05). Sensitivities, specificities, and accuracies in the diagnosis of hemodynamically significant stenosis (> 50% narrowing) were, respectively, 94%, 96%, and 96% for phase-contrast and 100%, 97%, and 98% for gadolinium-enhanced MR angiography (P > .05). CONCLUSION: Gadolinium-enhanced MR angiography is superior to phase-contrast MR angiography in accessory renal artery depiction. No statistically significant difference in the assessment of stenosis has been found between the two techniques.

Aged↗