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Close monitoring of estimated glomerular filtration rate (eGFR) is important for early recognition of worsening renal function to prevent further deterioration. Safe conversion from twice-daily tacrolimus (TD-Tac) to once-daily tacrolimus (OD-Tac) has been reported, but the effects on eGFR are contrasting. The aim of our study is to evaluate long-term stability of eGFR after 1:1 conversion from TD-Tac to OD-Tac and the effects on serum cytokine blood levels. Forty-six consecutive kidney transplant recipients treated with TD-Tac 3 to 5 years post-transplant, with stable renal function, were enrolled in the study (2009-2011). Clinical and biochemical parameters were evaluated for 12 months before conversion up to 6 years after conversion. The patients served as their own controls. A panel of cytokines was evaluated repeatedly during the first year after conversion. Mean values of eGFR were not different long-term after conversion (P = .11) compared with baseline, and the majority of patients remained stable on Kidney Disease: Improving Global Outcomes stage during the study period; eGFR was stable in 30.0% after 5 years, decreased > 1 mL/min/1.73 m2/y in 13.3%, and improved > 1 mL/min/1.73 m2/y in 56.7%. Cytokine levels and C-reactive protein did not show any significant deterioration. Metabolic parameters were stable during the 6 years of follow-up. OD-Tac therapy can preserve an effective immunosuppressive state together with a safe profile of eGFR.

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Prostanoid content prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) and endocrine cells population were evaluated in jejunal biopsies from celiac children; findings were compared to active celiac patients on a challenge diet. Patients were divided as follows: Group A: 14 children with active untreated celiac disease; Group B: 7 celiac children on gluten challenge who had received diet therapy for the past 2 years; Group C: 8 normal control children. Jejunal biopsies were used for endocrine cell population measurement by immunocytochemistry, using a specific marker (chromogranin), and for prostanoid radioimmunological evaluation. The quantitative assessment of the endocrine cell population in Groups A and B revealed a significantly higher number of endocrine cells (20 +/- 11.5; 18.4 +/- 9.8 n. cell/visual field respectively) compared to Group C (8.44 +/- 2.3 n. cell/visual field) (p less than 0.05). In the jejunal extract the PGE2 content (341.8 +/- 82.3) ng/g) for Group A biopsies was significantly higher than that of Group C biopsies (93 +/- 23 ng/g) (p less than 0.05. The PGE2 content (69.4 +/- +13.2 ng/g) for Group B did not show any statistically significant change. In contrast, TxB2 content in jejunal biopsies from all three groups was not significantly different.

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Prostanoid generation (prostaglandin E2 and thromboxane B2) in jejunal biopsy specimens from celiac patients was evaluated, comparing celiac patients with celiac patients on challenge diet and controls. Generation of prostaglandin E2 in jejunal specimens from 14 children with active celiac disease was significantly higher (341.8 +/- 82.3 ng/g; mean +/- SEM) than that from 7 celiac patients on gluten challenge diet (69.4 +/- 13.2 ng/g) or 8 normal children (92 +/- 23 ng/g) (p less than 0.05). In contrast, thromboxane B2 generation in jejunal specimens from all three groups did not show any statistically significant variation. Our results indicate that prostaglandin E2 generation is not merely related to the activity of clinical symptoms, since patients receiving gluten challenge had prostaglandin E2 levels that did not differ from those of controls.

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PGE2 plays an important role in gastric cytoprotection. Previous experience has shown that H2-blocker drugs may have a role in gastric cytoprotective mechanisms. The effects have been compared of ranitidine and famotidine on PGE2 content in duodenal ulcer patients. Twenty patients were treated for 4 weeks as follows: group A, ranitidine (150 mg twice daily); group B, famotidine (40 mg daily). The patients underwent EGDS before and after therapy. The results show that both famotidine and ranitidine significantly increase the PGE2 content of fundic mucosa (from 112.3 +/- 73 to 210.7 +/- 106 ng/g wet wt and from 109.6 +/- 52.4 to 230.2 +/- 104.6 ng/g wet wt, respectively) in duodenal ulcer patients (p less than 0.01). Similarly, the PGE2 content of duodenal mucosa significantly increases after famotidine treatment (from 51.9 +/- 27.5 to 105.3 +/- 55.6 ng/g wet wt) as well as ranitidine treatment (from 53.8 +/- 24 to 172.6 +/- 72.9 ng/g wet wt) (p less than 0.01). It is concluded that these drugs play an important role in gastric and duodenal cytoprotection.

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The existence of different neuroendocrine markers was investigated by immunocytochemistry in a case of Merkel cells tumor. Neuroplastic cells contain NSE,NF,CK and chromogranin A i.r. On the basis of the results the neuroendocrine nature of this uncommon neoplasm of the skin is confirmed and it is suggested that chromogranin A could represent an additional marker for Merkel cells tumors.

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