Recovery from vegetative state of patients with a severe brain injury: a 4-year real-practice prospective cohort study

Patients who have suffered severe traumatic or nontraumatic brain injuries can show a progressive recovery, transitioning through a range of clinical conditions. They may progress from coma to a vegetative state (VS) and/or a minimally conscious state (MCS). A longer duration of the VS is known to be related to a lower probability of emergence from it; furthermore, the literature seems to lack evidence of late improvements in these patients. This real-practice prospective cohort study was conducted in inpatients in a VS following a severe brain injury, consecutively admitted to a vegetative state unit (VSU). The aim of the study was to assess their recovery in order to identify variables that might increase the probability of a VS patient transitioning to MCS. Rehabilitation treatment included passive joint mobilisation and helping/placing patients into an upright sitting position on a tilt table. All the patients underwent a specific assessment protocol every month to identify any emergence, however late, from the VS. Over a 4-year period, 194 patients suffering sequelae of a severe brain injury, consecutively seen, had an initial Glasgow Coma Scale score ≤ 8. Of these, 63 (32.5%) were in a VS, 84 (43.3%) in a MCS, and 47 (24.2%) in a coma; of the 63 patients admitted in a VS, 49 (57.1% males and 42.9% females, mean age 25.34 ± 19.12 years) were transferred to a specialist VSU and put on a slow-to-recover brain injury programme. Ten of these 49 patients were still in a VS after 36 months; of these 10, 3 recovered consciousness, transitioning to a MCS, 2 died, and 5 remained in a VS during the last 12 months of the observation. Univariate analysis identified male sex, youth, a shorter time from onset of the VS, diffuse brain injury, and the presence of status epilepticus as variables increasing the likelihood of transition to a MCS. Long-term monitoring of patients with chronic disorders of consciousness should be adequately implemented in order to optimise their access to rehabilitation services.

Hydrogels: experimental characterization and mathematical modelling of their mechanical and diffusive behaviour

Hydrogels are materials widely used in biomedical, pharmaceutical, and nutraceutical applications. Knowledge of their mechanical and diffusive behaviour is desired to design new hydrogels-based-systems.

PoroViscoElastic model to describe hydrogels' behavior

Hydrogels are three-dimensional, cross-linked hydrophilic polymeric network able of absorb large amount of water. The mechanics of these systems is strictly coupled with the water transport resulting in the peculiar behavior known as poroviscoelasticy. This can be considered as sum of the viscoelastic behavior of the polymeric network and the poroelastic behavior caused by the water movement within the hydrogel. In this work a 3D monophasic model able to depict the poroviscoelastic behavior of these systems, within the field of nonlinear solid mechanics, is developed. The mass and momentum balances equations, supported by constitutive equations from non-equilibrium thermodynamics and by initial and boundary conditions, is implemented through the weak formulation in a commercial FEM-based software. A parametric study is performed in order to assess the relative importance of the model parameters on hydrogels' behavior.

On the design of tailored liposomes for KRX29 peptide delivery

The high interest in therapeutic peptides, due to the specificity of their mechanisms of action, has stimulated the research of new delivery strategies to overcome bioavailability problems concerning the use of peptides in their naked form. In this study liposomal suitable delivery system was designed and produced.

Isolation of Macrophage Early and Late Endosomes by Latex Bead Internalization and Density Gradient Centrifugation

Immortalized macrophage lines and primary macrophages display the ability to internalize small latex beads through the endocytic pathway. This protocol describes a simple and robust method for separating endocytic organelles from macrophages on a sucrose gradient, taking advantage of the significantly lower density of the organelles containing latex beads compared with other intracellular organelles. The latex beads are retained in the endosomes as they mature; therefore, harvesting cells at different time points after internalization permits the purification of different organelle fractions, particularly early and late endosomes.

Purification of Early and Late Endosomes

Proteomic analysis of early and late endosomes has been constrained by the limited purity of the endosomal fractions that can be achieved by biochemical methods. Here we briefly review endocytic pathways, and then introduce fractionation strategies that have been used to improve the purity of isolated endosomes. In addition, we describe innovative proteomics analysis methods that have been shown to partially circumvent the limitations found in the enrichment steps.

Isolation of Early and Late Endosomes by Density Gradient Centrifugation

Density gradient centrifugation is a common method for separating intracellular organelles. During centrifugation, organelles float or sediment until they reach their isopycnic position within the gradient. The density of an organelle depends on its content, size, shape, and the lipid:protein ratio. The degree of separation between different organelles will therefore be highly dependent on how different their isopycnic points are in a given buffer. Separation will also depend on the medium used to prepare the gradient, whether it is sucrose (the most common) or an alternative. Here we describe the use of both continuous and discontinuous (step) gradients to isolate endocytic organelles.

Homogenization of Mammalian Cells

Homogenization is the name given to the methodological steps necessary for releasing organelles and other cellular constituents as a free suspension of intact individual components. Most homogenization procedures used for mammalian cells (e.g., cavitation pump and Dounce homogenizer) rely on mechanical force to break the plasma membrane and may be supplemented with osmotic or temperature alterations to facilitate membrane disruption. In this protocol, we describe a syringe-based homogenization method that does not require specialized equipment, is easy to handle, and gives reproducible results. The method may be adapted for cells that require hypotonic shock before homogenization. We routinely use it as part of our workflow to isolate endocytic organelles from mammalian cells.

Ultrasonic energy in liposome production: process modelling and size calculation

The use of liposomes in several fields of biotechnology, as well as in pharmaceutical and food sciences is continuously increasing. Liposomes can be used as carriers for drugs and other active molecules. Among other characteristics, one of the main features relevant to their target applications is the liposome size. The size of liposomes, which is determined during the production process, decreases due to the addition of energy. The energy is used to break the lipid bilayer into smaller pieces, then these pieces close themselves in spherical structures. In this work, the mechanisms of rupture of the lipid bilayer and the formation of spheres were modelled, accounting for how the energy, supplied by ultrasonic radiation, is stored within the layers, as the elastic energy due to the curvature and as the tension energy due to the edge, and to account for the kinetics of the bending phenomenon. An algorithm to solve the model equations was designed and the relative calculation code was written. A dedicated preparation protocol, which involves active periods during which the energy is supplied and passive periods during which the energy supply is set to zero, was defined and applied. The model predictions compare well with the experimental results, by using the energy supply rate and the time constant as fitting parameters. Working with liposomes of different sizes as the starting point of the experiments, the key parameter is the ratio between the energy supply rate and the initial surface area.

Rehabilitation of acquired brain injuries: a multicentric prospective survey

BACKGROUND

The rehabilitation of the persons with Severe Acquired Brain Injury (ABI) is an important concern to be approached with a comprehensive program aimed to improve the recovery of patients.The efficacy of an early and intensive rehabilitation program has been shown in large number of studies. Few studies focused on the prevalence of TBI and the data are often extrapolated in indirect ways.

AIM

An analysis of the demographic characteristics of the population included in the GISCAR (Gruppo Italiano per lo Studio delle Gravi Cerebrolesioni Acquisite e Riabilitazione- Italian Group for the Study of the severe ABI) database, type and conditions associated to the index event; the treatment administered during hospitalization; and the prognosis according to outcome measures.

DESIGN

The study was an observational prospective survey looking at management of ABI (both traumatic and non-traumatic).

SETTING

In hospital rehabilitation.

POPULATION

Patients consecutively admitted in each of the 52 GISCAR centres.

METHODS

Every centre included a consecutive cohort and recorded demographic data and index event characteristics.

RESULTS

In the study population were included 2626 subjects suffering of a severe ABI. The difference of length of stay (LOS) was significantly different with 67.5 days for traumatic patients compared to the 80 days of non traumatic ones. In the study population the probability of discharge at home is significantly greater for the traumatic condition (odds ratio 0,4587; CI 0.3671-0.5731). The overall benefit of the rehabilitative treatment was encountered in a net gain in all disability scores taken into account: LCF classes; DRS as well as GOS scores. At discharge the main destination for severe ABI patients was home (67.2%).

CONCLUSIONS

A large number of patients admitted in Italian rehabilitative facilities for a severe ABI suffered from a TBI, more often these subjects were young male victims of road accident. The majority of subjects during the rehabilitative hospitalization demonstrated a significant recovery.

CLINICAL REHABILITATION IMPACT

Considering the evidence of an early treatment benefit the delay ofthe rehabilitation program start is far from being satisfactory. The high frequency of the home discharge indicate a good compliance of national family network.

Crystallinity and Linear Rheological Properties of Polymers

The crystallization of a polymer melt, taking place during transformation processes, has a great impact on the process itself, mainly because it causes a large increase in the viscosity (hardening). Knowledge of the hardening kinetics is important for modeling and controlling the transformation processes. In this work, first an overview is given of the experimental and modeling work on the hardening of crystallizing polymers. Next, we present isothermal crystallization experiments using differential scanning calorimetry (DSC) and rotational rheometry to measure the dynamic viscosity. The evolution of the relative crystallinity and normalized complex viscosity are correlated by a novel technique which allows simultaneous analysis of several runs, even if they are not carried out at same temperatures; the main requirement with the traditional technique. The technique, described in detail in this paper, provides an experimental relationship between the crystallinity and the hardening, i.e. the increase in the viscosity. Moreover, by measuring the dynamic viscosity at different frequencies, surprisingly, a master curve is obtained which combines the effects of shear rate, temperature and the level of crystallinity.

Therapeutic potential of nucleic acid-based drugs in coronary hyper- proliferative vascular diseases

The thickening of the vessel wall (intimal hyperplasia) is a pathological process which often follows revascularization approaches such as transluminal angioplasty and artery bypass graft, procedures used to re-vascularize stenotic artery. Despite the significant improvements in the treatment of intimal hyperplasia obtained in the last years, the problem has not completely solved. Nucleic acid based-drugs (NABDs) represent an emergent class of molecules with potential therapeutic value for the treatment of intimal hyperplasia. NABDs of interest in the field of intimal hyperplasia are: ribozymes, DNAzymes, antisense oligonucleotides, decoy oligonucleotides, small interfering RNAs and micro interfering RNAs. These molecules can recognize, in a sequencespecific fashion, a target which, depending on the different NABDs, can be represented by a nucleic acid or a protein. Upon binding, NABDs can down-modulate the functions of the target (mRNA/proteins) and thus they are used to impair the functions of disease-causing biological molecules.In spite of the great therapeutic potential demonstrated by NABDs in many experimental model of intima hyperplasia, their practical use is hindered by the necessity to identify optimal delivery systems to the vasculature. In the first part of this review a brief description of the clinical problem related to intima hyperplasia formation after revascularization procedures is reported. In the second part, the attention is focused on the experimental evidences of NABD therapeutic potential in the prevention of intimal hyperplasia. Finally, in the third part, we will describe the strategies developed to optimize NABD delivery to the diseased vessel.

Ruthenium-106 eye plaque brachytherapy in the conservative treatment of uveal melanoma: a mono-institutional experience

BACKGROUND

Traditional treatment for uveal melanoma is the enucleation of the eye with outcomes cosmetically unacceptable and loss of useful vision. Plaque brachytherapy, compared to enucleation, had the advantage to preserve the eye with outcomes cosmetically acceptable and preservation of vision.

PATIENTS AND METHODS

From July 1990 to December 2009 one hundred forty-two (142) patients (51 males and 91 females) with small to medium uveal melanoma were treated with 106Ru plaque brachytherapy. The patients underwent a complete staging before brachytherapy with indirect ophthalmoscopy and ultrasounds. Mean tumour thickness was 3.26 mm (1.6-6 mm). The dose scheduled was 80-100 Gy to the apex with a maximum dose of 800 Gy to the sclera.

RESULTS

One hundred forty-two have been treated, nine patients had lost the follow-up and drop out; 133 patients were assessed. Mean follow-up was 7.7 years (6 months-18 years). The overall survival at 5, 10 and 15 years was 92%, 85% and 78% respectively. Cancer fee survival was 95%, 90% and 83%, respectively at 5, 10 and 15 year. Radiation-induced toxicity was represented in 47 patients with a 5 year actuarial survival rate free from complications of 54%.

CONCLUSIONS

106Ru plaque brachytherapy is a valid approach for treatment of uveal melanoma. This technique is efficacy and safe, with a low toxicity profile.

The phosphorylation state of chloroplast transit peptides regulates preprotein import

Import of nuclear encoded proteins into chloroplast is an essential and well-regulated mechanism. The cytosolic kinases STY8, STY17 and STY46 have been shown to phosphorylate chloroplast preprotein transit peptides advantaging the binding of a 14-3-3 dimer. Analyses of sty8 sty17 sty46 mutant plants revealed a role for the kinases in chloroplast differentiation, possibly due to lack of transit peptide phosphorylation. Moreover we could show that not only phosphorylation but also transit peptide dephosphorylation appears to be required for the fine regulation of the back-transport of nuclear encoded proteins to the chloroplast.

The cytosolic kinases STY8, STY17, and STY46 are involved in chloroplast differentiation in Arabidopsis

In Arabidopsis (Arabidopsis thaliana), transit peptides for chloroplast-destined preproteins can be phosphorylated by the protein kinases STY8, STY17, and STY46. In this study, we have investigated the in vitro properties of these plant-specific kinases. Characterization of the mechanistic functioning of STY8 led to the identification of an essential threonine in the activation segment, which is phosphorylated by an intramolecular mechanism. STY8 is inhibited by specific tyrosine kinase inhibitors, although it lacked the ability to phosphorylate tyrosine residues in vitro. In vivo analysis of sty8, sty17, and sty46 Arabidopsis knockout/knockdown mutants revealed a distinct function of the three kinases in the greening process and in the efficient differentiation of chloroplasts. Mutant plants displayed not only a delayed accumulation of chlorophyll but also a reduction of nucleus-encoded chloroplast proteins and a retarded establishment of photosynthetic capacity during the first 6 h of deetiolation, supporting a role of cytosolic STY kinases in chloroplast differentiation.

Die Beziehung der Steroid-Hormon-Rezeptoren zum axillären Lymphknotenbefall beim Mammakarzinom

In 337 patients with primary cancer of the breast, the oestrogen and progesterone receptor concentration was correlated to the metastasis of axillary lymph nodes taking into account the age of the patients and the size of the primary tumour. The frequency of axillary lymph node involvement increases significantly with size, although not quite steadily but rather stepwise within the T classification. Whereas the tumour diameter influences the receptor status only slightly, the age of the patients plays a major rôle in the oestrogen receptor concentration. In the age group up to 50 years the oestrogen receptor concentration is significantly lower than in the age group over 50 years. There is no comparable influence of age on progesterone receptor concentration. With all 337 breast cancers, no difference in axillary lymph node metastasis is found either between oestrogen receptor positive and oestrogen receptor negative cancers, or between progesterone receptor positive and progesterone receptor negative cancers. In the age group up to 50 years, if looked upon separately, the oestrogen receptor positive cancers do show significantly more often an axillary lymph node involvement, than do oestrogen receptor negative cancers. As this difference exists in the age group up to 50 years only, it is assumed that endogenous oestradiol favours the axillary spread in oestrogen receptor positive cancers. With oestrogen receptor negative cancers the axillary lymph node involvement increases from the younger to the older age group, explaining why in unselected series the oestrogen receptor negative cancers show a more unfavourable course.

Treatment of neurogenic bowel dysfunction using transanal irrigation: a multicenter Italian study

STUDY DESIGN

Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions (NBD) were enrolled from Spinal Units and Rehabilitation Centers in Italy. Treatment was for 3 weeks using a newly developed integrated system with an enema continence catheter for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark).

OBJECTIVES

To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL).

SETTING

Italy.

METHODS

Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using McNemar Test and Sign Test.

RESULTS

Thirty-six patients were enrolled, and 32 patients completed the study. At the end of the treatment, 28.6% of patients reduced or eliminated their use of pharmaceuticals. Twenty-four patients became less dependent on their caregiver. There was a significant increase in patients' opinion of their intestinal functionality (P=0.001), QoL score (P=0.001) and their answers regarding their degree of satisfaction (P=0.001). A successful outcome was recorded for 68% of patients with fecal incontinence, and for 63% of patients with constipation.

CONCLUSION

Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.