Effects of physical training on straightening-up processes in patients with Parkinson's disease

PURPOSE

The aim of this study was to evaluate whether motor training could improve the straightening-up sequences in patients with Parkinson's disease and, consequently, could ease the capacity of the patients to change body's position.

METHODS

Twenty out-patients with idiopathic Parkinson's disease (12 males, 8 females; mean age 72.9; H-Y, 1. 5-3) were enrolled in a rehabilitation programme which included exercises for the mobility of the trunk, of upper and lower limbs and of each segment of the spine, in order to improve the coordination of movement and to avoid postural disturbances. They received 1 hour of group treatment twice a week for a 5 week consecutive period. No changes were made in the pharmacological treatment received by each patient. The patients were evaluated at the beginning and at the end of the rehabilitation training. The statistical evaluation was made using the Wilcoxon test.

RESULTS

Statistically significant differences were observed in all the motor parameters that were evaluated (supine to sitting and sitting to supine, supine rolling, standing from a chair).

CONCLUSIONS

The observations demonstrate that physical training can be effective in improving motor performance related to changes in position which affects the simple daily activities of the patients.

Small cytoplasmic antigens from Pseudomonas aeruginosa stimulate gammadelta T lymphocytes

Gammadelta T lymphocytes respond to different bacterial antigens and transformed cells. The antigenic molecules responsible for this activity have been studied extensively in antigenic preparations from Mycobacterium. We describe here the in vitro effect of Pseudomonas aeruginosa on gammadelta T lymphocytes and the properties of the implicated compounds. We found a preferential gammadelta T-cell expansion when we used heat-treated P. aeruginosa preparations and a dose-dependent inhibition of proliferation of peripheral blood mononuclear cells (PBMC) when non-heat-treated antigens were studied. This expansion corresponded to a Vgamma9-positive subpopulation. In contrast to alphabeta T lymphocytes, the highest stimulatory activity was restricted to very small cytosolic compounds. This activity was protease resistant and phosphatase sensitive and always dependent on interleukin (IL)-2 or alphabeta T-cell activation. We concluded that the antigenic molecules from P. aeruginosa that activated gammadelta T lymphocytes were small, non-peptidic, phosphorylated compounds, similar to those previously described from Mycobacterium.

Effect of aging and sex on the [3H]-paroxetine binding to human platelets

Since there exist conflicting results with regard to the possible effect of aging on platelet [3H]-imipramine binding, taken as a peripheral marker of the serotonin (5-HT) transporter, we reinvestigated this matter by comparing the binding of the more selective ligand [3H]-paroxetine in 20 aged and 23 young subjects. The results showed that neither the maximum binding capacity nor the dissociation constant (Kd) were significantly different in the two groups. When the subjects were compared according to sex, the young females revealed a statistically significant lower Kd than the males, while the contrary was true for the aged females. The Kd was significantly and negatively correlated to age in males. In addition, a significant age x gender interaction was also observed. Therefore, the sex of a subject would seem to provoke significant age-related changes in the Kd of [3H]-paroxetine binding to platelet membranes. This might indicate modifications in the 5-HT transporter that could form the basis of a sex-related difference in vulnerability to disorders, such as depression, where a dysfunction at this level is hypothesized.

Effect of reduced body weight on muscle aerobic capacity in patients with COPD

BACKGROUND

Reduced muscle aerobic capacity in COPD patients has been demonstrated in several laboratories by phosphorus magnetic resonance spectroscopy and by analysis of oxygen uptake (VO2) kinetics. COPD patients are usually elderly, hypoxemic, poorly active with muscle atrophy, and often malnourished. Under these conditions there is usually reduction of O2 delivery to the tissues (bulk O2 flow), redistribution of fiber type within the muscle, capillary rarefaction, and decreased mitochondrial function, alterations all capable of reducing muscle aerobic capacity. In COPD, the effect of reduced body mass on muscle aerobic capacity has not been investigated (to our knowledge).

METHODS

We studied 24 patients with stable COPD with moderate-to-severe airway obstruction (68+/-5 [SD] years; FEV1, 39+/-12% predicted; PaO2, 66+/-8 mm Hg; PaCO2, 41+/-3 mm Hg) with poor to normal nutritional status, as indicated by a low-normal percent of ideal body weight (IBW). Each subject first underwent 1-min maximal incremental cycle ergometer exercise for determination of VO2 peak and lactate threshold (LT). Subsequently, they performed a 10-min moderate (80% of LT-VO2) constant load exercise for determination of oxygen deficit (O2DEF) and mean response time VO2 (MRT). VO2, CO2 output (VCO2), and minute ventilation were measured breath by breath.

RESULTS

Patients displayed low VO2 peak (1,094+/-47 [SE] mL/min), LT-VO2 (35+/-3% predicted O2 max), and higher MRT-VO2 (67+/-4 s). Univariate regression analysis showed that percent of IBW correlated with indexes of maximal and submaximal aerobic capacity: vs VO2 peak, R=0.53 (p<0.01); vs MRT R=-0.77 (p<0.001). Using stepwise regression analysis, MRT correlated (R2=-0.70) with percent of IBW (p<0.01) and with PaO2 (p<0.05).

CONCLUSIONS

Reduced body mass has an independent negative effect on muscle aerobic capacity in COPD patients: this effect may explain the variability in exercise tolerance among patients with comparable ventilatory limitation.

Evaluation of cost of home therapy for patients with terminal diseases

Palliative care and palliative medicine embrace the philosophy and the body of knowledge regarding the correct treatment of patients with terminal disease. Palliative treatments can be delivered intramurally (eg, in a hospice or palliative care unit) or at home (home care hospice). The optimal delivery pattern consists of the co-utilization of both care settings, to allow patients who need palliative, supportive, and terminal care to benefit from each setting. In obtaining the available resources, health service costs in Western countries have lately become exorbitant. Home care hospice is a system capable of defeating the challenge on two fronts: to meet the patients' needs and to fulfill this task through economically advantageous practices. Home care hospice is undoubtedly more cost-effective than conventional or generic home care, conventional care (hospitalization), and inpatient hospice care. Its advantage is more evident in the last 3 months of life, due to shorter hospitalization and nonutilization of high-technology interventions and high-cost drugs. The development of a range of palliative care programs integrating primary territorial care and specialized palliative services can constitute the ideal synthesis to respond to patients' needs in a threefold manner: firstly, the patient's right to qualified palliative and terminal care; secondly, the requirements of health services, and lastly, cost containment through a correct and tailored use of available resources.

Effect of naloxone on morphine-induced changes in striatal dopamine metabolism and glutamate, ascorbic acid and uric acid release in freely moving rats

Recent findings have shown that systemic morphine increases extracellular dopamine (DA), dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), ascorbic acid (AA) and uric acid concentrations in the striatum of freely moving rats. The morphine-induced increase in DA oxidative metabolism is highly correlated with that of xanthine. In the present study, we evaluated the effects of subcutaneous (s.c.) naloxone (1 mg/kg) on morphine-induced changes in DA, DOPAC, HVA, 5-hydroxyindoleacetic acid (5-HIAA), AA, uric acid and glutamate in the striatum of freely moving rats using microdialysis. Dialysates were assayed by high performance liquid chromatography with electrochemical detection or (glutamate) ultraviolet detection. Morphine (5-20 mg/kg) given s.c. increased DA, DOPAC+HVA, 5-HIAA, AA and uric acid and decreased glutamate dialysate concentrations over a 3 h period after morphine. Morphine (1 mM), given intrastriatally, did not affect all the above parameters, with the exception of an early short-lasting decrease in AA concentration. Naloxone antagonised all morphine-induced changes with the exception of AA increase and glutamate decrease in dialysate concentrations. Systemic or intrastrial (0.2-2 mM) naloxone increased AA and decreased glutamate dialysate concentrations. When given intranigrally, morphine (1 mM) increased DOPAC+HVA, AA and uric acid and decreased glutamate dialysate concentrations over a 2 h period after morphine; DA and 5-HIAA concentrations were unaffected. These results suggest that: (i) morphine increases striatal DA release and 5-hydroxytryptamine oxidative metabolism by a micro-opioid receptor-mediated mechanism mainly at extranigrostriatal sites; (ii) morphine increases DA and xanthine oxidative metabolism and affects glutamate and AA release by a micro-opioid receptor mediated mechanism acting also at nigral sites; and (iii) a micro-opioid receptor-mediated mechanism tonically controls at striatal sites extracellular AA and glutamate concentrations.

Multiple myeloma and work in agriculture: results of a case-control study in Forlì, Italy

OBJECTIVES

To evaluate the relation between the exposure to specific pesticides in agricultural work and the risk of multiple myeloma (MM).

METHODS

A case-control study was conducted in the province of Forlì, Italy. Forty-six cases of MM (20 females, 26 males; mean age 64 years, range 40 to 74) identified through the Romagna Cancer Registry in the years 1987-90, and 230 age- and gender-matched controls from the general population were interviewed in-person using a structured questionnaire focused on exposure to pesticides and other occupational and nonoccupational variables.

RESULTS

Among nonoccupational factors, the education level and the altitude of the place of residence were related inversely to MM risk. First-degree familiarity for hematolymphopoietic neoplasias and previous herpes zoster diagnosis were associated positively with the disease. A nonsignificant increase in MM risk was observed among workers in agriculture as a whole (odds ratio [OR] = 1.31, 95 percent confidence interval [CI] = 0.62-2.74). An increased risk was associated specifically with the cultivation of apples and pears (OR = 1.75, CI = 1.05-2.91). As regards pesticide exposure, only the chlorinated insecticides were related to an increase in the risk of MM.

CONCLUSIONS

This study suggests that agricultural work and exposure to pesticides have a role in the etiology of MM.

Paclitaxel plus doxorubicin in breast cancer: an Italian experience

Based on preclinical data, phase I/II clinical trials were performed at Istituto Oncologico Romagnolo (IOR) Operative Units (Medical Oncology Departments of Forlì, Rimini, and Ravenna, Italy) to determine the efficacy and toxicity of sequential administration of doxorubicin followed by paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in the treatment of patients with advanced breast cancer that either had been previously untreated or that had relapsed after adjuvant therapy. In the phase I trial, 19 patients received bolus doxorubicin (50 mg/m2) followed after a 16-hour interval by paclitaxel (given at dose levels ranging from 130 to 250 mg/m2) by 3-hour infusion every 3 weeks, for a maximum of eight cycles. Paclitaxel doses were escalated in 30-mg/m2 increments if the maximum tolerated dose had not been reached in the previous dose level. Analysis of the 128 cycles assessable for toxicity demonstrated neutropenia (<500/microL) in 26 courses (20.3%), with no significant clinical events. No relevant clinical cardiotoxicity was observed. The paclitaxel maximum tolerated dose was not reached at the 250-mg/m2 dose level (no grade 3 or 4 extramedullary toxicity). In the IOR phase II trial, 13 patients were treated with fixed doses of both drugs (doxorubicin 50 mg/m2 and paclitaxel 220 mg/m2). Grade 4 neutropenia occurred in 39 of the 95 cycles, but was complicated by fever in only eight cycles (8.4%); three cycles required granulocyte colony-stimulating factor support. Peripheral neurotoxicity was the most common extramedullary side effect noted. Overall clinical responses in the IOR trials included 10 complete responses (31.3%) and 15 partial responses (46.9%), with an objective response rate of 78.1%. Comparison of these results with those obtained from a phase I trial using the opposite drug sequence showed comparable overall response rates, but IOR's sequence was associated with a higher complete response rate, as well as less frequent and less severe nonhematologic toxicity.

[Idiopathic CD4+ T-lymphocyte deficiency: the clinical evolution of a case]

The case of a patient with Salmonella arizonae sepsis, esophageal candidiasis, and a low CD4+ T lymphocyte count is presented. Follow-up continued for over 2 years after the patient was discharged from the hospital, and his clinical course and clinical-immunological examinations are described. After a period of several years during which the patient had recurrent acute infectious episodes, he improved markedly after cholecystectomy and toilette of the gingival inlets for severe parodontopathy. His CD4+ T cell count increased although it remained below normal values. This case points to possible hypothesis that chronic infective foci may further compromise the immune system when a congenital functional or numerical CD4+ T cell deficit is present.

Teicoplanin in the treatment of enterococcal endocarditis: clinical and microbiological study

Seven cases of enterococcal endocarditis treated with teicoplanin (7-10 mg/kg/day for 28-105 days) alone (one case) or in combination with aminoglycosides (six cases) were reviewed. All patients were cured. Serum bactericidal activity titres after intravenous gentamicin (5 mg/kg every 24 h) and teicoplanin (10 mg/kg every 24 h) were measured on day 7 of treatment in four patients against five enterococcal isolates: mean titres were 1:54 (range 1:16-64) and 1:22 (1:8-32) at 0.5 and 24 h post-infusion, respectively. Time-kill studies showed synergy between teicoplanin and gentamicin against three isolates. We conclude that single daily-dose teicoplanin/gentamicin combined therapy may represent a rational alternative to standard penicillin/gentamicin therapy and a useful regimen for home treatment of selected cases of enterococcal endocarditis.

Radon measurements in the Gran Sasso Underground Laboratory

Systematic radon monitoring in the Gran Sasso Underground Laboratory was performed in order to determine the background radon contribution to the sophisticated experimental apparatus and to check health physics standards for the personnel. As expected, the radon concentrations were found to depend strongly on the ventilation in the three experimental halls. Considerable reductions in the radon concentrations were obtained in 1993, when fresh air was drawn into the laboratory through a pipe and exhaust air was routed into the highway tunnel.

Doxorubicin and paclitaxel (sequential combination) in the treatment of advanced breast cancer

Based on preclinical data, we designed a phase I/II clinical trial to determine the efficacy and toxicity of doxorubicin followed by paclitaxel in the treatment of advanced breast cancer (either untreated or relapsed after adjuvant therapy). In the phase I dose-finding study, 19 enrolled patients received bolus doxorubicin (50 mg/m2) and, after a 16-hour interval, a three-hour infusion of paclitaxel in escalating doses from 130 to 250 mg/m2, increased by 30-mg/m2 increments for each dose-level group. The first dose level group (paclitaxel 130 mg/m2) included three patients. The other dose level groups included four patients. Treatment was repeated every three weeks for a maximum of eight cycles. The paclitaxel dose was escalated to 250 mg/m2 without reaching the maximum tolerated dose. In the 128 cycles assessable for toxicity, there were no relevant clinical signs or symptoms of cardiotoxicity. This absence of significant cardiotoxicity required confirmation in a phase II trial. Since a maximum tolerated dose of paclitaxel had not been reached during the first study and an increasing risk of neutropenia and peripheral neurotoxicity was feared if doses continued to escalate, a phase II confirmatory study was begun to evaluate treatment with fixed doses of doxorubicin (50 mg/m2) and paclitaxel (220 mg/m2), using the same schedule and interval as in phase I. The 13 patients enrolled in phase II received a total of 95 cycles of therapy; in 10 cycles (three patients) dose reductions were necessary because of toxicity. However, no significant clinical cardiotoxicity was observed in 12 of the 13 patients. One patient experienced an asymptomatic, transient decrease in left ventricular ejection fraction at a cumulative doxorubicin dose of 400 mg/m2. Overall clinical responses included 10 complete remissions (31.3%) and 15 partial remissions (46.9%) for an objective response rate of 78.1%. At 16 months' median follow-up, the median time to progression for all patients is nine months. The high response rate obtained in the phase I/II studies and, in particular, the absence of significant cardiotoxicity require confirmation in further clinical trials. To date, two confirmatory phase II trials are ongoing in our institutions.

Cytomegalovirus in bronchoalveolar lavage specimens from patients with AIDS: comparison with antigenaemia and viraemia

Pulmonary infection with cytomegalovirus (CMV) is a well recognised complication of AIDS. It is often possible to detect CMV-infected cells in bronchoalveolar lavage (BAL) specimens with monoclonal antibodies, but the clinical significance of their presence remains unclear. To investigate this, 24 AIDS patients were tested for CMV antigenaemia and viraemia, in addition to CMV detection in BAL. CMV was detected in the BAL of nine patients (38%), five with clinical and laboratory evidence of pulmonary infection and four without pulmonary involvement. Blood samples positive for CMV antigen were observed in two patients with CMV-positive BAL specimens and, in both cases, antigenaemia resolved without therapy. No case of viraemia was detected. Pneumocystis carinii was detected concomitantly with CMV in the BAL of four of the patients with pulmonary involvement and in one without signs of pulmonary infection. These data suggest that CMV-positive BAL results are of limited significance in the diagnosis of CMV pneumonia in AIDS patients, unless associated with high levels of antigenaemia or viraemia and compatible clinical symptoms.

Production of plasminogen activator and plasminogen activator inhibitors by alveolar macrophages in control subjects and AIDS patients

OBJECTIVE

To reveal a possible impairment of the plasminogen activator system in the pulmonary infections of AIDS patients.

DESIGN

To test the plasminogen activator system functionality in alveolar macrophages and bronchoalveolar lavage fluid (BALF) in control subjects and AIDS patients. Procedures were designed to detect the presence of imbalance in plasminogen activator activity and to ascertain if this imbalance is due to a direct effect of the HIV virus on macrophages or to superimposed opportunistic infection.

METHODS

Alveolar macrophages obtained by bronchoalveolar lavage (BAL) were either lysed with Triton X-100 or cultured for 24 h. Plasminogen activators and plasminogen activator inhibitors (PAI) were measured by chromogenic substrate assay and binding to 125I-urokinase followed by 10% sodium dodecyl-sulphate polyacrylamide gel electrophoresis (SDS-PAGE), respectively.

RESULTS

Plasminogen activator activity in BALF and in alveolar macrophages from AIDS patients was decreased. This reduction was independent of the presence of an infectious pulmonary process. In contrast, free PAI was increased in AIDS patients with Pneumocystis carinii infection. This increase is possibly caused by a different glycosylated form of PAI-2.

CONCLUSIONS

Our data support the view that the pulmonary fibrogenic response is in part secondary to an imbalance within the plasminogen activator system and provide the basis for clarifying the role of these alterations in the pathophysiology of AIDS-related pulmonary infections.

Oxygen effect on O2 deficit and VO2 kinetics during exercise in obstructive pulmonary disease

We evaluated the effect of supplemental O2 on energy metabolism of hypoxemic humans by measuring O2 uptake (VO2) kinetics and other cardiorespiratory parameters in nine male chronic obstructive pulmonary disease (COPD) patients and seven age-matched control subjects (on air and on 30% O2) at rest and during moderate cycle ergometer exercise. Heart rate, ventilation, VO2, CO2 output, respiratory exchange ratio, O2 cost of work, and work efficiency were measured with a computerized metabolic cart; O2 deficit and VO2 time courses were calculated. In COPD patients, 30% O2 breathing resulted in 1) reduction of O2 deficit (from 488 +/- 34 ml in air to 398 +/- 27 ml in O2; P < 0.05) and phase 2 VO2 time constant (from 116 +/- 13 s in air to 74 +/- 12 s in O2; P < 0.05); 2) a smaller steady-state increment in CO2 output than in room air (315 +/- 17 ml/min in O2 vs. 358 +/- 27 ml/min in air; P < 0.02), which resulted in a lower exercise respiratory exchange ratio (0.75 +/- 0.02 in O2 vs. 0.80 +/- 0.02 in air; P < 0.02); and 3) reduced steady-state ventilation (22.6 +/- 1.0 l/min in O2 vs. 25.4 +/- 1.1 l/min in air; P < 0.05). In conclusion, 30% O2 breathing accelerated exercise VO2 kinetics in mildly hypoxemic COPD patients. The observed VO2 kinetics improvement with O2 supplementation is consistent with an enhancement of aerobic metabolism in skeletal muscles during moderate exercise.