Investigating the EEG Profile of Elite and Non-Elite Players in the Basketball Free Throw Task

This study aimed to investigate the electroencephalographic profile of elite and non-elite basketball players seconds before and during the basketball free throw. Sixteen male subjects in the elite group (national team/premier league players with an average age of 22.06 ± 1.56) and 16 male non-elite subjects (university players with an average age of 22.37 ± 1.45) voluntarily participated in this research. Electroencephalographic data were measured from 28 cortical areas using a mobile wireless device. ANOVA with repeated measures were also performed to investigate the characteristics of theta, alpha, and beta frequency bands. The findings showed the higher cortical activity of the elite group. Different frequency bands exhibited similar asymmetry patterns, suggesting the higher activity of the left hemisphere in most of the homologous sites. Moreover, the activity of frequency bands in the left hemisphere rose by approaching the moment of throw. Furthermore, the activity of a limited number of right hemisphere sites increased by getting closer to the moment of action. In general, hemispheric asymmetry in favor of the left hemisphere has a cortical pattern, reflecting high-performance activities. In addition, the characteristics of different frequency bands of hemispheres are directed toward increasing cognitive processing, attention focusing, and inhibiting irrelevant information.

The Effect of Neurofeedback Training on Executive Control Network of Attention and Dart-Throwing Performance in Individuals with Trait Anxiety

This study aimed to investigate the effect of neurofeedback training on the executive control network of attention and dart-throwing skill performance in individuals with trait anxiety. Twenty girls (24.65 [Formula: see text] 2.83 years) participated in this study. They were divided into neurofeedback and control training groups. All participants practiced 14 sessions. The neurofeedback group performed neurofeedback training (increasing SMR wave, decreasing theta, and increasing alpha) and dart-throwing exercise, and the control group only completed the dart-throwing exercise. The post-test, including Attentional Networks Test (ANT) and dart-throwing, was conducted 48 h after the last training session. The results revealed a significant difference in the performance of the executive control network and dart-throwing skill between the neurofeedback and the control training group. In general, these findings support the effect of neurofeedback training on the neural mechanisms of the executive control network of attention, and performance in dart-throwing skill improves by improving attentional performance processes.

The Effect of Modeling Methods on Mirror Neuron Activity and a Motor Skill Acquisition and Retention

Introduction

Mirror neurons have been suggested as a potential neural mechanism of observational learning. This study aims to investigate the effect of self-modeling, skilled model, and learning model on mu rhythm suppression and golf putting acquisition and retention.

Methods

The study was conducted on 45 male volunteer students (aged 19.4±0.37 years) in three experimental groups, self-modeling, skilled, and learning models with six sessions of physical and observational training in three periods of pre-test, acquisition, and retention. In the pre-test, after the initial familiarity with the skill, participants performed 10 golf putting actions while scores were recorded. Then, electrical brain waves in C3, C4, and Cz regions were recorded during the observation of 10 golf putting actions by their group-related models. The acquisition period consisted of golf putting training during six sessions, each consisting of six blocks of 10 trials. Before each training block, participants observed golf putting related to their group 10 times in the form of a video. Acquisition and delayed retention tests were also performed by recording scores of 10 golf putting actions, as well as recording electrical brain waves while observing the skill performed by the related model.

Results

Mixed analysis of variance (ANOVA) showed that the mu rhythm suppression in the pre-test was more in the self-modeling group compared to the skilled model and learning model groups, but this suppression was not significantly different in all three groups in the acquisition and retention tests. In putting task variables, all three groups that had no significant difference in the pre-test period made considerable progress in learning the desired skill from the pre-test to the acquisition test, and this progress was somewhat stable until the retention test. Also, both in the acquisition and retention periods, the self-modeling group showed better performance than the other two groups; however, no significant difference was observed between these groups.

Conclusion

These results suggest that the model-observer similarity is a crucial factor in modeling interventions and can affect the rate of mu rhythm suppression.

The Effect of Mental and Muscular Fatigue on the Accuracy and Kinematics of Dart Throwing

In this study, we analyzed the effect of mental and muscular fatigue on the accuracy and kinematics of dart throwing. For this purpose, 28 young adults (19 females and 9 males) aged 25-35 years, without any regular experience in dart throwing, participated in this study. We evaluated their dart throwing skills in mental fatigue, muscular fatigue, and non-fatigue conditions. To induce mental fatigue, we used the Stroop task for 70 minutes and a simulated dart throwing exercise with an elastic band. In all three conditions, we collected accuracy data, based on the score of the dart on the board and the kinematic properties with a motion capture device. For analyzing the data and testing the research hypotheses, we employed ANOVA analyses with repeated measures after examining the normality of data distributions using skewness and kurtosis. We observed a significant decrease in the accuracy of dart throwing following mental fatigue (p = 0.027) and muscular fatigue (p = 0.001) compared to non-fatigue and following muscular fatigue compared to mental fatigue (p = 0.001). In the kinematic results, we observed a significant difference in the mean velocity of the elbow between different experimental conditions (p = 0.001). This variable decreased due to muscular fatigue, compared to the other two conditions. On the other hand, there was no significant difference among the three experimental conditions for the variables of elbow range of motion, shoulder range of motion, and mean velocity of the shoulder joint. These findings affirm mental and muscular fatigue effects on dart throwing and provide further detail regarding the specific aspects of these effects on dart throwing skills or other fine motor activities.

Effect of Knee Orthosis and Kinesio Taping on Clinical and Neuromuscular Outcomes in Patients with Knee Osteoarthritis: A Randomized Clinical Trial

Objectives

Impaired proprioception and muscle weakness may not only be a consequence of knee osteoarthritis (OA) but also part of its pathogenesis. Thus, the enhancement of quadriceps strength and proprioceptive accuracy can play a pivotal role in the management of knee OA. This study aimed to investigate the effects of Kinesio tape and flexible knee orthosis in terms of clinical and neuromuscular outcomes in patients with knee OA.

Methods

This clinical trial was conducted on 56 patients with knee OA, randomly allocated to two groups: knee orthosis or Kinesio tape. The knee orthosis group wore a neoprene knee support for 4 weeks. For participants in the Kinesio tape group, tape was applied once a week, for 4 weeks. The primary outcomes were pain intensity and physical function evaluated through the visual analog scale and the Western Ontario and McMaster OA index. The secondary outcomes were concentric and isometric quadriceps strength, Joint Position Sense (JPS), Threshold to Detect Passive Motion (TTDPM), and force sense (FS), all measured by isokinetic dynamometry.

Results

All outcome measures were significantly improved in the orthosis group. The Kinesio tape group also demonstrated significant changes in all outcome measures except three proprioception components namely JPS (70° target), FS, and TTDPM. At the end of the fourth week, there were no significant between-group differences for measured parameters.

Conclusion

Wearing a flexible knee orthosis and/or Kinesio tape for 4 weeks significantly improved knee pain, physical function, and quadriceps strength. Although knee orthosis showed significant beneficial effects on various components of proprioception, there were no significant differences between the two groups at the end of the 4-week intervention.

Pain-induced Impact on Movement: Motor Coordination Variability and Accuracy-based Skill

INTRODUCTION

Studies on pain are generally conducted for two purposes: first, to study patients with pain who have physical changes due to nerve and muscle lesions, and second, to regain the appropriate kinematic post-pain pattern. The present study aimed to investigate the effect of pain on the coordination variability pattern and throwing accuracy.

METHODS

The study participants included 30 people aged 18-25 years who volunteered to participate in the study. Participants practiced and acquired skills in 10 blocks of 15 trials. In the test phase associated with pain, Individuals were randomly divided into three groups: local pain, remote pain, and control. In their respective groups, participants were tested in a 15-block trial, 24 hours, and 1 week after acquisition.

RESULTS

The results revealed that pain did not affect the throwing accuracy (P=0.456). Besides, in the phase of acceleration in throwing, movement variability in the pain-related groups in the shoulder and elbow joints (P=0.518), elbow and wrist (P=0.399), and the deceleration and dart drop phase movement variability in the pain-related groups in the shoulder and elbow joints (P=0.622), elbow and wrist (P=0.534).

CONCLUSION

Based on the results, the accuracy and coordination variability in pain-related groups were similar. However, to confirm these results, more research is needed on performing motor functions in the presence of pain.

HIGHLIGHTS

Pain are generally conducted for two purposes.pain which has physical changes due to nerve and muscle lesions and pain to regain the appropriate kinematic post-pain pattern.People who experience pain show poor motor results.Pain restriction is ordinary in joints and the body compensates by increasing movement.

PLAIN LANGUAGE SUMMARY

One of the constant concerns of sports science experts is to find ways to improve performance or to know the factors that strengthen or weaken motor learning. After injury, pain has been described as one of the passive symptoms, and the mechanism of how overexertion of joints and muscles increases injury and pain is unknown. Following any injury, pain is one of the most important causes of disability and one of the most important problems in people's general health. Many treated individuals present with pain and impaired movement, and typically changes in movement control are a result of the pain. Research evidence suggests that pain induces changes in cortical excitability and the neuroplasticity model that accompanies practice of a new motor task interferes with the performance improvement that must occur simultaneously. According to the new approaches of motor and biomechanical learning and control, movement variability, especially in movement coordination, is considered as an important and influential factor of a person with different conditions. Novice athletes show high non-functional variability in order to reduce the degrees of freedom and then simplify their motor task, in contrast to skilled people, they display functional variability that allows them to perform a motor task better. in variable conditions. Scientists and researchers have concluded that in the presence of pain, there are changes in the pattern requirements and muscle coordination. Clearly, variability is a main feature of most neurological and musculoskeletal pains, and it is necessary for therapists to diagnose and classify incomplete movements and to effectively manage symptoms by controlling incomplete movements, so conducting such research in this field in order to show muscle and movement changes It is necessary under the influence of pain.

Estimation of Femur Length From Its Fragments in an Iranian Population

Stature is one of the important variables to identify an individual, and the previous reports show that intact femur has the highest correlation with stature. But the femur is usually damaged in forensic cases. Hence in the present study, the femur length is estimated from proximal and distal femoral fragments in the Iranian population. Sixty-four dry femora (32 from each side) without sex determination were studied. The variables were measured by using the osteometric board and digital vernier caliper. The bones with visible abnormalities were excluded from the study. The measured values were analyzed by SPSS 25 software. The linear regression is used for estimating maximum femur length from the other measurements of femoral fragments. The result of this study showed that the value of segmental measurements was different between the right and left sides, but it was not statistically significant. All segmental measurements were positively correlated and found to have a linear relationship with the maximum femoral length (P<0.05) except for femoral neck circumference, which was not significantly different. The regression equation suggested that the intertrochanteric crest length is the best estimator of maximum femur length. The data of this study showed that the femoral length could be estimated from proximal and distal femoral fragments with the help of a regression equation. Then femoral length can be used to estimate the stature. The result of this study can be used in the analysis of forensic bone remains.

Management of patients with severe asthma: results from a survey among allergists and clinical immunologists of the Central Italy Inter-Regional Section of SIAAIC

Background

Asthma, and severe asthma in particular, is often managed within a specialized field with allergists and clinical immunologists playing a leading role. In this respect, the National Scientific Society SIAAIC (Società Italiana di Allergologia, Asma ed Immunologia Clinica), structured in Regional and Inter-Regional sections, interviewed a large number of specialists involved in the management of this respiratory disease.

Methods

A survey entitled “Management of patients with asthma and severe asthma” based on 17 questions was conducted through the SIAAIC newsletter in 2019 thanks to the collaboration between GlaxoSmithKline S.p.A. and the Inter-Regional Section of SIAAIC of Central Italy.

Results

Fifty-nine allergists and clinical immunologists participated to the survey, and 40 of them completed the entire questionnaire. Almost all of the specialists (88%) reported that asthma control was achieved in above 50% of their patients, even if only one third (32%) actually used validated clinical tools such as asthma control test (ACT). Poor adherence to inhaled therapy was recognized as the main cause of asthma control failure by 60% of respondents, and 2–5 min on average is dedicated to the patient inhaler technique training by two-thirds of the experts (65%). Maintenance and as-needed therapy (SMART/MART) is considered an appropriate approach in only a minority of the patients (25%) by one half of the respondents (52%). A high number of exacerbations despite the maximum inhalation therapy were recognized as highly suspicious of severe asthma. Patients eligible for biological therapies are 3–5% of the patients, and almost all the responders (95%) agreed that patients affected by severe asthma need to be managed in specialized centers with dedicated settings. Biological drugs are generally prescribed after 3–6 months from the initial access to the center, and once started, the follow-up is initially programmed monthly, and then every 3–6 months after the first year of treatment (96% of responders). After phenotyping and severity assessment, comorbidities (urticaria, chronic rhinosinusitis with or without nasal polyps, vasculitis, etc.) are the drivers of choice among the different biological drugs. In the management of severe asthma, general practitioners (GPs) should play a central role in selecting patients and referring them to specialized centers while Scientific Societies should train GPs to appropriately recognize difficult asthma and promote public disease awareness campaigns.

Conclusions

This survey which collects the point of view of allergists and clinical immunologists from Central Italy highlights that asthma control is still not measured with validated instruments. There is a general consensus that severe asthma should be managed only in dedicated centers and to this aim it is essential to encourage patient selection from a primary care setting and develop disease awareness campaigns for patients.

Comparison of Visual Search Behavior and Decision-making Accuracy in Expert and Novice Fencing Referees

SIGNIFICANCE

Perceptual-cognitive skills are the capacity of athletes to identify task-relevant information in the environment and integrate information with the knowledge available for decision making or controlling motor responses. Gaze behavior is one performance-related perceptual skill and a key factor affecting expertise affecting referee performance.

PURPOSE

The aim of this study was to compare visual search behavior and decision-making accuracy of expert and novice fencing referees.

METHOD

Twenty-eight referees were divided into expert (n = 14) and novice (n = 14) groups. Participants were fitted with mobile eye trackers and participated in tests that consisted of five blocks of 10 video clips. Videos are provided annually by the World Fencing Federation for referee testing.

RESULTS

The results showed a significant difference between the two groups in terms of the accuracy of decision making, number, duration, and location of fixations. Expert referees had higher decision-making accuracy compared with novice referees. Expert referees had fewer fixations than did novice referees. Fixations of expert referees were longer than those of novice referees, and the locations of fixations of expert and novice referees were different.

CONCLUSIONS

According to the results of this study, it can be concluded that the difference in visual search behavior of expert and novice referees was one of the factors contributing to better decision making of expert referees.

Assessment of motor skill accuracy and coordination variability after application of local and remote experimental pain

Motor learning is a relatively permanent change in motor performance. Also, one of the factors that can affect movement acquisition and movement patterns is pain and injury. The present study aims to investigate the effect of the induced local and remote pain during dart-throwing skill acquisition by examining motor skill accuracy and coordination variability. Three groups of 30 participants with a mean age of 18-25 were randomly assigned to local and remote pain or control groups. Capsaicin gel was applied to the pain groups for measuring the severity of pain using the Visual Analogue Scale (VAS). The results revealed that pain had no impact on dart-throwing skill acquisition, and there was no significant difference (p = 0.732) among the three groups at three stages of retention test. The results also showed that there was a significant difference among the three groups in terms of variability in shoulder-elbow (p = 0.025) and elbow-wrist joints (p = 0.000) in the deceleration and dart-throwing phases. The Central Nervous System seems to make adjustments when the task is associated with pain during the acquisition phase. Also, the groups with or without pain have notably various strategies, so differently, to perceive motor skills.

Pain-Induced Impact on Movement: Motor Coordination Variability and Accuracy-Based Skill

Studies on pain are generally conducted for two purposes: first, to study patients with pain who have physical changes due to nerve and muscle lesions, and second, to regain the appropriate kinematic post-pain pattern. The present study aimed to investigate the effect of pain on the coordination variability pattern and throw accuracy. Participants included 30 people with a mean age of 18-25 years who volunteered to participate in the study. Individuals were randomly divided into three groups of local pain, remote pain, and control group. Without pain, participants practiced and acquired skills in 10 blocks of 15 trials. In the retention and transition phase, which were associated with pain, in their respective groups, included 1 hour, 24- hour, and 1- week acquisition; they were re-tested twice in a 15-block trial, which was once with and without pain. The results revealed that pain did not affect the throwing accuracy (p = 0.469). Besides, in the phase of decreasing acceleration in throwing, movement variability pattern in the pain-related groups in the shoulder and elbow joints (p = 0.000), elbow and wrist (p = 0.000), were more than the painless groups. Based on the results, it can be said that the increase in variability in pain-related groups is due to the different strategies and patterns that individuals use to avoid pain. Also, despite the pain, the nervous system attempts to increase the variability find the least painful pattern of movement and reduces this variability over time and using a repetitive pattern.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

The Effect of Visual and Tennis Training on Perceptual-Motor Skill and Learning of Forehand Drive in Table Tennis Players

Introduction: The present study was designed to investigate the effect of visual and skill training on learning forehand drive in table tennis and motor-perceptual abilities (reaction time, coincidence-anticipation timing, eye-hand coordination, and depth perception).Materials and Methods: Forty volunteer female students (Mean±SD age: 21.50±0.78 years) were selected and randomly assigned to one of four groups (each group had 10 participants): visual and tennis training group, visual training group, tennis training group, and control group. Motor perceptual abilities (reaction time, coincidence-anticipation timing, eye-hand coordination, and depth perception) and forehand drive performance were measured before and after the training period, and also after 24 h retention period. After the pretest, including the accuracy of the kicks test for assessment of forehand drive in table tennis and motor-perceptual test, the experimental groups underwent four weeks (three sessions per week) of visual training, table tennis forehand training, or both. The control group followed their normal daily life for the whole study period. Then, they participated in the posttest and 24 h later in the retention test of kick accuracy.Results: The results revealed that visual and table tennis training, visual training, and table tennis training had a significant effect on the reaction time (P=0.001), coincidence-anticipation timing (P=0.001) and eye-hand coordination (error time) (P=0.01). Moreover, visual and tennis training and table tennis training had a significant effect on the acquisition (P=0.001) and retention of forehand drive (P=0.005). Besides, the post hoc LSD (Least Significant Difference) test showed that visual and tennis training had a more significant impact on the learning forehand drive. Visual training and tennis training had a significant effect on eye-hand coordination (number of errors). The three types of training programs were not effective in the depth of perception.Conclusion: Visual training can be used as a supplementary program in the athletes’ training schedule.

Evaluation of two commercial peach extracts for skin prick testing in the diagnosis of hypersensitivity to lipid transfer protein. A multicenter study

Summary

The clinical usefulness of two commercial peach extracts for SPT (by Lofarma SpA and ALK-Abellò, respectively) was compared in a multicenter study carried out in Italy. Peach allergic patients were tested with the two extracts in parallel and underwent the detection of IgE specific for all three peach allergens currently available (Pru p1, Pru p3, and Pru p4, respectively). The two extracts were almost identical in terms of sensitivity and specificity, being able to detect virtually all patients sensitized to stable peach allergens (lipid transfer protein (LTP) and, presumably, peamaclein) but scoring negative in patients exclusively sensitive to labile allergens (either PR-10 and/or profilin). Thus, the two extracts represent an excellent tool to carry out a preliminary component-resolved diagnosis of peach allergy at the first patient visit.

Galactose-α-1,3-galactose syndrome: an Italian survey

Summary

Background. The term of α-Gal syndrome, which includes the delayed allergy to red meat and the allergic reactions following the administration of cetuximab, is associated to the presence of specific IgE to α-Gal. In Italy, only anecdotal cases were reported so far. The Association of Italian Allergists (AAITO) carried out a survey with the aim of evaluating presence, characteristics, clinical features, and distribution of the syndrome in Italy. Methods. A web structured questionnaire was made available on the website of AAIITO from July 2016 to January 2017. It included 31 multiple-choice questions concerning different items, including the site of physicians, the number of patients diagnosed as having cetuximab allergy and/or delayed red meat allergy, recall of tick bites, symptoms, time to reactions, elicitor foods, reactions with foods other than meat, and in-vivo and in-vitro tests used for the diagnosis. Results. Seventy-nine physicians completed the questionnaire. Nine cases of allergy to cetuximab and 40 cases of delayed red meat allergy were recorded across Italy. 22.5% of patients with cetuximab allergy and 62.5% of those with delayed red meat allergy recalled a tick bite. 75% of patients with delayed red meat allergy experienced symptoms after eating beef (butcher's cut in 72.5%). Urticaria was the most frequent clinical manifestation (65% of cases). In 60.6% of cases symptoms appeared 2 - 4 hours after meat ingestion, while in 7.9% symptoms appeared after > 4 hours. The most used diagnostic methods were the intradermal test for cetuximab allergy (88.9%) and the detection of IgE to α-Gal (55.5%) for red meat allergy. Most case reports came from Northern Italy. Conclusions. α-Gal syndrome is present in Italy and beef is the most frequent offending food. In most cases symptoms were not severe.

Allergic reactions after vaccination: translating guidelines into clinical practice

Summary

Vaccination represents one of the most powerful medical interventions on global health. Despite being safe, sustainable, and effective against infectious and in some cases also non-infectious diseases, it's nowadays facing general opinion's hesitancy because of a false perceived risk of adverse events. Adverse reactions to vaccines are relatively rare, instead, and those recognizing a hypersensitivity mechanism are even rarer. The purpose of this review is to offer a practical approach to adverse events after vaccination, focusing on immune-mediated reactions with particular regard to their recognition, diagnosis and management. According to clinical features, we propose an algorythm for allergologic work-up, which helps in confirming hypersensitivity to vaccine, nonetheless ensuring access to vaccination. Finally, a screening questionnaire is included, providing criteria for immunisation in specialized care settings.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project)

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

The Effect of Observational Practice by a Point-Light Model on Learning a Novel Motor Skill

PURPOSE

The purpose of this study was to investigate the effect of observing point-light and video models and physical practice on learning a crouch start.

METHOD

Thirty-two female students were randomly assigned into point-light, video, physical practice, and control groups. They performed 10 trials in pretest, 160 trials in acquisition phase, and 10 trials in 24-hour retention test. Kinematic features and reaction time were measured as dependent variables.

RESULTS

Results showed that physical practice group performed better than other groups in reaction time and range of motion of trunk and observational groups performed better than control groups in reaction time and range of motion of knee.

CONCLUSION

The results confirm the positive effects of observational practice on motor learning.

Activation of the immune system and coronary artery disease: the role of anti-endothelial cell antibodies

On the basis of the role of immuno-mediated inflammation in atherosclerosis we investigated, (1) the prevalence of anti-endothelial cell antibodies (AECA) in ischaemic heart disease (IHD); (2) if beta2-glycoprotein I (beta2-GPI) was the target antigen of AECA; (3) the relationship between AECA, tissue factor (TF) and tissue factor pathway inhibitor (TFPI). In 93 consecutive IHD patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and 105 controls AECA were detected by ELISA on human umbilical vein endothelial cells (HUVEC). AECA positive sera were evaluated for anti-beta2-GPI antibodies by ELISA. TF and TFPI plasma levels were assessed by ELISA. Twelve of 93 (12.9%) IHD patients and only one of 105 controls (0.95%) were AECA positive. The prevalence of AECA was higher in unstable angina (UA) than in effort angina (EA) (P=0.01). Three of 12 AECA positive sera resulted positive for anti-beta2-GPI and showed a marked decrease in EC-binding when tested on HUVEC cultured in serum-free medium. The binding was restored by the addition of beta2-GPI. TF and TFPI levels were similar in AECA positive and AECA negative patients. The rate of angiographically documented clinical recurrences was 66.7% in the AECA positive and 14.8% in the AECA negative group (P=0.0004) with a significant relationship between restenosis and AECA (P<0.0001), unchanged by the inclusion of cardiovascular risk factors in the regression model. Our results suggest a 'role' for AECA in the immune-mediated inflammation in UA beta2-GPI is not the only AECA target antigen. AECA are not responsible for high TF and TFPI levels. The high rate of clinical recurrences after PTCA, confirmed by angiography, in AECA positive patients is in line with such a role and suggests further large-scale 'ad hoc' studies.

High prevalence of mild hyperhomocysteinemia in patients with abdominal aortic aneurysm

PURPOSE

In vitro studies have recently demonstrated that homocysteine interacts with the aortic wall by inducing both elastolysis and endothelial perturbation. The aim of this study was to evaluate homocysteine plasma levels and their relationships with aortic diameter and endothelial damage in patients with abdominal aortic aneurysm.

SUBJECTS AND METHODS

Fifty-eight consecutive male patients (mean age, 69.5 +/- 6.6 years; age range, 49-78 years) who underwent abdominal aortic aneurysm surgery were enrolled in the study. Twenty-two of 58 patients had no clinical or instrumental evidence of atherosclerosis. Sixty control subjects were age matched and sex matched with the patients. In all of the subjects, we evaluated total homocysteine and thrombomodulin plasma levels and the distribution of the C677T methylenetetrahydrofolate reductase gene mutation.

RESULTS

Hyperhomocysteinemia was found in 26 (48%) of the 58 patients with abdominal aortic aneurysm, and homocysteine plasma levels were significantly higher in patients than in control subjects (15.7 +/- 6.5 micromol/L vs 9.6 +/- 3.9 micromol/L; P <. 0001). In addition, the subgroup of patients with abdominal aortic aneurysm who did not show evidence of atherosclerosis showed homocysteine plasma levels significantly higher than those in the controls (14.8 +/- 6.1 micromol/L vs 9.6 +/- 3.9 micromol/L; P <. 001). A larger aneurysmal size was detected in hyperhomocysteinemic patients than in those with normal homocysteine plasma levels (5.09 +/- 0.84 cm vs 5.79 +/- 1.5 cm; P <.05). The genotype distribution of the C677T methylenetetrahydrofolate reductase mutation was as follows: TT 21%, TC 55%, and CC 24% in the patients; TT 10%, TC 58%, and CC 32% in the controls. Moreover, in patients a significant correlation (P <.005) between homocysteine plasma level and 677TT methylenetetrahydrofolate reductase genotype was found. Thrombomodulin plasma levels were significantly higher (P <.00005) in patients (median, 30 ng/mL; range, 10-164 ng/mL) than in controls (median, 19 ng/mL; range, 13-44 ng/mL), and thrombomodulin levels were significantly higher (P <.005) in hyperhomocysteinemic patients (median, 39.5 ng/mL; range, 15-164 ng/mL) than in normohomocysteinemic patients (median, 27.5 ng/mL; range, 10-85 ng/mL). In addition, in patients with abdominal aortic aneurysm, a direct significant correlation (P <.005) was found between homocysteine and thrombomodulin.

CONCLUSIONS

These data indicate an association between the presence of AAA in patients selected for surgical treatment of AAA and elevated homocysteine plasma levels and suggest that homocysteine may induce endothelial perturbation and stimulation in these patients.

Five-year follow-up of 165 Italian patients with undifferentiated connective tissue diseases

OBJECTIVE

To study those conditions with a proven or hypothesised immunologic pathogenesis and denominated under a working definition of undifferentiated connective tissue diseases (UCTD).

METHODS

A multicentre prospective study was organised involving 10 tertiary referral centers of internal medicine in Italy, with the aim of describing the natural history of UCTD and the prevalence of its different clinical and immunological manifestations.

RESULTS

After a five-year follow-up period, data on 165 patients were available for analysis. UCTDs occur mainly in females in their fourth decade of life. Articular and mucocutaneous features and Raynaud's phenomenon represent the most common findings. Nevertheless, we also detected a relatively high incidence of permanent major organ damage. Regarding the immunologic parameters, we documented some conflicting results in the correlation between serologic abnormalities and clinical features. In 10 patients UCTD evolved to a major disease, generally systemic lupus erythematosus or Sjögren's syndrome.

CONCLUSION

A low rate of evolution to a defined autoimmune disease, the limited use of steroid or immunosuppressive therapy, and a favourable course in the majority of cases are the main characteristics of patients with UCTDs.

High prevalence of anti-beta2 glycoprotein I antibodies in patients with ischemic heart disease

Ischemic cardiac manifestations have been reported in a various percentage of patients with anti-phospholipid antibodies. As concerns the relationship between anti-beta2 glycoprotein I antibodies (anti-beta2-GPI) and ischemic heart disease (IHD), it was investigated in only one coronary primary prevention study. We investigated the prevalence of anti-beta2-GPI in a well characterized group of patients with different clinical manifestation of IHD. Sera from 37 patients (mean age 62.7 +/- 9.9) with IHD (20 with unstable angina-UA and 17 with effort angina-EA) and from 40 healthy subjects, matched for age and sex, were tested for the presence of IgG and IgM anti-beta2-GPI using an ELISA technique. Eleven/37 patients (29.7%) resulted positive for anti-beta2-GPI. A positivity for IgG anti-beta2-GPI was found in 10 patients, 1 patient was positive for IgM and 1 for both isotypes. The prevalence of anti-beta2-GPI in the control group resulted significantly lower (2.5%; p < 0.005) than in patients with IHD. Positivity for anti-beta2-GPI was found in 9/20 (45%) patients with UA and only in 2/17 patients (11.8%) with EA (p = 0.0365). IgG anti-beta2-GPI levels (median 7.7U/ml, range 2.6-24.1) were significantly higher in patients with UA compared to patients with EA (median 4.6 U/ml, range 2.3-11.5; p = 0.02) and controls (median 3.15 U/ml, range 2.3-9.0; p < 0.0001); also IgM levels resulted higher in patients with unstable angina. A positivity for anti-beta2-GPI was observed in 4/13 patients (30.8%) with a previous myocardial infarction (MI) and in 7/24 (29.2%) patients without a previous MI. Our findings suggest that anti-beta2-GPI could represent an expression of the T-cell activation detectable in patients with unstable angina. The lack of a significant difference in the prevalence of these antibodies in patients with or without a previous MI suggests that anti-beta2-GPI are not induced by tissue necrosis.

Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations

OBJECTIVE

To verify whether features of CNS involvement can be detected in SLE patients without overt neuropsychiatric manifestations.

METHODS

114 SLE patients who had never received a diagnosis of neuropsychiatric lupus (never-NPSLE) were studied and compared to 65 SLE patients with known neuropsychiatric involvement (NPSLE). The study relied on evaluation of neurocognitive functions by means of a battery of neuropsychological tests, on psychiatric and neuropsychological assessments and on neuroimaging studies (computed tomography, magnetic resonance, single photon emission computed tomography (SPECT)).

RESULTS

Clinical features, including disease duration/activity and pharmacological therapy, of never-NPSLE and NPSLE patients were similar. Short-term and long-term memory, visuo-spatial and verbal information processing were similarly compromised in never-NPSLE and in NPSLE patients; only attention was significantly more compromised in NPSLE patients. Psychiatric morbidity was higher than expected in never-NPSLE patients, although less than in the control neuropsychiatric group. Ischemic lesions, multiple small high intensity lesions and cortical atrophy, detected by CT and MR scans, as well as abnormal SPECT were also frequently detected in never-NPSLE patients. Interestingly, left parietal and occipital area hypoperfusion by SPECT was significantly more frequent in the patients with impaired visuo-spatial intelligence and short-term memory.

CONCLUSIONS

Most abnormalities detected by available diagnostic tools and characteristics of neuropsychiatric SLE are also present in non-symptomatic patients. They may derive from an unexpected widespread involvement of the CNS and are not per se sufficient, in the absence of clinical manifestations, for a diagnosis of neuropsychiatric SLE.

Monitoring of low-molecular-weight heparins in cardiovascular disease

Thrombin generation is a key event in the pathophysiology of coronary syndromes and provides the rationale for treatment with anticoagulants. Unlike standard heparin, low-molecular-weight heparin (LMWH) has little effect on activated partial thromboplastin time. LMWH treatment has been monitored by measurement of anti-Factor Xa activity, but this may not accurately reflect the anticoagulant action because LMWHs also inhibit Factor II. The Heptest is a clotting assay that is sensitive to both anti-Xa and anti-IIa activity, as well as inhibition of the extrinsic pathway by LMWH-stimulated release of tissue factor pathway inhibitor. The plasma thrombin neutralization assay has also been used to measure LMWH and to detect low concentrations to which chromogenic assays are insensitive. In the clinical setting, monitoring the anti-Xa activity in patients treated with LMWH after acute deep vein thrombosis offered no advantages over a standard weight-adjusted dose. Moreover, in acute coronary syndromes there is no increase in major hemorrhage rates with weight-adjusted LMWH. Monitoring of LMWH concentrations may be advisable in the presence of comorbid conditions carrying an increased risk of hemorrhage, such as renal disease, advanced age, severe over- or underweight, or a history of previous bleeding episodes.

Determination of antibodies to extractable nuclear antigens by commercial kits: a multicenter study

Several enzyme immunoassays for serum antibodies to extractable nuclear antigen have recently become available. The aim of this study was to evaluate the results obtained with: (1) the same kit under different conditions; (2) different enzyme immunoassays; (3) Western blot and enzyme immunoassays. Twenty-five sera from patients with autoimmune disorders were tested in five different laboratories by one Western blot and four enzyme immunoassay commercial kits. The different methods produced comparable qualitative results. However, semiquantitative evaluation, based on a cut-off value (index), yielded different results due both to laboratory conditions and to the kits employed. Standardization of commercial products and methods should be improved so that the results of different laboratories can be compared and large-scale and follow-up studies conducted. Western blot analysis could also be useful to analyze complex reactivities, although greater experience is necessary to interpret these results correctly.

[Hormone replacement therapy and cardiovascular pathology in menopause]

Although the incidence of vascular disease increases progressively with age, the increment observed in women between 50 and 60 years old does not seem to be directly correlated to the menopause. On the other hand, significant modifications of some risk factors, particularly those related to lipid metabolism and the hemostatic system have been observed in postmenopausal women. It should be stressed that the results of these studies, although generally concordant, cannot be applied directly to the entire population: the majority of women studied were well-educated and from the upper-middle social and economic classes and thus more prone to comply with behavioral and therapeutic precepts. Moreover, non-white women were excluded from these studies. At present, numerous data attest to the beneficial effect of hormone replacement therapy on cardiovascular disease in postmenopausal women. The presently running National Institutes of Health 9-year randomized primary prevention study (Women's Health Initiative) and the secondary prevention "Heart Estrogen/Progestin Replacement Study" should, within a few years, provide further and, it is hoped, definitive information concerning the utility of hormone replacement therapy for the primary and secondary prevention of cardiovascular disease.

Immunological findings in Kawasaki disease: an evaluation in a cohort of Italian children

OBJECTIVE

Multiple humoral and cellular abnormalities in Kawasaki disease (KD) have already been described. In this study an analysis of immunological findings in a cohort of 34 Italian children affected with KD is reported, and the potential clinical significance of such alterations in predicting the development of coronary aneurysm and the prognosis of the disease is evaluated.

METHODS

Levels of circulating immune complexes (CIC), antinuclear antibodies (ANA), anticardiolipin (aCL), antineutrophil cytoplasmic antibodies (ANCA), and anti-endothelial cells (AECA) and the T cell profile were determined in both the acute and the convalescent phases, and were compared to febrile, sex- and age-matched children.

RESULTS

CIC were present in 66% of the patients, 18 of whom were in the acute phase and 13 in the convalescent phase. In the control group CIC were detected in 47% of the children. ANA were negative in both the KD and in the febrile group. ANCA were present in 8%, AECA in 26%, and aCL in 30% of KD patients (IgG aCL antibodies were found in 14 patients, IgM aCL in, 1 and 1 had both). Among the controls, aCL antibodies were found in 5 patients (22%); in particular 1 (4.4%) had IgG and 4 (17.4%) had IgM aCL. An altered T cell profile, with an inverted CD4/CD8 ratio, was found in all KD children. All of the immune alterations showed a lower incidence in the convalescent than in the acute phase. No significant relationship between any of these immune findings and cardiac involvement or any other clinical manifestations was found.

CONCLUSION

Our data confirms the previously reported immunological anomalies in KD both in the acute and the convalescent phases, with a decreased incidence of such alterations in the convalescent phase. No prognostic significance for the occurrence of aneurysm could be demonstrated.

Some anti-thyroperoxidase antibodies positive sera give a pANCA pattern on ethanol-fixed human neutrophils: cross-reactivity or false positives?

Fifty-six sera from patients with autoimmune thyroiditis and 33 sera from patients with MPO-ANCA were examined in order to ascertain whether a cross reactivity between MPO-ANCA and anti-thyroperoxidase (aTPO) was present. Sera from 20 healthy donors aTPO and aMPO negative were used as control. About 95% of heat inactivated sera from patients with autoimmune thyroiditis and from controls gave positive results (atypical pANCA pattern) on ethanol-fixed neutrophils. The prevalence of positive results was significantly lower when unheated aTPO positive sera were used (17.8%). On the other hand, only 9% of sera with MPO-ANCA were positive on cryostatic sections of human thyroid. Indirect immunofluorescence tests (IF) on human neutrophils with MPO defect were negative with sera from patients with MPO-ANCA, but uninactivated sera with aTPO and positive for pANCA on normal neutrophils showed a very high prevalence of positive results (90%). According to our data only few sera positive for aTPO recognize "normal" MPO, but the majority of sera from patients with autoimmune thyroiditis and positive for pANCA on normal neutrophils recognize also an "abnormal" MPO. On the other hand MPO-ANCA usually recognize epitopes presently only on the normal enzyme, a small proportion of these autoantibodies can react with TPO. Heat inactivated sera give false positive results for pANCA on ethanol fixed human neutrophils.

Antiphospholipid antibodies (aPL) increase the potential monocyte procoagulant activity in patients with systemic lupus erythematosus

Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are frequently detected in sera from patients affected by systemic lupus erythematosus (SLE). However, the role of antiphospholipid antibodies (aPL) in thrombus formation has not been defined as yet. Twenty-two patients affected by SLE, all fulfilling the 1982 ARA revised criteria, and twenty healthy subjects were investigated for the presence of LA, aCL and other aPLs. Monocyte procoagulant activity-PCA (Tissue Factor production) was evaluated by one stage plasma recalcification time. In all patients the plasma levels of F1 + 2 and of plasminogen activator inhibitor (PAI) were also determined. Monocyte PCA was significantly higher in SLE patients with LA and/or aCL in comparison to SLE patients without LA and/or aCL (p < 0.01) and to controls (p < 0.05). However, no connection was observed between PCA expression by mononuclear cells and LA or aCL levels. No differences in F1 + 2 and PAI plasma levels were found between SLE patients with or without aPL and controls. In our SLE patients LA and/or aCL positivity appears strictly related to an increased monocyte activation that could play an important role in the occurrence of thrombotic events.

[Early diagnosis of rapidly progressive glomerulonephritis]

The term rapidly progressive glomerulonephritis (RPGN) designates a group of glomerular diseases with different pathogenetic and clinical features, rapidly leading to renal or patient death in about 90% of the untreated cases. Histopathologically, it is characterized by glomerular crescents in at least 50-75% of the glomeruli (necrotizing crescentic glomerulonephritis), and very often, glomerular necrosis. The situation is, however, potentially reversible if adequately treated, and a favourable outcome depends largely on early diagnosis and treatment. Early diagnosis can be achieved if due importance is given to even seemingly unspecific manifestations such as "flu like syndrome" associated with "glomerular" hematuria. These manifestations are detectable before the down-hill course of renal functional derangement becomes evident and should lead the physician to consider RPGN among the diagnostic possibilities. Final diagnosis rests on serological tests and kidney biopsy. The battery of diagnostic serological tests (anti-GBM, anti-DNA antibodies, cryoglobulins, etc.) has recently been enriched by the assay of anti-neutrophil cytoplasmic antibodies (ANCA). These antibodies are detectable in over 90% of cases of Wegener's granulomatosis and primary necrotizing crescentic glomerulonephritis with or without lung involvement. ANCA-associated glomerulonephritis is the commonest form of RPGN, and the new serological assay provides an important tool for its early recognition. Renal biopsy is necessary to evaluate the severity of the nephritic process and modulate treatment accordingly. Timely diagnosis is one of the most important factors contributing to successful treatment outcome over both the short and the long term.