HERVs: Expression Control Mechanisms and Interactions in Diseases and Human Immunodeficiency Virus Infection

Human endogenous retroviruses (HERVs) are the result of retroviral infections acquired millions of years ago; nowadays, they compose around 8% of human DNA. Multiple mechanisms have been employed for endogenous retroviral deactivation, rendering replication and retrotransposition defective, while some of them have been co-opted to serve host evolutionary advantages. A pleiad of mechanisms retains the delicate balance of HERV expression in modern humans. Thus, epigenetic modifications, such as DNA and histone methylation, acetylation, deamination, chromatin remodeling, and even post-transcriptional control are recruited. In this review, we aim to summarize the main HERV silencing pathways, revisit paradigms of human disease with a HERV component, and emphasize the human immunodeficiency virus (HIV) and HERV interactions during HIV infection.

The interaction of human immunodeficiency virus-1 and human endogenous retroviruses in patients (primary cell cultures) and cell line models

IMPORTANCE

In this work, we demonstrated that human immunodeficiency virus (HIV) infection leads to the modification of the human endogenous retrovirus (HERV) expression. Differential expression of multiple HERVs was found in peripheral blood mononuclear cells derived from HIV-infected patients compared to healthy donors and HIV-infected T cell cultures compared to non-infected. The effect of HIV presence on HERV expression appears to be more restricted in cells of monocytic origin, as only deregulation of HERV-W and HERV-K (HML-6) was found in these cell cultures after their infection with HIV. Multiple factors contribute to this aberrant HERV expression, and its levels appear to be modified in a time-dependent manner. Further studies and the development of optimized in vitro protocols are warranted to elucidate the interactions between HIV and HERVs in detail.

Multimodality imaging to assess severity and outcome in asymptomatic patients with aortic stenosis: a medium-long term follow-up study

Background

Multimodality imaging approach is becoming more and more common in evaluating the severity and outcome of aortic stenosis (AS).

Aim

To assess the outcome of asymptomatic AS and the usefulness of aortic calcium score (CS) by computed tomography (CT) for solving the dilemma of low flow, low gradients (LFLG) severe AS.

Methods

70 (81.4±8.4 years) prospective asymptomatic patients with AS were followed for 2.77±2.01 years with a trans-thoracic echo (TTE) every 6 months. End-points were all cause mortality, aortic valve replacement (AVR or TAVR), aortic velocity and gradients progression and symptoms occurrence. Prevalence of LFLG-AS was investigated and these patients underwent CT for CS calculation at the end of follow-up (FU), Figure 1.

Results

Baseline TTE results from the 70 pts were: peak velocity 3.1±0.8m/sec; peak gradient 44±21mmHg; mean gradient 26±14 mmHg; AVA 1±0.3 cm2; DVI 0.31±0.1; Svi 33.8±18 ml/m2; EF: 55±9% with an AS being mild in 32.9%, moderate in 28.4%, severe in 27.1%; 36.8% of severe AS were LFLG. During FU, 23 (32.8%) pts died (5.7% LFLG) and 13 (18.5%) underwent AVR/TAVR. Predictors of mortality were aortic gradients (p=0.03), AVA (p=0.008), DVI (p<0.001), pulse pressure (p=0.005) and dilated ascending aorta (p<0001). Predictors of AVR/TAVR were: gradients (p=0.003), peak aortic velocity (p=0.02) and dilated ascendent aorta (p=0.01). The best cut-off to predict survival was AVA = 1 cm2 (100% sensitivity and 80% specificity). In 34 pts ending FU we found an overall progression of AS severity (peak velocity 3.6±0.9m/sec; peak gradient 50±24 mmHg; mean gradient 33±15 mmHg; AVA 0.7±0.3 cm2; DVI 0.25±0.08; Svi 36±10 ml/m2; EF 54±10%; p<0.05 for all vs baseline) with 24 (70.5%) pts with severe AS and 10 (29.5%) with not severe AS. 18 (75%) of progressive severe AS were LFLG, 12 asymptomatic and 6 symptomatic and all underwent CS revealing that AS was not severe in 6 (1233±1123 AU; 622±55 AU/m2) and true severe in 12 (3388±1188 AU; 1858±795 AU/m2; p=0.005 and p=0.002, respectively). Symptomatic severe LFLG AS were all true severe according to CS (Figure 1). Table 1 shows the main CS correlations.

Conclusions

Asymptomatic AS in elderly people is associated with high mortality risk and rapid progression. AVA remains the best predictor of outcome. In severe LFLG AS, calcium score correlates with symptoms occurrence, progression of valve disease, LV hypertrophy and function and also with RV function.

Funding Acknowledgement

Type of funding sources: None.

P107 MULTIMODALITY IMAGING IN ASCENDING AORTA PSEUDO–ANEURYSM COMPLICATED BY MOBILE TROMBUS SYMPTOMATIC FOR RECURRENT ISCHEMIC STROKE

 

A 80–year–old male patient was admitted to hospital with a clinical picture of Broca‘s aphasia. The patient had arterial hypertension, diabetes, chronic kidney disease and peripheral vasculopathy. In remote cardiological history he presents long standing persistent atrial fibrillation on OAC and he had a biological aortic valve prosthesis (Medtronic 23). Overall time in the therapeutic range (INR 2.0–2.5) was adequate considering the presence of atrial fibrillation. A CT scan was performed on suspicion of stroke, showing a recent ischemic lesion in the left middle temporal region complicated by same–site subarachnoid blood suffusion. During the hospital stay there was a recurrence of the aforementioned symptoms: at the CT check a new acute ischemic same–site lesion and a new ischaemic lesion at the left temporal site was highlighted. In the suspicion of a cardio–embolic origin of cerebro–vascular events, it was decided to carry out imaging for the study of the aorta and heart cavities to exclude embolic sources. Given the patient‘s comorbidities and the reported allergies (contrast medium with angioedema–like reaction at a previous CT) it was decided to perform transesophageal echocardiography (TEE) first. TEE documented the presence of a saccular aneurysm of probable pseudo–aneurysmatic nature, which extends from 20 mm from the valvular plane, characterized by pedunculated, mobile thrombotic apposition, adhered to the internal collar, projecting into the psueudo–aneurysmatic cavity (image 1). This finding was confirmed and better characterized with the help of the real time three–dimensional echocardiographic method (image 2). To confirm and better characterize the extension of the pseudo–aneurysm and plan any strategy, a CT scan with contrast medium was required. Performing contrast–enhanced CT, after careful preparation with premedication with antihistamine and cortisone, confirmed the finding of pseudo–aneurysm of the ascending aorta, but the pedunculated thrombotic apposition was less clearly evidenced compared with TEE (giving the superior temporal resolution of TEE) (image 3). The case was therefore assessed in Heart Team and the patient was scheduled for surgically exclusion of the pseudo–aneurysm.

Conclusion

In our case a multimodality imaging approach was used to diagnose and confirm the presence of ascending aorta pseudo–aneurysm complicated by pedunculated thrombotic apposition inside it, symptomatic for recurrent ischaemic stroke.

P108 PLEURAL EFFUSION AND THE POSTERIOR THORACIC WINDOW: ONE MORE CHANCE TO IMAGE THE AORTIC VALVE

 

A 85–year–old woman was admitted to our institution with acute respiratory distress. Clinical examination revealed a 5/6 systo–diastolic murmur radiating to both carotid arteries and bilateral lung crackles. Laboratory workup was notable for a N–terminal pro–brain natriuretic peptide (NT–proBNP) of 15.000 ng/L (normal range: < 300 ng/L) and a moderate high–sensitive troponin T elevation of 245 ng/L (normal range: < 14 ng/L) with no increase on serial testing. The hemoglobin and renal function was normal. Evaluation by chest X–ray showed bilateral diffuse pulmonary infiltrates consistent with pulmonary edema and bilateral pleural effusion. The patient was admitted in CCU. A transthoracic echocardiogram was performed bedside, but it was extremely difficult to obtain good quality images from standard view given the ortopnoic decubitus of the patient. However, the aortic valve was heavily calcified and severe aortic stenosis was documented with a mean gradient of 42 mmHg from apical 5 chambers view; 35 mmHg from right parasternal view, with an functional aortic valve area ≈0.6 cm2 (figure, upper panel). Left ventricle shows eccentric hypertrophy and a moderate diffuse reduction of ejection fraction (EF 35–40%). Then, the patient was positioned sitting upright, because the left pleural effusion offered an additional acoustic window—the posterior thoracic window (PTW)—that allowed better alignment of the ultrasound beam with the aortic jet. Mean gradient was recorded definitely higher than from standard view at 50 mm Hg. Moreover, aortic regurgitation that appeared mild from standard view was documented as significant from PTW. In fact, a proper alignment of the aortic regurgitation jet was feasible from this view with a quantification of severity with multiparameter criteria as suggested from the guidelines (PHT 166 ms, Vena contracta 8 mm; Rvol 60 ml). (Figure, lower panel)

Conclusion

Obtaining adequate echocardiographic images in critically ill patients is important for better diagnosis and treatment. For several reasons, this group of patients remains among the most challenging with regard to quality of echocardiographic images. In presence of pleural effusion and technically difficult echo exams, the PTW should be considered in the assessment of cardiac structures including aortic valve as a potentially useful option to provide further diagnostic information.

Echocardiographically determined ejection fraction in the elderly admitted with non-ST-elevation acute coronary syndromes in a spoke hospital with no cath-lab facility and the treatment-risk paradox

Funding Acknowledgements

Type of funding sources: None.

Background

 The elderly with non-ST-elevation coronary syndromes (NSTE-ACS) represents an high risk group and may benefit from early invasive strategy, that may be difficult to achieve in spoke hospitals with no cath-lab facility. Although a strong predictor of mortality in NSTE-ACS, the role of echocardiographically determined left ventricular ejection fraction (EF) in this setting is poorly determined.

Purpose

 we aimed to analyze characteristics and outcomes of patients ≥80 years with NSTE-ACS admitted to spoke hospitals according to EF.

Methods

 Observational retrospective study of all consecutive NSTE-ACS patients admitted to a spoke hospital, where a same-day transfer between spoke hospital and hub center with a cath-lab facility to perform coronary angiography was available. Patients were divided in 3 groups according to EF: normal (EF≥55%), mild-moderate (EF 35-55%) and severe reduction (FE < 35%).

Results

 from 2013-2017, 181 patients ≥80 years (median 84, IQR 82-89) were admitted for NSTE-ACS in a spoke hospital of our provincial cardiology network.

Of these, 66 patients (36%) had normal EF, 79 (44%) had mild-moderate and 36 (20%) had severely EF reduction. GRACE risk score was high (>140) in the whole cohort, increasing with the lowering of EF (165 ± 27 in normal EF, 179 ± 28 in mildly-moderate and 193 ± 31 in severe reduction; p < 0.001). The three groups did not differ in term of age, gender, CV risk factors, known CAD, presence of severe COPD, PAD and atrial fibrillation (all p > 0.1). As expected, clinical signs of heart failure presented more frequently with worsening of EF (2% in normal EF, 8% in mildly-moderate and 56% in severe reduction; p < 0.001) and serum creatinine tended to be higher with worsening of EF (p = 0.05).

Of note, the invasive strategy was chosen less often with worsening of EF (68% in normal EF, 58% in mildly-moderate and 39% in severe reduction (p = 0.1).

When the invasive strategy was chosen, time from admission to cath lab consistently raised with worsening of EF (53 ± 35 hours in normal EF, 68 ± 46 in mildly-moderate and 104 ± 81 in severe reduction; p = 0.001), therefore the proportion of patients reaching the cath lab in <72 hours as recommended from guidelines decreased with worsening of EF (73% in normal EF, 67% in mildly-moderate and 39% in severe reduction; p = 0.03). Table. 

However, at 1-year follow-up, the overall survival did not differ across the EF groups (p = 0.26). Figure.

Conclusion

 in the elderly admitted with NSTE-ACS in a spoke hospital with no cath lab facility EF may be part of the "treatment-risk paradox": the worse is the EF, the less patients are sent for invasive strategy and when invasive strategy is chosen the more time they have to wait for cath lab. However, in this setting, the impact of classical classification of EF in normal, mildly-moderate and severe reduction on 1-year mortality may not be significant and should not impede the access to invasive strategy in a timely fashion. Abstract Table  Abstract Figure

Management and outcome of non-ST-elevation acute coronary syndromes in the elderly admitted to spoke hospitals with no cath-lab facility

Background

Current guidelines recommend an early invasive strategy in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, the role of an invasive strategy in elderly patients remains controversial and may be difficult to achieve in spoke hospitals with no cath-lab facility.

Purpose

We aimed to analyze characteristics and outcomes of patients ≥80 years with NSTE-ACS admitted to spoke hospitals.

Methods

Observational retrospective study of all consecutive NSTE-ACS patients admitted to two spoke hospitals, where a service strategy (same-day transfer between spoke hospital and hub center with a cath-lab facility to perform coronary angiography) was available.

Results

From 2013 to 2017, 639 patients were admitted for NSTE-ACS in a spoke hospital of our provincial cardiology network; of these, 181 (28%) were ≥80 years (median 84, IQR 82–89). In the elderly conservative strategy was chosen in 76 patients (42%). When the invasive strategy was chosen, 104 patients (93%) were managed with a Service strategy with no major adverse event observed during the back transfer from the invasive center to the referring spoke center, whereas the rest of the patients (8, 7%) were transferred from the spoke hospital to the hub center and completed their hospital stay without returning to the spoke center. Of patients initially managed with the service strategy, a shift of strategy after the invasive procedure was necessary for 11 (10%) and the patients remained in the hub center. The median time to access to cath-lab was 50 hours (IQR 25–87), with 73 patients (70%) reaching the invasive procedure <72 h from the hospital admission and 23 (22%) <24 h.

Conservative strategy was associated with older age, known previous CAD, clinical presentation with symptoms of LV dysfunction, lower EF, renal failure, higher GRACE score, presence of PAD, and atrial fibrillation (all p<0.03; Table).

At 1-year follow-up, the overall survival was significantly higher in patients treated with invasive strategy compared to patients managed conservatively (94%±2 vs. 54%±6, p<0.001; HR: 10.4 [4.7–27.5] p<0.001; Figure), even after adjustment for age, serum creatinine, known previous CAD and EF (adjusted HR: 2.0 [1.0–4.0]; p<0.001).

Conclusion

An invasive strategy may confer a survival benefits in the elderly with NSTE-ACS. When the invasive strategy is chosen, the same-day transfer between spoke hospital and hub center with the cath-lab facility (service strategy) is safe and granted the access to cath-lab in a timely fashion even in the elderly.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1

P914Balloon aortic valve valvuloplasty as palliative therapy in severe aortic valve stenosis: 10 years experience in a single centre

Background

Improved technology together with greater operator experience has led to refinement of balloon aortic valve valvuloplasty (BAV) in recent years. It may provide a palliative treatment option in high-risk patients, highly symptomatic, for whom no other invasive therapy is available. However, there has not been universal adoption of BAV as a standalone therapy.

Methods

A retrospective analysis of ten years of practice of BAV as palliative strategy in patient with symptomatic aortic stenosis between March 2008 and June 2018 was performed. Demographic, clinical, procedural, and follow-up data on all patients were collected.

Results

A total of 152 patients (95 women, 63%) with a mean age of 85±6 years underwent BAV. All patients had severe aortic stenosis, were considered not suitable to aortic valve replacement nor Trans-catheter aortic valve implantation (TAVI) for appreciable comorbidity (STS score 9±5) and had severe symptoms mainly of heart failure which required medical attention. A statistically significant decrease in trans-valvular gradient was observed (peak to peak gradient before BAV 52±22 mmHg, after BAV 29±16 mmHg, delta gradient 24±14 mmHg; p<0.0001). Only one patient, who undergone BAV because of cardiogenic shock, died during the procedure. Considering the high-risk population, intra-hospital mortality was low (7 patients died, 4%). Mortality at 1-year follow-up was 43% and survival free from new hospitalization for heart failure was 63% at 1-year follow-up and 53% at 2 years follow-up. 19 patients (13%) required repeated BAV during follow-up.

Conclusion

BAV as a palliative procedure in high-risk patients who are highly symptomatic, has a low operative mortality in our experience. BAV is associated with a significant reduction in aortic valve gradient and is valuable since half of the patients were alive without re-hospitalizations for heart failure at 2 years follow-up.

Acknowledgement/Funding

None

A Simple Method for Ex Vivo Evaluation of Biomaterial Interaction with Blood Platelets

The process of thrombus formation, as a consequence of the interaction of artificial surfaces with blood, is related to the activation of blood platelets. A simple ex vivo method, which is suitable for the evaluation of the platelet-surface interaction is described. This method has been used to compare the haemocompatibility of several artificial materials, including nylon-6, Silastic and pyrolytic carbon.

Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation

Background:

Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation. However, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative mitral regurgitation with a flail leaflet.

Methods:

MIDA (Mitral Regurgitation International Database) is a multicenter registry enrolling patients with degenerative mitral regurgitation with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1709) and replacement (n=213) overall, by propensity score matching, and by inverse probability-of-treatment weighting.

Results:

At baseline, patients undergoing MV repair were younger, had more comorbidities, and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching and inverse probability-of-treatment weighting, the 2 treatments groups were balanced, and absolute standardized differences were usually <10%, indicating adequate match. Operative mortality (defined as a death occurring within 30 days from surgery or during the same hospitalization) was lower after MV repair than after replacement in both the entire population (1.3% versus 4.7%; P <0.001) and the propensity-matched population (0.2% versus 4.4%; P <0.001). During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement in both the entire population (46% versus 23%; P <0.001) and the matched population (41% versus 24%; P <0.001). Similar superiority of MV repair was obtained in patient subsets on the basis of age, sex, or any stratification criteria (all P <0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.

Conclusions:

Among patients with degenerative mitral regurgitation with a flail leaflet referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival, and fewer valve-related complications compared with MV replacement.

A century of oil and gas exploration in Albania: assessment of Naturally Occurring Radioactive Materials (NORMs)

The Naturally Occurring Radioactive Materials (NORMs) that are potentially generated from oil and gas extractions in Albania have been disposed of without regulations for many decades, and therefore, an extensive survey in one of the most productive regions (Vlora-Elbasan) was performed. A total of 52 gamma ray spectrometry measurements of soil, oil-sand, sludge, produced water and crude oil samples were performed. We discovered that relatively low activity concentrations of (226)Ra, (228)Ra, (228)Th and (40)K, with concentrations of 23±2Bq/kg, 23±2Bq/kg, 24±3Bq/kg and 549±12Bq/kg, respectively, came from the oil-sands produced by the hydrocarbon extraction of the molasses formations. The mineralogical characterizations and the (228)Ra/(40)K and (226)Ra/(40)K ratios of these Neogene deposits confirmed the predictions of the geological and geodynamic models of a dismantling of the Mesozoic source rocks. The average activity concentrations (±standard deviations) of the radium isotopes ((226)Ra and (228)Ra) and of the (228)Th and (40)K radionuclides in soil samples were 20±5Bq/kg, 25±10Bq/kg, 25±9Bq/kg and 326±83Bq/kg, respectively. Based on the measurements in this study, the future radiological assessments of other fields in the region should be strategically planned to focus on the oil-sands from the molasses sediments. Disequilibrium in the (228)Ra decay segment was not observed in the soil, sludge or oil-sand samples within the standard uncertainties. After a detailed radiological characterization of the four primary oil fields, we concluded that the outdoor absorbed dose rate never exceeded the worldwide population weighted average absorbed dose rate in outdoor air from terrestrial gamma radiation.

Lifetimes of (214)Po and (212)Po measured with Counting Test Facility at Gran Sasso National Laboratory

The decays of (214)Po into (210)Pb and of (212)Po into (208)Pb tagged by the previous decays from (214)Bi and (212)Bi have been studied inserting quartz vials inside the Counting Test Facility (CTF) at the underground laboratory in Gran Sasso (LNGS). We find that the mean lifetime of (214)Po is (236.00 ± 0.42(stat) ± 0.15(syst)) μs and that of (212)Po is (425.1 ± 0.9(stat) ± 1.2(syst)) ns. Our results are compatible with previous measurements, have a much better signal to background ratio, and reduce the overall uncertainties.

Multistimulation Group Therapy in Alzheimer’s Disease Promotes Changes in Brain Functioning

Background. The growing social emergency represented by Alzheimer’s disease (AD) and the lack of medical treatments able to modify the disease course have kindled the interest in nonpharmacological therapies. Objective. We introduced a novel nonpharmacological approach for people with AD (PWA) named Multidimensional Stimulation group Therapy (MST) to improve PWA condition in different disease domains: cognition, behavior, and motor functioning. Methods. Enrolling 60 PWA in a mild to moderate stage of the disease, we evaluated the efficacy of MST with a randomized-controlled study. Neuropsychological and neurobehavioral measures and functional magnetic resonance imaging (fMRI) data were considered as outcome measures. Results. The following significant intervention-related changes were observed: reduction in Neuropsychiatric Inventory scale score, improvement in language and memory subscales of Alzheimer’s Disease Assessment Scale–Cognitive subscale, and increased fMRI activations in temporal brain areas, right insular cortex, and thalamus. Conclusions. Cognitive-behavioral and fMRI results support the notion that MST has significant effects in improving PWA cognitive-behavioral status by restoring neural functioning.

Dynamical transition in the D=3 Edwards-Anderson spin glass in an external magnetic field

We study the off-equilibrium dynamics of the three-dimensional Ising spin glass in the presence of an external magnetic field. We have performed simulations both at fixed temperature and with an annealing protocol. Thanks to the Janus special-purpose computer, based on field-programmable gate array (FPGAs), we have been able to reach times equivalent to 0.01 s in experiments. We have studied the system relaxation both for high and for low temperatures, clearly identifying a dynamical transition point. This dynamical temperature is strictly positive and depends on the external applied magnetic field. We discuss different possibilities for the underlying physics, which include a thermodynamical spin-glass transition, a mode-coupling crossover, or an interpretation reminiscent of the random first-order picture of structural glasses.

First characterisation of natural radioactivity in building materials manufactured in Albania

This study focuses on the radiological characterisation of building materials manufactured in Albania by using a high-resolution gamma-ray spectrometer. The average activity concentrations of (40)K, (226)Ra and (232)Th were, respectively, 644.1±64.2, 33.4 ± 6.4 and 42.2 ± 7.6 Bq kg(-1) in the clay brick samples and 179.7 ± 48.9, 55.0 ± 5.8 and 17.0 ± 3.3 Bq kg(-1) in the cement samples. The calculated activity concentration index (ACI), varied from 0.48±0.02 to 0.63±0.04 in the clay brick samples and from 0.29±0.03 to 0.37±0.02 in the cement samples. Based on the ACI, all of the clay brick and cement samples were categorised as A1 materials. The authors can exclude (at 3σ level) any restriction of their use as bulk materials.

A new FSA approach for in situ γ ray spectroscopy

An increasing demand of environmental radioactivity monitoring comes both from the scientific community and from the society. This requires accurate, reliable and fast response preferably from portable radiation detectors. Thanks to recent improvements in the technology, γ spectroscopy with sodium iodide scintillators has been proved to be an excellent tool for in-situ measurements for the identification and quantitative determination of γ ray emitting radioisotopes, reducing time and costs. Both for geological and civil purposes not only (40)K, (238)U, and (232)Th have to be measured, but there is also a growing interest to determine the abundances of anthropic elements, like (137)Cs and (131)I, which are used to monitor the effect of nuclear accidents or other human activities. The Full Spectrum Analysis (FSA) approach has been chosen to analyze the γ spectra. The Non Negative Least Square (NNLS) and the energy calibration adjustment have been implemented in this method for the first time in order to correct the intrinsic problem related with the χ(2) minimization which could lead to artifacts and non physical results in the analysis. A new calibration procedure has been developed for the FSA method by using in situ γ spectra instead of calibration pad spectra. Finally, the new method has been validated by acquiring γ spectra with a 10.16 cm × 10.16 cm sodium iodide detector in 80 different sites in the Ombrone basin, in Tuscany. The results from the FSA method have been compared with the laboratory measurements by using HPGe detectors on soil samples collected particular, the (137)Cs isotopes has been implemented in the analysis since it has been found not negligible during the in-situ measurements.

Second-order closure in stratified turbulence: simulations and modeling of bulk and entrainment regions

The parametrization of small-scale turbulent fluctuations in convective systems and in the presence of strong stratification is a key issue for many applied problems in oceanography, atmospheric science, and planetology. In the presence of stratification, one needs to cope with bulk turbulent fluctuations and with inversion regions, where temperature, density, or both develop highly nonlinear mean profiles due to the interactions between the turbulent boundary layer and the unmixed-stable-flow above or below it. We present a second-order closure able to cope simultaneously with both bulk and boundary layer regions, and we test it against high-resolution state-of-the-art two-dimensional numerical simulations in a convective and stratified belt for values of the Rayleigh number up to Ra∼10(10). Data are taken from a Rayleigh-Taylor system confined by the existence of an adiabatic gradient.

Numerical simulations of Rayleigh-Taylor front evolution in turbulent stratified fluids

We present state-of-the-art numerical simulations of a two-dimensional Rayleigh-Taylor instability for a compressible stratified fluid. We describe the computational algorithm and its implementation on the QPACE supercomputer. High resolution enables the statistical properties of the evolving interface that we characterize in terms of its fractal dimension to be studied.

Serenoa repens in benign prostatic hypertrophy: analysis of 2 Italian studies

AIM

Benign prostatic hypertrophy (BPH), which is characterized by a progressive swelling of the prostate causing symptoms of the lower urinary tract, is the second pathology as frequency among the diagnoses placed in men every year in Italy. The extract of Serenoa repens is an alternate therapeutic option to traditional drug therapies with a good profile of efficacy and safety for the management of the symptoms of BPH. The aim of this paper was to analyze systematically the results of two Italian studies carried out on patients with BPH treated with extract of serenoa repens (SABA. a product of Lampugnani Farmaceutici S.p.A.).

METHODS

The studies were carried out on a total of 70 adult patients with diagnosis of benign prostatic hypertrophy. In one study the patients were treated with Serenoa repens 320 mg/day for 30 days; in the other study the patients received Serenoa repens 320 mg/day or Pygeum africanum (Tadenan) 4 capsules of 25 mg/day for 30 days.

RESULTS

Both studies showed an improvement versus the baseline of about 50% of dysuria and pollakisuria, an about 50% increase in micturition rate with positive effects also in terms of reduction of the micturition rate and of prostate size. Also the tolerability profile was favorable.

CONCLUSION

The extract of Serenoa repens (SABA Lampugnani Farmaceutici S.p.A.) administered at the dose of 320 mg/day to patients with benign prostatic hypertrophy, is effective in terms of improvement of the functional symptomatologic picture improvement and of the instrumental parameters with a good tolerability profile.

Static versus dynamic heterogeneities in the D = 3 Edwards-Anderson-Ising spin glass

We numerically study the aging properties of the dynamical heterogeneities in the Ising spin glass. We find that a phase transition takes place during the aging process. Statics-dynamics correspondence implies that systems of finite size in equilibrium have static heterogeneities that obey finite-size scaling, thus signaling an analogous phase transition in the thermodynamical limit. We compute the critical exponents and the transition point in the equilibrium setting, and use them to show that aging in dynamic heterogeneities can be described by a finite-time scaling ansatz, with potential implications for experimental work.

Functional living skills assessment: a standardized measure of high-order activities of daily living in patients with dementia

AIM

Performance measures are tools aimed to directly evaluate social function in older adults. The authors present the standardization of a new direct performance measure for patients with dementia, the functional living skills assessment (FLSA).

METHODS

FLSA was conceived to detect functional impairment in very mild to moderate patients and to pick up functional modification due to intervention. The patient is asked to perform an activity, and the performance is scored according to completeness and level of assistance required. Eight areas of interest are evaluated (Resources, Consumer Skills, Public Transportation, Time Management, Money management, Leisure, Telephone Skills, Self-Care and Health). Subjects included 54 patients with dementia and 36 normal controls.

RESULTS

Total and partial FLSA scores significantly differed for the two groups (P<0.0001). Performance on FLSA could divide clinical dementia rating (CDR) 0 from CDR 1, CDR 2 e CDR 3 groups. Both sensitivity and specificity were 94%; inter-rater and test-retest reliability was good (P>0.9). Correction scores for education were calculated, while age influence was only marginally significant. Mini Mental State Examination (MMSE) and CDR highly influenced FLSA score (P< 0.0001); FLSA was highly correlated with another performance measure (the Direct Assessment of Functional Status; P=0.821), and with the Instrumental Activity of Daily Living (IADL) scale (P=-0.612), while no significant correlation was present with the Geriatric Depression Scale.

CONCLUSION

FLSA evidences construct, concurrent and discriminative validity. We suggest that this tool could be possibly useful when a high sensibility to different levels of functional impairment is needed, as evaluation of treatment efficacy (both non-pharmacological and pharmacological) identification of relatively intact functional areas to plan cognitive rehabilitation, and confirmation of dementia in the initial phase when there are doubts about functional decline.

Frequency and clinical features of Lewy body dementia in Italian memory clinics

BACKGROUND

The latest developments in Lewy Body Dementia (DLB) raise some controversies on clinical features, neuroimaging and therapy. The aim of our study is to determine clinical, neuropsychological, neuroimaging and EEG profile of DLB through retrospective and prospective data of 102 patients.

METHODS

data were collected with an analytical form that was developed by an expertise of neurologists.

RESULTS

DLB represented 4.8% of the dementia population, with no sex difference. Family history of dementia was common (24.5%), while familiarity for parkinsonism was rare (4.9%). Cognitive disturbances were the predominant clinical presentation at onset (49%), followed by behavioral symptoms (29.4%) and parkinsonism (21.6%). Clinical features at consultation were: memory disturbances (almost all cases), symmetrical (68.6%) or asymmetrical (18.6%) parkinsonism, cognitive fluctuations (49%), visuospatial deficits (53.9%), and visual hallucinations (44.1%). Autonomic signs were present in a third of the cases, while sleep disorders were present in 44.1%. Some clinical response to antiparkinsonian drugs was evident in half of the cases. MRI, SPET, EEG and Neuropsychiatric Inventory data were available in a subgroup of patients.

CONCLUSIONS

Most of our data were in accordance with the previous literature. However, some data underline the relationship between DLB, Alzheimer's and Parkinson's disease.

Functional brain changes in early Parkinson's disease during motor response and motor inhibition

Motor impairment represents the main clinical feature of Parkinson's disease (PD). Cognitive deficits are also frequently observed in patients with PD, with a prominent involvement of executive functions and visuo-spatial abilities. We used event-related functional MRI (fMRI) and a paradigm based on visual attention and motor inhibition (Go/NoGO-task) to investigate brain activations in 13 patients with early PD in comparison with 11 healthy controls. The two groups did not report behavioural differences in task performance. During motor inhibition (NoGO-effect), PD patients compared to controls showed an increased activation in the prefrontal cortex and in the basal ganglia. They also showed a reduced and less coherent hemodynamic response in the occipital cortex. These results indicate that specific cortico-subcortical functional changes, involving not only the fronto-striatal network but also the temporal-occipital cortex, are already present in patients with early PD and no clinical evidence of cognitive impairment. We discuss our findings in terms of compensatory mechanisms (fronto-striatal changes) and preclinical signs of visuo-perceptual deficits and visual hallucinations.

Nonequilibrium spin-glass dynamics from picoseconds to a tenth of a second

We study numerically the nonequilibrium dynamics of the Ising spin glass, for a time spanning 11 orders of magnitude, thus approaching the experimentally relevant scale (i.e., seconds). We introduce novel analysis techniques to compute the coherence length in a model-independent way. We present strong evidence for a replicon correlator and for overlap equivalence. The emerging picture is compatible with noncoarsening behavior.

Efficacy of recreational and occupational activities associated to psychologic support in mild to moderate Alzheimer disease: a multicenter controlled study

We evaluated the efficacy of a stimulation program mainly based on recreational and occupational activities, associated with a brief cycle of support psychotherapy for patients and caregivers, in mild to moderate Alzheimer Disease (AD) associated or not with cerebrovascular lesions. Sixty-seven patients and 31 controls from 2 Italian towns entered the study. The control group was comprised of AD subjects who voluntarily declined to participate in the program for practical reasons. Patients were divided in groups of 4 subjects: treatment was delivered for 6 weeks. Multidimensional efficacy assessment of functional, behavioral, and neuropsychologic aspects was performed. When comparing baseline with posttraining condition, patients displayed a substantial reduction in disruptive behavior, and a tendency to a general reduction of behavioral symptoms compared with controls (Revised Memory and Behavior Problems Checklist--RMBPC--symptoms frequency-total P=0.07; frequency of disruptive behavior P=0.008). This reduction was mirrored by a significant reduction of caregiver reaction to behavioral disturbances (RMBPC caregiver reaction-total P=0.035; reaction to disruptive behavior, P=0.011). At 3 months follow-up, the reduction of caregiver reaction to behavioral symptoms results was confirmed (RMBPC caregiver reaction-total P=0.014, caregiver reaction to disruptive behavior P=0.028). No other significant difference was detected. These results partially confirm findings of previous studies, showing that AD patients treated with similar techniques demonstrated an improvement in behavioral disturbances.

Specific Impairments of Selective Attention in Mild Alzheimer’s Disease

The aim of the present study was to evaluate selective visual attention in subjects affected by Alzheimer's Disease (AD), by means of a computerized spatial exploration test that adopts a Touch Screen (TS) interface, which has already proved able to characterize alternative strategies in performing search tasks. We assessed a group of 16 patients affected by mild to moderate AD, comparing them with 16 control subjects matched for age and education. In the experimental tasks the performance of the AD patients was worse than that of the normal elderly, both quantitatively (slower speeds) and qualitatively (poorer planning and higher number of omissions and perseverations). In the visual attention tasks there appeared to be no close connection between AD patients' performance and increased Reaction Times (RT); this evidenced a specific role of non-elementary cognitive structures enclosed in a higher attentional domain, rather than a general decrease in the speed of basic cognitive processes. Our results are in line with specific AD literature: while psychomotor speed and lower attention levels (sensorimotor) are preferentially impaired in subcortical forms of dementia, the higher levels of selective and divided attention could be the first to deteriorate and appear more markedly disrupted in the Alzheimer type of dementia.

Evaluating two group programmes of cognitive training in mild-to-moderate AD: is there any difference between a 'global' stimulation and a 'cognitive-specific' one?

This study evaluated the efficacy of two different group procedures of non-pharmacological treatment in mild-to-moderate Alzheimer's disease (AD). Thirty-two patients entered the study and were divided in groups of four subjects. We compared recreational activities ('global' stimulation) with a combination of procedural memory training on activities of daily living and neuropsychological rehabilitation of 'residual' functions ('cognitive-specific'). All patients and caregivers were ensured psychological support. Both group treatments were delivered for six weeks. Multidimensional efficacy assessment of functional, behavioural and neuropsychological aspects was performed. Patients receiving 'global' stimulation showed a substantial reduction in behavioural disturbances (Neuropsychiatric Inventory [NPI]: frequency p = 0.034; severity p = 0.012); Revised Memory Behaviour Problems Checklist (frequency p = 0.008; reaction p = 0.027), and better performance in the Functional Living Skills Assessment (FLSA), a standardized direct measure of performance in everyday life (p = 0.021) and Verbal Fluency for Letters (p = 0.000). Patients receiving 'cognitive-specific' treatment improved only on the scale evaluating functional competence in daily living (Nurses' Observation Scale for Geriatric Patients [NOSGER] p = 0.018). At follow-up (six months later), compared with baseline, patients following the 'global' stimulation treatment showed an improvement at caregiver distress on NPI (p = 0.04). No other significant difference was detected. Our results support the contention that a 'global' treatment can lead to a significant improvement in AD patients, both for behavioural and functional aspects. The 'cognitive-specific' treatment we used in this research did not show better efficacy.

L-Propionil Carnitine (LPC) is a Propionic Outcome of Carnitine

L-Propionil Carnitine (LPC) is a propionic derivative of Carnitine. It enhances mitochondrial activity, fat acids and free radical metabolism; it could therefore prove effective in preventing chronic oxidative diseases such as Cavernous fibrosis, which results essentially from an increase in endothelin, and a decrease in nitric oxide (NO) and prostaglandins (PGEi), as it occurs with hypoxia.

An incidence of about 15% of segmentary cavernous fibrosis is reported as a consequence of, at least, a 72-hour catheterization. The physiopathology of the syndrome is still uncertain, but strongly related to vasculitis.

We carried out a 15-month double-blind, prospective, randomized placebo-control study on 240 patients (age range: 42–68 years) on the possibility of preventing fìbrosis through LPC; study follow-up at 6 months, drug dose: 2g/day p.o.

Cavernous fibrosis was reported in 11% of LPC treated patients, and 14% of the placebo group (p = l).

Any kind of prevention, even if with poor outcomes as in our experience, should be usefully considered and improved.

Brain tissue damage in dementia with Lewy bodies: an in vivo diffusion tensor MRI study

The aim of the present study was to apply diffusion tensor MRI (DT-MRI), a quantitative MRI measure which reflects tissue organization, to dementia with Lewy bodies (DLB). DT-MRI scans were obtained from 15 patients with probable DLB and 10 sex- and age-matched healthy controls. Abnormalities were found in the corpus callosum, pericallosal areas and the frontal, parietal, occipital and, less prominently, temporal white matter of patients compared with controls. Abnormalities were also found in the caudate nucleus and the putamen. The average grey matter volume was lower in patients than in controls. These findings of concomitant grey matter atrophy and white matter abnormalities (as detected by DT-MRI) in regions with a high prevalence of long connecting fibre tracts might suggest the presence of neurodegeneration involving associative cortices. The modest involvement of the temporal lobe fits with the relative preservation of global neuropsychological measures and memory tasks in the early stage of DLB. The selective involvement of parietal, frontal and occipital lobes might explain some of the clinical and neuropsychological features of DLB, providing a possible distinctive marker for this disease. The abnormalities found in the subcortical grey matter may indicate that DLB and Parkinson's disease share a similar nigrostriatal involvement caused by common pathophysiological mechanisms.