Levodopa-carbidopa intestinal gel infusion (LCIG) in Parkinson disease with genetic mutations

BACKGROUND

Levodopa-carbidopa intestinal gel infusion (LCIG) is a therapeutic option for advanced Parkinson disease (PD) patients with troublesome motor complications, unresponsive to conventional oral treatment. There is some evidence to suggest that the genetic background may influence the clinical presentation and rate of progression of PD. Whether the genetic background influences the outcome of device-assisted therapies is currently debated. Some studies have investigated the effectiveness of deep brain stimulation (DBS) in PD patients with different genetic background, while evidence is lacking regarding LCIG.

METHODS

A cohort of LCIG patients underwent genetic testing. The motor and neuropsychological outcomes of LCIG were retrospectively analyzed.

RESULTS

Fifty-six patients were analyzed, nine of them (15%) had at least one mutation/variant in a PD-associated gene: five GBA1, two SNCA, one LRRK2, one PRKN; 13 (23%) carried the BDNF Val66Met polymorphism. The mean duration of follow-up was 4.9 ± 2.6 years. There were no significant differences in motor or neuropsychological outcomes between patients with and without these gene mutations/variants. No cognitive worsening was observed at follow-up among GBA-PD patients, and they responded well to LCIG in terms of motor symptoms.

CONCLUSIONS

Overall, we observed a significant benefit in terms of motor complications in our cohort, including patients carrying genetic mutations/variants. Due to the small sample and limited number of patients carrying genetic mutations/variants, no definitive conclusions can be drawn yet on the genotype impact on LCIG outcome. A careful selection of patients, regardless of the genetic background, is pivotal for an optimal outcome of LCIG.

An overview on pure autonomic failure

Pure autonomic failure (PAF) is a neurodegenerative disease affecting the sympathetic component of the autonomic nervous system and presenting as orthostatic hypotension (OH). It is a rare, sporadic disease of adults. Although OH is the primary symptom, the autonomic dysfunction may be more generalised, leading to genitourinary and intestinal dysfunction and sweating disorders. Autonomic symptoms in PAF may be similar to those observed in other autonomic neuropathies that need to be ruled out. PAF belongs to the group of α synucleinopathies and is characterised by predominant peripheral deposition of α-synuclein in autonomic ganglia and nerves. However, in a significant number of cases, PAF may convert into another synucleinopathy with central nervous system involvement with varying prognosis: Parkinson's disease (PD), multiple system atrophy (MSA), or dementia with Lewy bodies (DLB). The clinical features, the main differential diagnoses, the risk factors for "phenoconversion" to another synucleinopathy as well as an overview of treatment will be discussed.

Selenite ameliorates the ATP hydrolysis of mitochondrial F1FO-ATPase by changing the redox state of thiol groups and impairs the ADP phosphorylation

Selenite as an inorganic form of selenium can affect the redox state of mitochondria by modifying the thiol groups of cysteines. The F1FO-ATPase has been identified as a mitochondrial target of this compound. Indeed, the bifunctional mechanism of ATP turnover of F1FO-ATPase was differently modified by selenite. The activity of ATP hydrolysis was stimulated, whereas the ADP phosphorylation was inhibited. We ascertain that a possible new protein adduct identified as seleno-dithiol (-S-Se-S-) mercaptoethanol-sensitive caused the activation of F-ATPase activity and the oxidation of free -SH groups in mitochondria. Conversely, the inhibition of ATP synthesis by selenite might be irreversible. The kinetic analysis of the activation mechanism was an uncompetitive mixed type with respect to the ATP substrate. Selenite bound more selectively to the F1FO-ATPase loaded with the substrate by preferentially forming a tertiary (enzyme-ATP-selenite) complex. Otherwise, the selenite was a competitive mixed-type activator with respect to the Mg2+ cofactor. Thus, selenite more specifically bound to the free enzyme forming the complex enzyme-selenite. However, even if the selenite impaired the catalysis of F1FO-ATPase, the mitochondrial permeability transition pore phenomenon was unaffected. Therefore, the reversible energy transduction mechanism of F1FO-ATPase can be oppositely regulated by selenite.

Two separate pathways underlie NADH and succinate oxidation in swine heart mitochondria: Kinetic evidence on the mobile electron carriers

We have investigated NADH and succinate aerobic oxidation in frozen and thawed swine heart mitochondria. Simultaneous oxidation of NADH and succinate showed complete additivity under a variety of experimental conditions, suggesting that the electron fluxes originating from NADH and succinate are completely independent and do not mix at the level of the so-called mobile diffusible components. We ascribe the results to mixing of the fluxes at the level of cytochrome c in bovine mitochondria: the Complex IV flux control coefficient in NADH oxidation was high in swine mitochondria but very low in bovine mitochondria, suggesting a stronger interaction of cytochrome c with the supercomplex in the former. This was not the case in succinate oxidation, in which Complex IV exerted little control also in swine mitochondria. We interpret the data in swine mitochondria as restriction of the NADH flux by channelling within the I-III₂-IV supercomplex, whereas the flux from succinate shows pool mixing for both Coenzyme Q and probably cytochrome c. The difference between the two types of mitochondria may be ascribed to different lipid composition affecting the cytochrome c binding properties, as suggested by breaks in Arrhenius plots of Complex IV activity occurring at higher temperatures in bovine mitochondria.

The inhibition of gadolinium ion (Gd3+) on the mitochondrial F1FO-ATPase is linked to the modulation of the mitochondrial permeability transition pore

The mitochondrial permeability transition pore (PTP), which drives regulated cell death when Ca²⁺ concentration suddenly increases in mitochondria, was related to changes in the Ca²⁺-activated F₁F_O-ATPase. The effects of the gadolinium cation (Gd³⁺), widely used for diagnosis and therapy, and reported as PTP blocker, were evaluated on the F₁F_O-ATPase activated by Mg²⁺ or Ca²⁺ and on the PTP. Gd³⁺ more effectively inhibits the Ca²⁺-activated F₁F_O-ATPase than the Mg²⁺-activated F₁F_O-ATPase by a mixed-type inhibition on the former and by uncompetitive mechanism on the latter. Most likely Gd³⁺ binding to F₁, is favoured by Ca²⁺ insertion. The maximal inactivation rates (k_inact) of pseudo-first order inactivation are similar either when the F₁F_O-ATPase is activated by Ca²⁺ or by Mg²⁺. The half-maximal inactivator concentrations (K_I) are 2.35 ± 0.35 mM and 0.72 ± 0.11 mM, respectively. The potency of a mechanism-based inhibitor (k_inact/K_I) also highlights a higher inhibition efficiency of Gd³⁺ on the Ca²⁺-activated F₁F_O-ATPase (0.59 ± 0.09 mM^-1∙s^-1) than on the Mg²⁺-activated F₁F_O-ATPase (0.13 ± 0.02 mM^-1∙s^-1). Consistently, the PTP is desensitized in presence of Gd³⁺. The Gd³⁺ inhibition on both the mitochondrial Ca²⁺-activated F₁F_O-ATPase and the PTP strengthens the link between the PTP and the F₁F_O-ATPase when activated by Ca²⁺ and provides insights on the biological effects of Gd³⁺.

Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative mini-invasive approach

Background

Interstitial localisation of ectopic pregnancy is associated with high rates of maternal morbidity and mortality. Considering the rarity of interstitial pregnancy, the optimal treatment regimen remains unclear. We propose the management of interstitial pregnancy with local methotrexate injection using a combined hysteroscopic and ultrasonographic approach.

Technique

Hysteroscopy was performed under local anaesthesia in the operating room, using a 2.9-mm Hopkins II Forward-Oblique Telescope 30° endoscope with a 4.3-mm inner sheath and 5 FR instruments. A needle was pushed into the cornual region injecting methotrexate solution directly into the gestational sac and into the myometrial tissue tangentially at the four cardinal points. A contemporary transabdominal ultrasound (US) was performed in order to reduce risks of complications.

Experience

Five patients with an US diagnosis of interstitial ectopic pregnancy admitted to our department between January 2016 and September 2019 were managed with a local hysteroscopic injection of methotrexate. The technique was effective in all patients and no surgical complications occurred during or after the procedure. Three patients were evaluated for tubal patency with contrast ultrasonography confirming bilateral tubal patency 9 months from treatment, while one patient had a spontaneous birth 22 months from their initial surgery.

Conclusion

The hysteroscopic ultrasound-guided approach combined with the local injection of methotrexate is a minimally invasive conservative approach that seems to be promising in the management of interstitial ectopic pregnancy.

Sulfide affects the mitochondrial respiration, the Ca2+-activated F1FO-ATPase activity and the permeability transition pore but does not change the Mg2+-activated F1FO-ATPase activity in swine heart mitochondria

In mammalian cells enzymatic and non-enzymatic pathways produce H₂S, a gaseous transmitter which recently emerged as promising therapeutic agent and modulator of mitochondrial bioenergetics. To explore this topic, the H₂S donor NaHS, at micromolar concentrations, was tested on swine heart mitochondria. NaHS did not affect the F₁F_O-ATPase activated by the natural cofactor Mg², but, when Mg²⁺ was replaced by Ca²⁺, a slight 15% enzyme inhibition at 100 µM NaHS was shown. Conversely, both the NADH-O₂ and succinate-O₂ oxidoreductase activities were totally inhibited by 200 μM NaHS with IC₅₀ values of 61.6 ± 4.1 and 16.5 ± 4.6 μM NaHS, respectively. Since the mitochondrial respiration was equally inhibited by NaHS at both first or second respiratory substrates sites, the H₂S generation may prevent the electron transfer from complexes I and II to downhill respiratory chain complexes, probably because H₂S competes with O₂ in complex IV, thus reducing membrane potential as a consequence of the cytochrome c oxidase activity inhibition. The Complex IV blockage by H₂S was consistent with the linear concentration-dependent NADH-O₂ oxidoreductase inhibition and exponential succinate-O₂ oxidoreductase inhibition by NaHS, whereas the coupling between substrate oxidation and phosphorylation was unaffected by NaHS. Even if H₂S is known to cause sulfhydration of cysteine residues, thiol oxidizing (GSSG) or reducing (DTE) agents, did not affect the F₁F_O-ATPase activities and mitochondrial respiration, thus ruling out any involvement of post-translational modifications of thiols. The permeability transition pore, the lethal channel which forms when the F₁F_O-ATPase is stimulated by Ca²⁺, did not open in the presence of NaHS, which showed a similar effect to ruthenium red, thus suggesting a putative Ca²⁺ transport cycle inhibition.

Mitochondrial F1FO-ATPase and permeability transition pore response to sulfide in the midgut gland of Mytilus galloprovincialis

The molecular mechanisms which rule the formation and opening of the mitochondrial permeability transition pore (mPTP), the lethal mechanism which permeabilizes mitochondria to water and solutes and drives the cell to death, are still unclear and particularly little investigated in invertebrates. Since Ca²⁺ increase in mitochondria is accompanied by mPTP opening and the participation of the mitochondrial F₁F_O-ATPase in the mPTP is increasingly sustained, the substitution of the natural cofactor Mg²⁺ by Ca²⁺ in the F₁F_O-ATPase activation has been involved in the mPTP mechanism. In mussel midgut gland mitochondria the similar kinetic properties of the Mg²⁺- or Ca²⁺-dependent F₁F_O-ATPase activities, namely the same affinity for ATP and bi-site activation kinetics by the ATP substrate, in spite of the higher enzyme activity and coupling efficiency of the Mg²⁺-dependent F₁F_O-ATPase, suggest that both enzyme activities are involved in the bioenergetic machinery. Other than being a mitochondrial poison and environmental contaminant, sulfide at low concentrations acts as gaseous mediator and can induce post-translational modifications of proteins. The sulfide donor NaHS, at micromolar concentrations, does not alter the two F₁F_O-ATPase activities, but desensitizes the mPTP to Ca²⁺ input. Unexpectedly, NaHS, under the conditions tested, points out a chemical refractoriness of both F₁F_O-ATPase activities and a failed relationship between the Ca²⁺-dependent F₁F_O-ATPase and the mPTP in mussels. The findings suggest that mPTP role and regulation may be different in different taxa and that the F₁F_O-ATPase insensitivity to NaHS may allow mussels to cope with environmental sulfide.

Morningness-eveningness preference and sensation seeking

The aim of this study was to explore the relationship between circadian preference and sensation seeking. To this aim 1041 university students (408 males and 633 females), ranging in age between 18 and 30 years, filled the reduced version of the Morningness-Eveningness Questionnaire (MEQr) and the Sensation Seeking Scale-Form V (SSS-V). Males scored higher than females in SSS-V total score and all subscales, except experience seeking (ES). As regards circadian preference, evening types scored higher than morning types in SSS-V total score and all subscales, except boredom susceptibility (BS) where they significantly differed only from intermediate types. On the whole our results highlight a significant relationship between circadian preference and sensation seeking.

Mitochondrial Ca2+ -activated F1 FO -ATPase hydrolyzes ATP and promotes the permeability transition pore

The properties of the mitochondrial F₁ F_O -ATPase catalytic site, which can bind Mg²⁺ , Mn²⁺ , or Ca²⁺ and hydrolyze ATP, were explored by inhibition kinetic analyses to cast light on the Ca²⁺ -activated F₁ F_O -ATPase connection with the permeability transition pore (PTP) that initiates cascade events leading to cell death. While the natural cofactor Mg²⁺ activates the F₁ F_O -ATPase in competition with Mn²⁺ , Ca²⁺ is a noncompetitive inhibitor in the presence of Mg²⁺ . Selective F₁ inhibitors (Is-F₁ ), namely NBD-Cl, piceatannol, resveratrol, and quercetin, exerted different mechanisms (mixed and uncompetitive inhibition) on either Ca²⁺ - or Mg²⁺ -activated F₁ F_O -ATPase, consistent with the conclusion that the catalytic mechanism changes when Mg²⁺ is replaced by Ca²⁺ . In a partially purified F₁ domain preparation, Ca²⁺ -activated F₁ -ATPase maintained Is-F₁ sensitivity, and enzyme inhibition was accompanied by the maintenance of the mitochondrial calcium retention capacity and membrane potential. The data strengthen the structural relationship between Ca²⁺ -activated F₁ F_O -ATPase and the PTP, and, in turn, on consequences, such as physiopathological cellular changes.

Dissection of DLBCL microenvironment provides a gene expression-based predictor of survival applicable to formalin-fixed paraffin-embedded tissue

Background

Gene expression profiling (GEP) studies recognized a prognostic role for tumor microenvironment (TME) in diffuse large B-cell lymphoma (DLBCL), but the routinely adoption of prognostic stromal signatures remains limited.

Patients and methods

Here, we applied the computational method CIBERSORT to generate a 1028-gene matrix incorporating signatures of 17 immune and stromal cytotypes. Then, we carried out a deconvolution on publicly available GEP data of 482 untreated DLBCLs to reveal associations between clinical outcomes and proportions of putative tumor-infiltrating cell types. Forty-five genes related to peculiar prognostic cytotypes were selected and their expression digitally quantified by NanoString technology on a validation set of 175 formalin-fixed, paraffin-embedded DLBCLs from two randomized trials. Data from an unsupervised clustering analysis were used to build a model of clustering assignment, whose prognostic value was also assessed on an independent cohort of 40 cases. All tissue samples consisted of pretreatment biopsies of advanced-stage DLBCLs treated by comparable R-CHOP/R-CHOP-like regimens.

Results

In silico analysis demonstrated that higher proportion of myofibroblasts (MFs), dendritic cells, and CD4⁺ T cells correlated with better outcomes and the expression of genes in our panel is associated with a risk of overall and progression-free survival. In a multivariate Cox model, the microenvironment genes retained high prognostic performance independently of the cell-of-origin (COO), and integration of the two prognosticators (COO + TME) improved survival prediction in both validation set and independent cohort. Moreover, the major contribution of MF-related genes to the panel and Gene Set Enrichment Analysis suggested a strong influence of extracellular matrix determinants in DLBCL biology.

Conclusions

Our study identified new prognostic categories of DLBCL, providing an easy-to-apply gene panel that powerfully predicts patients’ survival. Moreover, owing to its relationship with specific stromal and immune components, the panel may acquire a predictive relevance in clinical trials exploring new drugs with known impact on TME.

Levodopa/carbidopa intestinal gel infusion and weight loss in Parkinson's disease

BACKGROUND AND PURPOSE

Weight loss (WL) is a frequent yet under-recognized complication of levodopa/carbidopa intestinal gel (LCIG) infusion, as well as a milestone of Parkinson's disease (PD) disability progression. The complex association between WL, poor nutritional status, motor complications and PD progression, however, remains unclear.

METHODS

Consecutive consenting patients with PD treated with LCIG (n = 44; PD duration, 18.3 ± 6.5 years) were enrolled in an open-label observational study assessing the extent of WL occurring during LCIG treatment. As secondary aims, we correlated the nutritional status, as detected by the Mini Nutritional Assessment, with the severity of motor symptoms [Movement Disorder Society Unified Parkinson's Disease Rating Scale part III], motor complications (Unified Parkinson's Disease Rating Scale part IV), activities of daily living (Schwab and England scale), cognitive impairment (Mini Mental State Examination), depression (Beck Depression Inventory), difficulties in feeding (Edinburgh Feeding Evaluation in Dementia Questionnaire) and levodopa equivalent daily dose (LEDD).

RESULTS

There was an average WL of 9.9 ± 10.5% (7.6 ± 7.1 kg) over an LCIG treatment period of 51.6 ± 28.5 months. The extent of WL correlated with the percentage of the waking day spent with dyskinesia (P < 0.05). The nutritional status correlated with motor symptom severity (P < 0.01), dysphagia (P < 0.01) and LEDD (P < 0.01).

CONCLUSIONS

Weight loss may occur in patients with PD undergoing LCIG in correlation with the percentage of the waking day spent with dyskinesia. Regardless of the extent of WL, the nutritional status correlated with higher LEDD, as well as with indices of disease progression, such as motor symptom severity and dysphagia.

Tumor Infiltrating Lymphocytes and Continuous Infusion Interleukin-2 after Metastasectomy in 61 Patients with Melanoma, Colorectal and Renal Carcinoma

AIMS AND BACKGROUND

Adoptive immunotherapy with tumor infiltrating lymphocyte (TIL) reinfusion plus continuous interleukin-2 (IL-2) infusion could represent an innovative way of treating immunogenic tumors. This study therefore recruited melanoma, colorectal and renal carcinoma patients whose metastases had been surgically removed.

STUDY DESIGN

The treatment was initially given to 22 patients with advanced disease and more recently to 39 disease-free (DF) patients after radical metastasectomy. The latter group was selected in view of a theoretically better lymphocyte/tumor cell ratio and with the aim to improve disease-free and overall survival (DFS-OS) in very high risk patients. The starting IL-2 dose was 12 MIU/day (West's schedule); doses were modulated on the bases of toxicity parameters. Even though patients received different total amounts of IL-2, all of them completed the treatment.

RESULTS

The treatment was offered to 22 advanced-stage cancer patients (12 melanomas, 9 colorectal carcinomas, 1 kidney carcinoma). Few and short stabilizations were observed with a median survival of 12 months (range, 3-29). Subsequently, another 39 patients were treated in an adjuvant setting after radical metastasectomy (18 melanomas, 19 colorectal carcinomas, 2 kidney cancers). Eleven out of 17 DF melanoma patients (64.7%) are still free of disease after a median of 37+ months (range, 5+ - 69+). In the group of DF colorectal cancer patients eight (44.4%) are still DF after a median of 21+ months (range, 7+ - 67+ months). One of the two patients with kidney cancer is still DF after 28+ months. Two patients (1 melanoma and 1 colorectal cancer) had just been treated and were therefore not evaluable. Severe toxicity occurred in three cases but was rapidly resolved. There was a great diversity in IL-2 doses administered; comparison of the total IL-2 dose administered between the patients who are still DF and those who progressed revealed no difference between the two groups of colorectal cancer patients, whereas melanoma patients who progressed received an average IL-2 dose of 6.5 MIU/day versus 15.8 MIU/day in DF patients. No differences were observed in any of the groups between the number of TILs reinfused and clinical response.

CONCLUSIONS

The study is still ongoing; it has been decided to focus on DF melanoma patients after radical metastasectomy, for whom the data seem to be encouraging. Further endpoints of the study are the role of IL-2 dosage in the adjuvant setting, and the possibility to make correlations between biological parameters and clinical results.

The effect of subscapularis tenotomy in athletes operated on for recurrent anterior shoulder dislocation

PURPOSE

Some authors consider preservation of the subscapularis tendon as one of the most important elements for a successful long-term outcome in patients operated on with open capsulorrhaphy for recurrent anterior shoulder dislocation. The purpose of this study was to evaluate whether vertical tenotomy of the subscapularis tendon might affect internal rotation strength recovery in patients operated on with open capsulorrhaphy for recurrent anterior shoulder dislocation.

METHODS

Ninety-six patients were retrospectively followed up at a mean of 72.5 months. They underwent clinical evaluation, Rowe and Walch-Duplay scoring scales, the Visual Analog Scale (VAS), and dynamometric measurements (side-to-side) of internal and external rotation, forward elevation, and abduction. All patients were athletes: 25% were practising risk-free sports, 44% contact sports, 14.5% sports with cocking of the arm, and 14.5% high-risk sports activities.

RESULTS

Five (5.2%) recurrences were registered, and all patients returned to pre-operative sports activity. The Rowe score was 98.12, the Walch-Duplay score 92.25, and the VAS score 0.1. Dynamometric assessment showed no significant differences (side-to-side) in internal rotation (p = 0.34), external rotation (p = 0.9), flexion (p = 0.7), and abduction (p = 0.7). Dominant arms showed better results than non-dominant arms (p < 0.01).

CONCLUSION

Complete tenotomy of the subscapularis tendon does not seem to negatively affect internal rotation strength recovery or external rotation movement in athletes.

Bone marrow failure may be caused by chromosome anomalies exerting effects on RUNX1T1 gene

Background

The majority of the cases of bone marrow failure syndromes/aplastic anaemias (BMFS/AA) are non-hereditary and considered idiopathic (80–85%). The peripheral blood picture is variable, with anaemia, neutropenia and/or thrombocytopenia, and the patients with idiopathic BMFS/AA may have a risk of transformation into a myelodysplastic syndrome (MDS) and/or an acute myeloid leukaemia (AML), as ascertained for all inherited BMFS. We already reported four patients with different forms of BMFS/AA with chromosome anomalies as primary etiologic event: the chromosome changes exerted an effect on specific genes, namely RUNX1, MPL, and FLI1, leading to the disease.

Results

We report two further patients with non-hereditary BM failure, with diagnosis of severe aplastic anaemia and pancytopenia caused by two different constitutional structural anomalies involving chromosome 8, and possibly leading to the disorder due to effects on the RUNX1T1 gene, which was hypo-expressed and hyper-expressed, respectively, in the two patients. The chromosome change was unbalanced in one patient, and balanced in the other one.

Conclusions

We analyzed the sequence of events in the pathogenesis of the disease in the two patients, including a number of non-haematological signs present in the one with the unbalanced anomaly. We demonstrated that in these two patients the primary event causing BMFS/AA was the constitutional chromosome anomaly. If we take into account the cohort of 219 patients with a similar diagnosis in whom we made cytogenetic studies in the years 2003–2017, we conclude that cytogenetic investigations were instrumental to reach a diagnosis in 52 of them. We postulate that a chromosome change is the primary cause of BMFS/AA in a not negligible proportion of cases, as it was ascertained in 6 of these patients.

Electronic supplementary material

The online version of this article (10.1186/s13039-017-0352-2) contains supplementary material, which is available to authorized users.

Health self-perception in patient with Crohn's disease: a web survey

BACKGROUND

Crohn's Disease (CD) has an incidence on the physical and psychological autonomy of the patient, such as to alter their daily life. The impact of the disease on the daily life of the patients is related to the symptoms and complications of the disease. Patient autonomy and participation in social and work life are the goals that nurses must reach for patients with CD to improve their quality of life.

AIM

To measure the perception of the health of people with a diagnosis of CD.

METHOD

Review of the literature on PubMed, and internet sites. Administration on the web of the standardised questionnaire Short Form Health Survey (SF-12).

RESULTS

A total of 228 patients with CD completed valid questionnaires and were enrolled. The SF-12 questionnaire scores make it possible to build a physical health index (PCS) with a median value of 36,10 (min 33,8; max 42,4) and mental health index (MCS) with a median value of 36,04 (min 28.5; max 38,4). There were statistically significant data related to the achievement of the degree with median 41.9 (min 35,1; max 48,4) compared to non-graduates with a p<0.001 and in relation to the employment level (median 37.9 min/max 34,7/46,7) compared to unemployed and inactive with a p = 0.03.

CONCLUSION

Despite the inevitable complications of the disease (intestinal and extra-intestinal symptoms), most of our sample did not exhibit significant physical limitations (surgical intervention, stomach packaging which generally causes a decrease in libido in both male and female patients ). The nurse cares for a patient with CD must have not only technical skills and specialist skills, but a holistic vision of the patient. Despite some findings in this study, this research orientation deserves more attention.

Anterolateral ligament reconstruction with autologous grafting: A biomechanical study

BACKGROUND

To evaluate the reliability of the Iliotibial band compared to gracilis tendon as a graft to be used in anterolateral ligament reconstruction.

METHODS

Gracilis tendon and a strip of Iliotibial band compared were harvested from 8 fresh human cadaveric knees. The gracilis tendon was prepared to obtain a graft of 10cm in length (Group 1). Iliotibial band compared was prepared to obtain a graft of 10cm in length and 0.5cm in width from the middle portion (Group 2). All the specimens were fixed on a servo hydraulic tensile machine with dedicated cryo-clamp. The loading protocol, used to compare the previously published results of ultimate failure load and Stiffness of the anterolateral ligament (Group 3), included a cyclic preconditioning between 10 and 25N at 0.1Hz for 10cycles and then a load to failure test at 20mm/min.

FINDINGS

Gracilis tendon showed higher Ultimante Failure Load and stiffness when compared to a strip of Iliotibial band. Gracilis tendon and a strip of Iliotibial band compared showed higher Ultimante Failure Load and stiffness when compared with native anterolateral ligament as reported by Kennedy.

INTERPRETATION

Both grafts tested in the present studies are suitable for an anatomical anterolateral ligament reconstruction.

The association between higher body mass index and poor school performance in high school students

BACKGROUND/OBJECTIVE

This study aimed to examine the association between body mass index (BMI) and school performance in high school students by controlling for relevant mediators such as sleep quality, sleep duration and socioeconomic status.

METHODS

Thirty-seven high school students (mean age: 18.16 ± 0.44 years) attending the same school type, i.e. 'liceo scientifico' (science-based high school), were enrolled. Students' self-reported weight and height were used to calculate BMI. Participants wore an actigraph to objectively assess the quality and duration of sleep. School performance was assessed through the actual grade obtained at the final school-leaving exam, in which higher grades indicate higher performance.

RESULTS

BMI, get-up time, mean motor activity, wake after sleep onset and number of awakenings were negatively correlated with the grade, while sleep efficiency was positively correlated. When performing a multiple regression analysis, BMI proved the only significant (negative) predictor of grade.

CONCLUSIONS

When controlling for sleep quality, sleep duration and socioeconomic status, a higher BMI is associated with a poorer school performance in high school students.

Hypertensive Encephalopathy: Clinical and Neuroradiological Findings

Hypertensive encephalopathy is a syndrome consisting of headache, seizures, visual changes, and other neurologic disturbances in patients with elevated systemic blood pressure. The purpose of this study was to analyse the clinical and neuroradiological findings in nine patients with hypertensive encephalopathy, observed in five years.

CT (n = 13), and MR (n = 12), examinations performed in these patients before and after resolution of symptoms were reviewed. Six had the preeclampsia-eclampsia syndrome, and three had hypertensive encephalopathy due to other causes. CT and MR findings in all patients having these examinations were indicative of oedema in the cortex and subcortical white matter in the occipital lobes. Two of the nine patients also had similar findings in the cerebellum and frontal lobes.

The findings on the CT and MR studies resolved on follow-up examinations performed after the hypertension was corrected.

Our results suggest that the radiological findings associated with hypertensive encephalopathy in the appropriate clinical setting are very useful to achieve an early diagnosis.

Muscle atrophy and fatty infiltration in rotator cuff tears: Can surgery stop muscular degenerative changes?

BACKGROUND

Rotator cuff tears are closely related with muscle atrophy and fatty infiltration and both affect healing after surgical treatment. The aim of this study was to compare surgical versus conservative management of medium-to-large reparable rotator cuff tears.

METHODS

Forty-one patients with clinical and radiological (MRI) diagnosis of medium-to-large rotator cuff tears were retrospectively identified and divided into two groups: Group A, arthroscopic repair; Group B, conservative treatment. At follow-up (T1) all patients underwent a new clinical (VAS, SST, Constant and Relative Constant Scale) and radiological evaluation (MRI).

RESULTS

When comparing the two groups at T1 (mean follow-up: Group A, 50 months; Group B, 61 months), we registered better results in Group A in the SST (p < 0.05), the VAS score (p < 0.01), the Constant and the Relative Constant Scale (p < 0.05). Radiological evaluation did not show a significant increase of fatty infiltration (p = 0.16) in Group A (no progression in 15 out of 17 patients -82.3%-, and an increase in 2 out of 17 patients -11.7%-), while in Group B a significant increase was detected (p < 0.01) in all patients; in regard to muscle atrophy, no cases of progression were detected in Group A (4 out of 17 patients -23.5%- showed an increased post-operative supraspinatus trophysm), while a significant worsening (p < 0.05) was found in Group B. In Group B a significant worsening of tendon retraction (p < 0.01) and of tear size (p = 0.01) was also detected.

CONCLUSIONS

Surgical treatment of complete rotator cuff tears seems to decrease the irreversible changes that involve muscle belly.

Lipid unsaturation per se does not explain the physical state of mitochondrial membranes in Mytilus galloprovincialis

Through a multiple approach, the present study on the mitochondrial membranes from mussel gills and swine heart combines some biochemical information on fatty acid composition, sterol pattern, and temperature dependence of the F1FO-ATPase activity (EC 3.6.3.14.) with fluorescence data on mitochondrial membranes and on liposomes obtained from lipid extracts of mitochondria. The physical state of mussel gills and swine heart was investigated by Laurdan steady state fluorescence. Quite surprisingly, the similar temperature dependence of the F1FO complex, illustrated as Arrhenius plot which in both mitochondria exhibits the same discontinuity at approximately 21°C and overlapping activation energies above and below the discontinuity, is apparently compatible with a different composition and physical state of mitochondrial membranes. Accordingly, mussel membranes contain highly unsaturated fatty acids, abundant sterols, including phytosterols, while mammalian membranes only contain cholesterol and in prevalence shorter and less unsaturated fatty acids, leading to a lower membrane unsaturation with respect to mussel mitochondria. As suggested by fluorescence data, the likely formation of peculiar microdomains interacting with the membrane-bound enzyme complex in mussel mitochondria could produce an environment which somehow approaches the physical state of mammalian mitochondrial membranes. Thus, as an adaptive strategy, the interaction between sterols, highly unsaturated phospholipids and proteins in mussel gill mitochondria could allow the F1FO-ATPase activity to maintain the same activation energy as the mammalian enzyme.

Subthalamic deep brain stimulation effects on odor identification in Parkinson's disease

BACKGROUND AND PURPOSE

Olfactory dysfunction is common in Parkinson's disease (PD) and it is one of the earliest non-motor symptoms. A few studies have suggested that deep brain stimulation of the subthalamic nucleus (STN-DBS) could improve olfactory function. Our aim was to evaluate the acute effect of bilateral STN-DBS on a commonly used smell test in PD patients.

METHODS

Fifteen PD patients who underwent bilateral STN-DBS and 15 controls were recruited. Patients and controls were tested for odor identification.

RESULTS

No statistical differences were documented between ON and OFF STN-DBS acute stimulation concerning olfaction. Controls presented a better performance for olfactory identification than patients.

CONCLUSIONS

Our exploratory study did not support that bilateral STN-DBS could have an acute effect on olfactory function in PD patients.

MicroRNAs and cancer: towards a personalized medicine

MicroRNAs (miRNAs) are de-regulated in cancer versus the normal tissue counterpart and actively participate in human carcinogenesis. Among the genes whose expression is under their control there are both oncogenes and tumor suppressor genes, revealing that it is not only limiting but simply wrong to assign them a function just as oncogenes or as tumor suppressor genes. In addition to primary tumors, miRNAs can be detected in almost all human body fluids and effectively help to diagnose cancer and to prognosticate clinical outcome and response to treatment of tumors. The advent of miRNA mimic and miRNA silencing molecules has allowed to modulate miRNA expression in tumors, showing that miRNAs can be effectively used as therapeutic agents. This review will focus on those findings that have provided the rationale for the use of miRNAs as patient "tailored" anti-cancer agents.