Lingual fasciculation: A point of call for the diagnosis of amyotrophic lateral sclerosis.

A 60-year-old female patient, with no notable medical history, was referred by the internal medicine department for a dry mouth workup. The clinical examination revealed an absence of dryness, and the presence of lingual fasciculations, associated with difficulties in mastication and phonation. These symptoms appeared spontaneously 9 months before the consultation, after leaving confinement. Given the presence of lingual fasciculations, the diagnostic hypothesis of a neurological pathology, in particular amyotrophic lateral sclerosis (ALS), was suspected. After performing an electromyogram (EMG), the diagnosis of ALS was retained. Riluzole treatment was then started, and physical therapy sessions were scheduled. Riluzole allows an average gain of 4 to 6 months of life expectancy. Speech therapy and physical therapy allow to maintain the functions as long as possible and to improve the end-of-life conditions. The interest of early detection of ALS allows delaying the progression of the disease.

Epidemiology of early pre-term delivery: relationship with clinical and histopathological infective parameters.

In this study, we want to evaluate which are the risk factors involved in early pre-term delivery (PTD). Spontaneous PTD results from two clinical conditions: (1) spontaneous pre-term labour (PTL) leading to PTD (idiopathic) and (2) pre-term premature rupture of membranes (pPROM). This is a multicentric, observational, retrospective, cross-sectional study, which includes 7,631 women admitted in the Obstetric units of Siena, Perugia, Torino, Trieste, Milano, Modena, Ancona, Foggia and Catania. Data were obtained from all patients having delivered spontaneously, pre-term or at term. The present study reveals the involvement of inflammation/infection in pathogenetic mechanisms leading to early PTD in the Italian population. A higher incidence of both clinical and pathological parameters of inflammation/infection - pPROM, genitourinary tract infections, placenta histopathological inflammation, WBC and C-reactive protein (CRP) - in early pre-term delivery in respect to late pre-term delivery and delivery at term, were shown.

Effects of urocortin 2 and urocortin 3 on IL-10 and TNF-α expression and secretion from human trophoblast explants.

OBJECTIVES: The aim of the present study was to evaluate the effect of Ucn2 and Ucn3 on cytokine expression and secretion from placental explants. STUDY DESIGN: Placentas were collected from healthy pregnancies at term elective caesarean delivery and trophoblast explants were prepared and treated with Ucn2 or Ucn3 in presence/absence of the selective CRH-R2 antagonist, astressin 2b. The mRNA expression and secretion of IL-10 and TNF-α were evaluated by Real Time RT-PCR and ELISA, respectively. MAIN OUTCOME MEASURES: To evaluate the possible role of Ucn2 and Ucn3 in inflammatory pathways. RESULTS: Ucn2 increased the mRNA expression and secretion of IL-10 and TNF-α, and Ucn3 increased the mRNA expression and secretion of IL-10, but did not modify the secretion of TNF-α. Ucn3 treatment reversed the LPS-induce increase of TNF-α expression and release, an effect blocked by astressin 2b. Ucn2 potentiated the LPS-induced increase of TNF-α expression and release, an effect reversed by astressin 2b. CONCLUSIONS: The present study showed that Ucn2 and Ucn3 differentially regulate the LPS-induced TNF-α and IL-10 expression and secretion in trophoblast explants acting through CRH-R2. A pro inflammatory effect of Ucn2 and an anti-inflammatory effect of Ucn3 in placental immunomodulatory mechanisms is suggested.

The inflammation-sensitive protein alpha 1-anti-chymotrypsin neutralizes fibrillar aggregation and cytotoxicity of the beta-amyloid peptide more effectively than alpha 1-antitrypsin.

OBJECTIVES: A neuroinflammatory process, triggered by amyloid-beta (Abeta)-peptide, is thought to play a central role in the neurodegenerative process leading to Alzheimer's disease (AD). Abeta(25-35) retains the functionality of Abeta(42) and was employed to investigate the effects of inflammation-sensitive proteins (ISPs) alpha1-antichymotrypsin (A1ACT) and alpha1-antitrypsin (A1AT) on fibrillar aggregation and cytotoxicity. DESIGN AND METHODS: Inhibitory concentrations of the ISPs were determined in an established human red blood cell lysis model of Abeta-cytotoxicity. For studies of Abeta-fibrillar aggregation CSF levels of A1ACT (0.041 microM)/A1AT (0.11 microM) were incubated with Congo Red dye 25 microM+Abeta(25-35) 10 microM noting the formation of visible aggregates and spectrophotometric changes over 24 h. RESULTS: A1ACT at CSF reported levels inhibited fibrillar aggregation and cytotoxicity while A1AT at CSF reported levels failed to cause a similar inhibition. CONCLUSIONS: A1ACT neutralizes fibrillar aggregation and cytotoxicity of Abeta-peptide more effectively than A1AT. Both proteins are known to be co-deposited with Abeta within senile plaques of AD brains.

Transthyretin inhibition of amyloid beta aggregation and toxicity.

OBJECTIVES: The aim of this study was to investigate transthyretin (prealbumin) effects on Abeta25-35-induced cytotoxicity. DESIGN AND METHODS: In view of the well-recognized literature data demonstrating that Abeta25-35 fibrillar aggregates cause in vitro cytotoxicity to human red blood cells and apoptotic changes to SK-N-BE neuroblastoma cells in cultures (ultrastructural evidence), we tested transthyretin effects on these two experimental models. RESULTS: Incubation of Abeta25-35 with transthyretin (at transthyretin concentrations equal to CSF physiological levels) demonstrated both inhibition of red blood cells lysis and neutralization of SK-N-BE neuroblastoma cells ultrastructural apoptotic changes. Moreover, transthyretin was shown to be able to inhibit the formation of fibrillar macroaggregates of Abeta25-35. CONCLUSIONS: The findings imply that experimental systems investigating Abeta-induced cytotoxicity consider the protective interaction of transthyretin with Abeta; an interaction to be considered also in vivo in view of the fact that transthyretin immunoreactivity has been previously demonstrated in amyloid plaques of brains from Alzheimer's disease patients.

Coenzyme Q10, antioxidant status and ApoE isoforms.

The aim of this study was to inquire the antioxidant status in plasma and lipoproteins isolated from normal subjects possessing different ApoE genotypes. For this purpose we investigated blood samples from 106 healthy blood donors: the distribution of ApoE alleles (E2/E2 = 0.9%, E2/E3 = 10.4%, E2/E4 = 2.8%, E3/E3 = 71.7%, E3/E4 = 12.3% and E4/E4 1.9% with 1, 11, 3, 76, 13, and 2 subjects respectively for each genotype) was in agreement with previous data. Almost no differences were found in the concentrations of both coenzyme Q10 (CoQ10) and vitamin E for the different genotypes. Concentration of CoQ10 in isolated lipoproteins was also similar, in the different genotypes, when referred to cholesterol; CoQ10 in LDL was higher for the E3/E3 subjects when referred to protein. Neither CoQ10 nor vitamin E correlated with paraoxonase (PON) activity or cholesteryl-ester hydroperoxides (CHP). Furthermore, there was no correlation between the same lipophilic antioxidants and CHP levels. The only E2 homozygous subject found had high levels of PON and low levels of CHP; the two E4/E4 subjects had low PON activity together with low levels of CHP.

Helicobacter pylori masks differences in homocysteine plasma levels between controls and type 2 diabetic patients.

BACKGROUND: Data in the literature have not clarified whether type 2 diabetes mellitus affects homocysteine plasma levels. Different variables able to influence homocysteine could be the cause of these controversial findings. An important but neglected confounding factor is Helicobacter pylori, which has been demonstrated to be a cause of elevated levels of homocysteine and which is prevalent in the Caucasian population, ranging from 30 to 40% incidence. Starting from these findings we wanted to verify whether differences in homocysteine levels exist between a type 2 diabetic population and a control group, taking into account the presence/absence of Helicobacter pylori. DESIGN: The study was carried out on a group of uncomplicated and normotensive type 2 diabetic patients (n = 30, 55.7 +/- 9.7 years) and on a control group (n = 43, 51.2 +/- 11.3 years). On these subjects we evaluated: main parameters of glyco- and lipo-metabolic balance, presence of Helicobacter pylori by 13C Urea Breath Test, plasma homocysteine, vitamin B12, folate and genetic polymorphism of methylenetetrahydrofolate reductase. RESULTS: Evaluating the two groups as a whole, significant differences in homocysteine were found when considering Helicobacter pylori presence/absence (14.0 +/- 6.5 vs. 10.6 +/- 4.7 micromol L-1, respectively, P < 0.01) without differences of vitamins and the genetic polymorphism of methylenetetrahydrofolate reductase. The positive interaction found among Helicobacter pylori, diabetes and homocysteine (P = 0.03) taking into account all the other evaluated confounding factors, demonstrates that a significant difference in homocysteine plasma levels exists between diabetics and controls (Helicobacter pylori-negative: diabetics 12.5 +/- 5.6 micromol L-1, controls 9.4 +/- 3.8 micromol L-1; Helicobacter pylori-positive: diabetics 13.6 +/- 5.8 micromol L-1, controls 14.3 +/- 7.0 micromol L-1). CONCLUSIONS: Type 2 diabetes seems to induce per se higher levels of homocysteine, which appears to be one of the factors responsible for the increased risk of vascular damage.

Transformation of beta-amyloid (A beta) (1-42) tyrosine to L-dopa as the result of in vitro hydroxyl radical attack.

A form of beta-amyloid peptide A beta ending at amino acid 42 (A beta42) is the major component of senile amyloid plaques in Alzheimer's Disease (AD). The A beta-peptide earliest modifications are extremely important since they constitute the key events in the progression towards further changes finally leading to fibril formation and to A beta deposits which constitute the core pathological change in AD. Chemical and conformational early modifications of the beta-amyloid peptide are critical steps in AD pathogenesis and have been widely investigated. We now show that a Fenton-type OH-generating system is capable of generating L-Dopa (3,4-dihydroxyphenylalanine) in the tyrosine residue of A beta-peptide via aromatic ring hydroxylation, as the result of hydroxyl radical attack on proteins. Since L-Dopa is not a constituent of mammalian proteins and peptides, the formation of L-Dopa in A beta in vitro constitutes a possible important modification caused by hydroxyl radical attack. These results lay the groundwork for further studies on modification and damage associated with the degenerative disorder in AD where oxidative stress and inflammation are known to occur.

In vitro peroxidase oxidation induces stable dimers of beta-amyloid (1-42) through dityrosine bridge formation.

beta-amyloid (A beta) is a normal soluble peptide found in the cerebrospinal fluid (CSF) and other biological fluids. A beta fibrils are associated with Alzheimer's disease (AD) senile plaques. We have used purified soluble A beta (1-42) and A beta (12-28) peptides in order to determine the oxidative modification induced in these peptides by exposure to peroxidase and hydrogen peroxide. We have demonstrated that under these in vitro conditions, dimeric forms of A beta (1-42) can be detected by high-resolution polyacrylamide SDS-PAGE electrophoresis. Further experiments performed by reverse-phase high performance liquid chromatography (RP-HPLC), and monitored by fluorescence detection, showed that the dimeric A beta (1-42) forms induced by the peroxidase reaction are the outcomes of dityrosine bridge formation. This cross-link results from the enzyme catalyzed oxidation. During this reaction, phenolic coupling of tyrosine residues of two A beta (1-42) peptides occurs. No detectable peroxidative modifications were observed with the A beta (12-28) peptide which lacks a tyrosine residue. Since oxidative stress is thought to be associated with AD, the experimental model described here can help in understanding the early events leading to chemical, structural and conformational modifications before the conversion of sA beta to amyloid fibrils and eventually the formation of senile plaques in AD.

Quantitation of intraplatelet Ca++ deposits as a potential marker of senility.

OBJECTIVE: To perform a morphometric evaluation of calcium deposits in human platelets as a quantitative procedure to seek a potential marker of senility in a peripheral cellular model. STUDY DESIGN: In human blood samples from middle-aged, healthy volunteers, the intraplatelet calcium content was cytochemically evidenced by the oxalatepyroantimonate (OPA) reaction. The number and area of OPA aggregates per square micrometer of total sampled area, the area of the deposits per square micrometer of platelet surface and the percentage of positive platelets were the ultrastructural features calculated by computer-assisted image analysis. RESULTS: OPA precipitates were easily identified in all the samples evaluated. The area of OPA deposits per square micrometer of platelet surface was rather constant not only among the measurements performed on the same sample but also comparing the different subjects analyzed. Other OPA deposit features showed higher variabilities; thus, to obtain a representative sample from each patient, several measurements had to be carried out. CONCLUSION: Quantitation of calcium deposits may be of help in evidencing increased Ca++ sequestering activity by platelets, supposedly due to altered calcium homeostasis. The OPA cytochemical procedure visualizes millimolar quantities of Ca++ ions; thus, only high calcium concentration sites (granules) can be detected by morphometric methods.

Apo E genotyping in Alzheimer disease (AD): multidimensional counseling by the geriatric assessment unit (GAU) to properly address scientific and bioethical issues emerging from molecular gerontology to geriatric practice.

Alzheimer Disease (AD) is an age-related dementia that is going to assume the characteristics of a health emergency. A reliable diagnosis of AD, especially at the very onset, is complicated. Moreover, it is known that about 20% of patients in hospital for Alzheimer-type dementia have unusual clinical symptoms and sometimes a reliable diagnosis depends on post-mortem analysis of brain tissues. Recently, progress has been achieved in the field of genetic risk assessment in AD, and this article discusses the current widespread use of apolipoprotein E (APO E) genotyping as a tool for investigating epidemiologic risk factors for this devastating disease. APO E genotyping investigations have now moved from research laboratories to clinical laboratories, and therefore bioethical controversies are present, because of laboratory investigations of the patient's genome and the scientific uncertainties still existing. These controversies strongly suggest the need for genetic counseling. Herein we propose a model for multidimensional counseling provided by the Geriatric Assessment Unit (GAU), a multidisciplinary approach to counseling involving genetic, medical, social, psychological and medico-legal support. Multidimensional counseling may help patient and family decisions about health problems with the aim of improving the patient's information and knowledge, and ensuring informed consent in decisions concerning a disease associated with cognitive impairment.

Synaptic structural dynamics and aging.

Synaptic junctional areas are not immutable structures, on the contrary, they are remodelled throughout the individual's lifespan as a consequence of environmental stimulations. This adaptive capacity of the synapses is discussed from a morphological standpoint with reference to aging. In old subjects, the number of contacts and the total surface area of synaptic appositions per unit volume of tissue decrease significantly, while the average synaptic size increases at a different extent according to the CNS area taken into account. This increase in synaptic average area is due to a higher percent of a subpopulation of enlarged contacts supposed to represent either the degenerating junctional zones or a compensatory phenomenon counteracting the synaptic reduction in number. Recent studies on perforated synapses support that the enlarged junctions are possible intermediates in synaptic physiological restructuring, thus the higher percentage of this type of contacts in the old CNS may witness unaccomplished synaptic turnover cycles. Taking into account the high metabolic rate of nerve cells, an age-related impairment in energy provision at synaptic terminal regions may constitute an early and subtle alteration affecting synaptic dynamic morphology in aging.

An in vitro bacterial model of cytotoxicity to living cells caused by dopamine and 6-hydroxydopamine oxidation at physiological pH.

The cytotoxicity of dopamine (DA) and 6-hydroxydopamine (6-OHDA) on living cells, in vitro, has been previously deeply investigated in neuroblastoma cells. This study was designed to explore the possibility to use bacteria as targets for studying DA and 6-HODA cytotoxicity. Both DA and 6-HODA oxidize when added to bacteriological media. The rate of autoxidation of 6-HODA was greater than DA within the first hours. The oxidation-dependent cytotoxicity caused bacterial growth-inhibition and killing at concentration of 10(-4)M. All the bacterial strains tested were slightly more susceptible to DA than to 6-HODA. Antioxidants (sodium metabisulfite, cysteine) prevented the oxidation and abolished the growth-inhibitory activity. The addition of exogenous catalase protected the cells against the effect of the oxidation of both the catecholamines up to the concentration of 5 mM, while the addition of exogenous superoxide dismutase protected the cells only at the minimal inhibitory concentrations. Taking into account that some of the results obtained are similar to those previously reported using neuroblastoma cells as targets, the use of bacteria for studying oxygen toxicity from these catecholamines seems to be a potentially useful model system.

Mueller-Hinton broth undergoes visible oxidative color changes in the presence of peroxidase and hydrogen peroxide.

In the presence of peroxidase and hydrogen peroxide, Mueller-Hinton broth undergoes a slow but clearly detectable color change from pale yellow to dark yellow or brown. An investigation of this phenomenon led to the conclusion that it is the result of the oxidation of tyrosine, a major component of the broth. Indeed, tyrosine has long been known to oxidize upon treatment with peroxidase and hydrogen peroxide. The observations reported here, besides being curious for the clinical microbiologist, might deserve attention for the possible implications in the medium color darkening which sometimes happens during microbial growth.

'Oxygen toxicity' induced by isoproterenol oxidation on living cells. An in vitro prokaryotic model.

Oxygen radical damage is a relevant problem in gerontological research. It has been implicated both in the aging process itself and in aging-related pathologies. Oxygen radicals from catecholamines seem to play an important role in central nervous system and cardiovascular system disorders during aging. Prokaryotic experimental systems have been shown to provide a simple and short term in vitro model for 'oxygen toxicity' from catecholamine oxidation which might be useful also in age-related research. In this paper we show that the synthetic sympathomimetic catecholamine, isoproterenol, oxidizes when added to bacteriological media and that this oxidation process causes bacterial growth inhibition. Both isoproterenol oxidation and the growth-inhibitory activity can be prevented by the addition of antioxidants. The addition of exogenous catalase (CAT), while unable to prevent isoproterenol oxidation, totally suppressed the bacterial growth inhibition; the addition of exogenous superoxide dismutase partially antagonized isoproterenol oxidation and suppressed bacterial growth inhibition although less efficiently than CAT. The model described suggests that besides 'oxygen toxicity' by endogenous natural catecholamines, iatrogenic tissue injury caused by the oxidation intermediates from this class of pharmacological compounds must also be considered.

[Bodily experiences and sexuality in obese women. A clinical study]. / Il vissuto corporeo e la sessualità nella donna obesa. Uno studio clinico.

The aim of the study was to investigate the centralized impulsive dynamics of 21 obese women in comparison with 21 normal ones, with particular reference to the unconscious bodily experiences and sexuality. Two tests comparing areas of unconscious experience and body organs and classes of feelings, and emotional self-assessment questionnaire and a colour choice test, were given. The statistical analysis of the results showed significant differences between the two groups studied, the obese women being immature, dependent, hypersensitive and introverted with great oral requirements and low autonomous control and with some confusion between food and affection. Their sexuality is pervaded with great aggressiveness and has little connection with its maternal and relational function. Finally, some psychotherapeutic strategies are mentioned.

Streptococcus faecalis susceptibility to amiloride depends on medium pH.

Amiloride is one of the major molecular probes in basic and applied investigations on the physiology of cation transport in animal cells. In these cells the drug also exerts growth inhibitory activity. Recently, we discovered that amiloride causes growth inhibition also on bacterial cells. In this paper we report that medium pH influences amiloride activity on Streptococcus faecalis. The lowering of external pH causes a drop in the susceptibility of this bacterium to amiloride up to an almost complete resistance. This finding, constitutes a novel aspect of the in vitro experimental pharmacology of this diuretic potentially useful also in clinical pharmacology and in animal cell investigations.

Whole-cell bacterial peroxidase test with isoproterenol as the hydrogen donor.

The beta-adrenergic compound isoproterenol was used as oxidizable reagent in a whole-cell assay for the detection of bacterial peroxidase activities. Isoproterenol has been shown to constitute a useful reagent for detecting peroxidase activities in enzymatic tests, utilizing standard purified enzymes, and in the microbiological application proposed. The procedure developed is simple and rapid to perform. In contrast to currently used whole-cell tests for bacterial peroxidases, the assay described here does not need preliminary permeabilization; moreover, the compound utilized does not have related toxicological problems. Therefore, the isoproterenol assay may represent a low-cost safe additional peroxidase test in clinical bacteriology.