[(123) I]FP-CIT-SPECT asymmetry index to differentiate Parkinson's disease from vascular parkinsonism.

OBJECTIVES: Differential diagnosis between vascular parkinsonism (VP) and Parkinson's Disease (PD) is often difficult, due to the overlap in clinical presentation and the lack of specificity at neuroimaging. Aim of the study was to identify a possible reliable marker at SPECT imaging useful to distinguish the two conditions. MATERIAL AND METHODS: We studied 20 PD, 20 VP and 20 essential tremor (ET) patients as control group, who had undergone a cerebral [(123) I] FP-CIT SPECT. A semiquantitative analysis was performed on DaTSCAN SPECT imaging and to establish the degree of asymmetry of the ligand uptake the Striatal Asymmetry Index (SAI) was used. RESULTS: The binding of the ligand in the most affected side resulted significantly lower in VP than in ET patients but higher compared to PD patients. SAI was significantly higher in PD compared to VP (P < 0.001) and ET (P < 0.001) groups. We found that a cut-off of SAI greater than 14.08 could differentiate PD from VP with a 100% specificity and a 50% sensitivity. CONCLUSIONS: SAI detected using [(123) I]FP-CIT SPECT can be used to differentiate VP and PD with a good degree of certainty.

Acute disseminated encephalomyelitis: a long-term prospective study and meta-analysis.

BACKGROUND: There are only a few series in the literature on acute disseminated encephalomyelitis (ADEM) in children. OBJECTIVES AND METHODS: the aims of this study were to perform (i) a prospective clinical/imaging study (1992-2009) on ADEM in children consecutively referred to our institution in Catania, Italy, and (ii) to undertake a systematic review and meta-analysis of published ADEM pediatric cohorts (>10 cases). RESULTS: We identified 17 patients with ADEM (incidence <10 years of age=1.1 per 100 000 person-years). 15 previously published cohorts were compared with our cohort: (i) systematically reviewed (750 cases); and (ii) meta-analyzed (492/750 cases). The 17 patients had the following characteristics: (a) male-to-female ratio, 1.4 (vs. 1.2-1.3 in previous cohorts); (b) mean age at presentation, 3.6 years (vs. 7.1 years in previous cohorts); (c) specific preceding triggering factor, 88% (vs. 69-79% in previous cohorts); (d) the most common initial signs were ataxia, seizures, headache, and thalamic syndrome; (e) brain imaging revealed >3 lesions in 100% (vs. 92% in previous cohorts); (f) the outcome was good in 94% (vs. 70-75% in previous cohorts); and (g) 12% relapsed once (vs. 18% in previous cohorts). CONCLUSIONS: ADEM is generally a benign condition that mosly affects boys more than girls and rarely recurs.

Quality of life in parents of children with cerebral palsy: is it influenced by the child's behaviour?

The aims of the present study were: to examine the quality of life (QOL) of parents of children with cerebral palsy (CP) and to establish the possible effect of behaviour problems on their QOL. One-hundred children with CP, aged between 4 and 10 years, and both their parents were included in the study. Both parents completed the WHOQOL-BREF, to assess their QOL. A sample of 60 parents of healthy children was used as control group. The primary caregiver also completed the CHILD BEHAVIOUR CHECKLIST (CBCL). Parents of children with CP showed lower scores on physical and psychological domains than the control group on QOL. In the psychological domain the mothers of children with hemiplegia had the lowest scores. The mothers reported lower scores than the fathers for the physical domain in the group of children with diplegia and quadriplegia and for the psychological domain in the group of children with hemiplegia. Children with hemiplegia showed externalizing scores at CBCL higher than the other groups, that could explain the poorer QOL scores of their mothers. In conclusions our results provide useful information on the QOL in families with different forms of CP, useful in planning interventions for the family of children with CP.

Biological properties of Cakile maritima Scop. (Brassicaceae) extracts.

OBJECTIVE: Cakile maritima scop. (CKM) is a herbaceous plant (Brassicaceae) growing also in high salinity environment. It is an annual plant growing in clumps or mounds in the sand on beaches and bluffs. MATERIALS AND METHODS: Stems, seeds, leaves and flowers of CKM were used to obtain 70% of ethanol extracts. The phenolic content of the different extracts was evaluated by the Folin-Ciocalteu method. The separation of phytochemical compounds was based on ultra-performance liquid chromatography coupled to mass spectrometry. Radical scavenging activity was determined by 1,1-diphenyl-2-picrylhydrazyl assay. The qualitative assay for the inhibition of α-glucosidase was quantified spectrophotometrically and the anti-inflammatory activity was determined in the U937 cell line by using gene expression of pro-inflammatory cytokines. Cell viability assay was done in U937, MM1S, and U266 cells by using the 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay. The antimicrobial activity was investigated by MIC determination, "double-triple combinations assay", and growth inhibition curves analysis, using the extracts individually or in various combination. Statistical analysis was performed by the Student's t-test and ANOVA. RESULTS: All parts of the plant exhibited a high antioxidant capacity as measured by DPPH assay. Furthermore, all extracts reduced (about 10 folds) the expression of inflammatory cytokines in macrophage following LPS treatment. As regards the antibacterial activity, only the seeds extract was able to inhibit both Gram-negative and Gram-positive bacteria when tested alone, whereas dual combinations of different extracts (leaves, flowers, stems and seeds) caused bacterial inhibition exhibiting a synergic action. Finally, we showed that the extracts did not exhibit cytotoxic effects in normal cells and that, surprisingly, it exhibited an anti-proliferative effect (inhibition ≈80%) in multiple myeloma U266 cells. CONCLUSIONS: Our study suggests that CKM possesses antioxidant, anti-inflammatory, antibacterial, anti-proliferative activities and such pleiotropic effects may be exploited under various pathological conditions.

A new antioxidant formulation reduces the apoptotic and damaging effect of cigarette smoke extract on human bronchial epithelial cells.

OBJECTIVE: In this study we evaluated the possible protective effect of an antioxidant formulation containing microfiltered milk derived polypeptides, Curcumin, Vitamin B2, Carnitine and N-Acetyl-cysteine (NAC) in an in vitro model of chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Human bronchial epithelial cells (16HBE) were used in this study. Cells were treated for 24 h in the presence or absence of 10% of cigarette smoke extract (CSE) and in the presence or absence of antioxidant formulation. We evaluated cell viability by MTT assay, reactive oxygen species by flow cytometer and quantitative analysis of gene expression by Real-time PCR. RESULTS: The data obtained showed a significant increase of cell viability in CSE-exposed cells and a significant reduction of reactive oxygen species (ROS) production compared to cells treated with only CSE. The antioxidant effects of formulation were confirmed by a decrease of inflammatory cytokines genes IL-1ß, IL-6, TNFα, nitric oxide synthase gene (NOS2) and through an induction of antioxidant genes such as heme oxygenase 1 (HO-1), nuclear transcription factor erythroid 2 (NRF2) and peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α). CONCLUSIONS: The results suggest that antioxidants combination plays a protective role on oxidative stress and inflammation, in an in vitro model of COPD, activating key genes in response to oxidative stress and decreasing the cytokines responsible for the inflammatory pathways.

Moringa oleifera Lam. improves lipid metabolism during adipogenic differentiation of human stem cells.

OBJECTIVE: Moringa oleifera Lam., a multipurpose tree, is used traditionally for its nutritional and medicinal properties. It has been used for the treatment of a variety of conditions, including inflammation, cancer and metabolic disorders. MATERIALS AND METHODS: We investigated the effect of Moringa oleifera Lam. on adipogenic differentiation of human adipose-derived mesenchymal stem cells and its impact on lipid metabolism and cellular antioxidant systems. RESULTS: We showed that Moringa oleifera Lam. treatment during adipogenic differentiation reduces inflammation, lipid accumulation and induces thermogenesis by activation of uncoupling protein 1 (UCP1), sirtuin 1 (SIRT1), peroxisome proliferator-activated receptor alpha (PPARα), and coactivator 1 alpha (PGC1α). In addition, Moringa oleifera Lam. induces heme oxygenase-1 (HO-1), a well established protective and antioxidant enzyme. Finally Moringa oleifera Lam. significantly decreases the expression of molecules involved in adipogenesis and upregulates the expression of mediators involved in thermogenesis and lipid metabolism. CONCLUSIONS: Our results suggest that Moringa oleifera Lam. may promote the brown remodeling of white adipose tissue inducing thermogenesis and improving metabolic homeostasis.

Multimodality therapy for locally advanced and limited stage IV breast cancer: the impact of effective non-cross-resistance late-consolidation chemotherapy.

To determine the effectiveness of non-cross-resistant late-consolidation chemotherapy in locally advanced breast cancer (LABC) and stage IV breast cancer, we review our experience with two regimens. Between 1985 and 1991, we enrolled 56 patients with LABC, who were treated with a doxorubicin-based adjuvant regimen, followed by a late-consolidation non-cross-resistant regimen containing methotrexate, 5-fluorouracil, cisplatin, and cyclophosphamide. Between 1985 and 1996, a total of 45 patients with limited stage IV breast cancer underwent surgical excision of all evaluable disease, making them metastatic (stage IV) with no evaluable disease. Surgery was followed by a doxorubicin-containing regimen and then a late-consolidation non-cross-resistant regimen, which was either methotrexate, 5-fluorouracil, cisplatinum, and cyclophosphamide or 5-fluorouracil, mitomycin, etoposide, and cisplatin. Twenty-four patients with limited bone metastases that were unresectable were treated with a doxorubicin-containing regimen, radiation therapy to all sites of disease, and then one of the two late non-cross-resistant regimens. With a median follow-up of 84 months, 78% of patients with LABC are alive, and 68% are free of disease. After a median follow-up of 44 months, 53% of patients with stage IV with no evaluable disease are alive and free of disease. The use of non-cross-resistant late-consolidation chemotherapy is an effective strategy in the treatment of patients with LABC and selected patients with limited stage IV breast cancer.

High dose chemotherapy with autologous bone marrow transfusion.

Details are given of response and toxicity after high dose chemotherapy followed by autologous bone marrow infusion. High dose nitrosurea therapy (600-1000 mg/m2 BCNU) was predominantly associated with hematopoietic toxicity but recovery was within 4-5 weeks after BCNU therapy. High dose combination chemotherapy using cytoxan, VP-16-23 and +/- BCNU produced a response rate of approximately 80% (CR + PR + less than PR) of usually short duration in 18 evaluable patients, 17 of whom were previously treated. Hematopoietic recovery was usually complete in 4 weeks. Initial experience with the hematopoietic toxicity experienced after high dose mitomycin and ABMT is also detailed. Future proposals utilizing high dose chemotherapy with ABMT in selected tumors is presented with associated rationale.

Effects of short-term in vivo administration of G-CSF on bone marrow prior to harvesting.

The brief administration of G-CSF to previously treated solid tumor patients has a positive impact on the overall cellularity and progenitor cell content of harvested bone marrow. Fifty-seven patients, fully recovered from therapy and growth factor support, had approximately 500 mL of steady-state marrow harvested as outpatients under local anesthesia. Each patient then received 5 micrograms/kg of G-CSF every 12 hours subcutaneously for either 24 hours (21 patients), 36 hours (20 patients), or 48 hours (16 patients) just before harvesting 500 mL of activated bone marrow. Bone marrow cellularity (x 10(6)/mL) increased from a steady-state mean of 10.7 (+/- 0.9) to 25.7 (+/- 2.8) after 24 hours, 9.3 (+/- 0.7) to 29 (+/- 2.5) after 36 hours, and 9.6 (+/- 0.7) to 28.4 (+/- 2.5) after 48 hours. Although the percentage of CD34+ cells did not significantly change in stimulated marrow, the total number of CD34+ cells (x 10(6)) collected increased from 34 (+/- 6.3) to 52 (+/- 6.6) after two injections, 28 (+/- 3.6) to 65 (+/- 8.5) after three injections, and 28 (+/- 5.4) to 75 (+/- 18) after four injections of G-CSF. Further phenotyping demonstrated significant increases in CD34+HLA-DR+ cells with all three schedules relative to steady-state marrow. There were no changes in the total number of CD34+HLA-DR- cells after two and four shots; however, this population increased from 10 x 10(6) in steady-state marrow to 23 x 10(6) (p = 0.012) after three injections. Analysis of peripheral blood indicated a statistically significant increase in the circulating white count, but more interestingly, there were significant increases in the number of CD34+ cells x 10(4)/mL, suggesting the onset of mobilization. Steady-state blood contained a mean of 0.86 x 10(4)/mL CD34+ cells, which increased to 4.37 x 10(4)/mL, 7.43 x 10(4)/mL, and 8.62 x 10(4)/mL after two, three, and four injections, respectively-levels of CD34+ cells that are comparable to steady-state marrow. Reinfusion of a median of 1.6 x 10(6) activated CD34+ cells/kg resulted in the recovery of > 100/mm3 neutrophils and > 20,000 platelets by days 9 and 19, respectively, which was faster than our previous patients who received steady-state marrow, and comparable to our patients who received mobilized peripheral stem cells.

Carcinoembryonic antigen levels in malignant pleural fluids obtained from patients with mammary cancer.

The clinical usefulness of the carcinoembryonic antigen test for defining the malignant origin of pleural fluids obtained from patients who have mammary cancer was evaluated. Of 57 malignant pleural fluids obtained from 51 patients who had mammary cancer, 31 (54.4%) demonstrated a significantly elevated carcinoembryonic antigen content: the ratio of pleural fluid to serum carcinoembryonic antigen values ranged from .24 to 3.55; whereas for 14 of 23 patients who had normal levels of both serum and pleural fluid carcinoembryonic antigen, the ratio ranged from 0.25 to 2.30. This study indicates that the pleural fluid carcinoembryonic antigen value may be significantly elevated in only 50-60% of mammary cancer patients having documented malignant pleural fluids, and that the pleural fluid to serum carcinoembryonic antigen ratio is of no value in defining the malignant origin of pleural fluids obtained from these patients.

A comparative mechanical analysis of the pointe shoe toe box. An in vitro study.

Dancing en pointe requires the ballerina to stand on her toes, which are protected only by the pointe shoe toe box. This protection diminishes when the toe box loses its structural integrity. The objectives of this study were 1) to quantify the comparative structural static and fatigue properties of the pointe shoe toe box, and 2) to evaluate the preferred shoe characteristics as determined by a survey of local dancers. Five different pointe shoes (Capezio, Freed, Gaynor Minden, Leo's, and Grishko) were evaluated to quantify the static stiffness, static strength, and fatigue properties (cycles to failure) of the shoes. Under axial loading conditions, the Leo's shoe demonstrated the highest stiffness level, and the Freed shoe exhibited the least strength. Under vertical loading conditions, the Leo's and Freed shoes demonstrated the highest stiffness levels, and the Gaynor Minden and Freed shoes exhibited the highest strength. Fatigue testing highlighted the greatest differences among the five shoes, with the Gaynor Minden demonstrating the highest fatigue life. Dancers rated the top five shoe characteristics, in order of importance, as fit, comfort, box/platform shape, vamp shape, and durability and indicated that the "best" shoe is one that "feels right" and permits artistic maneuvers, not necessarily the strongest or most durable shoe.

Nutritional and behavioral measures in the non-pharmacological treatment of elderly hypertensive subjects.

The antihypertensive treatments have resulted in favorable effects in terms of cardiovascular morbidity and mortality in the elderly, but the therapeutic approaches raise problems linked to the pathophysiological aspects of hypertensives and to the reduced homoeostatic capacity of the senile organism. The antihypertensive treatment in elderly must be aimed at achieving a maximal improvement in the cardiovascular risk profile with possibly minimal side effects. The first step is the non-pharmacological therapy which is a hygienic-behavioral program aimed at changing the patient's life style (physical exercise, reduced salt intake, body weight control, etc.). Non-pharmacological therapy in the elderly patients requires a preliminary evaluating protocol and a close monitoring of the individual responses. The diet, restriction of sodium intake (4-6 g/day), and aerobic physical exercise are important for decrease the development and persistence of hypertension. The non-pharmacological therapy has a low antihypertensive action, however, once established, it should not be abandoned, as its association with pharmacological treatment allows the use of fewer and lower doses of drugs, with a consequent reduction of the risks due to side effects.

On the importance of multidimensional evaluation of elderly oncologic patients.

The role of comorbidity and the psycho-affective attitudes have been studied in 108 elderly oncological patients, in comparison with 25 elderly subjects without tumor pathologies. The results have revealed positive correlations between the activity of daily living (ADL), as well as the instrumental activity of daily living (IADL) scales and the comorbidity both in the oncological subjects and the controls. The performance status defined by the eastern cooperative oncology group (ECOG-PS) positively correlated with the parameters of ADL and IADL scales, demonstrating an increased vulnerability and fragility of the oncological patients in their everyday activities. An increased psychological fragility of the oncological patients has also been revealed by the scores of the geriatric depression scale (GDS), which might be cause and consequence at the same time of the disease itself. In addition, the polypathologies are not associated with an increased gravity of the tumor stage, although there have been 2.5 accompanying pathologies, mainly diseases of osteoarticular and cardial character. The correction of functional damages of various organs due to aging or concomitant or previous diseases is a period of fundamental importance for an adequate oncological therapy. The principal goal of any intervention in the elderly oncological patient should certainly be an improvement of the quality of life, including an alleviation of the impact of the diagnostic and therapeutic procedures on it.

Comparison of ambulatory and clinical blood pressures, and their correlation with organic heart damage, in the elderly.

Casual blood pressure (BP) measurements may sometimes indicate the presence of cardiovascular morbidity and mortality, but the correlations between BP values and the subsequent occurrence of such complications are low. This may depend on the known inability of casual BP measurements to reflect accurately the 24-hour mean and overall profile of the BP. In this study, electrocardiography (ECG) of left ventricular muscle mass was related to various measures of BP during circadian ambulatory BP monitoring in 156 hypertensive and non-hypertensive elderly patients. Multiple regression analysis performed to establish the presence of left ventricular hypertrophy (LVH) revealed that the product of ambulatory systolic BP x diastolic BP (p = 0.027) and ambulatory diastolic BP were significant variables. Clinical pressure variables were not significant. Multiple linear regression analysis to establish the degree of LVH in function of the pressure variables generated a model where the variables included are the product of ambulatory systolic BP x diastolic BP (p = 2.7 x 10(-8)), ambulatory systolic BP (p = 7.8 x 10(-6)) and ambulatory diastolic BP (p = 2.4 x 10(-6)). Results obtained agree with the literature and revealed that LVH evaluated using ECG-Romhilt-Estes score was correlated in terms of presence/absence of organ damage and in terms of score to ambulatory monitoring values.

The effects of caloric restriction and controlled physical exercise on hypertension in the elderly.

The overweight and sedentary life style are associated with elevated blood pressure values in the elderly patients. The first step in the therapy of arterial hypertension should be hygienic-behavioral measures in order to modify the life style of the patients. The present study evaluates the independent effects of caloric restriction and physical exercise on the blood pressure and on the anti-hypertensive treatment in elderly subjects with mild-moderate hypertension. The number of enrolled patients was 74 in the age range of 61-72 years, showing up in our Geriatric Day Hospital. The results obtained confirm that the non-pharmacological measures represent a valid alternative to the pharmacological treatment of hypertension in the elderly patients, or may be applied in combination with the latter, in order to reduce the doses of pharmaca.

Urinary albumin excretion in elderly patients with white coat hypertension.

The so-called white coat effect occurs in about 42% of elderly patients. This phenomenon leads to several problems in treatment and may also cause renal disease. One of the most frequently controlled parameters is microalbuminuria, an index of renal damage. The present case-control study intended to evaluate the urinary excretion of albumin in elderly patients suffering from white coat hypertension, and comparing their data to those of normotensive subjects. In addition, the study searched for correlations between albuminuria and various clinical and ambulatory blood pressure values. A total of 258 patients were enrolled, but after screening, only 129 were considered; 13 of the latter were further excluded because of problems encountered during ambulatory monitoring of arterial blood pressure. Therefore, 116 hypertensive subjects were included in the study. This pool of hypertensive patients was compared to a normotensive group of 33 subjects. The results have shown the occurrence of white coat effect in 25% of cases, and the microalbuminuria of these patients was statistically not significantly different from that of the normotensive group of patients. The microalbuminuria correlated only with ambulatory systolic blood pressure measured during the day.

Echocardiographic studies on elderly patients with white coat hypertension to evaluate cardiac organ damages.

This case-control study was aimed at evaluating the distribution of some echocardiographic signs of cardiac organ damages in elderly patients with white coat hypertension (WCH), as compared with a normotensive group of elderly. Correlations between the signs of cardiac organ damages and the clinical and ambulatory blood pressure parameters (obtained by means of a 24-h monitoring) have also been evaluated. The first screening covered 258 elderly subjects of both sexes, aged from 65 to 82 years, with clinical diagnosis of hypertension (systolic and diastolic blood pressures being higher than 160 and 95 mmHg, respectively). Of this group, 116 subjects remained in the final pool, and their echocardiographic parameters were compared with 33 normotensive (N) subjects. Out of the 116 clinically hypertensive patients, 29 (25%) displayed WCH, according to the established criteria. Variance analyses on the ranks followed by Dunn's test revealed no statistically significant differences between the N and WCH groups, while the hypertensive group (H) proved to be significantly different from both the N and the WCH groups. In addition to the descriptive statistics, an analysis of correlations between the pressure variables and the echocardiographic parameters has also been performed by means of a forward-stepwise multiple linear regression method. The models generated by this regression analysis covered only the ambulatory diurnal systolic pressure, and the clinical diastolic pressure in most of the cases of the echocardiographic parameters, taken as independent variables. In all these cases, the standardizecl correlation coefficient of the diurnal systolic pressure was always higher than that of the clinical diastolic pressure, indicating that the echocardiographic parameters depend more strongly on the first than on the second pressure value.

Suicides and the third age.

The phenomenon of suicide represents a complex problem, the specific aspects of which should be examined by a multifactorial analysis, particularly in the elderly subjects. Although the research on risk factors continues to grow, only a limited knowledge is available on the biological changes increasing the risk for suicide. Similarly, limited information is at our disposal about the contributing psychosocial processes extending beyond the demographic factors. Although the best explored population is the elderly using primary care services, no proven interventions are known for the time being, although some efforts to test certain approaches reaching these older adults are under way. Apparently even more, continued efforts are needed to change the attitudes toward the mental illnesses and their treatments in general, in order to reach the older adults who are still outside of the health care services.

Expression of cell cycle-dependent genes and proliferative state of lymphocytes in aging.

The authors analyzed the expression of some genes involved in the control of T lymphocyte proliferation in a group of healthy elderly subjects. They focused their attention on genes involved in the G(0)/G(1) transition (TK, PCNA, H3, IL2-R) and showed decreased expression in the TK, H3 and IL2-R genes. Using flow cytofluorimetry, delayed transition from the G(0)/G(1) to the S stage was observed.

The leisure time and the third age: the experience of a geriatric day hospital.

Leisure time represents an important part of the so-called 'successful aging' and contributes to overcome the problems related to the reduction of the social roles, favoring a better subjective adaptation to old age. In this work we observed the elderly population frequenting our Day Hospital, by estimating the affective sphere (geriatric depression scale, GDS), the autosufficiency (activity of daily living, ADL; and instrumental activity of daily living, IADL) and the schooling years in correlation with the type and length of leisure time activities during the day. These data have been compared with those of the national statistics (ISTAT). The analyses revealed a very wide diffusion of the utilization of mass media and a large interindividual differentiation of the modes of using leisure time. The correlations between the indices of affectivity and autosufficiency show an effect on the types of leisure time activities, while the scholarity of the subjects has no influence on it. These results suggest considering leisure time as an indispensable part of the relational life of elderly subjects, having an important 'valency' for the affective sphere and the individual expectations and needs.