Robotic hand treatment of patients affected by chronic stroke: a monocentric longitudinal pilot study.

Few studies investigated the effects of a robotic treatment in hand motor recovery after stroke. Aim of the present study was to evaluate the efficacy of treatment by means of Gloreha Sinfonia® robotic glove in hand motor recovery of a chronic stroke sample of patients with different impairment severity. Thirteen chronic stroke subjects were assigned to either active-assisted robotic treatment or passive robotic treatment according to their ability to actively extend wrist for at least 20 degrees. All subjects underwent 20 sessions of treatment with Gloreha Sinfonia® and were evaluated before (T0), after treatment (T1) and after one month (T2) with clinical scales testing motor performance [Motor Power (MP); Fugl Meyer Upper-Extremity (FMUE)] and spasticity [Modified Ashworth Scale (MAS)]. Both groups showed significant motor recovery and spasticity reduction. Further randomized controlled trials with larger samples are needed to confirm our results.

High serum uric acid levels increase the risk of metabolic syndrome in elderly women: The PRO.V.A study.

BACKGROUND AND AIMS: Serum uric acid (SUA) is the end-product of purine metabolism in humans, and its levels often increase in subjects with metabolic syndrome (MetS). Despite several studies demonstrating a relationship between increased SUA levels and the prevalence of MetS, prospective data on SUA as a predictor of the incidence of MetS in the elderly are limited. Our aim was to conduct a prospective study on the association between SUA concentrations and the onset of MetS in an elderly Italian cohort. METHODS AND RESULTS: This is a cohort study (Progetto Veneto Anziani; Pro.V.A.) involving community-dwelling subjects aged ≥65 years and followed up for a mean 4.4 years. We included 1128 participants (aged 74.7 ± 7.1 years) without MetS at the baseline. Gender-specific SUA groups according to the standard deviation (SD) from the mean were considered, taking the incidence of MetS as the main outcome. The mean SUA level was significantly higher in men than in women (5.4 ± 1.2 vs. 4.5 ± 1.2 mg/dl; p < 0.0001). Over the 4.4-year follow-up, 496 individuals developed MetS. After adjusting for potential confounders, Cox's regression analysis revealed no relationship between higher baseline SUA concentrations and the incidence of MetS in men or in the sample as whole, while women with SUA levels more than 1 SD above the mean (≥5.7 mg/dl) carried a 58% higher risk (95%CI: 1.03-2.40; p = 0.03) of being newly diagnosed with MetS during the follow-up. CONCLUSION: High SUA levels significantly and independently predicted MetS in older women, but not in men, over a 4.4-year follow-up.

Detection of blood pressure increments in active elderly individuals: the role of ambulatory blood pressure monitoring.

BACKGROUND AND AIMS: Physiological aging can lead to an increase in blood pressure (BP) over time even in regularly exercising elders. Office BP measurements (OBPM) might be unable to detect these BP variations. The aim of this study was to analyze BP changes over 3.5 years in active elders using ABPM. METHODS AND RESULTS: The study involved 80 active subjects ≥65 years old who exercised regularly. At baseline and again 3.5 years later, all subjects had lab tests, weight, body mass index (BMI), body composition, resting energy expenditure (REE) recorded; they underwent OBPM, ABPM and physical activity assessment. Over 3.5 years, our sample's mean weight, BMI, body composition, REE, albumin, and physical activity levels, did not change significantly. The prevalence of hypertension detected by OBPM dropped from 68.8% to 61.3%. ABPM revealed an increase in mean 24-h BP (Δsystolic: 5.3 ± 13.6 mmHg; p = 0.001; Δdiastolic: 1.8 ± 6.7 mmHg; p = 0.018) and mean daytime BP (Δsystolic: 5.8 ± 13.5 mmHg; p = 0.001; Δdiastolic: 1.9 ± 7.1 mmHg; p = 0.022); the prevalence of hypertension detected by ABPM increased from 50% to 65%, also due to an increase (from 8.8% to 16.3%) in masked hypertension. There was no correlation between BP changes and changes in body composition and REE. CONCLUSION: BP tends to increase over time in active elders, regardless of changes in body composition or level of physical activity. ABPM is an appropriate method for detecting these BP variations in active elders and to reveal cases of masked hypertension that might otherwise escape detection by OBPM.

Gender- and age-related differences in muscular and nerve-mediated responses in human colon.

BACKGROUND: Gender- and age-related differences in muscular and nerve-mediated responses in human colon are poorly characterized. We studied carbachol-induced motor responses and electrically evoked contractions in sigmoid circular muscle from adult and elderly patients of different gender. METHODS: Sigmoid colon segments were obtained from 24 men and 16 women undergoing left hemicolectomy for colon cancer. Isometric tension was measured on muscle strips exposed to increasing carbachol concentrations. The effects of atropine, guanethidine, L-nitro arginine methyl ester (L-NAME), and tetrodotoxin on electrically evoked contractions were also studied. RESULTS: Female patients showed higher maximal response to carbachol than male patients, elderly females being the most sensitive to carbachol among all patient groups. Electrically evoked contractions were linearly related to stimulation frequency and abolished by tetrodotoxin. Electrically evoked contractions were significantly more pronounced in elderly male patients; they were reduced by atropine and guanethidine and increased by L-nitro arginine methyl ester in the presence of atropine and guanethidine (P < 0.05). The effect of L-NAME was most marked in elderly male patients and least pronounced in elderly females. CONCLUSIONS: The response to carbachol and the role of nitrergic pathways differ according to age and gender; this may depend on muscarinic receptor upregulation or humoral factors affecting nitric oxide release, respectively.

[Biochemical profile of the pancreatic function: pancreolauril and oral glucose tolerance tests]. / Evaluación bioquímica de la función pancreática: Pruebas del pancreolauril y de la tolerancia a la glucosa oral.

BACKGROUND: The pancreas is a mixed gland that takes part in the digestion of nutrients and in the homeostasis ofglycemia. Chronic pancreopathy is the cause of secretory insufficiency, characterized by an inflammatory process that leads to fibrosis of the pancreas, with a progressive loss of both exocrine and endocrine functions of the gland. OBJECTIVE: To study both the exocrine and endocrine pancreatic relationship in patients with pancreatopathies and other non-pancreatic digestive alterations, by means of serum pancreolauril (sPL) and oral glucose tolerance tests (OGTT). Glycemia and insulin, basal and at 30, 60 and 120 minutes; amylase and lipase; and the HOMA index (homeostatic model) were determined in serum. MATERIAL AND METHODS: Thirty-two patients were evaluated: normal OGTT (n=11, control group) and pathologic OGTT (n=21). From the latter group, a subgroup (n=11) with a diagnosis of chronic pancreatitis (CP) was studied. RESULTS: Patients with pathologic OGTT in relation with normal OGTT presented a significant increase of glycemia at the four periods of time and of insulin at 120 minutes (P < 0.05), and a significant decrease of sPL (P < 0.05). In patients with CP, men were more than women, and all of them presented a pathologic OGTT and the sPL was significantly lower (P < 0.001). CONCLUSION: By the biochemical tests used, pancreas functionality corresponds with a close relationship between exocrine and endocrine pancreas. Thus, we suggest the use of the sPL test as a helpful tool for the diagnosis of CP.

The effectiveness of extracorporeal shock wave therapy on breast cancer-related lymphedema: A literature review.

Lymphedema is one of the most dreaded complications related to breast cancer surgery, commonly resulting in upper limb functional, esthetic, and psychological impairment. The necessity to improve the efficacy of conventional treatments and the promising effect of extracorporeal shock wave therapy (ESWT) on lymphangiogenesis in vitro and animal models, has prompted studies involving women affected by breast cancer-related lymphedema. Since intervention modalities and treatment protocols used are different, a review is necessary to verify the effectiveness of ESWT, evaluating the quality of existing studies and the eventual need for further research. Data were obtained from PubMed, Scopus, Google Scholar, Cochrane Library and PEDro, including articles published until January 2019. Five studies met the inclusion criteria. Evident heterogeneity emerged among selected studies permitting only a purely descriptive analysis of their data and strongly limiting their comparison. When compared to other treatment modalities, ESWT showed a significant effect on measured outcomes. It is clear that further high quality research is necessary to assert with confidence the effects and possible superiority of ESWT over other conservative therapies in the management of breast cancer-related lymphedema.

A pressure-sensitive palatograph for speech analysis.

Electropalatography (EPG) is a clinical technique used to monitor contacts between the tongue and the hard palate, thus promoting correct articulation mechanisms. Currently, employed commercial tools have a good resolution but they do not provide contact pressure information. In this work, textile-based sensing technologies were employed to realize an innovative EPG tool able to both maintain the proper spatial resolution and perform quantitative pressure detection. The single sensing unit was developed using a thin polymeric sheet with a central hole, sandwiched between two piezoresistive fabric layers. Under load application, the two textile layers come into contact and the resistance of the sensor reduces significantly, measuring pressure in the range from 0 to 30 kPa. The complete prototype is composed of 62 sensing units disposed in a matrix structure: the dielectric layer contains all the sites arranged in rows and columns, according to the topography of the traditional tools, and this layer presents on both sides strips of piezoresistive textile. The entire system was covered with a thin latex membrane and fixed on a hard custom acrylic palate for the experimental characterization. The system was tested on a healthy subject, confirming the adequacy and effectiveness of the soft sensing technologies for the measuring of the tongue pressure during speech.

Feasibility study on the assessment of auditory sustained attention through walking motor parameters in mild cognitive impairments and healthy subjects.

Dementia and other cognitive disorders affect more than 35 million people worldwide. Over the last years, cognitive training tools were used to improve the brain functioning, thus to slow down the cognitive decline. Recently, research studies have demonstrated that aerobic exercise could play an important restorative role toward cognitive impairments. Therefore, the aim of this work is to present an innovative sensorized approach which combines aerobic exercise and traditional cognitive tools for daily training.

Development and testing of a new cognitive technological tool for episodic memory: A feasibility study.

Cognitive Rehabilitation Therapy refers to any systemic therapy specifically designed to enhance cognitive performance. Recent studies have shown that physical exercise is beneficial for cognitive activity in patients with degenerative diseases. Therefore, the objective of the present study is to provide training for cognitive functions that take advantage of the physical activity in the execution of the task. A feasibility study concerning the application of a new bioengineering technique in cognitive rehabilitation is presented and it divided into two parts. The first one aims at developing a new cognitive tool, called SmartTapestry (ST), for motor and cognitive rehabilitation. The second part aims at understanding its technical viability and its level of sensitivity in measuring the same cognitive domains covered by the standardized tests. The hypothesis of this study is that, despite the introduction of this new variable, the proposed system has the same sensitivity of the traditional tests. The results suggest a good correlation between the two approaches and that SmartTapestry can train the same cognitive functions of traditional cognitive tasks.

Vasoactive intestinal peptide receptor subtypes and signalling pathways involved in relaxation of human stomach.

Vasoactive intestinal peptide (VIP) relaxes smooth muscle by interacting with receptors coupled to cAMP- or cGMP-signalling pathways. Their relative contribution to human gastric relaxation is unknown. This study aimed at investigating, in terms of biological activity, receptor expression and related signalling pathways, the action of VIP separately on the human fundus and the antrum. VIP caused greater relaxation of smooth muscle cells (SMC) and strips of the antrum presenting on the former a higher efficacy and potency (ED(50): 0.53 +/- 0.17 nmol L(-1)) than on the fundus (ED(50): 3.4 +/- 1.4 nmol L(-1)). On both fundus and antrum strips, its effect was tetrodotoxin insentitive. Reverse transcriptase-polymerase chain reaction analysis showed the sole expression of VPAC2 and natriuretic peptide clearance receptors, with VPAC2 being more abundant in the antrum. Functional regional differences in receptor-related signalling pathways were found. Activation of the cAMP-pathway by forskolin or its inhibition by adenylate cyclase (2'5'-dideoxyadenosine) or kinase (Rp-cAMPs) inhibitors had more pronounced effects on antrum SMC. Activation of the cGMP-pathway by sodium nitroprusside or its inhibition by guanylate cyclase (LY83583) or kinase (KT5823) inhibitors had more effects on fundus SMC, on which a higher expression of endothelial nitric oxide synthase was found. In conclusion, regional differences in VIP action on human stomach are related to distinct myogenic properties of SMC of the antrum and the fundus.

Genetic analysis carried out on blood-spots of phenylalanine hydroxylase-deficient newborns detected by northeastern Italian neonatal screening.

The aim of this work was to perform genetic analysis on 18 different blood-spot samples collected from neonates detected as hyperphenylalaninemic by Northeastern Italian screening program. DNA was extracted from blood-spots. Exons/introns of PAH gene were amplified by polymerase chain reaction (PCR), and PCR products were purified and sequenced with both forward and reverse primers. The most frequent mutations were IVS12nt1g>a (16.7%) and R408W, P281L and L48S (all together 11.1%). As expected, compound heterozygosity was the usual finding; homozygosity was found only in two patients with R158Q and IVS2nt5g>c mutations. The V230I mutation was reported for the first time in Italy. We found six previously described polymorphisms (V245V, IVS4nt47c>t, IVS2nt19t>c, IVS3nt-22c>t, IVS5nt-54a>g, and E280>Q280). To our knowledge, four genotypes were not previously described: R158Q/V230I present in one patient with classical PKU; and L48S/R408Q, A403V/IVS2nt-13t>g, and G272X/V230I present in patients showing HPA phenotype. Most of the mutations were located in the exons 12 and 7 and in exon/intron 2 (83.3% detection of total mutations in PKU or HPA patients of Northeastern Italy). From a practical viewpoint, the genetic analysis of blood-spots collected on Guthrie cards for neonatal screening for PKU could be a simple method to establish the genotype of neonates. Consequently, the genotype/phenotype correlation could lead to a more accurate diagnosis and prognosis for families.

Gallbladder motility before and after Billroth II gastric resection.

The aim of this study was to determine the effect of Billroth II gastric resection (BII) without vagotomy on gallbladder contraction in response to meal and CCK-OP infusion. Fourteen duodenal ulcer patients were studied before surgery and six months postoperatively. Gallbladder volume was measured by real-time ultrasonography. After surgery, there was a significant increase in fasting gallbladder volume (P < 0.05). Postprandial gallbladder emptying was not significantly affected by gastrectomy apart from a trend towards a shorter t1/2 and a larger ejection volume. In addition, postoperative gallbladder relaxation was more pronounced at time 120 min. In response to cholecystokinin-octapeptide (CCK-OP) infusion, there was a significant decrease of t1/2 after BII and a prolonged contraction with a significantly reduced gallbladder volume. Our data show that the gallbladder response both to meal and CCK-OP infusion is modified after BII and a larger postoperative gallbladder volume may play a role in the pathogenesis of gallstone disease after gastric surgery.

Gallbladder motility in vitro in men with gallstones following Billroth II gastric resection.

Gastric surgery induces an increased incidence of gallstones. To investigate the changes in gallbladder kinetics after gastric resection, 20 male patients were studied: ten patients undergoing cholecystectomy for gallstones developed after Billroth II gastric resection and ten patients undergoing cholecystectomy for cholelithiasis without previous abdominal surgery. Longitudinal strips from the gallbladder wall were suspended in an organ bath and the isometric tension recorded. Dose-response curves to cholecystokinin-octapeptide and carbachol were obtained. Half the maximal response to cholecysto-kinin-octapeptide was 0.50 +/- 0.11 x 10(-7) M in the first group and 1.36 +/- 0.37 x 10(-7) M in the second group (P < 0.05). The ED50 to carbachol was 24.33 +/- 2.69 x 10(-7) M in the gastrectomy group and 40.39 +/- 5.01 x 10(-7) M in the control group (P < 0.01). There was no significant difference in the maximal contractile response either to cholecystokinin-octa-peptide or carbachol in the two groups. Our study shows an increased gallbladder sensitivity to cholecystokinin-octapeptide and carbachol in patients with gallstones developed after Billroth II gastric resection.

Effect of somatostatin on human gallbladder motility: an in vitro study.

In vivo studies have demonstrated that somatostatin induces human gallbladder relaxation. To determine whether this polypeptide acts directly on the gallbladder muscle, its effect on strips of human gallbladder was studied in vitro. Strips of gallbladder were set up isometrically in an organ bath containing oxygenated Krebs' solution. Dose-response curves to cholecystokinin-octapeptide and carbachol were first established. The ability of somatostatin to cause relaxation under basal conditions and during 50% maximal stimulation by cholecystokinin-octapeptide (7.2 x 10(-8) M) and carbachol (3.5 x 10(-6) M) was assessed in 32 strips at 4.3 x 10(-6) M concentration which mimics the plasma concentrations found in patients with somatostatinoma and in 12 additional strips at 4.3 x 10(-8) M concentration. Somatostatin action on the intrinsic innervation by using electrical field stimulation (EFS) (200 mA 5 msec in duration, 30 Hz; 400 mA, 1 msec in duration, 10 Hz) was also evaluated in 39 strips. Somatostatin had no effect on the basal or carbachol-generated tensions. On the contrary, somatostatin (4.3 x 10(-6) M) reduced cholecystokinin-octapeptide-generated tensions by 8% (P < 0.001) and reduced EFS-generated tensions at 30 Hz by 7.7% (P < 0.01) and those at 10 Hz by 41.2% (P < 0.01). All responses to cholecystokinin-octapeptide and carbachol were abolished by dibutyryl-guanosine 3', 5'-cyclic monophosphate (5 x 10(-3) M) and atropine (10(-5) M), respectively (P < 0.0002 and P < 0.0002). All responses to electrical field stimulation were reduced or abolished by tetrodotoxin (2 x 10(-6) M) (P < 0.001 and P < 0.0001, respectively). Our findings show that somatostatin exerts its inhibitory action on the response to cholecystokinin-octapeptide and on the intrinsic innervation of the gallbladder smooth muscle. The probable neurotransmitter is the acetylcholine.

Ultrasonic vocalization in response to unavoidable aversive stimuli in rats: effects of benzodiazepines.

The effects of two benzodiazepine derivatives (diazepam, 0.5-1 mg/kg; alprazolam, 1.25-2.5 mg/kg) on ultrasonic calling elicited in adult rats by unavoidable aversive stimuli (footshocks) were investigated. The results show that either diazepam or alprazolam affected the duration of ultrasonic calls. In particular, a significant decrease in the length of ultrasounds was found in the group of animals treated with these benzodiazepines. The effects of diazepam were counteracted by the benzodiazepine-antagonist Ro 15-1788. On the other hand, neither a neuroleptic agent, such as haloperidol (0.5-1 mg/kg), nor an antidepressant, such as desipramine (5-10 mg/kg) influenced the parameters of ultrasonic emission in this experimental situation. The present results suggest that ultrasonic vocalization in response to unavoidable aversive stimuli could be considered as a potential new tool for studying drugs with antianxiety properties.

Colonic smooth muscle responses in patients with diverticular disease of the colon: effect of the NK2 receptor antagonist SR48968.

BACKGROUND: Little is known about the pathophysiology of diverticular disease. AIM: To compare passive and active stress and the response to carbachol of colonic smooth muscle specimens from patients with diverticular disease and patients with colon cancer. The effect of the NK2 receptor antagonist, SR48968, on electrically evoked contractions of circular muscle was also investigated. PATIENTS: Sigmoid colon segments were obtained from 16 patients (51-83 years) undergoing elective sigmoid resection for diverticular disease and 39 patients (50-88 years) undergoing left hemicolectomy for non-obstructive sigmoid colon cancer. METHODS: Isometric tension was measured on circular or longitudinal taenial muscle. Strips were stretched gradually to Lo (length allowing the development of optimal active tension with carbachol) and were also exposed to increasing carbachol concentrations. The effects of atropine, tetrodotoxin and SR48968 on electrically evoked (supramaximal strength, 0.3 ms, 0.1-10 Hz) contractions of circular strips from 8 patients with diverticular disease and 19 patients with colon cancer were also studied. RESULTS: Both passive and active stress in circular muscle strips obtained from patients with diverticular disease was higher than in patients with colon cancer (P < 0.05). Electrically evoked contractions were significantly reduced by atropine in all preparations and were virtually suppressed by combined SR48968 and atropine. Tetrodotoxin suppressed electrically evoked contractions only in patients with colon cancer, whereas a tetrodotoxin-resistant component was identified in patients with diverticular disease. CONCLUSIONS: The changes in both passive and active stress in specimens from patients with diverticular disease may reflect circular smooth muscle dysfunction. Acetylcholine and tachykinins are the main excitatory neurotransmitters mediating electrically evoked contractions in human sigmoid colon circular muscle.

Ultrasonic calling in rodents: a new experimental approach in behavioural toxicology.

Ultrasonic calls are emitted by many species of rodents in a variety of situations. In particular, infants commonly emit such calls when removed from the nest; the rate and intensity of calling are related to the degree of development of homoiothermy. The relevant biological significance of these signals is documented by their capability to promote parental behaviour, such as maternal retrieval. There is recent evidence that ultrasonic vocalization in rodent pups could be valuable as a bioassay in Behavioural Toxicology. In particular, the results of our recent studies together with those of other authors suggest that ultrasonic calls emitted by infant rats could be considered a useful test in detecting subtle effects of adverse treatment during development.

Aneurysms of the hypogastric artery following surgery of the abdominal aorta. A report of two cases and review of the literature.

Isolated aneurysms of the hypogastric artery are very rare and account for between 0.04% and 0.4% of all intra-abdominal aneurysms. In 85% of cases they are monolateral and are present in association with an aneurysm of the infrarenal abdominal aorta and of the common and external iliac arteries, they make up part of a poly-aneurysmal disease. Unless the patient is an extremely poor condition, surgical treatment is generally indicated for aneurysms greater than 3 cm; close monitoring of those with smaller aneurysms is recommended. Two patients presented with isolated aneurysm of an internal iliac artery which had developed several years after aortoiliac surgery. The one received surgical treatment; the other, who was in poor general conditions and at high risk for surgery, underwent endovascular embolization. Both procedures were successful, with a current follow-up between 15 and 18 months. Endovascular embolization, as performed in the 2(nd) patient, provided an alternative to the surgical procedure. After injection in the aneurysmal sac of the Gianturco spirals, a covered stent was placed in the iliac axis to exclude the inflow of the hypogastric artery. According to our experience of 2 patients, the one treated surgically and the other submitted to a less invasive endovascular procedure, we can state that both methods are practicable. The final choice lies with the vascular surgeon, after weighing the multiple factors that each case involves.

Cystic adventitial disease of the popliteal artery. Report of 1 case and review of the literature.

Cystic adventitial disease (CAD) of the popliteal artery is a rare but well-known cause of intermittent claudication, especially in young patients. The etiology of the disease is still controversial and the literature reports various hypotheses for its origin. Diagnosis starts with thorough history taking and physical examination; non invasive diagnostic studies comprise color duplex scanner (ECD), computed tomography (CT), better if elicoidal (3D CT) and magnetic resonance imaging (MRI), which can aid in establishing correct recognition of the disease in most cases. A 48-year-old man presented with intermittent right calf claudication that had begun 4 months earlier; the symptom-free interval was about 100 m. MRI and MR angiography of right popliteal fossa revealed the presence of an oval cystic (maximum diameter 45 mm). The caudal aspect of the cyst showed pedicles protruding between the popliteal vein and the popliteal artery that compressed the artery, causing complete occlusion of its lumen. Surgery was performed through the posterior approach using an S-shaped incision; the affected segment of the popliteal artery was successfully excised and replaced with an autogenous external saphenous vein graft. A follow-up is underway, both clinical and with; no cyst recurrence has so far been detected either clinically or by duplex scanner during the 15-month postoperative follow-up period; the graft is patent and the patient is completely symptom free. Severe claudication in young patients, possibly without significant vascular risk factors, should prompt the clinical suspicion of adventitial cystic disease of the popliteal artery. Medical history, clinical examination and non invasive instrumental investigations, such as duplex scanner, elicoidal CT and/or MRI, may aid in establishing the correct diagnosis.

Evaluation of the BAX system for detection of Listeria monocytogenes in foods: collaborative study.

A multilaboratory study was conducted to compare the automated BAX system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.