Resting state EEG rhythms in different stages of chronic kidney disease with mild cognitive impairment.

Here, we tested that standard eyes-closed resting-state electroencephalographic (rsEEG) rhythms may characterize patients with mild cognitive impairment due to chronic kidney disease at stages 3-4 (CKDMCI-3&4) in relation to CKDMCI patients under hemodialysis (CKDMCI-H) and mild cognitive impairment (MCI) patients with cerebrovascular disease (CVMCI). Clinical and rsEEG data in 22 CKDMCI-3&4, 15 CKDMCI-H, 18 CVMCI, and 30 matched healthy control (HC) participants were available in a national archive. Spectral rsEEG power density was calculated from delta to gamma frequency bands at scalp electrodes. Results showed that (1) all MCI groups over the HC group showed decreased occipital rsEEG alpha power density; (2) compared to the HC and CVMCI groups, the 2 CKDMCI groups had higher rsEEG delta-theta power density; and (3) the CKDMCI-3&4 group showed the lowest parietal rsEEG alpha power density. The present rsEEG measures may be useful to monitor the impact of circulating uremic toxins on brain regulation of cortical arousal for quiet vigilance in CKDMCI patients.

[Effects of cascade filtration in combination with interferon and ribavirin in the treatment non responder chronic hepatitis C patients]. / La filtrazione a cascata nei pazienti HCV positivi.

In 40% of patients with chronic hepatitis C, standard therapy is unable to eradicate the virus. Since the response to pharmacological treatment depends on the initial viral load, there is a rationale for reducing this load by means of apheretic depletion of the C virus. The aim of this work was to administer cascade filtration (CF) to non responder patients affected by hepatitis C (pts) before resuming the pharmacological treatment. 10 pts underwent 12 sessions of CF, 3 per week (treated plasma volume/session: 3000 mL). After the first week, therapy with PEG-IFN (1.5 ug/Kg/week) plus Ribavirin (1200 mg/day) was added. The viral load was determined before and after each CF session, and at the 1st, 3rd and 6th month. The mean pre-apheresis viral load dropped from 2176275+/-3109997 U/mL at the first session to 1486726+/-2091975 U/mL by the fourth (p<0.001), and 347500+/-637428 U/mL before the last (p<0.001). The mean percentage reduction of the viral load went from a minimum of 29.5% to a maximum of 42%. Early viral response (EVR) was obtained in 70% of these patients as compared with only 10% in an age- and sex-matched control group consisting of 10 patients. Unfortunately, we did not get the same good results in terms of sustained viral response (SVR: 10% in apheretic patients vs 0% in the control group). Efficacious removal of HCV was obtained with CF. However, the successful reduction in the viral load achieved with apheresis in terms of EVR was not confirmed when we considered the SVR.

[Does rheopheresis reduce the cardiovascular risk?]. / La reoferesi riduce il rischio cardio-vascolare?

Rheopheresis comprises various types of apheresis procedures, namely double filtration plasmapheresis, LDL apheresis, and fibrinogen apheresis. These techniques are used to remove high molecular weight proteins from the circulation and have been shown to exert a protective effect on the vessel walls. The vascular protection can be attributed to pleiotropic mechanisms, especially from LDL apheresis, that safeguard against endothelial dysfunction by reducing the concentrations of proinflammatory and procoagulation factors. In addition, rheopheresis improves whole-blood viscosity, principally by reducing fibrinogen and lipoproteins, stimulates endothelium-mediated vasodilation, and has a positive effect on the hemorheological picture, improving perfusion in the microcirculation. All of this helps to correct the functional vessel alterations caused by aggression factors, and is translated into an extremely fast clinical response, only a few hours after the end of apheresis. Demonstrated efficacy has been obtained especially in the microcirculation, as has been observed in ischemic optic neuropathy, sudden hearing loss, and peripheral arterial disease. Although the short-term effects on the functional component of the vascular damage seem to be temporary, long-term effects on the morphological alterations have been shown. It is still not clear which of the many suggested actions, or others still to be confirmed (for instance a short-term increase in endothelial progenitor cells) constitutes the main vessel protective mechanism.

Different Abnormalities of Cortical Neural Synchronization Mechanisms in Patients with Mild Cognitive Impairment due to Alzheimer's and Chronic Kidney Diseases: An EEG Study.

This study tested whether resting state alpha rhythms (8-13 Hz) may characterize mild cognitive impairment due to Alzheimer's disease (ADMCI) compared with MCI due to chronic kidney disease (CKDMCI). Clinical and resting state eyes-closed electroencephalographic (rsEEG) rhythms from 40 ADMCI, 29 CKDMCI, and 45 cognitively normal elderly (Nold) subjects were available in a national archive. Age, gender, and education were matched in the three groups, and Mini-Mental State Evaluation (MMSE) score was paired in the ADMCI and CKDMCI groups. Delta (<4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), beta 2 (20-30 Hz), and gamma (30-40 Hz) cortical sources were estimated by eLORETA freeware and classified across individuals by area under the receiver operating characteristic curve (AUROCC). Compared with Nold group, posterior alpha 1 source activities were more reduced in ADMCI than CKDMCI group. In contrast, widespread delta source activities were greater in CKDMCI than ADMCI group. These source activities correlated with the MMSE score and correctly classified between Nold and all MCI individuals (AUROCC = 0.8-0.85) and between ADMCI and CKDMCI subjects (AUROCC = 0.75). These results suggest that early AD affects cortical neural synchronization at alpha frequencies underpinning brain arousal and low vigilance in the quiet wakefulness. In contrast, CKD may principally affect cortical neural synchronization at the delta frequencies. Future prospective cross-validation studies will have to test these candidate rsEEG markers for clinical applications and drug discovery.

Computer Aided Detection System for Prediction of the Malaise during Hemodialysis.

Monitoring of dialysis sessions is crucial as different stress factors can yield suffering or critical situations. Specialized personnel is usually required for the administration of this medical treatment; nevertheless, subjects whose clinical status can be considered stable require different monitoring strategies when compared with subjects with critical clinical conditions. In this case domiciliary treatment or monitoring can substantially improve the quality of life of patients undergoing dialysis. In this work, we present a Computer Aided Detection (CAD) system for the telemonitoring of patients' clinical parameters. The CAD was mainly designed to predict the insurgence of critical events; it consisted of two Random Forest (RF) classifiers: the first one (RF1) predicting the onset of any malaise one hour after the treatment start and the second one (RF2) again two hours later. The developed system shows an accurate classification performance in terms of both sensitivity and specificity. The specificity in the identification of nonsymptomatic sessions and the sensitivity in the identification of symptomatic sessions for RF2 are equal to 86.60% and 71.40%, respectively, thus suggesting the CAD as an effective tool to support expert nephrologists in telemonitoring the patients.

Pleiotropic effects of LDL apheresis.

LDL apheresis (LA), a technique employed to remove atherogenic lipoproteins, has been shown to exert a protective function on the vessel walls. This effect can be attributed to pleiotropic mechanisms that safeguard against endothelial dysfunction by reducing the concentrations of pro-inflammatory and pro-coagulation markers. Besides these actions, LA improves whole blood viscosity and endothelium-mediated vasodilation, and has a positive effect on the hemorheological picture, improving perfusion in the microcirculation. Although the short term effects on the functional component of the vascular damage seem to be temporary, long term effects on the morphological alterations have also been shown. It is still not clear which of the many proposed actions, or others still to be discovered, is the principal vessel protective mechanism.