Hypoperfusion of brain parenchyma is associated with the severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis: a cross-sectional preliminary report.

BACKGROUND: Several studies have reported hypoperfusion of the brain parenchyma in multiple sclerosis (MS) patients. We hypothesized a possible relationship between abnormal perfusion in MS and hampered venous outflow at the extracranial level, a condition possibly associated with MS and known as chronic cerebrospinal venous insufficiency (CCSVI). METHODS: We investigated the relationship between CCSVI and cerebral perfusion in 16 CCSVI MS patients and 8 age- and sex-matched healthy controls. Subjects were scanned in a 3-T scanner using dynamic susceptibility, contrast-enhanced, perfusion-weighted imaging. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the gray matter (GM), white matter (WM) and the subcortical GM (SGM). The severity of CCSVI was assessed according to the venous hemodynamic insufficiency severity score (VHISS) on the basis of the number of venous segments exhibiting flow abnormalities. RESULTS: There was a significant association between increased VHISS and decreased CBF in the majority of examined regions of the brain parenchyma in MS patients. The most robust correlations were observed for GM and WM (r = -0.70 to -0.71, P < 0.002 and P corrected = 0.022), and for the putamen, thalamus, pulvinar nucleus of thalamus, globus pallidus and hippocampus (r = -0.59 to -0.71, P < 0.01 and P corrected < 0.05). No results for correlation between VHISS and CBV or MTT survived multiple comparison correction. CONCLUSIONS: This pilot study is the first to report a significant relationship between the severity of CCSVI and hypoperfusion in the brain parenchyma. These preliminary findings should be confirmed in a larger cohort of MS patients to ensure that they generalize to the MS population as a whole. Reduced perfusion could contribute to the known mechanisms of virtual hypoxia in degenerated axons.

Antidoping attitudes among elite athletes: a cross sectional study in biathlon using a suitably developed questionnaire.

BACKGROUND: The attitude of athletes towards antidoping interventions was surveyed among biathletes by a properly developed questionnaire. METHODS: Topics and items were identified by a multidisciplinary team. A demographics and an awareness sections exploring respondents' characteristics and knowledge of the antidoping rules were added. The anonymous, self-administered tool was distributed to athletes during two international events. Two hundred forty-four biathletes participated in the survey. The structure of the questionnaire, determined by factor analysis, included three domains: safety (items N.=12) acceptance (N.=11), and satisfaction (N.=13) exploring respectively the perceived protection from cheating, the acceptance of the limitations on daily activities imposed by the antidoping interventions and the satisfaction with antidoping rules and actions. The domain scores and a general antidoping attitude score were calculated. RESULTS: The questionnaire, which displayed construct validity (r=0.500, P<0.001), good internal consistency (α=0.82) and significant acceptable test-retest reliability (k=0.59), revealed a good antidoping attitude (general score: 64.9/100±8.8) and in relation to each domain a satisfaction of athletes with antidoping interventions (65.3±13.6), good acceptance of the related restrictions (70.1±10.9), and concerns about safety (59.5±11.9), which was the lowest scoring domain (P<0.001). The degree of awareness, differently from age and gender, influenced the antidoping attitude score. CONCLUSIONS: The new questionnaire revealed a positive mood of biathletes towards antidoping interventions, pointed out their necessity of protection from cheating and highlighted the positive influence of awareness of the rules on antidoping attitude. The questionnaire is not sport-specific, which allows any international federation to evaluate the impact of antidoping strategies on athletes.

Effects of a "test in-train out" walking program versus supervised standard rehabilitation in chronic stroke patients: a feasibility and pilot randomized study.

BACKGROUND: The loss of normal ambulatory function after stroke, besides causing disability, leads to progressive deconditioning and exposes patients to increased risk of cardiovascular diseases and recurrent stroke. Conventional rehabilitation is mainly limited to the subacute period after stroke. Effective, safe and sustainable interventions for patients and healthcare system, including the long-term, should be identified. AIM: To verify the feasibility, safety and preliminary efficacy of an original home-based rehabilitation model compared to a standard supervised program in chronic hemiplegic stroke survivors. DESIGN: Pilot, two-arm, parallel group, randomized, controlled clinical trial. SETTING: Community-dwelling poststroke patient/Hospital. POPULATION: Twelve chronic hemiplegic stroke patients (age=66.5±11.9 years, males, N.=9). METHODS: Participants were randomly assigned for a 10-week period to a structured home-based exercise program (N.=6) and a standard supervised group-setting program (N.=6). The feasibility outcomes included adherence to interventions, retention rate and safety. Satisfaction was also evaluated by the Client Satisfaction Questionnaire. Efficacy was assessed by the 6-minute walk test, Timed Up and Go and Stair Climb tests. The impact on Quality-of-life was estimated using the physical activity domain of the Short Form-36 questionnaire. Operators' time consuming was also calculated. RESULTS: Adherence was 91% in the home-based exercise group and 92% in the standard supervised group. The retention rate was 100%, with no adverse events reported and high satisfaction scores for both interventions. 6-minute walk test and physical activity domain significantly increased in both groups (P=0.03). Timed Up and Go improved in both groups, significantly for the home-based exercise group (P=0.03) while Stair Climb remained stable. Time required to operators to implement the home-based exercise program was 15 hours vs. 30 hours for the standard supervised one. CONCLUSIONS: In a sample of hemiplegic chronic stroke patients, a structured home-based exercise program was feasible, safe and capable of inducing improvements in functional capacity and Quality-of-life comparable to a conventional supervised rehabilitation program A future larger randomized controlled trial will be needed to confirm such results. CLINICAL REHABILITATION IMPACT: With the limitation of a small sample size, the study suggested that a home-based program for chronic stroke might be an effective alternative to traditional supervised programs with the peculiarity of being sustainable for patients and healthcare system.

Sport therapy for hypertension: why, how, and how much?

Exercise may prevent or reduce the effects of metabolic and cardiovascular diseases, including arterial hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, decrease blood pressure and avoid or reduce the need for pharmacologic therapy in patients with hypertension. The hypotensive effect of exercise is observed in a large percentage of subjects, with differences due to age, sex, race, health conditions, parental history, and genetic factors. Exercise regulates autonomic nervous system activity, increases shear stress, improves nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulates antioxidant enzymes. Endurance training is primarily effective, and resistance training can be combined with it. Low-to-moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs make exercise safe and effective also in special populations. Supervised or home-based exercise programs allow a nonpharmacological reduction of hypertension and reduce risk factors, with possible beneficial effects on cardiovascular morbidity.