The Body Fat-Cognition Relationship in Healthy Older Individuals: Does Gynoid vs Android Distribution Matter?

OBJECTIVE: To examine the relationship between regional and whole body fat accumulation and core cognitive executive functions. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: 78 healthy men and women aged between 65 and 75 years recruited through consumer's database. MEASUREMENTS: DXA measured percentage total body fat, android, gynoid distribution and android/gynoid ratio; inhibition and working memory updating through Random Number Generation test and cognitive flexibility by Trail Making test. First-order partial correlations between regional body fat and cognitive executive function were computed partialling out the effects of whole body fat. Moderation analysis was performed to verify the effect of gender on the body fat-cognition relationship. RESULTS: Results showed a differentiated pattern of fat-cognition relationship depending on fat localization and type of cognitive function. Statistically significant relationships were observed between working memory updating and: android fat (r = -0.232; p = 0.042), gynoid fat (r = 0.333; p = 0.003) and android/gynoid ratio (r = -0.272; p = 0.017). Separating genders, the only significant relationship was observed in females between working memory updating and gynoid fat (r = 0.280; p = 0.045). In spite of gender differences in both working memory updating and gynoid body fat levels, moderation analysis did not show an effect of gender on the relationship between gynoid fat and working memory updating. CONCLUSIONS: Results suggest a protective effect of gynoid body fat and a deleterious effect of android body fat. Although excessive body fat increases the risk of developing CDV, metabolic and cognitive problems, maintaining a certain proportion of gynoid fat may help prevent cognitive decline, particularly in older women. Guidelines for optimal body composition maintenance for the elderly should not target indiscriminate weight loss, but weight maintenance through body fat/lean mass control based on non-pharmacological tools such as physical exercise, known to have protective effects against CVD risk factors and age-related cognitive deterioration.

Cosmetic injectable devices: a review of the injection techniques.

An ever increasing number of devices and procedures designed to rejuvenate the aging face are available to dermatologists and plastic surgeons. These devices include products consisting of autologous materials, natural polymers, and synthetic compounds. The diversity of these materials is reflected by the wide variety of techniques used to administer them. Differences in terms of injection technique and the equipment used for each device are usually a consequence of the nature of the material. The depth at which a substance is deposited is also very important as device-related adverse events are often a result of improper placement. The techniques used to inject the commonly encountered soft tissue fillers and volume enhancers are compared here, with special reference to the degree with which injection technique causes device-related adverse events.

Effects of Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial.

Physical and cognitive training seem to counteract age-related decline in physical and mental function. Recently, the possibility of integrating cognitive demands into physical training has attracted attention. The purpose of this study was to evaluate the effects of twelve weeks of designed physical-cognitive training on executive cognitive function and gait performance in older adults. Thirty-six healthy, active individuals aged 72.30 ± 5.84 years were assigned to two types of physical training with major focus on physical single task (ST) training (n = 16) and physical-cognitive dual task (DT) training (n = 20), respectively. They were tested before and after the intervention for executive function (inhibition, working memory) through Random Number Generation and for gait (walking with/without negotiating hurdles) under both single and dual task (ST, DT) conditions. Gait performance improved in both groups, while inhibitory performance decreased after exercise training with ST focus but tended to increase after training with physical-cognitive DT focus. Changes in inhibition performance were correlated with changes in DT walking performance with group differences as a function of motor task complexity (with/without hurdling). The study supports the effectiveness of group exercise classes for older individuals to improve gait performance, with physical-cognitive DT training selectively counteracting the age-related decline in a core executive function essential for daily living.

Calibration of methods for determining numbers of dorsal root ganglion cells.

Numbers of primary afferent neurons underlie important generalizations concerning the organization of primary sensory systems. A major difficulty, however, is that different investigators do not agree on the neuronal counts. The problem, in our opinion, is that the various methods used to determine these numbers do not provide the same results. Thus to be certain that a method provides accurate counts, calibration is necessary. To do this, true numbers of ganglion cells were determined by serially reconstructing significant parts of four rat lumbar dorsal root ganglion cell populations. Then 6 commonly used methods of counting neurons were used to determine neuron numbers for these same populations. The data indicate that the empirical method, using the modifications recommended in this paper, estimates numbers of neurons with the needed accuracy whereas the other 5 do not. Thus, of the tested counting procedures, the empirical method is recommended. If other methods are to be used, they should also be calibrated.

Do neuropeptides in the dorsal horn change if the dorsal root ganglion cell death that normally accompanies peripheral nerve transection is prevented?

Peripheral nerve section causes the death of dorsal root ganglion cells and changes in neuroactive peptides in the dorsal horn of the spinal cord. The relationship between these 2 events has not been previously studied, however. One approach would be to prevent sensory cell death and then determine changes in peptide immunoreactivity. To do this, transected rat sciatic nerve stumps were placed in an impermeable silicone tube for one month. The tube was then removed and after 30 additional days the cells were counted. The data indicate that no cell death occurred. We conclude that the sensory cells are first saved due to some factor present in the tube, and then after 30 days, the cells become independent of the tube and its contents. In these same animals, all of the peptides we examined were significantly changed. Four of the peptides, calcitonin gene-related peptide (CGRP), substance P (SP), cholecystokinin octapeptide (CCK) and galanin (GAL) were significantly depleted in the medial L4-L5 superficial dorsal horn, and vasoactive intestinal polypeptide (VIP) was significantly increased. We conclude that there are major changes in spinal peptide systems following peripheral nerve transection even if there is no accompanying death of sensory neurons. Thus we suggest that dramatic central changes in peptide immunoreactivity following peripheral nerve transection are independent of the sensory cell death that usually occurs in response to this injury.

Clinical pathogenesis of macular holes in patients affected by retinitis pigmentosa.

BACKGROUND: To define the main clinical mechanisms involved in the pathogenesis of macular holes (MH) in patients affected by Retinitis Pigmentosa (RP). METHODS: 236 RP subjects were enrolled in this study and ophthalmologically examined according to a standard FIARP (Italian Federation of the RP Associations) protocol. The prevalence of posterior vitreous detachment (PVD) as well as all types of RP-related macular abnormalities--especially vitreoretinal interface alterations (VRIA), cystoid macular edema (CME), "bull's eye maculopathy" (BEM) and MH--was reported; statistical analyses and correlations were assessed by means of Student t test and Pearson chi2. RESULTS: VRIA and CME were observed in 26.15% and 9.45% of the cases respectively and resulted significantly associated with MH, since they were constantly present in 22 of the 25 eyes affected by MH (88%) (chi2 = 50.4; p < 0.01). In particular, in 9 of these cases (40.9%) MH was correlated to both CME and VRIA, while in 11 (50%) and 2 (9.1%) eyes CME or VRIA were present separately. A normal biomicroscopic macular appearance, PVD and BEM were found in 26.81%, 6.6% and 21.54% of the cases respectively. CONCLUSIONS: Further studies involving a larger number of patients are required to complete these preliminary results. However, the present investigation seem to confirm the data already reported in the literature, i.e. that pathogenesis of MH in RP is strictly correlated to the presence of VRIA, cellophane maculopathy and cystic foveal degeneration with CME.

Deflazacort treatment of cystoid macular edema in patients affected by Retinitis Pigmentosa: a pilot study.

BACKGROUND: To investigate the efficacy of a long-term treatment with Deflazacort (DFZ), a third generation synthetic glucocorticoid, in patients affected by Retinitis Pigmentosa (RP) complicated by Cystoid Macular Edema (CME). METHODS: A randomized group of 10 RP subjects were selected for this pilot study and treated with DFZ for one year according to a standard protocol. Far and near Best Corrected Visual Acuity (BCVA), fluorescein angiography (Heidelberg Retina Angiograph) and computerized perimetry (Humphrey Visual Field Analyzer) were statistically assessed. RESULTS: Near visual acuities, fluorescein angiographic findings and perimetric data improved significantly (p < 0.01) while far BCVA varied only slightly (p < 0.05). No ocular or systemic side effects were recorded. CONCLUSIONS: Further case-control studies, also involving a larger number of patients, are required to confirm these preliminary results. However, the present investigation seem to suggest that DFZ could be effective in reducing fluorescein angiographic findings and improving perimetric data and near visual acuities in RP patients, even though the pathogenesis of CME remains poorly understood.

An anatomical classification of maxillary ameloblastoma as an aid to surgical treatment.

Maxillary ameloblastoma is a different entity from its mandibular counterpart. It is reported to behave more aggressively and have a poorer prognosis. Eleven maxillary ameloblastomas (three recurrent) are reported with a follow-up ranging from 1 month to 12 years with no recurrences. It is proposed that radical treatment of these tumours, with good reconstruction, can give satisfactory function and survival. To that end, the tumours have been classified as to their position in the maxilla and surgical resection related to this.

A cadaver investigation of the blood supply of the galeal frontalis flap.

The vascular anatomy of the galeal frontalis flap was studied in 12 fresh cadavers by an intraarterial dye injection technique. Special attention was directed to the length limit of this flap. The general belief that the galeal frontalis flap has a robust vascularity by means of the supratrochlear and supraorbital arteries was not demonstrated in this study. In the medial half of the forehead, superficial branches of both arteries penetrated the frontalis muscle immediately above the supraorbital rim and ran superficially in the subcutaneous tissue. In the lateral half, some of the superficial branches of the supraorbital artery traveled with the frontalis muscle and anastomosed with the frontal branch of the superficial temporal artery. Deep branches of the supratrochlear and supraorbital arteries showed an axial distribution on the periosteum only for a short distance. One or two branches of the supraorbital artery were found to take a superficial course within the subgaleal layer, pierce the frontalis muscle, and anastomose with the superficial temporal artery. These findings suggest that the galeal frontalis flap should be elevated in the lateral forehead. The preservation of the periosteum with the flap is recommended in order to ensure the temporoparietal extension.

Ophthalmic complications after surgery for nasal and sinus polyposis.

PURPOSE: To describe ophthalmic complications after nasal and sinus surgery. METHODS: Four cases with orbital complications were retrospectively selected from among more than 2000 cases of orbital pathologies. RESULTS: Motility disturbances due to extraocular muscle injury occurred in two patients after intranasal ethmoidectomy and in one patient after a Caldwell-Luc procedure. In the fourth case an orbital apex syndrome was noted after intranasal ethmoidectomies. CONCLUSIONS: Ophthalmic complications may occur after nasal and sinus surgery, even using an endoscopic procedure. Successful handling of these complications could be reached by on their early recognition and treatment.

A comparison of upper arm and forearm tourniquet tolerance.

This study examined the use of upper arm and forearm tourniquets for hand surgery. 40 subjects (20 males, 20 females) were randomly assigned to one of four groups: left upper arm, left forearm, right upper arm and right forearm. Tourniquets were applied to these areas. Subjects were asked to rate their discomfort at 10-minute intervals and the total time of tourniquet tolerance was recorded. The results of a three-factor ANOVA revealed no statistically significant differences in either pain rating or tourniquet tolerance between any of the groups. In addition, forearm tourniquets were used in 18 clinical cases. None of the individuals with tourniquet times less than 30 minutes required any medication in order to tolerate this procedure. Of the 13 patients with tourniquet times greater than 30 minutes, ten required medication in order to tolerate the procedure. We conclude that patients tolerate upper arm and forearm tourniquets equally.

[Corneal neovascularization: epidemiological, physiopathological, and clinical features]. / Néovascularisation cornéenne : aspects épidémiologiques, physiopathologiques et cliniques.

Corneal neovascularization is defined as the presence of vessels within the normally avascular corneal stroma. This physiopathological process is the consequence of local hyper-expression of pro-angiogenic factors in response to tissue damage. These new vessels (neovessels), initially immature and poorly developed, predispose the cornea to lipid exudation, inflammation, and scarring. Additionally, the influx of vascular cells into the stroma induces a loss of the cornea's immune privilege, resulting in a higher rate of graft rejection. In this literature review, we touch on epidemiological, physiopathological, and clinical aspects of corneal neovascularization, as well as secondary complications.

Functional changes after treatment of optic pathway paediatric low-grade gliomas.

OBJECTIVE: To evaluate the functional changes after treatment of paediatric optic pathway gliomas (OPGs). METHODS: All patients with monofocal OPG seen from January 2004 to January 2011 were included. Best corrected visual acuity (BCVA, LogMAR), contrast sensitivity (Hiding-Heidi low-contrast 'face' test (HH) and Pelli-Robson (PR) contrast sensitivity test), and the Color Test (Ishihara plate) were obtained. RESULTS: Twenty-one patients (10 boys and 11 girls with a mean age of 5.5 ± 4.4 years at diagnosis) were included in the study. Neurofibromatosis was present in four cases. Eighteen patients (85.7%) were treated with initial surgery and three patients (14.3%) with initial chemotherapy. BCVA was 0.67 ± 0.8 LogMAR at baseline and 0.62 ± 0.9 LogMAR at last visit (P=0.41). The Color test was not significantly changed at last visit (P=0.62). Contrast sensitivity with the HH test was 9.1 ± 11.1% at baseline and 3.8 ± 6.4% at last visit (P=0.03). Contrast sensitivity with PR chart was 1.33 ± 0.9 log at baseline and 1.05 ± 0.7 log at last visit (P=0.005). A reduction in contrast sensitivity at both tests was significantly greater in patients who relapsed than in patients who did not relapse (P=0.001). CONCLUSION: After the treatment of paediatric optic pathway low-grade gliomas, a reduction in contrast sensitivity during follow-up was observed and may be correlated with tumour relapses.

Evaluation of retinal nerve fiber layer and ganglion cell complex thickness after ocular blunt trauma.

PURPOSE: To evaluate circumpapillary retinal nerve fiber layer (cpRNFL) and ganglion cell complex (GCC) after ocular blunt trauma. METHODS: Best-corrected visual acuity (BCVA), cpRNFL and GCC were evaluated by RTVue-100 OCT in all consecutive patients with previous monocular blunt trauma seen between January 2012 and December 2012. RESULTS: Twenty-two patients (11 females, 11 males, mean age 43.9 ± 14.2 years) were included in the study. Patients were seen after a mean of 8.42 ± 13.3 (range, 0.08-55.3) years from ocular blunt trauma. BCVA was normal in 11 cases and was less than 0.4 LogMAR in all cases. In 9/22 patients (40.9%), cpRNFL and GCC were reduced, whereas in one case an isolated reduction of GCC with normal cpRNFL was present. In patients with reduction of cpRNFL and GCC, mean BCVA was 0.17 ± 0.17 LogMAR. In 6/9 patients (66.6%) with cpRNFL and GCC reduction, BCVA was ≤ 0.1 LogMAR. CONCLUSION: cpRNFL and GCC reduction may be present after ocular blunt trauma and may be associated with preserved visual acuity.

[Efficacy of intravitreal injections of ranibizumab compared to visudyne phototherapy in myopic choroidal neovascularization associated with high myopia]. / Comparaison du traitement par injections intravitréennes de ranibizumab à la photothérapie dynamique dans la néovascularisation choroïdienne compliquant la myopie forte.

INTRODUCTION: Myopic choroidal neovascularization (CNV) is the first cause of CNV in young patients. The aim of this study was to compare the efficacy of intravitreal injections (IVT) of ranibizumab with photodynamic therapy (PDT) in this indication. PATIENTS AND METHODS: Retrospective comparative study analyzing the visual acuity (VA) outcomes of CNV myopic patients treated with either IVT or PDT. RESULTS: Twenty-seven eyes of 25 patients were treated with PDT (group 1) and 18 eyes of 17 patients were treated with IVT of ranibizumab (group 2). Demographic data were similar in the two groups. The median initial VA was 20/80 for group 1 and 20/160 for group 2 (P=0.37). At 1 year, the median VA was 20/80 for group 1 (P=0.32) and 20/63 for group 2 (P=0.04). A significant improvement in VA was observed in 23.1% and in 27.3% of cases in groups 1 and 2, respectively (P=0.53). A significant VA worsening was observed in 34.6% of cases in group 1 and in 9.1% of cases in group 2 (P=0.21). CONCLUSION: IVT of ranibizumab compared to PDT treatment showed greater efficacy in this study.

[Multiple evanescent white dot syndrome and multiple sclerosis]. / Syndrome des taches blanches évanescentes et sclérose en plaques.

PURPOSE: To describe a patient who fulfilled the criteria for both clinically definite multiple evanescent white dot syndrome (MEWDS) and multiple sclerosis. METHODS: We performed a complete ophthalmologic and neurological examination in a 30-year-old woman who was referred to our department for blurred vision in her left eye (LE) with photopsia. RESULTS: Following a complete ophthalmologic examination, the patient was diagnosed with MEWDS and coincident multiple sclerosis. She underwent therapy with intravenous methylprednisolone (1000 mg/day) for three days, followed by oral prednisone (1 mg/kg per day) for 15 days. Most of the symptoms and signs apparently regressed within one month, despite a still abnormal OCT macular scan, probably due to atrophic post-inflammatory changes in the outer and photoreceptor layers (rods and cones). CONCLUSION: This report, showing the clinical features of MEWDS associated with multiple sclerosis, strongly suggests common neuropathological and inflammatory mechanisms between MS and white dot syndromes.

[A chart for low visual acuities: experience in a center for low vision and rehabilitation]. / Intérêt de mesurer les acuités visuelles très basses dans un centre de réadaptation pour déficients visuels.

INTRODUCTION: Commonly used visual test charts can be used to measure 1-m minimal visual acuities (VA) of 20/1000 (Snellen chart) and 1/40 (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts). METHODS: In a prospective study, we considered all patients who visited in a Low Vision and Rehabilitation Center between September 2007 and January 2009. Distance best corrected VA (DBCVA) was evaluated with the ETDRS LogMAR 4-m chart and a customized ETDRS 1-m chart, while near best corrected VA (NBCVA) was measured with the LogMAR conversion of the Parinaud 30-cm chart. RESULTS: One hundred and sixteen eyes (58 patients; 34 males and 24 females with a mean age of 69+/-19.4 [19-94] years) were included in the study. Mean DBCVA was 0.97+/-0.58 LogMAR, mean NBCVA was 0.28+/-0.2 LogMAR. In 52 eyes (44.8%), distance VA was less than 1/20 (DBCVA 1.86+/-0.5 LogMAR, NBCVA 0.08+/-0.05 LogMAR). Among the 58 best seeing eyes, DBCVA was 0.87+/-0.6 LogMAR, while NBCVA was 0.34+/-0.2 LogMAR. In 18 of 58 cases (31%), distance VA was less than 1/20 (DBCVA 1.86+/-0.59 and NBCVA 1.51+/-0.42). CONCLUSION: In a center for low vision and visual rehabilitation, a customized chart was necessary in 31% of cases for evaluation of VA. A fine measurement of low VA is useful for baseline assessment and for evaluation of changes during rehabilitation.

Intravitreal bevacizumab vs intravitreal triamcinolone combined with macular laser grid for diffuse diabetic macular oedema.

OBJECTIVE: To evaluate the 12-month clinical outcome of patients with persistent non-ischaemic diffuse diabetic macular oedema (DME) treated with intravitreal bevacizumab (IVB) or with intravitreal injection of triamcinolone combined with macular laser grid (IVTA-MLG) from September 2005 to February 2008. METHODS: Retrospective interventional comparative study. Best-corrected visual acuity (BCVA, ETDRS LogMAR scale) and foveal thickness (FT) at optical coherence tomography (OCT) were obtained at baseline and during 12 months after first treatment. Re-treatment was based on clinical or OCT-based evidence of persistent macular oedema or deterioration in visual acuity. RESULTS: Forty-three eyes (32 patients) with DME were treated with IVB. Ninety-six eyes (52 patients) with DME were treated with combined laser grid treatment and intravitreal triamcinolone. At baseline, mean BCVA and FT were 0.92+/-0.34 LogMAR and 372+/-22 microm in the IVTA-MLG group, and 1.07+/-0.49 LogMAR and 423+/-33 microm in the IVB group, respectively. At 1- and 3-month visits, BCVA and FT had significantly improved in both groups. After 6 and 12 months, the IVB group experienced a statistically significant improvement in visual acuity (0.83+/-0.21 LogMAR, P<0.001 at 6 months; BCVA 0.86+/-0.24 LogMAR, P<0.001 at 12 months) and FT (248+/-18 microm, P<0.001 at 6 months; 262+/-28 microm, P=0.001 at 12 months) when compared with baseline, whereas the IVTA-MLG group did not show statistically significant improvement in vision and FT. An increase in intraocular pressure (IOP) was present in 10 of 96 (10.4%) eyes treated with IVTA-MLG, and in two cases it was resistant to topical treatment. No significant side effects were reported in the IVB group. CONCLUSIONS: At 6 and 12 months after first treatment for chronic DME IVB provided significant improvement of BCVA and FT, whereas improvement after IVTA-MLG was not significant. Increased IOP occurred in 10.4% of patients who received IVTA, with two patients requiring trabeculectomy.

Comparison of time domain Stratus OCT and spectral domain SLO/OCT for assessment of macular thickness and volume.

PURPOSE: To compare retinal thickness and volume measurements obtained with Stratus time domain optical coherence tomography (OCT) and spectral domain scanning laser ophthalmoscope OCT (SD-SLO/OCT). METHODS: In a cross-sectional study, 52 eyes with a normal macula, 30 eyes with retinal oedema, and 10 eyes with a myopia higher than 6 D have been evaluated with both time domain OCT (TD-OCT, Stratus OCT, Carl Zeiss Meditec, USA) and SD-SLO/OCT (OTI, Toronto, Canada). Retinal thickness and volume measurements in the nine areas of the 6-mm ETDRS ring were compared. Artefacts were defined as the discordance between the automatically detected anterior and posterior retinal boundaries and the boundaries detected by the examiner. RESULTS: Artefacts were more frequent with TD-OCT (35 vs26%). Mean retinal thickness was significantly higher with SD-SLO/OCT by 30.1 microm (+/-25.8) (P=0.003) in presence of the artefacts and by 39.2 microm (+/-25.8) (P=0.003) after their exclusion. The correlation between the two retinal thickness data sets before exclusion of the artefacts (r=0.59, P<0.001) increased after their removal (r=0.84, P<0.001). A strong correlation was present between the two retinal volume data sets before (r=0.94, P<0.001) and after exclusion of the artefacts (r=0.96, P<0.001). CONCLUSIONS: SD-SLO/OCT produced fewer artefacts than Stratus TD-OCT. This could be attributed to the greater resolution and acquisition speed of SD-SLO/OCT. The macular retinal thickness values measured with SD-SLO/OCT were significantly higher than those measured with Stratus TD-OCT. Retinal volumes measured with Stratus TD-OCT and SD-SLO/OCT were strongly correlated.