Early diagnosis of Alzheimer's disease: the role of biomarkers including advanced EEG signal analysis. Report from the IFCN-sponsored panel of experts.

Alzheimer's disease (AD) is the most common neurodegenerative disease among the elderly with a progressive decline in cognitive function significantly affecting quality of life. Both the prevalence and emotional and financial burdens of AD on patients, their families, and society are predicted to grow significantly in the near future, due to a prolongation of the lifespan. Several lines of evidence suggest that modifications of risk-enhancing life styles and initiation of pharmacological and non-pharmacological treatments in the early stage of disease, although not able to modify its course, helps to maintain personal autonomy in daily activities and significantly reduces the total costs of disease management. Moreover, many clinical trials with potentially disease-modifying drugs are devoted to prodromal stages of AD. Thus, the identification of markers of conversion from prodromal form to clinically AD may be crucial for developing strategies of early interventions. The current available markers, including volumetric magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebral spinal fluid (CSF) analysis are expensive, poorly available in community health facilities, and relatively invasive. Taking into account its low cost, widespread availability and non-invasiveness, electroencephalography (EEG) would represent a candidate for tracking the prodromal phases of cognitive decline in routine clinical settings eventually in combination with other markers. In this scenario, the present paper provides an overview of epidemiology, genetic risk factors, neuropsychological, fluid and neuroimaging biomarkers in AD and describes the potential role of EEG in AD investigation, trying in particular to point out whether advanced analysis of EEG rhythms exploring brain function has sufficient specificity/sensitivity/accuracy for the early diagnosis of AD.

Validity and reliability of the HEMPA method for patient handling assessment.

Specific methods currently exist to assess occupational hazards resulting from patient handling in the healthcare sector, according to ISO/TR 12296. They are all similar in nature, but with a different analysis perspective; for that reason a comparison of the most relevant methods was performed in a previous research. As a result, a basis of a new tool that integrates the complementary aspects of those methods was proposed. To verify the validity and reliability of that method, a study within a hospital setting was carried out in five medical and surgical units of a public health institution. Based on the obtained results, the analysed method (called HEMPA) proved to be valid and reliable. Also, this method reflects a positive correlation between risk and damage and correctly quantifies risks regarding patient's dependence.

Simple route for nano-hydroxyapatite properties expansion.

Simple surface modification of nano-hydroxyapatite, through acid-basic reactions, allows expanding the properties of this material. Introduction of organic groups such as hydrophobic alkyl chains, carboxylic acid, and amide or amine basic groups on the hydroxyapatite surface systematically change the polarity, surface area, and reactivity of hydroxyapatite without modifying its phase. Physical and chemical properties of the new derivative particles were analyzed. The biocompatibility of modified Nano-Hap on Raw 264.7 cells was also assessed.

Does EEG montage influence Alzheimer's disease electroclinic diagnosis?

There is not a specific Alzheimer's disease (AD) diagnostic test. AD diagnosis relies on clinical history, neuropsychological, and laboratory tests, neuroimaging and electroencephalography. Therefore, new approaches are necessary to enable earlier and more accurate diagnosis and to measure treatment results. Quantitative EEG (qEEG) can be used as a diagnostic tool in selected cases. The aim of this study was to answer if distinct electrode montages have different sensitivity when differentiating controls from AD patients. We analyzed EEG spectral peaks (delta, theta, alpha, beta, and gamma bands), and we compared references (Biauricular, Longitudinal bipolar, Crossed bipolar, Counterpart bipolar, and Cz reference). Support Vector Machines and Logistic Regression classifiers showed Counterpart bipolar montage as the most sensitive electrode combination. Our results suggest that Counterpart bipolar montage is the best choice to study EEG spectral peaks of controls versus AD.

Absence of cervical schistosomiasis among women from two areas of north-eastern Brazil with endemic Schistosoma mansoni.

Genital manifestations in schistosomiasis haematobium are common and are associated with considerable morbidity. Although Schistosoma mansoni may also cause genital disease, the frequency of this complication is not known. Cervical biopsies (N=401) and Pap smears (N=981) were therefore collected from women living in two S. mansoni-endemic areas (in the states of Alagoas and Ceará, in north-eastern Brazil). The women were screened for the presence of sexually transmitted diseases and for the presence, in their cervical smears and/or biopsies, of S. mansoni eggs. Attempts at schistosomiasis control, which began in both study areas in 1977, have led to generally low intensities of infection (<30 eggs/g faeces in 99% of infections) and community prevalences of infection that range between 1% and 52%. As no schistosome ova were detected in any of the biopsies or smears, it appears that the risk, among women, of genital manifestations of S. mansoni infection is small in areas where the parasite load in the population is low (as the result of interventions to control intestinal schistosomiasis).

Clear-PEM: a dedicated PET camera for improved breast cancer detection.

Positron emission mammography (PEM) can offer a non-invasive method for the diagnosis of breast cancer. Metabolic images from PEM using 18F-fluoro-deoxy-glucose, contain unique information not available from conventional morphologic imaging techniques like X-ray radiography. In this work, the concept of Clear-PEM, the system presently developed in the frame of the Crystal Clear Collaboration at CERN, is described. Clear-PEM will be a dedicated scanner, offering better perspectives in terms of position resolution and detection sensitivity.

Banked cadaveric fascia lata: 3-year follow-up.

Autologous fascial and synthetic materials have been widely used to repair the stress form of urinary incontinence (SUI) as well as pelvic floor prolapse. The safety and long-term durability of cadaveric fascia lata in orthopedic and ophthalmologic surgery have encouraged urogynecologists to use this material for a sling material. The rationale of placement of a sling from cadaveric fascia lata is based upon decreasing the complication rates caused by autologous and synthetic materials. However, the high costs of the commercially available tissues in Brazil have limited its use in public health. In our institution we developed a cadaveric fascia lata bank, harvesting the material according to the Brazilian Transplantation Legislation and storing it at -70 degrees C. The safety of the tissue is achieved by 25-kGy irradiation. Since 1999, 30 patients have undergone surgery using material from five donors in repairs for stress urinary incontinence and pelvic floor prolapse at a mean of 34 months' follow-up (ranging from 30 to 40 months), there was no evidence of rejection. Therefore, we have shown the safety of cadaveric fascia lata harvested and treated as described above in our group of patients.

Pubovaginal sling using cadaveric allograft fascia for the treatment of female urinary incontinence.

OBJECTIVES: The technique and outcomes of patients treated with allografts or autografts as pubovaginal sling are compared. METHODS: Fascia lata was included among the tissues harvested from brain-dead patients considered for multiple organ donation. After informed consent, segments of allograft (group A) cadaveric fascia lata autografts (group B) were compared with used for sling operations in 60 women from 37 to 73 years of age (mean 53.4 years), who presented with stress incontinence requiring a pubovaginal sling. RESULTS: At a mean follow-up of 36 months (range = 22 to 44 months), 40% of group A patients were cured and 28% were improved. At a mean follow-up of 33 months (range = 24 to 41) 70% of group B patients were cured and 20% improved (P <.05). There were no adverse outcomes of sling erosion or infection in either group. Placement of allograft sling took an average of 62 minutes while the mean duration of sling placement requiring fascial harvest was 81 minutes (P <.05). The mean duration of hospital stay was shorter in the allograft (1.25 days) than the autograft (2.48 days) group (P <.05). CONCLUSION: Use of allografts was associated with a shorter operative time and duration of hospital stay compared to an autograft, but the 3-year continence rate was lower in the autograft group.

The Akt/PKB pathway is constitutively activated in Theileria-transformed leucocytes, but does not directly control constitutive NF-kappaB activation.

The intracellular protozoan parasites Theileria parva and Theileria annulata transform leucocytes by interfering with host cell signal transduction pathways. They differ from tumour cells, however, in that the transformation process can be entirely reversed by elimination of the parasite from the host cell cytoplasm using a specific parasiticidal drug. We investigated the state of activation of Akt/PKB, a downstream target of PI3-K-generated phosphoinositides, in Theileria-transformed leucocytes. Akt/PKB is constitutively activated in a PI3-K- and parasite-dependent manner, as judged by the specific phosphorylation of key residues, in vitro kinase assays and its cellular distribution. In previous work, we demonstrated that the parasite induces constitutive activation of the transcription factor NF-kappaB, providing protection against spontaneous apoptosis that accompanies transformation. In a number of other systems, a link has been established between the PI3-K-Akt/PKB pathway and NF-kappaB activation, resulting in protection against apoptosis. In Theileria-transformed leucocytes, activation of the NF-kappaB and the PI3-K-Akt/PKB pathways are not directly linked. The PI3-K-Akt/PKB pathway does not contribute to the persistent induction of IkappaBalpha phosphorylation, NF-kappaB DNA-binding or transcriptional activity. We show that the two pathways are downregulated with different kinetics when the parasite is eliminated from the host cell cytoplasm and that NF-kappaB-dependent protection against apoptosis is not dependent on a functional PI3-K-Akt/PKB pathway. We also demonstrate that Akt/PKB contributes, at least in part, to the proliferation of Theileria-transformed T cells.

[Volume and demand of rheumatologic problems and their management at a primary health care center]. / Estudio del volumen y la demanda de problemas reumatológicos y su manejo en un centro de atención primaria.

The present study was carried out as a part of the elaboration process of the Program of Rheumatologic Diseases of the health center of Chapela. The following rates are reported: the volume of patients affected by these problems (14.5%), the generated care demand (6.9% of the overall demand), the age and sex distribution, their importance as a reason of disability (14.4% of the overall number of sick leaves), and the different specific diagnoses. To evaluate how these patients were managed by the team, a series of indicators were used, such as the number of identified patients, the quality of the documentation, the types of complementary investigations, the referral of patients to the secondary level, and the adequacy of therapies. As conclusions, a significant volume of rheumatologic consultations and work disabilities was found, with a high use rate of radiological studies and a low use rate of laboratory investigations, the use of basically NSAI drugs in the therapy, and the need for a specifically oriented clinical record to be used in the diagnosis and follow up of these conditions.