Peak width of skeletonized mean diffusivity (PSMD) and cognitive functions in relapsing-remitting multiple sclerosis.

Peak width of skeletonized mean diffusivity (PSMD) is a new MRI marker, which has shown clinical relevance in some neurological conditions and, in preliminary data, in multiple sclerosis (MS). We aimed here to investigate, in a group of relapsing-remitting MS (RRMS) patients, the relationship between PSMD and cognitive performances, in comparison with other MRI measures. RRMS patients (n = 60) and normal controls (n = 15) underwent a 3 T MRI examination. MRI-based white matter (WM) lesion volume, microstructural integrity (assessed with Tract-Based Spatial Statistics of diffusion tensor imaging [DTI] images) and brain volumes (i.e., total brain, grey matter [GM] and WM) were computed. In addition, PSMD was calculated through "skeletonization" of WM tracts and diffusion histograms. Cognition was evaluated with Rao's Brief Repeatable Battery (BRB), which incorporated tests of verbal and visual memory, attention, concentration, information processing speed and verbal fluency. PSMD closely correlated with symbol digit modalities test (SDMT) (r = -0.70, p < 0.001) and, to a lesser extent, with verbal and visual memory tests. Multiple regression analysis showed that PSMD explained SDMT variance (R2 = 0.54, p < 0.001) more than other MRI measures. Results point out the relevance of microstructural damage, as assessed by PSMD, as a reliable marker of cognition in MS, especially in explaining dysfunction in information processing speed.

Listening to the neurological teams for multiple sclerosis: the SMART project.

OBJECTIVE: Aim of the research was to define the quality of life of Italian neurologists and nurses' professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. MATERIAL AND METHODS: One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. RESULTS: Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. CONCLUSION: The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it.

The clinical spectrum of anti-MOG associated acquired demyelinating disorders: Three case-reports.

BACKGROUND: The spectrum of differential diagnosis of acquired demyelinating disorders of the central nervous system has been recently broadened. There is now growing evidence that supports anti-myelin oligodendrocyte antibodies associated demyelination as a distinct disease entity, with some clinical characteristics that somehow overlap those of Multiple Sclerosis (MS) and anti-AQP4+ Neuromyelitis Optica Spectrum Disorders (AQP4+NMOSD) but different pathogenesis and treatment strategies. SUMMARY: We hereby present 3 cases of anti-MOG+ patients with different disease courses - ranging from mild to severe - all presenting with Optic neuritis (ON) at the onset. Optic neuritis (ON) is a common manifestation of different central nervous system (CNS) inflammatory disorders and can represent the first clinical event of MS and NMOSD. ON is also the most common presentation of antiMOG demyelinating disorders, followed by - and sometimes associated with - myelitis, most commonly extended over more than 2 spinal cord segments and defined as longitudinally extended transverse myelitis (LETM). All the three patients tested negative for oligoclonal bands in CSF and anti-AQP4 Ab in serum, had a relapsing disease course characterized by prominent involvement of the optic nerve and spinal cord, with good recovery after treatment with high-dose corticosteroids. However, they had a different disease course at follow-up and underwent different treatment approaches. CONCLUSIONS: Since anti-MOG+ patients can have a multiphasic disease course and accumulate disability over time, a high degree of suspicion and early diagnosis are of critical importance for treatment decision-making in clinical practice. AIM: The aim of this case report is to enhance focus on an emerging disease spectrum among acquired CNS demyelinating disorders.

No association between chronic cerebrospinal venous insufficiency and pediatric-onset multiple sclerosis.

OBJECTIVE: Chronic cerebrospinal venous insufficiency (CCSVI) was hypothesized to play a causative role in multiple sclerosis (MS). The assessment of pediatric-onset MS (POMS) may provide a unique window of opportunity to study hypothesized risk factors in close temporal association with the onset of the disease. METHODS: Internal jugular veins, vertebral veins and intracranial veins were evaluated with extracranial and intracranial ultrasound in 15 POMS and 16 healthy controls. Assessor's blinding was maintained during the study. We considered subjects positive to CCSVI when at least two criteria were fulfilled. RESULTS: CCSVI frequency was comparable between POMS and controls (p > 0.05). Clinical features were not significantly different between CCSVI-positive and CCSVI-negative patients. CONCLUSIONS: Our findings add to previous data pointing against a causative role of CCSVI in MS.

Cognitive impairment in early stages of multiple sclerosis.

Cognitive dysfunction involves 40-65% of multiple sclerosis patients and can have a great functional impact. It can be detected in all the disease phenotypes since the early stages of the disease, and tends to progress over time. Memory, complex attention, information-processing speed and executive functions are most commonly involved. The relationship between cognitive changes and magnetic resonance imaging (MRI) findings may involve changes in different areas, including white matter lesions, cortical and deep grey matter and normal appearing brain tissue on conventional MRI. The search for effective therapeutic strategies is a major undertaking, involving the use of both pharmacologic and rehabilitative approaches. Early treatment with disease-modifying drugs that can contain the disease burden in the brain seems to be highly advisable in order to prevent or delay the development of cognitive impairment.

Response to thermal stress and personality.

Tolerance to cold and heat exposure shows large variations for which there is still insufficient explanation. On the other hand the relationship between the responses to mental stress and individual personality is well documented. The aim of this study was then to find if personality traits have some influence on the responses to environmental temperature exposure. A group of 20 young adults were exposed for 90 min to cold (10 degrees C) while skin temperature (Ts), oxygen consumption and discomfort rating were recorded. In a second experiment they were exposed to heat (40 degrees C) for 90 min when the sweat rate and the discomfort rating were recorded. Prior to these tests the Big Five Personality Test was used to measure the personality traits of the subjects. The results show significant negative correlation between neuroticism and the O(2) consumed, the discomfort rating and Ts for the test in the cold, while extraversion was positively related to O(2) consumption but not to Ts and discomfort rating. In response to heat, neuroticism predominance was associated with greater discomfort, reduced tolerance and diminished sweat rate. The discomfort rating, in this case, was negatively related to extraversion. It is proposed that the reduced O(2) consumption in the cold and the lower rate of sweating in the heat observed with neuroticism, are caused by enhanced activity of the sympathetic nervous system. Further investigation is required to assess the validity of this proposal. Overall, the present investigation shows that physical environmental stresses, in common with mental stress, could be in some ways related to personality traits.

Evaluation of a brief intervention for increasing seat belt use on a college campus.

The authors evaluated a brief intervention for increasing seat belt use among the front seat occupants of cars at a junior college, in a jurisdiction with a mandatory belt use law. The intervention included public posting of performance feedback and distribution of an informational flyer to cars in target parking lot. Feedback was the display of the proportion of drivers observed wearing seat belts on the previous observation day. Seat belt use among drivers increased from 64% during the baseline phase to 71% during the intervention phase. Seat belt use among front passengers increased from 49% during the baseline phase to 67% during the intervention phase. In both cases, seat belt use at follow-up was comparable to seat belt use during the intervention phase, although a trend toward decreasing belt use was noted. Also found was higher seat belt use among females as compared with males irrespective of their front seat occupant status (driver or passenger). Effects of the intervention are discussed in the context of increasing seat belt use in a hardcore nonuser population of predominantly young adults.

Evaluation of a preservation solution containing fructose-1,6-diphosphate and mannitol using the isolated perfused rat kidney. Comparison with Euro-Collins and University of Wisconsin solutions.

The renal preservation ability of a flushing solution (F-M) with fructose-1,6-diphosphate (1 g/dl) and mannitol (2 g/dl) during cold ischaemia was studied with the isolated perfused rat kidney model and compared with the Euro-Collins (EC) and University of Wisconsin (UW) solutions. Kidneys were stored in hypothermia for 4 and 18 h after initial flushing with the solution being tested, and then reperfused at 37 degrees C in an isolated perfusion circuit for 90 min with a Krebs-Henseleit solution containing 4.5% albumin. Forty-four kidneys were studied and divided in a control group and six study groups according to the cold ischaemia time and flushing solution used. Renal functional parameters of plasma flow rate (PFR), renal vascular resistance (RVR), urine flow rate (UFR) glomerular filtration rate (GFR), fractional (FRNa) and net (TNa) sodium reabsortion were assessed during reperfusion. Conventional histology and malondialdehyde tissue levels (MDA) were also evaluated. Our results show that PFR, RVR, and UFR were similar in all study groups. After 4 and 18 h of cold ischaemia, GFR, FRNa and TNa were better, and conventional histology worse in F-M than in EC flushed kidneys. After 4 and 18 h of cold ischaemia, GFR, FRNa and TNa, in fact, were not different between F-M and UW flushed kidneys. After 4 h of cold ischaemia, conventional histology was similar in F-M and UW flushed kidneys. Nevertheless, after 18 h of cold ischaemia, UW flushed kidneys showed worse histological parameters than F-M flushed kidneys. After 4 h of cold ischaemia, MDA was similar in kidneys flushed with three solutions. After 18 h of cold ischaemia MDA was higher in EC than in F-M or UW flushed kidneys. In summary, our newly developed cold storage solution shows promising results in renal preservation and its ability to preserve is at least as good as UW solution assessed in the isolated perfused rat kidney.

Changes in depressive status associated with topical beta-blockers.

Depression and sexual dysfunction have been related to side effects of topical beta-blockers. We performed a preliminary study in order to determine any difference between a non selective beta-blocker (timolol) and a selective beta-blocker (betaxolol) regarding CNS side effects. Eight glaucomatous patients chronically treated with timolol 0.5%/12h, suffering from depression diagnosed through DMS-III-R criteria, were included in the study. During the six-month follow up, depression was quantified through the Beck and Zung-Conde scales every two months. In a double blind cross-over study with control group, the patients under timolol treatment presented higher depression values measured through the Beck and the Zung-Conde scales (p < 0.001 vs control). These results suggest that betaxolol could be less of a depression-inducer than timolol in predisposed patients.

[Comparative study of two lipid emulsions in patients receiving total parenteral nutrition]. / Estudio comparativo de dos emulsiones lipídicas en enfermos que reciben nutrición parenteral total.

INTRODUCTION: the use of lipid emulsions together with glucose as a calorie source in parenteral nutrition has undisputed advantages. Their isotony and high calorie content mean they are essential for peripheric parenteral nutrition and in parenteral nutrition of long duration they are important in providing essential fatty acids. OBJECTIVE: to determine the constant of elimination of two commercial lipid emulsions with similar compositions, and evaluate whether significant differences exist between them. MATERIAL, METHODS AND PATIENTS: 20 candidates for total parenteral nutrition were studied over a period of at least ten days. These patients showed no severe stress, sepsis or IRA. The patients received total parenteral nutrition for at least 3 days prior to commencing the study; 12 hours after initiation, total parenteral nutrition was administered, without lipids. Afterwards, one of the emulsions studied was infused centrally (in Y with the parenteral nutrition) at a rate of 0.15 g/kg/hour for 3 hours, 24 hours later, the other emulsion was infused under the same conditions. Commencing with one or the other was done at random, and both at 10%. Blood samples were taken at the following times:--10.0 (end of the infusion of the emulsion), 10, 30, 60 and 90 minutes, and the following parameters studied: total cholesterol (col), triglycerides (tg) and phospholipids (pl); tg, col ad pl of the VLDL, HDL and LDL, free fatty acids and lipoprotein lipase. The analytical methods employed were: ultracentrifugation with compressed air and precipitation with PEG-6000. RESULTS: significant differences were observed in the constant of elimination of total tg (2.54 +/- 0.73 in emulsion A compared to 2.8 +/- 0.66 in B), in the Kd of the VLDL tg (1.65 +/- 0.86 in A compared to 1.99 +/- 0.77 in B) and in the Kd of the VLDL P1 (0.98 +/- 0.53 in the case of A compared to 1.1 +/- 0.43 in emulsion B), no significant differences were found in the other parameters studied. The Student T was applied, and no lipase lipoprotein activity was observed. DISCUSSION: the differences found may perhaps be explained by the action of the emulgent on the intravascular metabolism of the fats. Although in both cases this is egg lecithin, the composition of this has not been studied in depth. Emulsion A = Intralipid (n. reg). Emulsion B = Tutolipid (n. reg.).