Improvements in one severe progressive multiple sclerosis patient quality of life after an intensity fluid dynamic treatment.

Clinical case: A 49-year-old man (MM72) affected by Secondary Progressive Multiple Sclerosis (SP-MS) since 1998. On last 3 years, neurologists valued 9.0 the patient MM72's EDSS. Methods: MM72 was treated by acoustic waves, modulated in frequency and power by the MAM device, according to an ambulatory intensive protocol. Patient's treatments schedule was organized in thirty cycles of DrenoMAM and AcuMAM, and manual cervical spinal adjustments. Before and after treatments, MSIS-29, Barthel, FIM, EDSS, ESS, and FSS questionnaires were administered to the patient. Results: MM72 patient had improvements in all index score (MSIS-29, Barthel, FIM, EDSS, ESS and FSS) after 30 treatments by MAM plus cervical spine chiropractic adjustments. He showed a significative improvement of his disability and the restore of many functions. After MAM treatments, MM72's cognitive sphere improved of 370%. Fur-thermore, after 5 years of paraplegy, he regained his lower limbs and feet fingers movements with an increase of 230%. Conclusion: We suggest ambulatory intensive treatments by fluid dynamic MAM protocol in SP-MS patients. Statistical analyses are in progress on a larger sample of SP-MS patients.

The incidence of the multiple sclerosis in Italy: 2011-2015.

Introduction: There are very few scientific papers (and only on de-limited areas) about incidence and prevalence of the multiple sclerosis (MS) in Italy. We analysed 2011-2015 national data by correlating INPS database with ISTAT data. Materials: we assessed 10,725 MS invalids. We compared geographical distribution of MS patients with the Italian census. Results: We found a MS mean incidence equal to 3.54 patients every 100,000 Italian residents. The female MS mean incidence was 4.52 versus the male mean incidence of 2.52 (p<0.001). MS incidence is growing up from 2011 to 2015. Incidence values, for 100,000 inhabitants, become from 2.8 to 4.0 (female from 3.6 to 5.2 and male from 1.9 to 2.7). During 2011-2015 period, the MS patients median age decreases of two years (p<0.01). Conclusions: We couldn't calculate the MS prevalence because we do not have an official database managed by a national authority. This work wishes to be a stimulus to investigate more deeply and to promote public health in the care of the multiple sclerosis patients. We propose our work to realize a base more appropriate health planning on the national and regional territories for MS patients care.

Associations between bone retraction, lost teeth, and metabolic syndrome. A cross-sectional study in dentistry patients aged over 60 years.

INTRODUCTION: In Italy, the number of elder is growing and people over 70 may be a problem in public health on present and next years. [ISTAT 2019]. METHODS: In this paper we analysed 150 patients aged 60÷99 by medical and instrumental examinations. Results. We analysed all data patients into three age groups: "A" patients aged 60÷69 years; "B" patients aged 70÷79 years, and "C" patients aged 80÷99 years. CONCLUSION: This is the first study carried out on old and very old dentistry patients. Our people sample showed lost teeth, and bone retractions more than 6 millimetres associated with unilateral and/or bilateral carotidal plaques. They also suffered for many other pathologies connected with cardiovascular system. In our paper, we showed these specific aspects more in "B" subjects than in "A" and "C" elder patients.

Risk of jugular compression blocks in workers exposed to prolonged upright posture.

BACKGROUND: The working posture affects the peripheral venous circulation, although the current literature does not report any correlation between working posture and the abnormalities of the jugular veins flow. The purpose of this preliminary research is to study, in female workers, the prevalence of Venous Compressive Syndrome (VCS) caused by total block of the internal jugular veins flow, so-called "White Compression". Due to complete compression by postural, muscular, fascial, anatomical or bone anomalies, White Compression is not visible by EchoColorDoppler (ECD) and its flow can only be detected by the rotational movements of the head or by Valsalva's maneuver. METHODS: We studied a sample of female workers with ECD (n=128), in supine and upright position divided into subgroups according to the obliged posture maintained during working hours: group A, seated work (n = 61; 47.7%); group B, standing work (n = 41; 32.0%); group C, mixed (both standing and seated work) (n = 26; 20.3%). The total sample (n = 128) had the mean age of 46 ± 10 years (minimum 18 and maximum 67 years) and mean Body Mass Index (BMI) of 23 ± 4 kg/m2 (min 16 kg/m2 and a maximum of 42 kg/m2). RESULTS: Group A and group C did not show any White Compression in orthostatic and clinostatic position. The 9.75% (p = 0.0125) of Group B had a White Compression in orthostatic position: two female workers on the left side (4.9%) and two female workers on the right side (4.9%). CONCLUSIONS: We conclude that there is a risk of jugular compression blocks in female workers exposed to prolonged upright posture. Yet there is no longitudinal study that identifies the White Compressions as etiology of a chronic neurodegenerative disease. The authors hope that some wider studies can confirm the prevalence of these compressions in standing posture and their patho-physiological consequences.

New perspectives for transcatheter aortic valve implantation: more than a "simple" alternative to surgery.

To date, the gold standard of aortic stenosis treatment is surgical valve replacement. However, in inoperable or high risk patients a valid alternative is transcatheter aortic valve implantation (TAVI). Several trials showed feasibility, efficacy and safety of TAVI, with a tailored strategy for these patients on the basis of their clinical and anatomical conditions. The selection of valve type (CoreValve® or Edwards Sapien®) and transcatheter approach (transfemoral, transapical, subclavian or direct aortic approach) is an important step in the management of aortic stenosis. However, mortality is high and it is mainly related to non-cardiac reasons, given the high clinical risk profile of these patients. Moreover, the less invasive approach, the faster recovery, the reduced morbidity and the improved psychological tolerance, typical of TAVI, suggest that this technique could be used in a broader spectrum of cases, becoming a valid therapeutic alternative even in patients with severe aortic stenosis with a low surgical risk or asymptomatics. The identification of aortic stenosis patients by the medical community and their assessment over time, before they become candidates only for "extreme" strategies, remains the main challenge.

Obesity and the metabolic syndrome in a student cohort from Southern Italy.

BACKGROUND AND AIM: Cardiovascular (CV) risk factors present in childhood predict future CV events. Few data regarding the metabolic syndrome (MS) prevalence are available in adolescents from Mediterranean areas where obesity is becoming a social emergency. This study presents data of MS prevalence in a student cohort from southern Italy. METHODS AND RESULTS: 1629 students between 7 and 14 years of age underwent anthropometric measurements and a blood sample was obtained to assess biochemical parameters. MS risk factors were calculated based on age and gender adjusted percentiles of parameter distributions. MS prevalence rate was 0.022 using paediatric, age-adjusted criteria; the rate increased to 0.029 using a 90th percentile criteria for fasting blood glucose instead of >100mg/dL. Using the criteria issued by the International Diabetes Federation the MS prevalence rate dropped to 0.005. The exploratory factor analysis identified four factors: age/fat related, lipids, blood pressure and blood glucose. Family history of type 2 diabetes mellitus was associated with triglyceride [OR=1.55 (1.0-2.3)] and BMI [OR=1.71 (1.2-2.4)] but not to blood glucose by logistic regression analysis. CONCLUSIONS: In a student cohort from Southern Italy, obesity is associated with the features of MS.

Results from the first computerised Italian surveillance of human Salmonella isolates. The Italian SALM-NET Working Group.

We report all the first computerised data collected in Italy for the surveillance of Salmonella isolates. Primarily, within the wide framework of the European Community Human Salmonella Surveillance Project (SALM-NET), we report data on the most commonly isolated serotypes in Italy from January 1994 to December 1996. In addition, we report all computerised data historically collected by some Italian regions regarding the period 1980-1993. Total data included in the Italian SALM-NET data base account for 59,336 Salmonella isolates. In the list of the most frequent isolates starting from 1989, S. Enteritidis always ranked first, followed by S. Typhimurium.

Results of the three-year surveillance by the Italian SALM-NET System: human isolates of Salmonella serotypes.

Within the wide framework of the European Community Human Salmonella Surveillance Project (SALM-NET), the data on the most commonly isolated serotypes in Italy from January 1994 to December 1996 are reported. The total data included in the Italian SALM-NET data base account for 34,412 Salmonella isolates. In the list of the most frequent isolates, S. enteritidis ranked always first in the years 1994, 1995 and 1996 with 5435 (43.4%), 4589 (37.1%) and 4044 (42.4%), respectively, over the total number of Salmonella isolates. This serotype is followed by S. typhimurium in the list of the top ten isolates, with 2236 (17.9%), 2831 (22.9%) and 2239 (23.5%). The other serotypes included in this list accounted for a much lower number and percentages ranging from 505 isolates of S. derby (4.0%) to 99 isolates of S. brandenburg (0.8%).

The antibiotic resistance patterns of Salmonella Typhi isolates in Italy, 1980-96. The Italian SALM-NET Working Group. Salmonella Network.

In this paper we report the distribution of Salmonella Typhi isolates in Italy and their resistance patterns to antibiotics. The data were collected by the Italian SALM-NET surveillance system in a pilot retrospective study of the period 1980-96. Data on drug-resistance were available for 82 isolates out of 176 S. Typhi isolated in Italy. Of these 82 isolates, 32 (39%) were resistant or intermediate to 1 or more antibiotics. Eight isolates were resistant and 7 intermediate to streptomycin; 4 isolates were resistant to ampicillin alone or in association with other antibiotics; only 2 strains (1 isolated in Lombardia in 1993 and the other 1 in Lazio in 1994) were resistant to chloramphenicol, and 2 (isolated in Sardegna and Piemonte in 1995 and 1996, respectively) showed intermediate resistance to chloramphenicol. The strains showing resistance to 3 or more antibiotics were very scarce: 1 (with 5 complete resistances) was isolated in Lazio in 1994, and another 1 (with complete resistance to 10 antibiotics and intermediate resistance to 2 antibiotics) was isolated in Molise in 1988. In conclusion, besides the routine activities to control typhoid fever, an accurate and continuous surveillance is necessary in order to quickly identify multidrug-resistant (MDR) S. Typhi strains and prevent their spread, even though their level, in our country, is still quite low.

Evaluation of the SIMI system, an experimental computerised network for the surveillance of communicable diseases in Italy.

In Italy, the current communicable disease notification system is organised as follows: in each region, Local Health Units (LHU) fill in and forward case report forms (CRF) to the Regional Health Authority, which send aggregated and individual notifications to several central-level institutions. In most regions, all data are recorded manually on hardcopy. Although most relevant data from CRFs are eventually entered into a computerised database at the National Institute of Statistics (ISTAT), the national database is only available 3-4 years later and no data-quality control is performed at that time. To improve the quality and timeliness of notification, in 1994, the Istituto Superiore di Sanità (the National Institute of Health) began to develop an experimental computerised surveillance network for communicable diseases (referred to as 'SIMI'). Specifically, a software was created and distributed to the LHUs and the Regional Health Authorities; staff training was performed; and feedback and analyses of collected data was promoted. SIMI was evaluated in the 13 regions that were participating in 1997 (out of a total of 20 regions in Italy), using criteria commonly used for surveillance systems (i.e., completeness and coherence of data, case definitions, costs, timeliness, and feedback). SIMI was implemented at a limited cost and the data collected were observed to have had a high degree of completeness and internal consistency. The SIMI system has since been adopted for the routine notification of communicable diseases in nearly all regions. Similar evaluations will be necessary for assessing the performance of the various notification systems used across Europe and to include them in a European network.

Muscarinic cholinoceptor subtypes in the rat frontoparietal cortex after ipsilateral lesions of the nucleus basalis magnocellularis.

Muscarinic cholinoceptor subtypes (M1 and M2) were studied in membrane particles of the rat frontoparietal cortex 72 h and 1, 2, 3, and 4 weeks after ipsilateral lesioning of the nucleus basalis magnocellularis (NBM). The affinity of the ligand used to characterize muscarinic cholinoceptors, 3H-quinuclidinyl benzilate did not significantly change in lesioned compared with sham-operated rats as well as the density of high affinity (M1) sites. Low affinity muscarinic cholinoceptors (M2 sites) were significantly decreased in NBM-lesioned rats 72 h and 1 week after lesioning. The density of M2 sites did not significantly differ in lesioned rats 2 or 3 weeks after NBM lesioning, but increased, in comparison with sham-operation 4 weeks after NBM lesioning. These findings suggest that frontoparietal M2 muscarinic cholinoceptors, which probably have a presynaptic localization, are sensitive to NBM lesions. Their changes at different times after NBM lesioning suggest the occurrence of loss, compensation and upregulation of cholinergic projections arising to the neocortex from the NBM.

Hippocampal long-term potentiation in nucleus basalis magnocellularis-lesioned rats.

The probability of hippocampal long-term potentiation induction in the mossy fiber CA3 and commissural/associational CA3 responses and the cortical levels of choline acetyltransferase (ChAT) activity were compared in right nucleus basalis magnocellularis (NBM)-lesioned rats. A 50% reduction in the right cortical ChAT activity was demonstrated 4 weeks after an ibotenic acid lesion of the NBM. No significative differences were found in the probability of LTP induction of right hippocampal slices in sham-operated rats from 10 to 40 days after the injection into the right NBM. On the contrary, a progressive and significative increase in the probability of LTP induction was shown in right hippocampal slices of NBM-lesioned rats from 10 to 40 days after the injection of ibotenic acid into the right NBM. The results demonstrated the appearance of a paradoxical increase of hippocampal synaptic plasticity when the cortical cholinergic biochemical alterations are still present. This finding might be responsible for a behavioural recovery, in NBM-lesioned rats.

Effect of choline alfoscerate treatment on changes in rat hippocampus mossy fibres induced by monolateral lesioning of the nucleus basalis magnocellularis.

We have recently demonstrated that monolateral lesions of the Nucleus Basalis Magnocellularis (NBM), which is a nucleus sending cholinergic projections to the fronto-parietal cortex, cause a loss in the intensity of Timm staining in the intrahippocampal pathway of mossy fibres (MF). Moreover, these lesions induce ultrastructural changes consistent with the occurrence of degeneration of presynaptic buttons of MF. The present study was designed to quantify the effects of NBM lesioning on the morphology of the presynaptic buttons of MF. Moreover the effects of 4-week choline alfoscerate (alphaGFC) treatment on the density of Timm staining and on the ultrastructure of presynaptic buttons of MF were assessed, alphaGFC, which was given at an oral daily dose of 100 mg/kg, is a precursor in the biosynthesis of several brain phospholipids which increases the availability of choline in the nervous tissue. Monolateral lesions of NBM cause, 4 weeks after lesioning, a significant decrease in the intensity of Timm staining in the MF area accompanied by a loss of about 23% of presynaptic buttons of MF. Moreover about 40% of presynaptic buttons of MF show an impaired morphology. alphaGFC administration restored the intensity of Timm staining in the MF area. In alphaGFC-treated rats, the loss of presynaptic buttons and the number of impaired buttons were reduced to about 12% and 27%, respectively in comparison with non-treated animals. These results confirm and extend our previous observations indicative of the occurrence of transneuronal degenerations in the MF of the hippocampus after monolateral NBM lesioning. Moreover these findings show that alphaGFC treatment is able to counter in part these degenerative changes.

Changes in the intensity of sulfide staining in fronto-parietal cortex of the rat following nucleus basalis magnocellularis lesions: possible relevance to Alzheimer's disease.

The sulfide staining technique, known also as neo-Timm staining, predominantly stains associational fibres arising from cortical interneurons located primarily in the neuropil of layers I-III of the rat cerebral cortex. The density of these fibres, considered to have a possible role in cognitive and mnemonic processes, has been demonstrated to be related to the density of zinc-containing presynaptic buttons in the cerebral cortex. The unilateral injection of ibotenic acid into the nucleus basalis magnocellularis (NBM) resulted in no changes in the density of sulfide staining in the first 3 weeks after neurotoxin injection and in a significant loss of sulfide staining in the neuropil of cortical layers I-III 4 weeks after NBM lesion in the fronto-parietal cortex ipsilaterally to the lesion. These data suggest that unilateral lesioning of the NMB may cause changes of chemo-specific zinc-containing intracortical pathways. Moreover, they indicate that, in a manner similar to that described in the brain of Alzheimer's disease patients, NBM-lesioned rats show a decrease of zinc tissue stores in the fronto-parietal cortex.

Nucleus basalis magnocellularis lesions impair mossy fiber system in rat hippocampus: a quantitative histochemical and ultrastructural study.

Lesions of the nucleus basalis magnocellularis (NBM) cause depletion of choline acetyltransferase (ChAT) in the cerebral cortex and behavioral changes consisting of impaired ability to learn avoidance tasks. Since hippocampal mossy fibers (MF) are involved in the elaboration of passive avoidance responses, we analyzed MF by means of Timm's histochemical technique and electron microscopy, to find out whether monolateral lesions of NBM had any effect on MF system. NBM-lesioned rats, 3 weeks after lesioning, showed a significant and progressive decrease in the density of Timm staining as well as significant changes of the morphology of synapic boutons of the MF. These results suggest that, although NBM does not send direct projections to the hippocampus, lesions of this nucleus may have a neurodegenerative effect on the intrahippocampal pathway involved in avoidance responses.

Absence of right-left asymmetries in the rat hippocampus as demonstrated by Timm staining.

Although biochemical and behavioural studies have shown right-left differences in several areas of the rat limbic system, some anatomical studies reported no significant right-left differences in several morphological parameters of the hippocampus. The purpose of the present study was to determine whether there are asymmetries in the micro-anatomy of the rat hippocampus by examining the intensity of Timm staining in various hippocampal fields and the area occupied by mossy fibres by the use of combined microdensitometric and quantitative image analysis techniques. Timm staining demonstrates the distribution of intrahippocampal association pathways because it is a histochemical marker of zinc and other heavy transition metals. There were no right-left differences in the density of Timm staining at the level of the dentate gyrus, in the dendritic layer of CA1 and CA2 fields, in the mossy fibre area or in the subiculum. These findings provide further evidence of a lack of morphological asymmetry in the rat hippocampus.

Antiepileptic effects of N6-L-phenylisopropyladenosine (L-PIA) on penicillin-induced epileptogenic focus in rabbits.

In the present work the effects of a stable analog of adenosine (N-6-L-phenylisopropyladenosine, L-PIA) have been investigated against the epileptic focus induced by intracortical injection of penicillin. The intracortical (i.c.) injection of penicillin (300 units) in rabbits elicits an epileptiform EEG and motor activity. Pretreatment with L-PIA (1.5 mg/kg i.v.) prevents the motor component of the epileptic phenomenon, while the EEG seizures are unaffected. The i.c. injection of L-PIA (20 nMoles in the left cortex), 10 minutes before penicillin (300 units in the right cortex) prevents the spreading of the epileptic activity from the right to the left hemisphere. These results suggest that adenosine might regulate the spreading of seizures. The possible role played by adenosine in the spontaneous arrest of epilepsy has also been discussed.

An investigation on the mechanism of anticonvulsant action of ketamine and phencyclidine on convulsions due to cortical application of penicillin in rabbits.

The intracortical injection of 500 units of penicillin in rabbits elicited intermittent bilateral spikes or spike-wave complexes followed by generalization of the epileptiform activity characterized by repeated ictal high-voltage, high frequency spikes paralleled by generalized convulsions. Administration of phencyclidine (PCP) (0.7-1.0 mg/Kg i.v.), ketamine (KT) (20-40 mg/Kg i.v.), pentobarbital (PB) (10 mg/Kg i.v.) and diazepam (3 mg/Kg i.v.) inhibited the generalization of the epileptiform activity induced by penicillin (500 units) counteracting the EEG and motor patterns of the ictal events, while did not influence the interictal spike-and-wave complexes. Physostigmine (0.1 mg/Kg i.v.), clonidine (0.1 mg/Kg i.v.), haloperidol (1 mg/Kg i.v.) and naloxone (10 mg/Kg i.v.) did not affect the inhibitory influence of PCP on epileptiform activity due to cortical application of penicillin. Thus, the mechanism of this anticonvulsant action of PCP seems not to depend on the neurotransmitter system related to the reported drugs. The mechanism of action of PCP and KT is discussed in connexion with the similarities of the effects of this drugs in respect to sigma opiate agonists and pentobarbital.