Intrathecal Baclofen Infusion-Botulinum Toxin Combined Treatment Efficacy in the Management of Spasticity due to Cerebral Palsy.

BACKGROUND: Cerebral Palsy (CP) is a group of permanent, but not unchanging, disorders of movement and/or posture and motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain. One clinical presentation is muscle spasticity, which leads to a significant impact on the individual's functionality and quality of life. Spasticity treatment is multidisciplinary and includes pharmacological and physical intervention; intrathecal baclofen shows a positive effect in severe spasticity and suboptimal response to oral drugs, while local injection of Botulinum toxin type A (BTXA) improves muscle tone, motion and pain. OBJECTIVE: The aim of this study was to evaluate the efficacy of the combined intrathecal baclofen infusion (ITB) - botulinum toxin treatment in the management of spasticity in CP. METHODS: 8 patients with spastic tetraparesis were enrolled. All patients were treated with intrathecal Baclofen; in lower limbs, no spastic symptoms appeared, while marked spasticity was noted in upper limbs. We injected the right and left Biceps Brachial (BB) and Flexor Digitorum Superficialis (FDS) muscles with botulinum toxin type A. All patients underwent Myometric measurement, Ashworth Scale, Numerical Rating Scale, and Visual Analogic Scale evaluation before infiltration (T0), 30 days after injection (T1), 60 days after injection (T2), and 90 days after treatment (T3). RESULTS: All data demonstrated an improvement in spasticity, pain, quality of life, and self-care during the study, with p < 0.05. No side effects appeared. CONCLUSION: This study demonstrated the efficacy and safety of intrathecal baclofen infusion and botulinum toxin combined treatment in the management of spasticity, pain, quality of life, and selfcare in CP patients.

Mineralogy and heavy metal assessment of the Pietra del Pertusillo reservoir sediments (Southern Italy).

The Pietra del Pertusillo freshwater reservoir is a major artificial lake of environmental, biological, and ecological importance located in the Basilicata region, southern Italy. The reservoir arch-gravity dam was completed in 1963 for producing hydroelectric energy and providing water for human use, and nearby there are potential sources of anthropogenic pollution such as urban and industrial activities. For the first time, the minero-chemistry of the lake and fluvio-lacustrine sediments of the reservoir have been evaluated to assess the environmental quality. Moreover, the composition of fluvial sediments derived from the peri-lacual zone of the reservoir and of local outcropping bedrock were also studied to understand the factors affecting the behavior of elements in the freshwater reservoir, with particular attention paid to heavy metals. In Italy, specific regulatory values concerning the element threshold concentration for lake and river sediments do not exist, and for this reason, soil threshold values are considered the standard for sediments of internal waters. The evaluation of the environmental quality of reservoir sediments has been performed using enrichment factors obtained with respect to the average composition of a reconstructed local upper continental crust. We suggest this method as an innovative standard in similar conditions worldwide. In the studied reservoir sediments, the trace elements that may be of some environmental concern are Cr, Cu, Zn, As, and Pb although, at this stage, the distribution of these elements appears to be mostly driven by geogenic processes. However, within the frame of the assessment and the preservation of the quality of aquatic environments, particular attention has to be paid to As (which shows median value of 10 ppm, reaching a maximum value of 26 ppm in Quaternary sediments), constantly enriched in the lacustrine samples and especially in the fine-grained fraction (median = 8.5 ppm).

Mobility of trace metals in serpentinite-derived soils of the Pollino Massif (Southern Italy): insights on bioavailability and toxicity.

This paper deals with the evaluation of geo- and bioavailability of trace elements, including heavy metals, present in a typical serpentinite-derived soil of the Pollino Massif (Southern Italy). Precisely, the research was aimed to (1) assess processes and factors controlling the mobility of metals in the soil in order to identify the elements "potentially harmful" for the human health, (2) estimate possible metals accumulation in horticultural crops, and (3) evaluate phyto- and genotoxicity of Cr naturally present in soils and water. The studied profile has a homogeneous mineralogical composition consisting of metal-rich phases as prevailing minerals. The three-step sequential extraction was performed on soil samples from which four fractions (exchangeable, reducible, oxidizable, and residual) were obtained and analysed by ICP-MS. The lowest contents of metals are in the exchangeable and oxidizable fractions suggesting a metal contamination is unlikely for the studied soil. Conversely, the residual and reducible fractions are the more metal enriched fractions. Among heavy metals, mainly Pb and Cd and subordinately Ni, Cr, Cu, and Zn are associated with Fe- and Mn-oxi/hydroxides that, under acidic conditions, may release the adsorbed metals in circulating water. The high contents of heavy metals, including Cr and Ni, of analysed vegetables suggest a metal transfer from soil to plant. However, no significant effects on Vicia faba seeds were observed by in vivo phyto- and genotoxicity tests. Conversely in vitro genotoxicity tests, performed on HepG2 human cell line, showed that DNA damage and cytotoxic effect depending on Cr concentration may occur.