Mitoresilience: Hormesis, Psycho-physical Resilience, Mitochondria and Heart Rate Variability as Relevant Interplaying Elements in Longevity Medicine.

Psycho-biological resilience is considered one of the most important factors in the epigenetics of aging. Cell senescence exhibits a series of possible biochemical derangements concerning mitochondria, proteasome, genome and membranes. Research has shown that resilience can be acquired through hormesis, a set of conservative and adaptive processes based on biphasic doseresponse to specific mild stressors, such as fasting, intake of polyphenols, exercising, physical and chemical stress and mental engagement. These stimuli were shown to elicit beneficial cellular metabolic pathways, such as sirtuin activation, mechanistic target of rapamycin and insulin growth factor- 1 downregulation, nuclear related factor 2 upregulation and autophagy. The complex of these resilience-building processes plays a documented role in longevity. Mitochondria are regarded as one of the core actors of aging processes and represent the main target of hormetic approaches [mitohormesis]; furthermore, the influence of the mind on mitochondria, and thus on the balance of health and disease has been recently established, leading to the so-called mitochondria psychobiology. Hence, psychologic and physical stress that reflects on these organelles may be regarded as a relevant factor in cell senescence, and thus the proposed "mitoresilience" denomination may be pertinent within the biomedical science of aging. Finally, the quantification of individual resilience is becoming increasingly important in aging science, and the investigation of the autonomic nervous system through heart rate variability (HRV) proved to be a valid method to quantify this parameter. In conclusion, an integrated approach targeting hormetic pathways to improve psychophysical resilience (namely mitoresilience), supported by the monitoring of HRV, may represent a valuable option in longevity medicine.

Predictors of 1-year outcome in very old patients managed in a Heart Failure Unit after an acute decompensation.

PURPOSE: Consensus exits about the clinical benefits of an early referral to multidisciplinary Heart Failure Unit-HFU for old frail patients with HF. Nevertheless, few data are present regarding the prognosis and the predictors of outcome in oldest-old patients managed in this clinical setting. The aim of present study is to identify predictors of 1-year all-cause mortality in very old patients enrolled in our multidisciplinary HFU after an episode of acute decompensated HF. METHODS: This study is a retro-prospective, single-center cohort analysis of patients managed in our multidisciplinary HFU. Inclusion criterion was diagnosis of HF according to ESC guidelines and age ≥ 85 years, while no exclusion criteria were pre-defined. Baseline clinical and comprehensive geriatric evaluations were recorded during the first visit and follow-up visits were repeated according to our standardized timetable protocol. Primary end-point was 1-year all-cause mortality. RESULTS: We enrolled 75 patients aged 89.2 ± 2.8 years; 39 (52.0%) were females. During 1-year follow-up, seventeen patients (22.7%) died. Residual congestion with higher level (> 4) of EVEREST score (HR 1.24: 95% CI 1.04-1.47) and living alone (HR 3.34: 95% CI 1.16-9.64) resulted the two independent predictors of 1-year all-cause mortality at the multivariate Cox regression model. Finally, patients living alone and with an EVEREST score > 4 experienced a worse prognosis as clearly described by a steeper descendent Kaplan-Meier curve. CONCLUSION: In a very old population of patients after an acute decompensated HF, residual congestion and social isolation as living alone identify those with high risk of 1-year death.

Crowding results from optimal integration of visual targets with contextual information.

Crowding is the inability to recognize an object in clutter, usually considered a fundamental low-level bottleneck to object recognition. Here we advance and test an alternative idea, that crowding, like predictive phenomena such as serial dependence, results from optimizing strategies that exploit redundancies in natural scenes. This notion leads to several testable predictions: crowding should be greatest for unreliable targets and reliable flankers; crowding-induced biases should be maximal when target and flankers have similar orientations, falling off for differences around 20°; flanker interference should be associated with higher precision in orientation judgements, leading to lower overall error rate; effects should be maximal when the orientation of the target is near that of the average of the flankers, rather than to that of individual flankers. Each of these predictions were supported, and could be simulated with ideal-observer models that maximize performance. The results suggest that while crowding can affect object recognition, it may be better understood not as a processing bottleneck, but as a consequence of efficient exploitation of the spatial redundancies of the natural world.

Performance and Usability Evaluation of an Extended Reality Platform to Monitor Patient's Health during Surgical Procedures.

An extended-reality (XR) platform for real-time monitoring of patients' health during surgical procedures is proposed. The proposed system provides real-time access to a comprehensive set of patients' information, which are made promptly available to the surgical team in the operating room (OR). In particular, the XR platform supports the medical staff by automatically acquiring the patient's vitals from the operating room instrumentation and displaying them in real-time directly on an XR headset. Furthermore, information regarding the patient clinical record is also shown upon request. Finally, the XR-based monitoring platform also allows displaying in XR the video stream coming directly from the endoscope. The innovative aspect of the proposed XR-based monitoring platform lies in the comprehensiveness of the available information, in its modularity and flexibility (in terms of adaption to different sources of data), ease of use, and most importantly, in a reliable communication, which are critical requirements for the healthcare field. To validate the proposed system, experimental tests were conducted using instrumentation typically available in the operating room (i.e., a respiratory ventilator, a patient monitor for intensive care, and an endoscope). The overall results showed (i) an accuracy of the data communication greater than 99 %, along with (ii) an average time response below ms, and (iii) satisfying feedback from the SUS questionnaires filled out by the physicians after intensive use.

The factor structure of the short form of the Wisconsin schizotypy scales.

The Chapman psychosis-proneness scales-also known as Wisconsin schizotypy scales (WSS)-are among the most used tools to measure schizotypy. The factor structure of the short-form WSS was investigated in a mixed sample of patients with chronic mental disorders and of healthy subjects from the general population. One hundred patients with a chronic mental disorder were enrolled over a 6-month period. For each patient, two controls of same sex and similar age (±5 years) were enrolled; 131 accepted to take part in the study. The unidimensional, the correlated four-factor, the second-order two-factor models, and the bifactor model with two or four orthogonally independent factors of the short-form WSS were tested with confirmatory factor analysis. Good reliability of the short-form WSS was confirmed, as its capacity of differentiating people with and without schizotypy. The bifactor models were superior to other models. However, in both bifactor models the explained common variance (ECV) attributable to the general factor and the percentage of uncontaminated correlations (PUC) were too low to use a general summary score as a measure of a single latent schizotypy variable. Symptoms scores derived from the short-form WSS can be better appreciated within a multidimensional model of schizotypy.

Recurrent renal hyperparathyroidism due to parathyromatosis.

Parathyromatosis is the most severe type of recurrent secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX) in haemodialysis patients. It is difficult to completely remove all foci of parathyroid tissue and neck re-explorations are often required. Here, we report for the first time a case of recurrent SHPT due to parathyromatosis treated by radio-guided PTX. A haemodialysed 48-year-old woman with recurrent SHPT due to parathyromatosis was treated by radio-guided PTX. Preoperatively Ultrasonography, (99)Tc-SestaMIBI scintigraphy and magnetic resonances of the neck and thorax were performed. The preoperative imaging techniques detected four parathyroid nodules, while intraoperative gamma probe identified six nodules (three in atypical site). No frozen sections were performed during surgery. Post-operative intact parathyroid hormone levels were stabilized in the range 300-500 pg/mL during the 26 month follow-up by means of cinacalcet and paricalcitol therapy. In cases of parathyromatosis, the preoperative imaging techniques are inadequate, while intraoperative gamma probe is useful to detect the parathyroid tissue and allows a more extensive cytoreduction because it ensures the removal of undetectable and ectopic parathyroid foci. The operative time is reduced and frozen sections are unnecessary. However, the radio-guided PTX do not rule out parathyromatosis recurrence and complementary medical treatment is appropriate.

A novel thermostable sulfite oxidase from Thermus thermophilus: characterization of the enzyme, gene cloning and expression in Escherichia coli.

A novel sulfite oxidase has been identified from Thermus thermophilus AT62. Despite this enzyme showing significant amino-acid sequence homology to several bacterial and eukaryal putative and identified sulfite oxidases, the kinetic analysis, performed following the oxidation of sulfite and with ferricyanide as the electron acceptor, already pointed out major differences from representatives of bacterial and eukaryal sources. Sulfite oxidase from T. thermophilus, purified to homogeneity, is a monomeric enzyme with an apparent molecular mass of 39.1 kDa and is almost exclusively located in the periplasm fraction. The enzyme showed sulfite oxidase activity only when ferricyanide was used as electron acceptor, which is different from most of sulfite-oxidizing enzymes from several sources that use cytochrome c as co-substrate. Spectroscopic studies demonstrated that the purified sulfite oxidase has no cytochrome like domain, normally present in homologous enzymes from eukaryotic and prokaryotic sources, and for this particular feature it is similar to homologous enzyme from Arabidopsis thaliana. The identified gene was PCR amplified on T. thermophilus AT62 genome, expressed in Escherichia coli and the recombinant protein identified and characterized.

Identification and characterization of a novel bacterial sulfite oxidase with no heme binding domain from Deinococcus radiodurans.

An open reading frame (draSO) encoding a putative sulfite oxidase (SO) was identified in the sequence of chromosome II of Deinococcus radiodurans; the predicted gene product showed significant amino acid sequence homology to several bacterial and eukaryotic SOs, such as the biochemically and structurally characterized enzyme from Arabidopsis thaliana. Cloning of the Deinococcus SO gene was performed by PCR amplification from the bacterial genomic DNA, and heterologous gene expression of a histidine-tagged polypeptide was obtained in a molybdopterin-overproducing strain of Escherichia coli. The recombinant protein was purified to homogeneity by nickel chelating affinity chromatography, and its main kinetic and chemical physical parameters were determined. Northern blot and enzyme activity analyses indicated that draSO gene expression is constitutive in D. radiodurans and that there is no increase upon exposure to thiosulfate and/or molybdenum(II).

The role of nuclear medicine in evaluation of vesicoureteral reflux and/or reflux nephropathy.

Early identification of different categories of the risk of scarring in children with first (or follow up) urinary tract infection and/or early detection and treatment of vesicoureteral reflux are important to prevent kidney impairment. The demonstration and grading of reflux is crucial in examination and follow up of any child with urinary tract infection. Nephro-urologic radionuclide studies are able to detect vesicoureteral reflux and reflux nephropathy, such as radionuclide cystography--RNC--(both direct radionuclide voiding cystography--DRVC--and indirect radionuclide cystography-IRC), renal DMSA scintigraphy, MAG3 renal diuresis scintigraphy and DTPA renal diuresis scintigraphy. They allow to assess renal parenchyma integrity, to detect pyelonephritic scars, to evaluate the different aspects of urinary tract function and to measure absolute and relative function after intravenous injection of radiopharmaceuticals. The procedure, image acquisition and processing and the diagnostic relevance of all aforesaid nephro-urologic radionuclide studies are illustrated.