As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. Driving during lower visibility conditions, such as inclement weather, is especially ch...As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. Driving during lower visibility conditions, such as inclement weather, is especially challenging for older drivers due to their sensitivity to glare and reduced visibility. As a result, older drivers may adjust their behavior during adverse weather. This paper explores the differential impacts of weather on older drivers with cognitive decline compared to older drivers with normal cognitive function. Data were from a naturalistic driving study of older drivers in Omaha, Nebraska. Driver speed and weather data were extracted and the correlation between speed compliance, road weather conditions, and the cognitive/neurological status of the drivers was examined. Speed compliance was used as the surrogate safety measure since driving at lower speeds can indicate that the driver is challenged by roadway or environmental conditions and can therefore indicate a risk. The percentage of time during a trip when drivers were 16.1 kph under the speed limit was modeled as the dependent variable using beta regression. The variables that resulted in the best fit model were mild cognitive impairment (MCI), age group, traffic density, and weather. Results indicated that the youngest group of older drivers (young-old) spent less time driving at impeding speeds and had the least variability compared to the other two age groups. The middle group of older drivers (middle-old) had the highest amount of time driving at impeding speeds and had more variability than young-old drivers. The oldest group of older drivers (old-old) were the most likely to drive at impeding speeds and had the most variability. In general, older drivers were more likely to drive at impeding speeds during peak hours than during non-peak hours. Additionally, in most cases, older drivers spent less time below the speed limit when the weather was clear than in adverse conditions. Results indicate that older drivers are impacted by weather conditions, and distinct patterns were noted between older drivers who were cognitively impaired compared to drivers with normal cognition.展开更多
It is believed that overproduction and deposition of amyloid-β (Aβ) plaques in the hippocampus and cortex region of the brain cause neuronal dysfunction leading to cognitive impairments in Alzheimer’s disease (AD)....It is believed that overproduction and deposition of amyloid-β (Aβ) plaques in the hippocampus and cortex region of the brain cause neuronal dysfunction leading to cognitive impairments in Alzheimer’s disease (AD).Until now,there has been no effective treatment to reduce plaque load from the brain.Recent studies have shown that regular treadmill exercise lowers plaques from the brain of a mouse model of AD.展开更多
Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system...Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system. Objectives: to evaluate if the damage of the nociceptive system was related to post herptic nevral-gia (PHN) development in a sample of 26 patients affected by Herpes zooster (HZ);secondly to assess if the impairment of thermal pathway and PHN development were related. Methods: Thirty-two patients were selected for the study, 26 of these were included in the study, whereas 6 were excluded because of cog- nitive impairment. All 26 study patients were sub- mitted to LEP analysis at baseline (T0) and after six months (T1), and the correlation between clinical thermal disease and the development of PHN was monitored. Results: pain duration was evidenced by the presence or absence of an instrumental signal in patients with acute HZ infection. There was total concordance between the absence of LEP signal and pain duration. The concordance between the clinical thermal disease and the pain duration was statisti- cally significant for 43% of the sample. Conclusions: our results suggested a possible role of LEP for PHN prognosis estimation;indeed, most patients affected by acute HZ, with absence of instrumental LEP signal had pain > 6 months. We also noted a significant (43% of cases) clinical concordance between the thermal pathway damage, the absence of instrumental signal and PHN development. Further studies are needed to address this issue.展开更多
AIM： To evaluate the myoelectric manifestations of peripheral fatigability in patients with primary biliary cirrhosis in comparison to healthy subjects. METHODS： Sixteen women with primary biliary cirrhosis without ...AIM： To evaluate the myoelectric manifestations of peripheral fatigability in patients with primary biliary cirrhosis in comparison to healthy subjects. METHODS： Sixteen women with primary biliary cirrhosis without comorbidity and 13 healthy women matched for age and body mass index （BMI） completed the selfreported questionnaire fatigue impact scale. All subjects underwent surface electromyography assessment of peripheral fatigability. Anterior tibial muscle isometric voluntary contraction was executed for 20 s at 80% of maximal voluntary isometric contraction. During the exercise electromyographic signal series were recorded and root mean square （expression of central drive） as well as mean and median of electromyographic signal frequency spectrum （estimates of muscle fatigability） were com- puted. Each subject executed the trial two times. EMG parameters were normalized, then linear regression was applied and slopes were calculated. RESULTS： Seven patients were fatigued （median fatigue impact scale score： 38, range： 26-66） and 9 were not fatigued （median fatigue impact scale score： 7, range： 0-17）. The maximal voluntary isometric contraction was similar in patients （82, 54-115 N） and controls （87, 74-101 N）, and in patients with high （81, 54-115 N） and low fatigue impact scale scores （86, 65-106 N）. Root mean square as well as mean and median of frequency spectrum slopes were compared with the Mann-Whitney U test, and no significant difference was found between fatigued and non-fatigued patients and controls. CONCLUSION： No instrumental evidence of peripheral fatigability can be found in women with primary biliary cirrhosis but no comorbidity, suggesting that fatigue in such patients may be of central origin.展开更多
Objective:To explore the relationship of the effect of antioxidant status of patients with malignant gliomas at the time of their admission to a tertiary care hospital and the clinical condition after a post operative...Objective:To explore the relationship of the effect of antioxidant status of patients with malignant gliomas at the time of their admission to a tertiary care hospital and the clinical condition after a post operative follow up over a period of two years.Methods: Several antioxidant enzymes like erythrocytic glutathione reductase,glutathione peroxidase,catalase,superoxide dismutase,plasma ceruloplasmin,antioxidant vitamins A,E and C and lipid peroxidation products like erythrocytic thiobarbituric acid reacting substances and plasma conjugated dienes were analyzed both in controls and glioma patients.Results: It was observed that patients who exhibited an overall higher turnover of antioxidants presented with recurrence.Conclusion: Free radical toxicity may adversely affect the outcome of such cancer patients.展开更多
We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical e...We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical evaluation. Our data reveal high occurrence of sleep disorders in this group of women if compared to literature data about general population, in the absence of statistically significant differences among the three menopausal stages: we find only a trend toward a higher risk of OSAS (Obstructive Sleep Apnea Syndrome) in PM versus early PM and MT. However, none of women in our survey underwent PSG (polysomnography), essential to confirm the diagnosis of OSAS and none was diagnosed with RLS (Restless Legs Syndrome) (prior to our survey) by the Gynecologist or General Pratictioner: these data reveal the issue of too low attention towards sleep disorders in this contest. Generic “sleep complaints” are clearly associated with depressed mood and worse-quality life along the menopausal process. In our sample, a non-specific definition of insomnia shows a peculiar relationship with a mood disorder: it is only variable not associated with higher BDI and KI scores, in fact. This might suggest that the conditions linked to depression of these women could be more specific sleep disturbances, such as RLS and OSAS.展开更多
Background: Despite advances in surgical and first-line adjuvant treatment, glioblastoma multiforme (GBM) always recurs as disease natural history. Currently, there is no consensus as to the optimal second-line treatm...Background: Despite advances in surgical and first-line adjuvant treatment, glioblastoma multiforme (GBM) always recurs as disease natural history. Currently, there is no consensus as to the optimal second-line treatment of recurrent GBM. Patients and Methods: This is a retrospective study of a series of adult patients consecutively treated at a single institution for supratentorial cerebral GBM at first relapse. All patients had previously received the standard concomitant radiochemotherapy protocol as first-line therapy. At recurrence/progression, all patients were treated with a metronomic temozolomide (TMZ) schedule at a daily dosage of 50 mg/m2 of body surface. Radiologic, clinical, and laboratory data were collected for all patients, with a minimum follow-up of 18 months. Results: From January 2010 to June 2011, 43 patients were treated at our facility. A mean of 10 metronomic TMZ cycles (range, 3 - 21) was administered. Radiologically, we observed 2 complete responses (4.6%), 16 partial responses (37.2%), 18 stable disease (41.9%) and 7 progressive disease (16.3%). Steroids administration was safely tapered in 23 patients (53.5%). Karnofsky-Performance-Status (KPS) results improved in 20 patients (46.5%), stabilized in 20 (46.5%), and worsened in 3 patients (7.0%), with a mean KPS score increased from 65.1 at baseline to 75.3 at follow-up. Six-month progression-free survival was 53.5. One year after recurrence/progression diagnosis, 22 patients were still alive, with a 1-year overall survival rate of 51.6%. Conclusions: The proposed TMZ schedule seems a safe and effective option for patients with recurrent GBM, with high radiologic response rates and good clinical impact. Strict clinical observation of patients may enable obtaining better results than those already present in the literature and further investigation appears auspicable.展开更多
Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persi...Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persistent back pain following spinal surgery, often leads to disability and increased healthcare utilization. Methods: This randomized, controlled, blind clinical trial aimed to investigate the efficacy of Transcranial Direct Current Stimulation (tDCS) in managing pain from post-laminectomy syndrome in patients. Twenty-four participants were assigned to three groups: sham stimulation, active stimulation over primary motor cortex (M1), or stimulation over dorsolateral prefrontal cortex (DLPFC). Stimulation was administered for five consecutive days, 20 minutes per session, using a current of 1.5 mA through 25 cm<sup>2</sup> electrodes. Pain intensity was assessed using Visual Analog Scale (VAS) before, during, and after intervention. Results: An ANOVA model demonstrates significant reduction in pain intensity compared to baseline in VAS, (F(7, 285) = 12.292;p 0.001;Power = 1.000;η2p = 0.534), in tDCS applied to M1, after five days of intervention. After stimulation, a significant improvement was observed in WHOQoL-Bref Quality of life item 1 (p = 0.04), considering statistical significant difference p 0.05. Correlation between the variables: quality of life, depression, anxiety and pain also demonstrates reduction in depression and anxiety according to Beck’s Depression and Anxiety Inventories (BDI and BAI), p 0.05. This effect was not observed in DLPFC stimulation group. Patients who believed they received active stimulation, in sham group, demonstrated potential for effective blinding. Conclusion: The tDCS applied to primary motor cortex effectively improved pain management and psychiatry symptoms in post-laminectomy syndrome patients. The technique’s low cost, ease of use, and high tolerability make it a promising adjuvant therapy for chronic pain conditions like post-laminectomy syndrome.展开更多
BackgroundPre-eclampsia(PE)is a serious hypertensive disorder of pregnancy with lifelong deleterious effects including an increased risk of stroke postpartum(PP).In the present study,we aimed to determine whether prev...BackgroundPre-eclampsia(PE)is a serious hypertensive disorder of pregnancy with lifelong deleterious effects including an increased risk of stroke postpartum(PP).In the present study,we aimed to determine whether previous PE exacerbates ischemic injury during PP and investigate the underlying mechanisms.MethodsFemale Sprague-Dawley rats were studied at 4–9 months PP after either a normal pregnancy postpartum(NormP-PP,n=7)or experimental PE(ePE)induced using a high-cholesterol diet(ePE-PP,n=9).The animals underwent transient middle cerebral artery occlusion for 2 h with 1 h of reperfusion.Dual-site laser Doppler flowmetry was used to measure cerebral blood flow changes in the middle cerebral artery and collateral territories.Ischemic injury was measured using 2,3,5-triphenyl tetrazolium chloride staining.Circulating 8-isoprostane,3-nitrotyrosine,and oxidized low-density lipoprotein levels were measured using enzyme-linked immunosorbent assays.In separate groups of animals,NormP-PP(n=10)and ePE-PP(n=9)at 3–4 months PP,isolated pial collateral vessels,leptomeningeal anastomoses,and mesenteric arteries were studied using pressure myography.ResultsPrevious ePE worsened stroke outcome in the PP period,significantly increasing infarction and edema in ePE-PP compared to NormP-PP animals(40.6±7.6%vs.13.7±6.5%,p<0.01;5.1±2.0%vs.2.6±0.4%,p<0.01)despite comparable changes in cerebral blood flow in the middle cerebral artery and pial collateral territories during ischemia and reperfusion.When infarction was analyzed as a function of perfusion deficit,the ePE-PP animals showed greater sensitivity to ischemia.Pial collaterals had increased pressure-induced myogenic tone in ePE-PP compared to NormP-PP rats.Percentage tone at 80 mmHg for ePE-PP vs.NormP-PP was 15.5±1.6%vs.8.6±1.9%(p<0.01).ePE-PP animals showed significantly elevated levels of circulating 8-isoprostane and 3-nitrotyrosine but not oxidized low-density lipoprotein after transient middle cerebral artery occlusion(p<0.05,and p<0.01,respectively).ConclusionsWorsened stroke outcomes after ePE pregnancy were related to increased ischemia sensitivity,increased pial collateral tone,and elevated levels of oxidative stress markers.Thus,the pathological effects of ePE persisted PP and negatively affected stroke outcomes.展开更多
While in one hand, due to genetic alterations, lifestyle changes, infections or injuries, or sudden turn of life events, we get health problems, on the other, we have been endowed with enormous natural remedies to tak...While in one hand, due to genetic alterations, lifestyle changes, infections or injuries, or sudden turn of life events, we get health problems, on the other, we have been endowed with enormous natural remedies to take care our health. Cinnamon, the brown bark of cinna- mon tree, is one such natural product that has already been being used for centuries throughout the world as spice or flavoring agent. In addition, medieval physicians used cinnamon for medical purposes to treat a variety of disorders including arthritis, coughing, hoarseness, sore throats, etc. It was once so highly-prized that several wars were fought over it.展开更多
Objective: To measure white matter (WM) and gray matter (GM) atrophy and lesion load in a large population of patients with multiple sclerosis (MS) using a fully automated, operatorindependent,multiparametric segmenta...Objective: To measure white matter (WM) and gray matter (GM) atrophy and lesion load in a large population of patients with multiple sclerosis (MS) using a fully automated, operatorindependent,multiparametric segmentation method. Methods: The study population consisted of 597 patients with MS and 104 control subjects. The MRI parameters were abnormal WM fraction (AWM-f), global WM-f (gWM-f), and GM fraction (GM-f). Results: Significant differences between patients with MS and control subjects included higher AWM-f and reduced gWM-f and GM-f. MRI data showed significant differences between patients with relapsing-remitting and secondary progressive forms of MS. Significant correlations between MRI parameters and between MRI and clinical data were found. Conclusions: Patients with multiple sclerosis have significant atrophy of both white matter (WM) and gray matter (GM); secondary progressive patients have significantly more atrophy of both WM and GM than do relapsing-remitting patients and a significantly higher lesion load (abnormal WM fraction); lesion load is related to both WM and even more to GM atrophy; lesion load and WM and GM atrophy are significantly related to Expanded Disability Status Scale score and age at onset (suggesting that the younger the age at disease onset, the worse the lesion load and brain atrophy); and GM atrophy is the most significant MRI variable in determining the final disability.展开更多
To evaluate whether the chemosensitivity of primary central nervous system ly mphomas to water soluble drugs could result from improved drug delivery, we qu antitatively assessed pharmacokinetic factors in seven pat...To evaluate whether the chemosensitivity of primary central nervous system ly mphomas to water soluble drugs could result from improved drug delivery, we qu antitatively assessed pharmacokinetic factors in seven patients. The capillary p ermeability surface product was found to be significantly increased in central n ervous system lymphomas compared with glioblastoma multiforme, medulloblastomas, and metastases. Tumoral blood flow was significantly greater than in normal whi te matter. Our results suggest favorable pharmacokinetics to water and lipid soluble drugs in primary central nervous system lymphomas.展开更多
AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life(QOL). METHODS: Sixty-nine participants were administered the following psycho...AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life(QOL). METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-Ⅱ, Beck Hopelessness Scale(BHS), and QOLin Epilepsy(QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures. RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy(89.57 ± 25.49 vs 72.86 ± 36.38; t 63 =-2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ≥ 9 indicating a higher suicidal risk. The study did not control for years of the illness. CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients.展开更多
In the present research, we have used the brain entrainment (BWE) treatment simultaneously recording time series data of R-R intervals of the ECG during rest condition. In detail, we have used alpha brain stimulation ...In the present research, we have used the brain entrainment (BWE) treatment simultaneously recording time series data of R-R intervals of the ECG during rest condition. In detail, we have used alpha brain stimulation and we have found that it induces an enhancement of HRV, particularly in Total Variability and Vagal Modulation activities. The experiment has been performed by us on ten subjects with age ranging from 20 to 70 years old. The risk induced from low HRV is by this time well known in literature. Therefore, the obtained result promises to be of valuable interest not only in terms of the basic neurological investigation but also because it delineates new possibilities in terms of clinical application.展开更多
Formation of Lewy body inclusions（LBs）in the substantia nigra（SN）is a very well-characterized pathological hallmark of Parkinson’s disease（PD）.LBs are aggregates of many biologically inactive proteins including...Formation of Lewy body inclusions（LBs）in the substantia nigra（SN）is a very well-characterized pathological hallmark of Parkinson’s disease（PD）.LBs are aggregates of many biologically inactive proteins including structural elements,alpha-synuclein（asyn）-binding proteins,synphilin-1-binding proteins,and components of the ubiquitin-proteasome system.展开更多
Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifical...Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ<sup>2</sup> = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were referred for outpatient follow-up (23%, n = 336) in specialized mental health services or at the Primary Healthcare Unit, highlighting the general hospital’s pivotal role in integrating patients into the broader healthcare network. Conclusion: Variables such as gender (female), age group (young adults), and psychiatric history exhibited stronger associations with suicide attempts compared to the group assisted by CLP for other reasons. Furthermore, a noteworthy correlation between the method employed and the psychiatric diagnosis was identified.展开更多
文摘As drivers age, roadway conditions may become more challenging, particularly when normal aging is coupled with cognitive decline. Driving during lower visibility conditions, such as inclement weather, is especially challenging for older drivers due to their sensitivity to glare and reduced visibility. As a result, older drivers may adjust their behavior during adverse weather. This paper explores the differential impacts of weather on older drivers with cognitive decline compared to older drivers with normal cognitive function. Data were from a naturalistic driving study of older drivers in Omaha, Nebraska. Driver speed and weather data were extracted and the correlation between speed compliance, road weather conditions, and the cognitive/neurological status of the drivers was examined. Speed compliance was used as the surrogate safety measure since driving at lower speeds can indicate that the driver is challenged by roadway or environmental conditions and can therefore indicate a risk. The percentage of time during a trip when drivers were 16.1 kph under the speed limit was modeled as the dependent variable using beta regression. The variables that resulted in the best fit model were mild cognitive impairment (MCI), age group, traffic density, and weather. Results indicated that the youngest group of older drivers (young-old) spent less time driving at impeding speeds and had the least variability compared to the other two age groups. The middle group of older drivers (middle-old) had the highest amount of time driving at impeding speeds and had more variability than young-old drivers. The oldest group of older drivers (old-old) were the most likely to drive at impeding speeds and had the most variability. In general, older drivers were more likely to drive at impeding speeds during peak hours than during non-peak hours. Additionally, in most cases, older drivers spent less time below the speed limit when the weather was clear than in adverse conditions. Results indicate that older drivers are impacted by weather conditions, and distinct patterns were noted between older drivers who were cognitively impaired compared to drivers with normal cognition.
基金supported by merit awards (1I01BX005002 and I01BX005613) from US Department of Veterans Affairsa grant (AT10980) from NIH (to KP)。
文摘It is believed that overproduction and deposition of amyloid-β (Aβ) plaques in the hippocampus and cortex region of the brain cause neuronal dysfunction leading to cognitive impairments in Alzheimer’s disease (AD).Until now,there has been no effective treatment to reduce plaque load from the brain.Recent studies have shown that regular treadmill exercise lowers plaques from the brain of a mouse model of AD.
文摘Background: selective activation and the contempo- rary recording of A delta and C fibers from Yap laser on the scalp is a new neurophysiological assessment, allowing the selective activation of the nociceptive system. Objectives: to evaluate if the damage of the nociceptive system was related to post herptic nevral-gia (PHN) development in a sample of 26 patients affected by Herpes zooster (HZ);secondly to assess if the impairment of thermal pathway and PHN development were related. Methods: Thirty-two patients were selected for the study, 26 of these were included in the study, whereas 6 were excluded because of cog- nitive impairment. All 26 study patients were sub- mitted to LEP analysis at baseline (T0) and after six months (T1), and the correlation between clinical thermal disease and the development of PHN was monitored. Results: pain duration was evidenced by the presence or absence of an instrumental signal in patients with acute HZ infection. There was total concordance between the absence of LEP signal and pain duration. The concordance between the clinical thermal disease and the pain duration was statisti- cally significant for 43% of the sample. Conclusions: our results suggested a possible role of LEP for PHN prognosis estimation;indeed, most patients affected by acute HZ, with absence of instrumental LEP signal had pain > 6 months. We also noted a significant (43% of cases) clinical concordance between the thermal pathway damage, the absence of instrumental signal and PHN development. Further studies are needed to address this issue.
文摘AIM： To evaluate the myoelectric manifestations of peripheral fatigability in patients with primary biliary cirrhosis in comparison to healthy subjects. METHODS： Sixteen women with primary biliary cirrhosis without comorbidity and 13 healthy women matched for age and body mass index （BMI） completed the selfreported questionnaire fatigue impact scale. All subjects underwent surface electromyography assessment of peripheral fatigability. Anterior tibial muscle isometric voluntary contraction was executed for 20 s at 80% of maximal voluntary isometric contraction. During the exercise electromyographic signal series were recorded and root mean square （expression of central drive） as well as mean and median of electromyographic signal frequency spectrum （estimates of muscle fatigability） were com- puted. Each subject executed the trial two times. EMG parameters were normalized, then linear regression was applied and slopes were calculated. RESULTS： Seven patients were fatigued （median fatigue impact scale score： 38, range： 26-66） and 9 were not fatigued （median fatigue impact scale score： 7, range： 0-17）. The maximal voluntary isometric contraction was similar in patients （82, 54-115 N） and controls （87, 74-101 N）, and in patients with high （81, 54-115 N） and low fatigue impact scale scores （86, 65-106 N）. Root mean square as well as mean and median of frequency spectrum slopes were compared with the Mann-Whitney U test, and no significant difference was found between fatigued and non-fatigued patients and controls. CONCLUSION： No instrumental evidence of peripheral fatigability can be found in women with primary biliary cirrhosis but no comorbidity, suggesting that fatigue in such patients may be of central origin.
文摘Objective:To explore the relationship of the effect of antioxidant status of patients with malignant gliomas at the time of their admission to a tertiary care hospital and the clinical condition after a post operative follow up over a period of two years.Methods: Several antioxidant enzymes like erythrocytic glutathione reductase,glutathione peroxidase,catalase,superoxide dismutase,plasma ceruloplasmin,antioxidant vitamins A,E and C and lipid peroxidation products like erythrocytic thiobarbituric acid reacting substances and plasma conjugated dienes were analyzed both in controls and glioma patients.Results: It was observed that patients who exhibited an overall higher turnover of antioxidants presented with recurrence.Conclusion: Free radical toxicity may adversely affect the outcome of such cancer patients.
文摘We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical evaluation. Our data reveal high occurrence of sleep disorders in this group of women if compared to literature data about general population, in the absence of statistically significant differences among the three menopausal stages: we find only a trend toward a higher risk of OSAS (Obstructive Sleep Apnea Syndrome) in PM versus early PM and MT. However, none of women in our survey underwent PSG (polysomnography), essential to confirm the diagnosis of OSAS and none was diagnosed with RLS (Restless Legs Syndrome) (prior to our survey) by the Gynecologist or General Pratictioner: these data reveal the issue of too low attention towards sleep disorders in this contest. Generic “sleep complaints” are clearly associated with depressed mood and worse-quality life along the menopausal process. In our sample, a non-specific definition of insomnia shows a peculiar relationship with a mood disorder: it is only variable not associated with higher BDI and KI scores, in fact. This might suggest that the conditions linked to depression of these women could be more specific sleep disturbances, such as RLS and OSAS.
文摘Background: Despite advances in surgical and first-line adjuvant treatment, glioblastoma multiforme (GBM) always recurs as disease natural history. Currently, there is no consensus as to the optimal second-line treatment of recurrent GBM. Patients and Methods: This is a retrospective study of a series of adult patients consecutively treated at a single institution for supratentorial cerebral GBM at first relapse. All patients had previously received the standard concomitant radiochemotherapy protocol as first-line therapy. At recurrence/progression, all patients were treated with a metronomic temozolomide (TMZ) schedule at a daily dosage of 50 mg/m2 of body surface. Radiologic, clinical, and laboratory data were collected for all patients, with a minimum follow-up of 18 months. Results: From January 2010 to June 2011, 43 patients were treated at our facility. A mean of 10 metronomic TMZ cycles (range, 3 - 21) was administered. Radiologically, we observed 2 complete responses (4.6%), 16 partial responses (37.2%), 18 stable disease (41.9%) and 7 progressive disease (16.3%). Steroids administration was safely tapered in 23 patients (53.5%). Karnofsky-Performance-Status (KPS) results improved in 20 patients (46.5%), stabilized in 20 (46.5%), and worsened in 3 patients (7.0%), with a mean KPS score increased from 65.1 at baseline to 75.3 at follow-up. Six-month progression-free survival was 53.5. One year after recurrence/progression diagnosis, 22 patients were still alive, with a 1-year overall survival rate of 51.6%. Conclusions: The proposed TMZ schedule seems a safe and effective option for patients with recurrent GBM, with high radiologic response rates and good clinical impact. Strict clinical observation of patients may enable obtaining better results than those already present in the literature and further investigation appears auspicable.
文摘Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persistent back pain following spinal surgery, often leads to disability and increased healthcare utilization. Methods: This randomized, controlled, blind clinical trial aimed to investigate the efficacy of Transcranial Direct Current Stimulation (tDCS) in managing pain from post-laminectomy syndrome in patients. Twenty-four participants were assigned to three groups: sham stimulation, active stimulation over primary motor cortex (M1), or stimulation over dorsolateral prefrontal cortex (DLPFC). Stimulation was administered for five consecutive days, 20 minutes per session, using a current of 1.5 mA through 25 cm<sup>2</sup> electrodes. Pain intensity was assessed using Visual Analog Scale (VAS) before, during, and after intervention. Results: An ANOVA model demonstrates significant reduction in pain intensity compared to baseline in VAS, (F(7, 285) = 12.292;p 0.001;Power = 1.000;η2p = 0.534), in tDCS applied to M1, after five days of intervention. After stimulation, a significant improvement was observed in WHOQoL-Bref Quality of life item 1 (p = 0.04), considering statistical significant difference p 0.05. Correlation between the variables: quality of life, depression, anxiety and pain also demonstrates reduction in depression and anxiety according to Beck’s Depression and Anxiety Inventories (BDI and BAI), p 0.05. This effect was not observed in DLPFC stimulation group. Patients who believed they received active stimulation, in sham group, demonstrated potential for effective blinding. Conclusion: The tDCS applied to primary motor cortex effectively improved pain management and psychiatry symptoms in post-laminectomy syndrome patients. The technique’s low cost, ease of use, and high tolerability make it a promising adjuvant therapy for chronic pain conditions like post-laminectomy syndrome.
基金support of the Centers of Biomedical Research Excellence(COBRE)Supplement from the National Institute of General Medicine grant P20 GM135007-04S1the National Institute of Neurological Disorders and Stroke Grant R01 NS093289.
文摘BackgroundPre-eclampsia(PE)is a serious hypertensive disorder of pregnancy with lifelong deleterious effects including an increased risk of stroke postpartum(PP).In the present study,we aimed to determine whether previous PE exacerbates ischemic injury during PP and investigate the underlying mechanisms.MethodsFemale Sprague-Dawley rats were studied at 4–9 months PP after either a normal pregnancy postpartum(NormP-PP,n=7)or experimental PE(ePE)induced using a high-cholesterol diet(ePE-PP,n=9).The animals underwent transient middle cerebral artery occlusion for 2 h with 1 h of reperfusion.Dual-site laser Doppler flowmetry was used to measure cerebral blood flow changes in the middle cerebral artery and collateral territories.Ischemic injury was measured using 2,3,5-triphenyl tetrazolium chloride staining.Circulating 8-isoprostane,3-nitrotyrosine,and oxidized low-density lipoprotein levels were measured using enzyme-linked immunosorbent assays.In separate groups of animals,NormP-PP(n=10)and ePE-PP(n=9)at 3–4 months PP,isolated pial collateral vessels,leptomeningeal anastomoses,and mesenteric arteries were studied using pressure myography.ResultsPrevious ePE worsened stroke outcome in the PP period,significantly increasing infarction and edema in ePE-PP compared to NormP-PP animals(40.6±7.6%vs.13.7±6.5%,p<0.01;5.1±2.0%vs.2.6±0.4%,p<0.01)despite comparable changes in cerebral blood flow in the middle cerebral artery and pial collateral territories during ischemia and reperfusion.When infarction was analyzed as a function of perfusion deficit,the ePE-PP animals showed greater sensitivity to ischemia.Pial collaterals had increased pressure-induced myogenic tone in ePE-PP compared to NormP-PP rats.Percentage tone at 80 mmHg for ePE-PP vs.NormP-PP was 15.5±1.6%vs.8.6±1.9%(p<0.01).ePE-PP animals showed significantly elevated levels of circulating 8-isoprostane and 3-nitrotyrosine but not oxidized low-density lipoprotein after transient middle cerebral artery occlusion(p<0.05,and p<0.01,respectively).ConclusionsWorsened stroke outcomes after ePE pregnancy were related to increased ischemia sensitivity,increased pial collateral tone,and elevated levels of oxidative stress markers.Thus,the pathological effects of ePE persisted PP and negatively affected stroke outcomes.
基金supported by grants from National Institutes of Health(AT6681 and NS83054)
文摘While in one hand, due to genetic alterations, lifestyle changes, infections or injuries, or sudden turn of life events, we get health problems, on the other, we have been endowed with enormous natural remedies to take care our health. Cinnamon, the brown bark of cinna- mon tree, is one such natural product that has already been being used for centuries throughout the world as spice or flavoring agent. In addition, medieval physicians used cinnamon for medical purposes to treat a variety of disorders including arthritis, coughing, hoarseness, sore throats, etc. It was once so highly-prized that several wars were fought over it.
文摘Objective: To measure white matter (WM) and gray matter (GM) atrophy and lesion load in a large population of patients with multiple sclerosis (MS) using a fully automated, operatorindependent,multiparametric segmentation method. Methods: The study population consisted of 597 patients with MS and 104 control subjects. The MRI parameters were abnormal WM fraction (AWM-f), global WM-f (gWM-f), and GM fraction (GM-f). Results: Significant differences between patients with MS and control subjects included higher AWM-f and reduced gWM-f and GM-f. MRI data showed significant differences between patients with relapsing-remitting and secondary progressive forms of MS. Significant correlations between MRI parameters and between MRI and clinical data were found. Conclusions: Patients with multiple sclerosis have significant atrophy of both white matter (WM) and gray matter (GM); secondary progressive patients have significantly more atrophy of both WM and GM than do relapsing-remitting patients and a significantly higher lesion load (abnormal WM fraction); lesion load is related to both WM and even more to GM atrophy; lesion load and WM and GM atrophy are significantly related to Expanded Disability Status Scale score and age at onset (suggesting that the younger the age at disease onset, the worse the lesion load and brain atrophy); and GM atrophy is the most significant MRI variable in determining the final disability.
文摘To evaluate whether the chemosensitivity of primary central nervous system ly mphomas to water soluble drugs could result from improved drug delivery, we qu antitatively assessed pharmacokinetic factors in seven patients. The capillary p ermeability surface product was found to be significantly increased in central n ervous system lymphomas compared with glioblastoma multiforme, medulloblastomas, and metastases. Tumoral blood flow was significantly greater than in normal whi te matter. Our results suggest favorable pharmacokinetics to water and lipid soluble drugs in primary central nervous system lymphomas.
文摘AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life(QOL). METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-Ⅱ, Beck Hopelessness Scale(BHS), and QOLin Epilepsy(QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures. RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy(89.57 ± 25.49 vs 72.86 ± 36.38; t 63 =-2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ≥ 9 indicating a higher suicidal risk. The study did not control for years of the illness. CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients.
文摘In the present research, we have used the brain entrainment (BWE) treatment simultaneously recording time series data of R-R intervals of the ECG during rest condition. In detail, we have used alpha brain stimulation and we have found that it induces an enhancement of HRV, particularly in Total Variability and Vagal Modulation activities. The experiment has been performed by us on ten subjects with age ranging from 20 to 70 years old. The risk induced from low HRV is by this time well known in literature. Therefore, the obtained result promises to be of valuable interest not only in terms of the basic neurological investigation but also because it delineates new possibilities in terms of clinical application.
基金funded by MJ FOX Foundation Rapid Response Innovation Award Grant to AR
文摘Formation of Lewy body inclusions（LBs）in the substantia nigra（SN）is a very well-characterized pathological hallmark of Parkinson’s disease（PD）.LBs are aggregates of many biologically inactive proteins including structural elements,alpha-synuclein（asyn）-binding proteins,synphilin-1-binding proteins,and components of the ubiquitin-proteasome system.
文摘Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ<sup>2</sup> = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were referred for outpatient follow-up (23%, n = 336) in specialized mental health services or at the Primary Healthcare Unit, highlighting the general hospital’s pivotal role in integrating patients into the broader healthcare network. Conclusion: Variables such as gender (female), age group (young adults), and psychiatric history exhibited stronger associations with suicide attempts compared to the group assisted by CLP for other reasons. Furthermore, a noteworthy correlation between the method employed and the psychiatric diagnosis was identified.
