Associations of a biopsychosocial frailty phenotype with all-cause dementia, Alzheimer's disease, vascular dementia, and other dementias: the Italian PRoject on the Epidemiology of Alzheimer's disease (IPREA)

Frailty is a critical intermediate status of the aging process including physical, cognitive, and psychosocial domains/phenotypes. We operationalized a new biopsychosocial frailty construct, estimating its impact on the odds of all-cause dementia, Alzheimer's disease (AD), vascular dementia (VaD), and other dementias in 2838 older individuals from the population-based Italian PRoject on the Epidemiology of Alzheimer's disease (IPREA). Biopsychosocial frailty operationalization was based on the results of a previous comprehensive geriatric assessment and the presence of physical frailty. In this cross-sectional study, participants with biopsychosocial frailty showed an increased odds ratio of all-cause dementia [odds ratio (OR): 5.55, 95% confidence interval (CI): 3.72-8.28, p < 0.001], in particular for probable AD (OR: 3.62, 95% CI: 1.55-8.45, p < 0.001), probable VaD (OR: 10.05, 95% CI: 5.05-19.97, p < 0.001), and possible VaD (OR: 17.61, 95% CI: 6.42-48.32, p < 0.001). No statistically significant association was found between this biopsychosocial frailty phenotype and possible AD (OR: 2.84, 95% CI: 0.81-9.97, p = 0.09) or other dementias (OR: 1.77, 95% CI: 0.75-0.21, p = 0.19). In conclusion, in a large cohort of Italian older individuals, a biopsychosocial frailty model was associated to all-cause dementia, probable AD, and probable and possible VaD. In the next future, other large and prospective population-based studies evaluating the association between the biopsychosocial frailty phenotype and incident all-cause dementia, AD, and VaD are needed, addressing also potential bias and confounding sources.

Gilteritinib as treatment for extra-medullary relapse of FLT3-ITD acute myeloid leukemia FLT3-ITD, after allogeneic haematopoietic stem cell transplantation

Case of a patient with acute myeloid leukemia (AML) positive for mutations in both genes NPM1 and FLT3-ITD who underwent two allogeneic haematopoietic stem cell transplants (HSCT); the second allograft one was followed by extramedullary relapse (granulocytic sarcoma of right breast), with blast cells positive for FLT3-ITDmutation.  Treatment with Gilteritinib, a second generation selective oral type I FLT3 inhibitor, was started after the second HSCT with complete regression of breast granulocytic sarcoma in absence of hematological and extra hematologic toxicity. We conclude that Gilteritinib can represent an effective therapy for extra hematologic relapse, with acceptable toxicity and outpatient management.

Plasminogen Activator Inhibitor-1 (PAI-1) Promoter 4G/5G Genotype and Increased PAI-1 Circulating Levels in Postmenopausal Women with Coronary Artery Disease

Increased circulating levels of type 1 plasminogen activator inhibitor (PAI-1) have been associated with coronary artery disease (CAD). However, genetic and environmental determinants of PAI-1 expression are only partially understood. The levels of PAI-1 have been found to relate to 4/5 guanosine (4G/5G) polymorphism in the promoter region of the PAI-1 gene. The 4G allele in this polymorphism has been associated with higher levels of plasma PAI-1 activity, but despite the strong correlation between PAI-1 activity and antigen, no association has been found between PAI-1 antigen levels and the PAI-1 promoter 4G/5G genotype. The aim of the present study was to analyze the influence of the PAI-1 promoter 4G/5G genotype on PAI-1 levels in post-menopause women with coronary disease in comparison with healthy women in pre and postmenopausal status, and the influence of this genotype on variations in PAI-1 levels after hormone replacement therapy (HRT). No differences between 4G/5G allele distribution in the groups studied were observed. The group of postmenopausal women with CAD showed significantly increased PAI-1 antigen and activity levels in comparison with the control groups, and the levels of PAI-1 correlated with the 4G/5G genotype. A multivariate analysis revealed that in the CAD group there was a high correlation between 4G allele dosage and PAI-1 antigen levels, which were also influenced by the triglyceride levels but not by estrogen or glucose levels. After hormone replacement therapy the decrease in PAI-1 levels was correlated with the 4G allele dosage. We conclude that in the group of postmenopausal women with CAD the influence of the PAI-1 promoter 4G/5G genotype on PAI-1 levels is more evident than in the control groups, and that the decrease in PAI-1 levels after HRT in CAD women correlates with the 4G allele dosage.

Mechanical analysis of the roundhouse kick according to height and distance in taekwondo

Competition regulation in taekwondo has experienced several changes during the last few years, for example, kicks to the head score more points than kicks to the chest. In addition, some external factors such as the height of target and execution distance seem to affect the kick performance. The aim of this study was to analyse selected biomechanical parameters (impact force, reaction time, and execution time) according to the height and execution distance in two different male groups (experts (n = 12) and novices (n = 21)). Athletes kicked twice from every execution distance (short, normal and long) and towards two different heights of target (chest and head) in a random order. Novices kicked to the head with a longer reaction time than to the chest (p < 0.05) but experts were able to kick with similar performance for both heights. From short and normal distances experts kicked with similar performance; whereas from the normal distance novices had longer reaction and execution time than from the short distance (p < 0.05). In conclusion, in counterattacking situations, experts should perform the roundhouse kick to the head instead of to the chest, because it produces better scores with similar performance; whereas novice athletes should avoid kicking to the head because they are not able to kick with similar performance. Moreover, it is recommended that during counterattacks higher-level taekwondo athletes should intend to kick from normal distances.

Relationship between optimism, disease variables, and health perception and quality of life in individuals with epilepsy

Epilepsy is a relatively frequent chronic condition with an important impact on the health perception and quality of life (QOL) of patients. The aim of the present study was to identify variables related to health status perception and QOL in persons with epilepsy. Participants were 200 persons with epilepsy, 53.5% of whom were males. The mean age was 39.6; 95% had seizures, and 99% were taking antiepileptic medication. The self-report questionnaire administered assessed four types of variables: demographic, disease, epilepsy-specific optimistic attitude, and outcome variables. Results demonstrated that an optimistic orientation is related to better perception of physical and mental health status and better perception of QOL. The variables that best predict positive outcomes are optimistic orientation, perception of cognitive functioning, and perception of seizure control. These results question the importance attributed to seizure characteristics for everyday functioning and everyday life of individuals with epilepsy, and stress the importance of facilitating an epilepsy-specific optimistic orientation.

Temporal lobe epilepsy surgery: different surgical strategies after a non-invasive diagnostic protocol

AIM

To test a non-invasive presurgical protocol for temporal lobe epilepsy (TLE) based on "anatomo-electro-clinical correlations".

METHODS

All consecutive patients with suspected TLE and seizure history <2 years were entered into the protocol, which included video-electroencephalographic (EEG) monitoring and magnetic resonance imaging (MRI). Three different TLE subsyndromes (mesial, lateral, mesiolateral) were identified by combined anatomical, electrical, and clinical criteria. "Tailored" surgery for each subsyndrome was offered. Patients with seizure history <2 years, MRI evidence of temporal mass lesion, and concordant interictal EEG and clinical data bypassed video-EEG monitoring and were directly scheduled for surgery.

RESULTS

Lesionectomy was performed without video-EEG recording in 11 patients with tumorous TLE. Of 146 patients studied with video-EEG, 133 received a TLE diagnosis. Four were excluded for neuropsychological risks, eight refused surgery, and 121 underwent surgery. Of 132 consecutive patients who underwent surgery, 101 had at least one year of follow up. They were divided into a "hippocampal sclerosis/cryptogenic" group (n = 57) and a "tumours/cortical organisation disorders" group (n = 44). In the first group, extensive temporal lobectomy (ETL) was performed in 40 patients, anteromesial temporal lobectomy (AMTL) in 17 patients. At follow up, 47 patients were seizure free. In the second group, lesionectomy plus ETL was performed in 23 patients, lesionectomy plus AMTL in six patients, and lesionectomy alone in 15 patients. Thirty nine patients were seizure free.

CONCLUSIONS

These findings suggest that different TLE subsyndromes can be identified accurately using non-invasive anatomo-electro-clinical data and can be treated effectively and safely with tailored surgery.

Apoptosis is regulated by polyamines in the cell cycle of Chinese hamster ovary cells

This paper deals with the relationship between the polyamine metabolism and apoptosis in the different phases of the cell cycle in a Chinese hamster ovary (CHO) cell line. Synchronously growing cells were obtained by the addition of 1.2 mM hydroxyurea and the progression through the cell cycle was monitored by determining the incorporation of 3H-thymidine in the DNA. Ornithine decarboxylase (ODC) activity showed a peak in S phase, while intracellular putrescine and spermine contents increased constantly, reaching to a maximum level at G2 phase; spermidine content doubled during G2 and increased four times during M, compared to G1. The increment in the endogenous polyamine content was associated to a diminished uptake from the medium. The apoptotic index was higher in G2 phase, coinciding with the maximum level observed in putrescine content. The results support the idea that intracellular putrescine level is closely related to apoptosis.

Plasminogen activator inhibitor-1 (PAI-1) promoter 4G/5G genotype and increased PAI-1 circulating levels in postmenopausal women with coronary artery disease

Increased circulating levels of type 1 plasminogen activator inhibitor (PAI-1) have been associated with coronary artery disease (CAD). However, genetic and environmental determinants of PAI-1 expression are only partially understood. The levels of PAI-1 have been found to relate to 4/5 guanosine (4G/5G) polymorphism in the promoter region of the PAI-1 gene. The 4G allele in this polymorphism has been associated with higher levels of plasma PAI-1 activity, but despite the strong correlation between PAI-1 activity and antigen, no association has been found between PAI-1 antigen levels and the PAI-1 promoter 4G/5G genotype. The aim of the present study was to analyze the influence of the PAI-1 promoter 4G/5G genotype on PAI-1 levels in post-menopause women with coronary disease in comparison with healthy women in pre and postmenopausal status, and the influence of this genotype on variations in PAI-1 levels after hormone replacement therapy (HRT). No differences between 4G/5G allele distribution in the groups studied were observed. The group of postmenopausal women with CAD showed significantly increased PAI-1 antigen and activity levels in comparison with the control groups, and the levels of PAI-1 correlated with the 4G/5G genotype. A multivariate analysis revealed that in the CAD group there was a high correlation between 4G allele dosage and PAI-1 antigen levels, which were also influenced by the triglyceride levels but not by estrogen or glucose levels. After hormone replacement therapy the decrease in PAI-1 levels was correlated with the 4G allele dosage. We conclude that in the group of postmenopausal women with CAD the influence of the PAI-1 promoter 4G/5G genotype on PAI-1 levels is more evident than in the control groups, and that the decrease in PAI-1 levels after HRT in CAD women correlates with the 4G allele dosage.

Organization and technical problems of LDL-apheresis

The Authors consider problems related to technique and organization of LDL-Apheresis with respect to some particular aspects. They evaluate: a) Technical complexity of procedures both in devices to use and in staff preparation; b) Length of treatment which conditions the other fields of activity; c) Problems in management treatments periodicity; d) Usually high cost of this kind of procedures; e) Problems related to vascular accesses; f) Problems related to pediatric patients, both for their low weight and vascular accesses; g) Management of cardio-vascular complications; h) Difficulties in evaluation of regression of vascular lesions. Finally, it is particularly difficult the management of psychological aspects related to somatic symptoms of the disease and to the acceptance of treatment.

Project of computer-aided management of therapeutical apheresis

The great increase in hemapheresis units activity that occurred during the last years caused the need for a computer-aided management (1, 2). We present a project for a data base system able to manage therapeutical apheresis (3). The program consists of five sections. a) Patient's file card: it allows to record anamnesis, examination and blood test results easily and under computer's guidance. b) Choice of therapeutic protocol: Therapeutic protocol is fixed in this section (device to be used, apheretic method, plasma volume to be processed, blood tests before and after apheresis). c)

PROCEDURES

It provides procedure's data entry and guides the operator during the treatment on the ground of therapeutical protocol. d) Data processing: It allows statistics on data placed in the data base. e) Registers: It includes both a general register and the possibility of search by disease, device and method.

Experience of computer-aided management of hemapheresis unit

Several programs are available for blood banks management but none of them is particularly made for hemapheresis. We studied a data base application able to manage any aspect of hemapheresis unit activity. The programming general criteria were: 1) easiness of use even for people without any previous experience in using Personal Computers; 2) maximum saving time in operating; 3) easily modifiable system in reply to problems or new needs; 4) automatic checks in order to have the highest automation together with the smallest error risk; 5) quick view on state of activity and on material consumption; 6) simplification of donor recruitment. After a three year long experience, we describe our program structure in order to give a basis for the development of a standardized management system which is useful for different needs and open to future applications of blood cell separators.

Experience of Computer-Aided Management of Hemapheresis Unit

Several programs are available for blood banks management but none of them is particularly made for hemapheresis.

We studied a data base application able to manage any aspect of hemapheresis unit activity. The programming general criteria were:

1) easiness of use even for people without any previous experience in using Personal Computers;

2) maximum saving time in operating;

3) easily modifiable system in reply to problems or new needs;

4) automatic checks in order to have the highest automation together with the smallest error risk;

5) quick view on state of activity and on material consumption;

6) simplification of donor recruitment.

After a three year long experience, we describe our program structure in order to give a basis for the development of a standardized management system which is useful for different needs and open to future applications of blood cell separators.

Organization and Technical Problems of LDL-apheresis

The Authors consider problems related to technique and organization of LDL-Apher-esis with respect to some particular aspects. They evaluate:

a) Technical complexity of procedures both in devices to use and in staff preparation;

b) Length of treatment which conditions the other fields of activity;

c) Problems in management treatments periodicity;

d) Usually high cost of this kind of procedures;

e) Problems related to vascular accesses;

f) Problems related to pediatric patients, both for their low weight and vascular accesses;

g) Management of cardiovascular complications;

h) Difficulties in evaluation of regression of vascular lesions.

Finally, it is particularly difficult the management of psychological aspects related to somatic symptoms of the disease and to the acceptance of treatment.

Project of Computer-aided Management of Therapeutical Apheresis

The great increase in hemapheresis units activity that occurred during the last years caused the need for a computer-aided management (1, 2).

We present a project for a data base system able to manage therapeutical apheresis (3). The program consists of five sections.

a) Patient's file card: it allows to record anamnesis, examination and blood test results easily and under computer's guidance.

b) Choice of therapeutic protocol: Therapeutic protocol is fixed in this section (device to be used, apheretic method, plasma volume to be processed, blood tests before and after apheresis).

c) Procedures: It provides procedure's data entry and guides the operator during the treatment on the ground of therapeutical protocol.

d) Data processing: It allows statistics on data placed in the data base.

e) Registers: It includes both a general register and the possibility of search by disease, device and method.

Treatment of severe hypercholesterolaemia by LDL-apheresis

The most severe forms of hypercholesterolaemia scarcely respond to diet and conventional drugs administration and need, therefore, alternative treatments. Terapeutic Plasma Exchange demonstrated an improved survival of subjects with Familial Hypercholesterolaemia (FH) in spite of its limitations. Semi-selective and selective techniques have been developed in order to remove LDL cholesterol alone. We studied the efficiency in LDL removal both of membrane filtration as of dextrane sulphate adsorption on 14 FH patients, performing 302 procedures. Cholesterol extraction with the different methods was in the range of 40-65%. Mean cholesterol level was reduced from 7% to 64% depending on the protocol used. The procedures were all performed on an outpatient basis. Side effects occurred rarely and were always of not serious degree. The short and the middle term clinical effects of LDL-Apheresis are then evaluated.

Infrared prism coupling characterization and optimization via near-field m-line scanning

The use of a detailed analysis of the near-field m-line pattern to characterize and optimize prism coupling into infrared waveguides is described. Experimental results at 10.6 microm are presented which completely confirm the theoretical predictions.