Energy expenditure, body composition and dietary habits in progressive supranuclear palsy

Introduction

Little is known about metabolic changes in progressive supranuclear palsy. Goals of the present study are to: (1) investigate whether early progressive supranuclear palsy is associated with changes in energy expenditure, body composition and dietary intake compared with Parkinson’s disease and healthy controls; (2) assess the accuracy of the Harris–Benedict equation to predict measured rest energy expenditure in progressive supranuclear palsy; (3) verify differences according to sex, phenotypes, disease severity and presence of dysphagia in progressive supranuclear palsy.

Methods

Twenty-one progressive supranuclear palsy, 41 Parkinson’s disease and nine healthy controls were included. Rest energy expenditure was assessed with indirect calorimeter, body composition with bio-impedance analysis and physical activity and dietary intake were estimated with a validated frequency questionnaire. Parametric testing was used to analyze differences between groups.

Results

Progressive supranuclear palsy showed reduced total daily energy expenditure and physical activity compared to both other cohorts (p < 0.001) and a tendency toward lower fat-free mass compared to Parkinson’s disease (p > 0.05). Limited accuracy was shown for the Harris–Benedict equation (accurate prediction frequency < 60%). Greater disease severity was associated with lower rest energy expenditure (p = 0.030), fat-free mass (p = 0.026) and muscle mass (p = 0.029).

Conclusion

Greater disease severity is associated with reduction in rest energy expenditure likely due to the reduction in lean mass and muscle mass. Such data may pave the way to clinical trials evaluating the efficacy of muscle-targeted nutritional support and physical therapy in preserving muscle mass and improving motor performances in progressive supranuclear palsy at early stages.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00415-021-10846-6.

Halide and hydroxide anion binding in water

The formation of halide and hydroxide anion complexes with two ligands L1 (3,6-bis(morpholin-4-ylmethyl)-1,2,4,5-tetrazine) and L2 (3,6-bis(morpholin-4-ylethyl)-1,2,4,5-tetrazine) was studied in aqueous solution, by means of potentiometric and ITC procedures. In the solid state, HF₂^-, Cl^- and Br^- complexes of H₂L2²⁺ were analysed by single crystal XRD measurements. Further information on the latter was obtained with the use of density functional theory (DFT) calculations in combination with the polarizable continuum model (PCM). The presence of two halide or bifluoride HF₂^- (F-H-F^-) anions forming anion-π interactions, respectively above and below the ligand tetrazine ring, is the leitmotiv of the [(H₂L2)X₂] (X = HF₂, Cl, Br, I) complexes in the solid state, while hydrogen bonding between the anions and protonated morpholine ligand groups contributes to strengthen the anion-ligand interaction, in particular in the case of Cl^- and Br^-. In contrast to the solid state, only the anion : ligand complexes of 1 : 1 stoichiometry were found in solution. The stability of these complexes displays the peculiar trend I^- > F^- > Br^- > Cl^- which was rationalized in terms of electrostatic, hydrogen bond, anion-π interactions and solvent effects. DFT calculations performed on [(H₂L2)X]⁺ (X = F, Cl, Br, I) in PCM water suggested that the ligand assumes a U-shaped conformation to form one anion-π and two salt bridge interactions with the included anions and furnished structural information to interpret the solvation effects affecting complex formation. The formation of hydroxide anion complexes with neutral (not protonated) L1 and L2 molecules represents an unprecedented case in water. The stability of the [L(OH)]^- (L = L1, L2) complexes is comparable to or higher than the stability of halide complexes with protonated ligand molecules, their formation being promoted by largely favourable enthalpic contributions that prevail over unfavourable entropic changes.

Sensorineural hearing loss in ankylosing spondylitis treated with TNF blockers

OBJECTIVES

Sensorineural hearing loss (SNHL) in the uncommon disease ankylosing spondylitis (AS) has been previously reported. We analysed the relationships between AS, anti-TNF drug treatment, and SNHL.

METHODOLOGY

We determined pure tone thresholds in 28 consecutive patients with AS who were treated with the TNFalpha inhibitors etanercept or infliximab, or with a TNFalpha inhibitor plus methotrexate (MTX).

RESULTS

SNHL was diagnosed in 16 patients (57.1%): 7/7 (100%) of those treated with anti-TNFalpha plus MTX, and 9/21 (43%) of those treated with anti-TNFalpha alone. We found a significant association between SNHL and treatment modality (p = 0.011) or treatment time in months (p = 0.020).

CONCLUSIONS

The SNHL rate was significantly higher in patients treated with anti-TNFalpha plus MTX than those treated with anti-TNFalpha alone. The culpability of anti-TNF therapy was supported by the association between SNHL and treatment time, which was longer for anti-TNFalpha plus MTX than for anti-TNFalpha alone. SNHL may be due not only to AS, but also to drug-induced vasculitis of the labyrinthine artery or its cochlear branch.

Evaluation of magnetic resonance signal modification induced by hyaluronic acid therapy in chondromalacia patellae: a preliminary study

Hyaluronic Acid (HA) is an alternative method for the treatment of osteoarthritis (OA), which acts on pain through a double action: anti-inflammatory and synovial fluid (SF) visco-supplementation. Magnetic Resonance Imaging (MRI), utilizing specific sequences, is a valid method for studying the initial phase of chondral damage. The analysis of the data, obtained through the intensity of values taken by positioning Region of Interest (ROIs) within the lesion, determining the differences before and after treatment with HA injected into the knee. The results obtained after six months and one year from the injection were statistically different in respect to those taken before, immediately and after three months of treatment. MRI represents a valid tool to evaluate the grade of chondromalacia patellae and also to follow the cartilage modification induced by HA therapy.

Characteristics of tinnitus in childhood

Despite its incidence, there are still few reports in literature relating to tinnitus in children. Almost all data were collected by means of questionnaires or in a limited population of children. In order to collect data in a homogeneous way and directly from the patients, the protocol of study proposed by Savastano has been applied to 1,100 children. The results showed tinnitus as present in 374 children but only 6.5% of the cases complained spontaneously about it. In all, 76.4% of the children demonstrated normal hearing, whereas 64.5% reported being bothered by their tinnitus. Tinnitus measurements were obtained and are reproducible in all patients older than 8 years of age. The loudness level was <10 dB in 48.6% of cases, which was higher than 10 dB in 51.4%. As for the frequency distribution, in most cases it appears to be between 0 and 1,000 Hz. There is a correspondence between the loudness level and masking level. A total inhibition of <60 s for most children with lower loudness was obtained. The present study demonstrates that the application in the infancy of a specific protocol of study allows the presence of tinnitus to be discovered, giving specific and detailed information about it so as to minimize its damage to be obtained. Moreover, for the first time, data regarding the measurement of tinnitus in childhood has been gathered.

Superficial inflammatory and primary neoplastic lymphadenopathy: diagnostic accuracy of power-doppler sonography

OBJECTIVE

To evaluate the sensitivity, specificity and diagnostic accuracy of a cut-off of the resistive index of 0.5 for the differentiation between inflammatory and neoplastic primary lymphadenopathies.

SUBJECTS AND METHODS

We measured the resistive index of superficial enlarged lymph nodes in a total of 50 patients (29 males and 21 females; age range 12-72 years, mean age 41.6 year) using an ATL 5000 HDI. A resistive index greater than or equal to 0.5 indicated an inflammatory lymph node and a resistive index <0.5 was consistent with neoplastic primary lymphadenopathies. The gold standard was either surgical biopsy or lymph-node reduction seen with ultrasound examination after antibiotic therapy.

RESULTS

The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathy was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% (P < 0.001, statistically significant).

CONCLUSION

The results of this study indicate that power-Doppler using a resistive index cut-off of 0.5 was a valid technique for distinguishing between inflammatory and primary neoplastic lymph nodes in patients with superficial lymphadenopathies.

Importance of behavior in response to tinnitus symptoms

Among subjects affected by tinnitus, two groups are distinguished: patients who can cope positively with the symptom and patients who cannot cope with it. These differing attitudes suggest the necessity to study affected patients' "illness behavior" (i.e., a subjective interpretation of symptoms concerning body functioning). Our study considered 125 idiopathic tinnitus sufferers who requested a visit by an otorhinolaryngologist expressly for this symptom. All patients were invited to complete the illness behavior questionnaire (IBQ). IBQ mean score results were lower for affective inhibition and irritability and resulted in higher denial. Patients with more psychological suffering presented higher levels of hypochondria, disease convinction, and dysphoria. Results revealed a correlation between psychological suffering and tinnitus intensity: The group of patients with stronger psychological suffering included more subjects with a higher intensity level. The other group included more subjects with a moderate intensity level. Within the psychological evaluation of tinnitus sufferers, the IBQ results demonstrated particular sensitivity in revealing patients' nonadaptation area in coping with the symptom.

Intradermal injection vs. oral treatment of tinnitus

Local pharmacological intradermal infiltration is a therapy being used more and more thanks to the positive results achieved, particularly for all those therapies acting on the microcirculation. In trying to better the results obtained with medical therapy for tinnitus sufferers, to assess the effect of a vasoactive drug, the method of administration by the intradermal route, which allows a strengthening of the pharmacological effect, has been added. The present study comprised 120 tinnitus sufferers who underwent intradermal auricle infiltration with a vasoactive drug. The control group includes 115 tinnitus sufferers who underwent systemic vasoactive therapy with the same drug. Forty-five days after beginning intradermal treatment the symptom improved and continued to do so following further infiltrations which patients underwent every 15 days. In the control group we noticed a moderate improvement 45 days after the beginning of oral therapy; thereafter the results reached a plateau by the 60th day. Intradermal vasoactive therapy for idiopathic tinnitus seems to be a new success, which will be an interesting progression in the therapy of this kind of symptom.

Audiometric and epidemiological analysis of elderly in the Veneto region

BACKGROUND

Presbyacusis, or age-related hearing loss, has become a problem of increasing social interest due to the rise in the mean age of the population. Investigations performed to date have generally been carried out with the aid of self-reporting questionnaires, without the support of objective findings.

OBJECTIVE

The purpose of this study was to analyze an extensive series of elderly people from different areas of the Veneto region to obtain an epidemiological descriptive analysis, as detailed as possible, of their presbyacusis, considering their hearing thresholds at various frequencies, distinguishing findings according to sex and age in classes and the geographical area where the survey was performed.

METHODS

The survey was carried out collecting information from the audiometric reports on 13,710 subjects of both sexes aged 60 years and over, with a proportion of males (M/F x 100) of 92.02%, referred spontaneously for hearing examination to the ENT departments of eight hospitals between 1986 and 1994. The catchment area includes three provincial capitals and five mainly rural municipalities.

RESULTS

The results show that the hearing threshold rises progressively with age in both sexes. The hearing loss is milder in women than in men, especially at the higher frequencies. No important differences emerged among findings recorded in their 80s and in their 90s or among findings in the different geographical areas considered.

CONCLUSIONS

Statistical descriptive analysis confirms the typical trend of the audiometric curve in presbyacusis, tracing the typical audiometric curve of old age described in the literature. The mean values of the audiometric curve reveal no significant differences between people residing in the country and people living in the cities.

Otorhinolaryngological assessment and psychological adjustment in tanning industry workers

The purpose of the study was to verify the presence of any symptoms and otorhinolaryngological pathologies and to determine any discomfort and psychophysical changes among workers in the tanning industry. The study involved 129 subjects working in tanning industries in the Chiampo valley (Veneto region of Italy). Their clinical history was recorded and they underwent objective ENT examination and pure-tone audiometry. For the psychodiagnostic evaluation, four questionnaires were administered (EPI, STAI, ZUNG and GHQ). ENT assessment revealed no objective problems and findings were within the normal range in the majority of cases. Hearing function was also generally normal or within the normal range for an individual's age. Psychological evaluation revealed a valid psychological adjustment in almost all cases, despite the majority of workers reporting some subjective discomfort attached mainly to the particularly unpleasant smell in a micro-climate with a high rate of humidity. The findings of this preliminary investigation enable us to claim that the working environment in the tanning industries is not severely harmful for the upper airways and hearing function. It is worth noting the normality of the workers' psychological adjustment, which indicates a valid psycho-physical balance in these subjects who operate in an environment with unpleasant features.

Psychological distress in patients with tinnitus

OBJECTIVE

This study was conducted to evaluate the psychological distress in patients with tinnitus that is often correlated with sleeping disorders, difficulties in concentration, and compromized social relations.

METHODS

Eighty-four patients were studied using preliminary clinical and audiologic evaluations, and successive psychological tests.

RESULTS

The cluster analysis indicated two essential groups composed of 45 patients (CLST-1) and 38 patients (CLST-2), respectively. The CLST-1 group had higher scores for depression, anxiety, and neuroticism. The IBQ CLST-1 revealed a greater degree hypochondria, conviction of disease dysphoria, and irritability.

CONCLUSIONS

Our results indicate that the relationship between the intensity of the tinnitus and the extent of the distress is supported by the larger number of patients with more intense tinnitus in the first cluster. The CLST-2 with its normal psychological test results, apart from marked denial, would support the hypothesis of a somatic expression of the distress.

Fuzzy identification of systems with unsupervised learning

The paper describes a mathematical tool to build a fuzzy model whose membership functions and consequent parameters rely on the estimates of a data set. The proposed method proved to be capable of approximating any real continuous function, also a strongly nonlinear one, on a compact set to arbitrary accuracy. Without resorting to domain experts, the algorithm constructs a model-free, complete function approximation system. Applications to the modeling of several functions among which classical nonlinear ones such as the Rosenbrock and the sine (x, y) functions are reported. The proposed algorithm can find applications in the development of fuzzy logic controllers (FLC).

Illness behaviour, personality traits, anxiety, and depression in patients with Menière's disease

OBJECTIVE

This study was conducted to evaluate illness behaviour, personality traits, anxiety and depression in patients with Menière's disease.

DESIGN

A prospective study of patients and review of the literature is presented.

METHODS

Fifty patients presenting to the ENT department of the Padua University were studied using the Illness Behaviour Questionnaire (IBQ), Eysenck Personality Inventory (EPI), State Trait Anxiety Inventory, and the Zung Self-Rating Depression Scale.

RESULTS

Mean scores were found to be higher than normal for neuroticism with a stronger psychological perception of disease and a lower level of affective inhibition. Cluster analysis of the IBQ scores identified a subgroup of Meniere's patients with normal scores and another with severe psychological distress associated with high levels of neuroticism and psychoticism in the EPI and an abnormal illness behaviour: these were older patients with a longer history of Menière's disease and more hospital stays.

CONCLUSION

Our results indicate the possibility of distinguishing those patients whose personality traits could facilitate the development of abnormal illness behaviour and psychological symptoms in relation to Menière's disease. Analysis of the data suggests that there is no specific link between such psychological aspects and the clinical disease.

Combined modality staging of low risk rectal cancer

The work-up conducted in order to reach a correct diagnosis based on a combined modality staging in patients with low risk rectal cancer, is presented. The diagnostic accuracy of each imaging technique is analyzed by the comparison of the radiologic TN with the histologic TN in 13 patients directly referred to surgery based on combined modality staging. Control with histologic findings has staged as T1-T2 13 patients directly referred to surgery, while only a patient was shown to have microinfiltration of perirectal fat. As for T, diagnostic accuracy was 90% for transrectal US, 66% for MRI, 61% for CT. Accuracy of transrectal sonography in the differentiation of T1 from T2 was 70% with a trend towards overstaging. None of the procedures has suggested the presence of metastatic lymph nodes while on histology small neoplastic foci were evidenced in a normal-sized perirectal lymph node. The high diagnostic accuracy of US in the definition of T in rectal cancer is confirmed. It is underlined that no procedure enables the detection of neoplastic microinfiltration of normal lymph nodes.

Antigen non-specific immunological tests in progressive sensorineural hearing loss

The purpose of the present study was to determine the validity of antigen non-specific immunological tests in order to develop a risk-clinical profile of patients with immune-mediated inner ear pathology. The study was carried out on 38 patients with progressive sensorineural hearing loss and a control group of 26 subjects. Serological testing was used to determine cell activation complexes. In patients with hearing loss, T-lymphocyte subpopulations were found to have an increase in cytotoxic T-cells when compared to T-helper, but only for interleukin-2 receptor expression. This difference was significant between patients and the control group. Present findings suggest that T-lymphocyte "early" marker is of particular interest for developing a risk-clinical profile of patients with sensorineural progressive hearing loss of immune origin.

Idiopathic progressive sensorineural hearing loss in children

Clinical observations were made of 42 children with bilateral idiopathic progressive sensorineural hearing loss considering hearing loss distribution in relation to age at onset, audiometric features, audiologic characteristics and possible correlation with some haematochemical alterations. Patients were divided into 2 groups on the basis of hearing onset: Group I, 0-6 years; Group II, 7-14 years. A peak in the distribution of onset age was observed in the range of 4-6 years. In most cases a 'descending' curve was recognized accompanied by recruitment. The haematochemical tests only suggested a possible correlation between hearing loss and anaemia. Finally, no significant difference of incidence between the sexes was observed.

[Sudden deafness and acute synovitis: a case report]

A case of sudden deafness followed by arthritic manifestations is reported. The importance of immunologic tests, such as circulating immune complexes and the HLA system, in making a correct diagnosis is emphasized, which in turn suggests the possibility of establishing new diagnostic strategies.

Brain cortex gangliosides and (Na+, K+)ATPase system of the stria vascularis in guinea pig

This paper presents the results of an investigation into the possibility that gangliosides (brain cortex glycosphingolipids) are capable of being functionally incorporated into cell membranes and of interfering with enzymatic activity of the ATPase system on the stria vascularis and spiral ligament in the guinea pig. Labelled gangliosides (3H-GM1) were incorporated into the cell membranes of the tissues under examination. (Na+, K+)ATPase activity increased l0 minutes after intravenous injection of gangliosides and prevented the decrease in (Na+, K+)ATPase system produced by ethacrynic acid. The action of gangliosides on the (Na+, K+)ATPase system is discussed.