Prehabilitation and heart failure: perspective in primary outcomes, a randomized controlled trial

OBJECTIVE

Prehabilitation, intended as a multidisciplinary approach where physical training is combined with educational and counselling training, in cardiology could optimizing care, and has been shown to be able to reduce morbidity and mortality in several diseases. The present study aims to assess the effectiveness of a prehabilitation program in elderly patients (over 65) with chronic heart failure and to evaluate functional and quality indices of life.

PATIENTS AND METHODS

This is randomized, single blind controlled trial. Fourteen older adult patients diagnosed with chronic heart failure were enrolled. Patients were randomly assigned into the study or the control group. Patients in the study group underwent physical training organized into 10 twice-weekly meetings, nutritional and lifestyle counseling.

RESULTS

In the Study Group, the quality of life improved significantly (EQoL-5D), and between the two groups there is a statistically significant difference in the motor dimension of SF-36.

CONCLUSIONS

Because of our preliminary results, prehabilitation program should be included among the management strategies of in elderly patients with chronic heart failure to better manage their disease and to improve their Quality of Life.

Bacteria-assisted removal of fluoroquinolones from wheat rhizospheres in an agricultural soil

Extensive fluoroquinolone antibiotics use results in their widespread occurrence in various environments including soil, which threatens the soil ecology and public health. The fate of fluoroquinolones in agricultural soil and the efficacy of enhanced degradation in the presence of an agricultural crops and antibiotic degrading bacteria could be better understood. The current study examined ciprofloxacin (CIP), enrofloxacin (ENR), and levofloxacin (LEV) biodegradation in a Maury Silt Loam soil in greenhouse conditions by bacterial-assisted removal of individual and mixed antibiotics in wheat rhizospheres. Fluoroquinolones were added at rates of 5, 50, and 100 mg kg^-1. Three bacterial isolates were applied at 10⁶ CFU g^-1 soil individually and in consortium. Antibiotics appeared in wheat tissue, with more accumulation in roots than shoots. Low recoveries (<50%) of CIP, ENR, and LEV were observed at all levels and treatments in a bacteria and wheat-free control compared to the initial concentrations applied Contaminated soil with wheat had greater antibiotic recovery than the wheat-free control. Antibiotic recovery with bacterial inoculum was less than that of the indigenous bacteria. The least antibiotic recovery occurred with wheat and bacterial inoculum together. At concentrations of 5 and 50 mg kg^-1, but not at 100 mg kg^-1, CIP, ENR, and LEV were below detection limits in soil after 30 days through the combination of wheat and bacteria compared to the control. This synergistic removal of the fluoroquinolone antibiotics is proposed to be due to enhanced antibiotic bioavailability, which suggests it as an environment-friendly approach to biodegradation.

Current Espghan Guidelines for Celiac Disease in Pediatric Age, Tertiary Care Center Experience: A Proposal for Further Simplification

According to the 2012 ESPGHAN criteria for diagnosis of celiac disease (CD), duodenal biopsy (DB) can be avoided in children with a clear malabsorption syndrome, anti-tissue transglutaminase IgA (tTG2) ≥ 10x the cut-off, anti-endomysium IgA (EMA) and HLA DQ2/DQ8 genes. The aim of this study is to report our experience and evaluate the accuracy of the actual guidelines.

PATIENTS AND METHODS

This is a retrospective study conducted on all patients diagnosed CD from 2012 to 2018 in our Center. For all patients enrolled were analyzed: data of family history, symptoms, serology, genetics, Marsh grade and follow-up.

RESULTS

A total of 481 children [mean age 6,4 yrs; F:M= 1.8:1] were included in the study. The mean age of patients who were not subject to DB was lower (4.51 yrs) comparing with patients that received DB (6.48 yrs). Out of the 256 patients with anti-tTG2 ≥ 10 fold, 121 underwent DB because of mild symptoms (84/121) or no symptoms (37/121). In all cases Marsh type 3 was found and HLA haplotypes was compatible with CD diagnosis.

CONCLUSIONS

Our study confirms that the serology has a primary importance to diagnose CD, regardless of the symptoms. These data suggest that biopsy and HLA haplotypes search, in presence of anti-tTG2 IgA ≥ 10x the cut-off, are wasteful and unhelpful for the patients.

Tetracycline desorption kinetics in municipal biosolids and poultry litter amendments determined by diffusive gradients in thin films (DGT)

Tetracycline (TET) is commonly used to treat bacterial diseases in humans and chickens (Gallus gallus domesticus), is largely excreted, and is often found at elevated concentrations in treated sewage sludge (biosolids) and poultry litter (excrement plus bedding materials). Land spreading of these materials is practiced worldwide to improve soil fertility, but the practice raises questions about whether TET could be released to the environment and cause adverse effects. Hazard risks largely depend on the concentration in the solid phase that can be released to the solution phase (labile TET), it's desorption rate constant, and diffusion rate of dissolved TET in amendments. In this study, these quantities were evaluated in biosolids and three types of litter amendments by combinations of equilibrium sorption-desorption isotherm and desorption kinetic studies using diffusive gradient in thin films (DGT) samplers. Results from isotherm experiments showed that TET partitioning was inhibited at the high dissolved organic carbon (DOC) concentrations in amendments (6-15% of dry mass). Despite low partition coefficients determined at high particle/DOC concentrations of amendments (K_d = 9-46 mL g^-1), results from DGT experiments revealed that TET release by desorption and diffusion would be slow and short-lived (<3 d) due to small effective diffusion coefficients (<8 × 10^-8 cm² s^-1) and low concentrations of labile TET in amendments (<5% of total TET). Despite this, evaluations of antibiotic uptake during microbial colonization and plant root interception of amendment surfaces are highly warranted.

TMS Over the Cerebellum Interferes with Short-term Memory of Visual Sequences

Growing evidence suggests that the cerebellum is not only involved in motor functions, but it significantly contributes to sensory and cognitive processing as well. In particular, it has been hypothesized that the cerebellum identifies recurrent serial events and recognizes their violations. Here we used transcranial magnetic stimulation (TMS) to shed light on the role of the cerebellum in short-term memory of visual sequences. In two experiments, we found that TMS over the right cerebellar hemisphere impaired participants' ability to recognize the correct order of appearance of geometrical stimuli varying in shape and/or size. In turn, cerebellar TMS did not affect recognition of highly familiar short sequences of letters or numbers. Overall, our data suggest that the cerebellum is involved in memorizing the order in which (concatenated) stimuli appear, this process being important for sequence learning.

Sorption-desorption equilibrium and diffusion of tetracycline in poultry litter and municipal biosolids soil amendments

Tetracycline (TET) is commonly used to treat bacterial diseases in humans and chickens (Gallus gallus domesticus), is largely excreted, and is found at elevated concentrations in treated sewage sludge (biosolids) and poultry litter (excrement plus bedding materials). Routine application of these nutrient-and carbon-enriched materials to soils improves fertility and other characteristics, but the presence of antibiotics (and other pharmaceuticals) in amendments raises questions about potential adverse effects on biota and development of antibiotic resistance in the environment. Hazard risks are largely dictated by sorption-desorption and diffusion behavior in amendments, so these processes were evaluated from sorption-desorption equilibrium isotherm and diffusion cell experiments with four types amendments (biosolids, poultry manure, wood chip litter, and rice hull litter) at three temperatures (8 °C, 20 °C and 32 °C). Linear sorption-desorption equilibrium distribution constants (Kd) in native amendments ranged between 124-2418 L kg^-1. TET sorption was significantly increased after treatment with alum, and there was a strong exponential relationship between Kd and the concentration of bound Al³⁺ in amendments (R² = 0.94), which indicated that amendments contained functional groups capable of chelating Al³⁺ and forming metal bridges with TET. Effective diffusion coefficients of TET in amendments ranged between 0.1 and 5.2 × 10^-6 cm² s^-1, which were positively related to temperature and inversely related to Kd by a multiple regression model (R² = 0.86). Treatment of organic amendments with alum greatly increased Kd, would decrease D_s, and so would greatly reduce hazard risks of applying these organic amendments with this antibiotic to soils.

A role for NMDAR-dependent cerebellar plasticity in adaptive control of saccades in humans

BACKGROUND

Saccade pulse amplitude adaptation is mediated by the dorsal cerebellar vermis and fastigial nucleus. Long-term depression at the parallel fibre-Purkinjie cell synapses has been suggested to provide a cellular mechanism for the corresponding learning process. The mechanisms and sites of this plasticity, however, are still debated.

OBJECTIVE

To test the role of cerebellar plasticity phenomena on adaptive saccade control.

METHODS

We evaluated the effect of continuous theta burst stimulation (cTBS) over the posterior vermis on saccade amplitude adaptation and spontaneous recovery of the initial response. To further identify the substrate of synaptic plasticity responsible for the observed adaptation impairment, subjects were pre-treated with memantine, an N-methyl-d-aspartate receptor (NMDAR) antagonist.

RESULTS

Amplitude adaptation was altered by cTBS, suggesting that cTBS interferes with cerebellar plasticity involved in saccade adaptation. Amplitude adaptation and spontaneous recovery were not affected by cTBS when recordings were preceded by memantine administration.

CONCLUSION

The effects of cTBS are NMDAR-dependent and are likely to involve long-term potentiation or long-term depression at specific synaptic connections of the granular and molecular layer, which could effectively take part in cerebellar motor learning.

Reconstructing contralateral fiber tracts: methodological aspects of cerebello-thalamocortical pathway reconstruction

The identification of pathways connecting the cerebral cortex with subcortical structures is critical to understanding how large-scale brain networks operate. The cerebellum, for example, is known to project numerous axonal bundles to thecerebral cortex passing through the thalamus. This paper focuses on the technical details of cerebello-thalamo-cortical pathway reconstruction using advanced diffusion MRI techniques in humans in vivo. Pathways reconstructed using seed/target placement on super-resolution maps, created with track density imaging (TDI), were compared with those reconstructed by defining regions of interest (ROIs) on non-diffusion weighted images (b0). We observed that the reconstruction of the pathways was more anatomically accurate when using ROIs placed on TDI rather than on b0 maps, while inter-subject variability and reproducibility were similar between the two methods. Diffusion indices along pathways showed a position-dependent specificity that will need to be taken into consideration in future clinical investigations.

Desorption kinetics of ciprofloxacin in municipal biosolids determined by diffusion gradient in thin films

Ciprofloxacin (CIP) is a commonly-prescribed antibiotic that is largely excreted by the body, and is often found at elevated concentrations in treated sewage sludge (biosolids) at municipal wastewater treatment plants. When biosolids are applied to soils, they could release CIP to surface runoff, which could adversely affect growth of aquatic organisms that inhabit receiving water bodies. The hazard risk largely depends on the amount of antibiotic in the solid phase that can be released to solution (labile CIP), its diffusion coefficient, and sorption/desorption exchange rates in biosolids particles. In this study, these processes were evaluated in a Class A Exceptional Quality Biosolids using a diffusion gradient in thin films (DGT) sampler that continuously removed CIP from solution, which induced desorption and diffusion in biosolids. Mass accumulation of antibiotic in the sampler over time was fit by a diffusion transport and exchange model available in the software tool 2D-DIFS to derive the distribution coefficient of labile CIP (K_dl) and sorption/desorption rate constants in the biosolids. The K_dl was 13 mL g^-1, which equated to 16% of total CIP in the labile pool. Although the proportion of labile CIP was considerable, release rates to solution were constrained by slow desorption kinetics (desorption rate constant = 4 × 10^-6 s^-1) and diffusion rate (effective diffusion coefficient = 6 × 10^-9 cm² s^-1. Studies are needed to investigate how changes in temperature, water content, pH and other physical and chemical characteristics can influence antibiotic release kinetics and availability and mobility in biosolid-amended soils.

A machine learning tool for re-planning and adaptive RT: A multicenter cohort investigation

PURPOSE

To predict patients who would benefit from adaptive radiotherapy (ART) and re-planning intervention based on machine learning from anatomical and dosimetric variations in a retrospective dataset.

MATERIALS AND METHODS

90 patients (pts) treated for head-neck cancer (H&N) formed a multicenter data-set. 41 H&N pts (45.6%) were considered for learning; 49 pts (54.4%) were used to test the tool. A homemade machine-learning classifier was developed to analyze volume and dose variations of parotid glands (PG). Using deformable image registration (DIR) and GPU, patients' conditions were analyzed automatically. Support Vector Machines (SVM) was used for time-series evaluation. "Inadequate" class identified patients that might benefit from replanning. Double-blind evaluation by two radiation oncologists (ROs) was carried out to validate day/week selected for re-planning by the classifier.

RESULTS

The cohort was affected by PG mean reduction of 23.7±8.8%. During the first 3weeks, 86.7% cases show PG deformation aligned with predefined tolerance, thus not requiring re-planning. From 4th week, an increased number of pts would potentially benefit from re-planning: a mean of 58% of cases, with an inter-center variability of 8.3%, showed "inadequate" conditions. 11% of cases showed "bias" due to DIR and script failure; 6% showed "warning" output due to potential positioning issues. Comparing re-planning suggested by tool with recommended by ROs, the 4th week seems the most favorable time in 70% cases.

CONCLUSIONS

SVM and decision-making tool was applied to overcome ART challenges. Pts would benefit from ART and ideal time for re-planning intervention was identified in this retrospective analysis.

Circulating cell-free DNA: a promising marker of regional lymphonode metastasis in breast cancer patients

PURPOSE

We undertook the current study with untreated breast cancer to (1) role the variations in the plasma levels of cfDNA and the size distribution in early stage, (2) determine the frequency in plasma of methylation of three candidate genes, RASSF1A, MAL, and SFRP1, and (3) to determine whether detection of cfDNA variations and methylation changes in plasma might have specific clinical utility.

METHODS AND MATERIALS

Thirty-nine patients woman patients (median age 64 years; range, 36-90 years) who underwent surgery for primary BR and 49 healthy females' subjects (control group without any breast lesion) were evaluated. The cfDNA levels were analyzed using quantitative real-time polymerase chain reaction of β-globin. Based on the ALU repeats, the cfDNA was considered as either total (fragments of 115 bp, ALU115) or tumoral (fragments of 247 bp, ALU247). The association between the levels of the ALU247, ALU115 repeat, and ALU 247/115and the pathologic tumor characteristics was analyzed. Used methylight qPCR method, cfDNA from plasma samples of healthy donors and patients with breast cancer were evaluated for the diagnotic value of the methylation status of three genes (RASSF1A, MAL, SFRP1) frequently methylated in breast cancer.

RESULTS

The baseline levels of cfDNA were significantly higher in the patients with cancer, and the level of ALU247 was the most accurate circulating cfDNA marker in discriminating the cancer from non-cancer subjects. A high statistical significance was found by considering the T stage and patients with regional LN metastasis positive cancers showed significantly higher cfDNA level of ALU247. Moreover, patients with methylation of at least one of the gene under investigate showed a higher quantity of cfDNA ALU115 (p< 0.0001) and ALU247 level (p< 0.0001).

CONCLUSIONS

We observed that necrosis could be a potential source of circulating tumour-specific cfDNA ALU247; and that cfDNA ALU247 and methylated cfDNA (RASSF1A, MAL and SFRP1) are both a phenotypic feature of tumour biology.

Characteristics of spontaneous physical activity and executive functions in postmenopause

AIM

Executive functions are susceptible to age-related changes, and menopause has also been shown to be linked with their decline. The aim of the present study was to investigate the variables related to executive functions in postmenopausal women not involved in controlled dietary and physical exercise programs and without hormone-replacement therapy.

METHODS

Fifty-seven women (58.39 ±4.16 yr) were investigated for their medical history, blood lipids, insulin resistance (HOMA-IR), body composition, blood pressure, executive functions (Digit Span and Trail Making tests), maximal aerobic capacity, dietary habits, and spontaneous physical activity.

RESULTS

Cluster analysis performed on the basal data of the Digit Span scores and Trail Making tests identified two subgroups: Group A (N.=24) that showed better executive functions than Group B (N.=33). Although these subgroups differed across several variables of body composition, plasma lipids, dietary habits, spontaneous physical activity, aerobic fitness, and insulin resistance, logistic regression models showed B10m/die as the only predictive variable for subgroup membership.

CONCLUSION

In the absence of a physical exercise program, the knowledge of how spontaneous physical activity is organized (B10m/die) is important for executive functions of post-menopausal women. It is the specific moderate to intense physical activity characteristic of B10m/die, rather than generic physical activity, that seems to determine the maintenance or attainment of cognitive health through body movement.

Lifestyle and high density lipoprotein cholesterol in postmenopause

OBJECTIVES

Menopause is characterized by hormonal and metabolic changes. These are linked to increased risk of cardiovascular disease, for which low blood plasma levels of high density lipoprotein (HDL) cholesterol are an independent risk factor. The present study investigated variables linked with basal plasma HDL cholesterol levels and the effects of aerobic training, on their variations, in 40 postmenopausal women.

METHODS

We assessed body composition, dietary habits and maximal aerobic capacity of participants. Characteristics of daily physical activity and plasma lipoproteins were measured. The women walked on 4 days/week, for 14 weeks, at moderate intensity, and they were grouped according to the resulting tertiles of basal plasma HDL cholesterol levels.

RESULTS

Logistic regression analysis showed that waist-to-hip ratio and number of daily bouts of moderate-intensity physical activity, held for at least 10 consecutive minutes (B10m/day), are predictive variables of basal plasma HDL cholesterol levels. After the training period, the first and second tertiles increased plasma HDL cholesterol levels, while the third tertile decreased plasma HDL cholesterol levels. The tertiles showed different remodelling of spontaneous physical activity: the third tertile reduced B10m/day, while the others did not.

CONCLUSIONS

This study provides knowledge about the relationships of plasma HDL cholesterol levels with characteristics of physical activity. Furthermore, it shows that physical exercise engagement can result in negative compensation of spontaneous physical activity that could counteract or reduce the positive effects of the aerobic training on plasma HDL cholesterol levels.

Multivariate analysis approach to the serum peptide profile of morbidly obese patients

BACKGROUND

Obesity is currently epidemic in many countries worldwide and is strongly related to diabetes and cardiovascular disease. Mass spectrometry, in particular matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) is currently used for detecting different pattern of expressed protein. This study investigated the differences in low molecular weight (LMW) peptide profiles between obese and normal-weight subjects in combination with multivariate statistical analysis.

MATERIALS

Serum samples of 60 obese patients and 10 healthy subjects were treated by cut-off membrane (30000 Da) to remove the most abundant proteins. The filtrates containing the LMW protein/peptides were analyzed by MALDI-TOF mass spectrometry. Dataset was elaborated to align and normalize the spectra. We performed cluster analysis and principal component analysis to detect some ionic species that could characterize and classify the subject groups.

RESULTS

We observed a down-expression of ionic species at m/z 655.94 and an over-expression of species at m/z 1518.78, 1536.77, 1537.78 and 1537.81 in obese patients. Furthermore we found some ionic species that can distinguish obese patients with diabetes from those with normal glucose level.

CONCLUSION

Serum peptide profile of LMW associate with multivariate statistical approach was revealed as a promising tool to discriminate and characterize obese patients and it was able to stratify them in relation to comorbidity that usually are associated with this disease. Further research involving a larger sample will be required to validate these findings.

Late-onset bursts evoked by mossy fibre bundle stimulation in unipolar brush cells: evidence for the involvement of H- and TRP-currents

Synaptic transmission at central synapses has usually short latency and graded amplitude, thereby regulating threshold crossing and the probability of action potential generation. In the granular layer of the vestibulo-cerebellum, unipolar brush cells (UBCs) receive a giant synapse generating a stereotyped excitatory postsynaptic potential (EPSP)-burst complex with early-onset (∼2 ms) and high reliability. By using patch-clamp recordings in cerebellar slices of the rat vestibulo-cerebellum, we found that mossy fibre bundle stimulation also evoked (in ∼80% of cases) a late-onset burst (after tens to hundreds of milliseconds) independent of EPSP generation. Different from the early-onset, the late-onset burst delay decreased and its duration increased by raising stimulation intensity or the number of impulses. Although depending on synaptic activity, the late-onset response was insensitive to perfusion of APV ((2R)-5-amino-phosphonopentanoate), NBQX (2,3-dioxo-6-nitro-tetrahydrobenzo(f)quinoxaline-7-sulfonamide) and MCPG ((RS)-α-methyl-4-carboxyphenylglycine) and did not therefore depend on conventional glutamatergic transmission mechanisms. The late-onset response was initiated by a slow depolarizing ramp driven by activation of an H-current (sensitive to ZD7288 and Cs(+)) and of a TRP- (transient receptor potential) current (sensitive to SKF96365), while the high voltage-activated and high voltage-activated Ca(2+) currents (sensitive to nimodipine and mibefradil, respectively) played a negligible role. The late-onset burst was occluded by intracellular cAMP. These results indicate that afferent activity can regulate H- and TRP-current gating in UBCs generating synaptically driven EPSP-independent responses, in which the delay rather than amplitude is graded with the intensity of the input pattern. This modality of synaptic transmission may play an important role in regulating UBC activation and granular layer functions in the vestibulo-cerebellum.

NAD(P)H oxidase p22(phox) polymorphism and cardiovascular function in amateur runners

AIM

NAD(P)H system represents the major source of superoxide production at cardiovascular (CV) level. It has several genetic variants: in particular, the C242T polymorphism of its p22(phox) subunit is associated with a different oxidase activity, being the T allele related to a lower superoxide production. Although several authors investigated the protective effect of T allele in CV diseases, only few data are available on its functional role in physiological conditions. The aim of our study was to investigate the relationship between the p22(phox) C242T polymorphism and CV function in amateur runners.

METHODS

Seventy-three male amateur runners were screened for CYBA polymorphism. CV analysis was performed by echocardiographic-Doppler examination and by PulsePen tonometer assessment.

RESULTS

The genetic subgroups (CC and CT/TT) did not differ for VM O(2max) and cardiac dimension. Nevertheless, T carriers (n = 40) were characterized by a more efficient myocardial contraction and left ventricular (LV) filling, as evidenced by significant higher values of the midwall fractional shortening, systolic excursion of the tricuspid annular plane and of early/late diastolic wave velocities ratio and by a lower E wave deceleration time. Pulse wave velocity and augmentation index, parameters related to the arterial stiffness, were higher in CC subjects compared with CT/TT also when the analysis was adjusted for weight and diastolic pressure.

CONCLUSION

In amateur runners, CYBA variants may influence both systolic and diastolic function and arterial stiffness. We suppose that the lower oxidative activity that characterizes 242T subjects may positively influence the excitation-contraction and arterial-ventricular coupling mechanisms, thus leading to a more efficient CV function.

Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization

BACKGROUND

Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective bladder catheterization.

METHODS

Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective bladder catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student's t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson's χ2 test. Results were considered significant when the P value <0.05.

RESULTS

Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%).

CONCLUSION

Bladder scanners timely detect POUR following lower joint arthroplasty, making elective bladder catheterization unnecessary.

The cerebellar network: from structure to function and dynamics

Since the discoveries of Camillo Golgi and Ramón y Cajal, the precise cellular organization of the cerebellum has inspired major computational theories, which have then influenced the scientific thought not only on the cerebellar function but also on the brain as a whole. However, six major issues revealing a discrepancy between morphologically inspired hypothesis and function have emerged. (1) The cerebellar granular layer does not simply operate a simple combinatorial decorrelation of the inputs but performs more complex non-linear spatio-temporal transformations and is endowed with synaptic plasticity. (2) Transmission along the ascending axon and parallel fibers does not lead to beam formation but rather to vertical columns of activation. (3) The olivo-cerebellar loop could perform complex timing operations rather than error detection and teaching. (4) Purkinje cell firing dynamics are much more complex than for a linear integrator and include pacemaking, burst-pause discharges, and bistable states in response to mossy and climbing fiber synaptic inputs. (5) Long-term synaptic plasticity is far more complex than traditional parallel fiber LTD and involves also other cerebellar synapses. (6) Oscillation and resonance could set up coherent cycles of activity designing a functional geometry that goes far beyond pre-wired anatomical circuits. These observations clearly show that structure is not sufficient to explain function and that a precise knowledge on dynamics is critical to understand how the cerebellar circuit operates.

[Determinants of short-term memory: is there a difference between young adults and postmenopausal women?]

AIM

The literature indicates that several variables are influencing cognitive health. The aim of the study was to investigate the main determinants of the short-term memory among anthropometric, dietary and performance variables in a sample of healthy women. The role played by the age was also investigated.

METHODS

Forty-five healthy overweight women were recruited through general physicians: 23 were young adults (24.63±4.17 years) and 22 were postmenopausal (53.30±2.95 years). Overweight condition was assessed according to the age-adjusted reference values. Participants were analyzed for Digit Span, blood pressure, body composition, aerobic fitness and dietary habits.

RESULTS

Young adults and postmenopausal women did not differ either in Digit Span or in dietary habits. In postmenopausal women Digit Span was positively correlated with body weight, body mass index, body fat, waist circumference and daily intake of vitamin D. Linear regression model indicated vitamin D as the only significant predictor variable of Digit Span. In young adults Digit Span had no correlations with the others investigated variables.

CONCLUSION

In postmenopause, vitamin D daily intake is important not only for skeletal, but also for cognitive health. Even though young adults and post-menopausal women did not differ for health status, short-term memory in young adulthood seems to be differently linked with the investigated variables than during post-menopause.

Relationships between physical exercise practice, dietary behaviour and body composition in female university students

AIM

The relationship between female body composition, total energy expenditure and physical exercise energy expenditure is not very strong because women can compensate by increasing their energy intake. The aim of this study was to investigate the relationship between total minutes of exercise per week, dietary habits and body composition in female university students using physical activity and the habit to cook as covariates.

METHODS

Fifty-one female university students were investigated for body composition, dietary habits, aerobic fitness, physical activity and physical exercise practice. Participants were grouped in three sub-samples (1, 2 and 3) according to the 33rd and 66th percentiles of weekly minutes (min/wk) of training.

RESULTS

Group 1 had 0.00 min/wk, group 2 had 95±35.59 min/wk and group 3 had 231.66±85.97 min/wk of training. Sub-samples did not differ for IPAQ parameters while differed for aerobic fitness (P=0.001). Group 3 had a higher energy intake (EI) (P=0.008), a higher intake of lipids (P=0.017), saturated (P=0.042) and monounsaturated fat (P=0.024) and a lower intake of carbohydrates (P=0.007). Group 3 maintained the higher EI and the worse composition of lipid intake considering the habit to cook as covariate. Group 3 also had higher muscle mass.

CONCLUSION

In order to positively affect body composition, in the sedentary women it is enough to control the energy balance, whereas in those that trained regularly it is necessary to control both energy balance and composition of daily meals.

Transcranial magnetic stimulation over the cerebellum and eye movements: state of the art

Transcranial magnetic stimulation (TMS) transiently induces an electrical field in the tissues beneath the area of application, thereby perturbing local cortical activity if applied over the scalp. It can therefore be used to modulate cerebellar function in healthy humans. Even though the role of the cerebellum in eye movement control and adaptation is well known, few experiments have used eye movements to evaluate the effect of TMS over the cerebellum. Single-pulse TMS over the posterior vermis resulted in impaired accuracy of reflexive saccades, acceleration of smooth pursuit, and coordination of saccades and head movements. TMS over the cerebellar hemisphere decreased pursuit gain. Repetitive TMS (rTMS) over the posterior vermis impaired saccade adaptation in a double-step paradigm. Comparing the effects of TMS on different behavioural paradigms could be useful to test cerebellar control of reflexive and voluntary eye movements, and as a probe of cerebellar plasticity. rTMS appears to be especially interesting since its effects outlast the stimulation period and its behavioural consequences can therefore be measured without interfering with the execution of eye movements or with the experimental procedures.

Autism and genius: is there a link? The involvement of central brain loops and hypotheses for functional testing

Mental processing is the product of the huge number of synaptic interactions that occur in the brain. It is easier to understand how brain functions can deteriorate than how they might be boosted. Lying at the border between the humanities, cognitive science and neurophysiology, some mental diseases offer new angles on this problematic issue. Despite their social deficits, autistic subjects can display unexpected and extraordinary skills in numerous fields, including music, the arts, calculation and memory. The advanced skills found in a subgroup of people with autism may be explained by their special mental functioning, in particular by their weak central coherence, one of the pivotal characteristics of the disorder. As a result of the increasing interest in autistic talent, there has recently emerged a tendency to screen any eccentric artist or scientist for traits of the autistic spectrum. Following this trend, we analyze the eccentricity of the popular pianist Glenn Gould and briefly discuss the major functional hypotheses on autistic hyperfunctioning, advancing proposals for functional testing. In particular, the potential involvement of rhythm-entrained systems and cerebro-cerebellar loops opens up new perspectives for the investigation of autistic disorders and brain hyperfunctioning.

Cognitive memory control in borderline personality disorder patients

BACKGROUND

It has been demonstrated that the mechanism of cognitive memory control in humans is sustained by the hippocampus and prefrontal cortices, which have been found to be structurally and functionally abnormal in borderline personality disorder (BPD). We investigated whether the memory control mechanism is affected in BPD.

METHOD

Nineteen Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV BPD patients and 19 matched healthy controls (HC) performed a specific think/no-think paradigm exploring the capacity of remembering and suppressing pair of words previously learned. After the think-no think phase, the second member of each word pair has to be remembered either when subjects are presented with the cue word showed at the beginning of the test (Same Probe Test; SPT) or when they are presented with an extra-list categorical word (Independent Probe Test; IPT). We evaluated the effect of suppression and of retrieval activity on later retention of words.

RESULTS

Both on the SPT and on the IPT, HC showed the expected improvement of memory retrieval on to-be-remembered words, unlike BPD patients. On the SPT, HC, but not BPD patients, correctly recalled significantly more words among remembered words (RW) than among suppressed words (SW). Similarly to HC, subjects with BPD without a history of childhood abuse showed a significantly higher percentage of correctly recalled words among RW than among SW.

CONCLUSIONS

The mechanism of active retrieval of memories and of improvement through repetition is impaired in BPD, particularly in those who experienced traumatic experiences. This impairment might play an important role, possibly resulting in the emergence of unwanted memories and dissociative symptoms.

Timing in the cerebellum: oscillations and resonance in the granular layer

The brain generates many rhythmic activities, and the olivo-cerebellar system is not an exception. In recent years, the cerebellum has revealed activities ranging from low frequency to very high-frequency oscillations. These rhythms depend on the brain functional state and are typical of certain circuit sections or specific neurons. Interestingly, the granular layer, which gates sensorimotor and cognitive signals to the cerebellar cortex, can also sustain low frequency (7-25 Hz) and perhaps higher-frequency oscillations. In this review we have considered (i) how these oscillations are generated in the granular layer network depending on intrinsic electroresponsiveness and circuit connections, (ii) how these oscillations are correlated with those in other cerebellar circuit sections, and (iii) how the oscillating cerebellum communicates with extracerebellar structures. It is suggested that the granular layer can generate oscillations that integrate well with those generated in the inferior olive, in deep-cerebellar nuclei and in Purkinje cells. These rhythms, in turn, might play a role in cognition and memory consolidation by interacting with the mechanisms of long-term synaptic plasticity.

Development of a disease-specific quality of life questionnaire for children & adolescents with idiopathic thrombocytopenic purpura (ITP-QoL)

Quality of life (QoL) assessment in children with coagulation disorders is a relatively unstudied area. While hemophilia-specific questionnaires (such as Haemo-QoL) are available, no instrument for children with idiopathic thrombocytopenic purpura (ITP) has been validated yet. A disease-specific questionnaire for children with ITP was therefore developed (ITP-QoL) in three phases: (a) a preparatory phase; (b) a developmental phase; (c) a pilot testing phase. Since dimensions of Haemo-QoL were considered important for children with ITP, items were adapted, reformulated and additional dimensions were included. Two age-group versions were designed for children (aged 3-7, 8-18 years) and parents in Italian, German, and Swedish languages and were pilot tested.

Synaptic plasticity at the cerebellum input stage: mechanisms and functional implications

The mf-GrC relay provides the case of a synapse at which elementary neurotransmission mechanisms are particularly well understood allowing a precise investigation of synaptic plasticity. An interesting consequence is that a presynaptic mechanism of LTP could be precisely documented on the basis of quantal analysis. By being presynaptically expressed, LTP becomes instrumental to regulation of short-term synaptic dynamics thereby controlling time-dependent transformations of the incoming mossy fiber input. It is unknown to what extent these considerations could be generalized, but early observations were provided for comparable concepts and mechanisms in neocortical synapses (Tsodyks and Markram, 1997). Although several aspects remain to be investigated, mf-GrC LTP provides a wide substrate for information storage in the cerebellum. In the rat cerebellum, there are 10(11) GrCs and 4 times as many mf-GrC synapses. Mathematical models have suggested that mf-GrC LTP improves mutual information transfer, and that the combination of synaptic and non-synaptic changes improves sparse representation of the mf input (Schweighofer et al., 2000; Philipona et al., 2003). Moreover, mf-GrC LTP could play a key role in regulating neurotransmission dynamics, implementing adaptability in delay lines early envisioned by Breitenberg (1967) and then revisited by Medina and Mauk (2002). These observations challenge the simple view of spatial pattern separation proposed by Marr (1969). The potential consequences of mf-GrC LTP need to be further investigated and confronted with computational models of the cerebellar network.

Role of calcium binding proteins in the control of cerebellar granule cell neuronal excitability: experimental and modeling studies

Calcium binding proteins, such as calretinin, are abundantly expressed in distinctive patterns in the central nervous system but their physiological function remains poorly understood. Calretinin is expressed in cerebellar granule cells which provide the major excitatory input to Purkinje cells through parallel fibers. Calretinin deficient mice exhibit dramatic alterations in motor coordination and in Purkinje cell firing recorded in vivo through unknown mechanisms. In the present paper, we review the results obtained with the patch clamp recording techniques in acute slice preparation. This data allow us to investigate the effect of a null mutation of the calretinin gene on the intrinsic electroresponsiveness of cerebellar granule cells at a mature developmental stage. Calretinin deficient granule cells exhibit faster action potentials and generate repetitive spike discharge showing an enhanced frequency increase with injected currents. These alterations disappear when 0.15 mM of the exogenous fast calcium buffer BAPTA is infused in the cytosol to restore the calcium buffering capacity. Furthermore, we propose a mathematical model demonstrating that the observed alterations of granule cell excitability can be explained by a decreased cytosolic calcium buffering capacity due to the absence of calretinin. We suggest that calcium binding proteins modulate intrinsic neuronal excitability and may therefore play a role in the information processing in the central nervous system.

Rapid, sensitive, microscale determination of phosphate in water and soil

A rapid and sensitive analysis of inorganic and organic phosphorus (P) is needed to analyze water and soil extracts at submicromolar concentrations. The proposed method, based on the complexation of malachite green with phosphomolybdate under acidic conditions, was adapted to a 96-well microtiter plate format, and was tested for matrix interferences using 15 soils and some common extractants, including water, KCI, CaCl2, NaOH, and HCl. The accuracy of P determination was affected when CaCl2 and HCl concentrations were greater than 0.1 M and when NaOH concentration exceeded 0.4 M. Potassium chloride concentration up to 1 M did not interfere with P determination. The molar absorptivity was 46 841 M(-1) cm(-1) and the reagent blank absorbance was 0.071+/-0.003 (n = 10). At the 99% confidence limit, the method detection limit was calculated to be 0.006 mg P L(-1). Recovery of added inorganic P in different types of soils and extracts ranged between 95 and 112% with an average of 102%. The proposed microplate method allows P to be determined rapidly in a wide range of soil types and extracts and requires limited volume (20-200 microL). The procedure uses limited quantities (40 microL) of two stable reagents (>1 yr), and generates low amounts of hazardous waste.

Factors influencing the shape of the inspiratory flow

An index (IS), quantitating the departure of the inspiratory flow profile (IFP) from the rectangular one, i.e. the optimal profile (IS=0), was computed from pneumotachograms recorded in 26 normal, anesthetized subjects breathing spontaneously through the endotracheal tube (ETT) or face mask (FM) with or without added resistances (R) and in 27 awake subjects breathing through the mouth and FM in the supine and seated posture at rest and during exercise (40 W) on a cycloergometer, through the nose and FM, and through the mouthpiece (MP). During anesthesia, IS decreased with R both while breathing through the ETT (DeltaIS=-0.037+/-0.006 (SE); P<0.001) and FM (DeltaIS=-0.054+/-0.008; P<0.001). This indicates that (a) the change of IFP towards the optimal shape is reflex in nature and related to the dynamic inspiratory load, and (b) tracheobronchial mechanoreceptors and inspiratory muscles are involved in this response. The reflex is also operative in awake subjects, since IS decreased whenever the inspiratory dynamic load was increased, as on turning from seated to supine posture (DeltaIS=-0.024+/-0.003; P<0.001), shifting from mouth to nose breathing (DeltaIS=-0.034+/-0.003; P<0.05), from rest to mild exercise (DeltaIS=-0.066+/-0.005; P<0.001). The different IS value between FM and MP breathing (DeltaIS=0.036+/-0.004; P<0.001) indicates, however, that other factors, likely behavioral, also affect the IFP.

Safety and Immunogenicity of a Conjugate Vaccine againstHaemophilus influenzaeType b in Splenectomized and Nonsplenectomized Patients with Cooley Anemia

Patients with thalassemia are at increased risk for infections, especially after undergoing splenectomy. Vaccinations and antimicrobial prophylaxis are recommended in these patients, but the optimal immunization schedule for Haemophilus influenzae type b (Hib) vaccine is unknown. The immunogenicity of a conjugate Hib vaccine was investigated in 57 patients with thalassemia, 32 of whom had undergone splenectomy. Anti-capsular antibodies to Hib (anti-polyribosylribitol phosphate) were measured before vaccination and 2, 6, 12, 24, and 36 months after vaccination. Immunization was well tolerated. All patients achieved protective (>1 microg/mL) antibody levels. Antibody titers declined after the initial postvaccination increase, becoming undetectable in 4 patients and decreasing to concentrations of 0.15-1 microg/mL in another 2 patients when tested 2-3 years after vaccination. Hib conjugate vaccine is safe and immunogenic in patients with thalassemia major; however, additional studies are needed to assess the need and timing of booster vaccination to maintain long-term immunity.

Beyond parallel fiber LTD: the diversity of synaptic and non-synaptic plasticity in the cerebellum

In recent years, it has become clear that motor learning, as revealed by associative eyelid conditioning and adaptation of the vestibulo-ocular reflex, contributes to the well-established cerebellar functions of sensorimotor integration and control. Long-term depression of the parallel fiber-Purkinje cell synapse (which is often called 'cerebellar LTD') is a cellular phenomenon that has been suggested to underlie these forms of learning. However, it is clear that parallel fiber LTD, by itself, cannot account for all the properties of cerebellar motor learning. Here we review recent electrophysiological experiments that have described a rich variety of use-dependent plasticity in cerebellum, including long-term potentiation (LTP) and LTD of excitatory and inhibitory synapses, and persistent modulation of intrinsic neuronal excitability. Finally, using associative eyelid conditioning as an example, we propose some ideas about how these cellular phenomena might function and interact to endow the cerebellar circuit with particular computational and mnemonic properties.