POS0487 THE CROSSTALK OF THE SKIN-ORAL-GUT MICROBIOME AXIS IN LIMITED AND DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS

Background

Systemic sclerosis (SSc) is a complex and still unclear rare disease. Microbiota has recently emerged as an important environmental factor in SSc pathogenesis, either at gut, oral and skin level.

Objectives

To investigate the role of microbiota in SSc subsets, focusing on the skin-oral-gut microbiota axis and serum and fecal free fatty acids (FFA) profile.

Methods

Twenty-six consecutive SSc patients (22 females) (mean disease duration (SD): 13 ± 6.91 yrs), classified according to the ACR/EULAR2013 criteria, were enrolled. Demographic, clinical and laboratory data were recorded. Gastrointestinal symptoms were investigated with UCLA GIT-2.0-questionnaire. Fecal, unstimulated saliva and superficial epidermal samples were collected. Microbiota was assessed through 16S ribosomal RNA Next Generation gene-sequencing analysis. Gas Cromatography-Mass Spettroscopy was used to measure FFAs in serum and fecal samples.

Results

Thirteen patients had limited cutaneous SSc (lcSSc), 13 diffuse cutaneous (dcSSc). The two subsets displayed a different cutaneous and fecal microbiota profile. In detail, the class of cutaneous Sphingobacteria was significantly higher in lcSSc (p<0.05), while the phylum of Lentisphaerae, the family of Victivallaceae and the genus of Victivallis were significantly higher in fecal samples of lcSSc (all p<0.05). A significant increase of fecal propionic acid was observed in lcSSc patients (p<0.05). Moreover, all fecal medium-chain FAs and hexanoic acids were significantly higher in lcSSc (p<0.05 and p<0.001, respectively). The analysis of serum FFAs levels showed an increase of valeric and octanoic acids in lcSSc (both p<0.05). A negative correlation between UCLA-GIT-2.0 total score and fecal octanoic acid (rho=-0.61; p=0.03), and a positive correlation with serum propionic acid (rho=0.55; p=0.05) was found in lcSSc.

Conclusion

Our findings show a different microbiota signature in the skin and gut, and a different FFAs profile in lcSSc and dcSSc. Such a differential regulation of microbiota composition and bacterial metabolite production suggests different dynamics of skin-oral-gut microbiota axis in SSc subsets. This data could be useful to develop personalized therapies targeting gastrointestinal and skin involvement.

Disclosure of Interests

None declared.

AB0132 STIMULATION OF SOLUBLE GUANYLATE CYCLASE (sGC) FOSTERS ANGIOGENESIS AND BLUNTS ENDOTHELIAL-TO-MESENCHYMAL TRANSITION (EndoMT) OF SYSTEMIC SCLEROSIS (SSc) DERMAL MICROVASCULAR ENDOTHELIAL CELLS

Background

In SSc, early abnormalities in microvessel morphology and angiogenic impairment in parallel advance with the development of tissue fibrosis orchestrated by myofibroblasts. Increasing evidence suggests that the EndoMT process, in which endothelial cells transdifferentiate into profibrotic myofibroblasts, may take centre stage in SSc pathogenesis [1,2]. sGC is an enzyme regulating cell growth/proliferation and vascular tone/remodelling by catalysing the production of cyclic guanosine monophosphate. Previous studies reported that sGC stimulation inhibits TGFβ-induced fibroblast-to-myofibroblast differentiation and collagen synthesis by blocking non-canonical ERK-dependent TGFβ signalling, and that sCG stimulators (sGCS) may exert antifibrotic effects in experimental models of fibrotic disorders.

Objectives

To investigate the possible modulatory effects of sGC stimulation on impaired angiogenesis and EndoMT of SSc dermal microvascular endothelial cells (SSc-MVECs).

Methods

To evaluate the effects of treatment with sGCS on endothelial cell viability/proliferation, 5 lines of SSc-MVECs and 5 lines of healthy dermal MVECs (H-MVECs) were challenged with sGCS (here MK-2947) and assayed with both annexin V/PI flow cytometry and WST-1. To analyse the modulation of angiogenesis by sGCS, SSc-MVECs were challenged with MK-2947 and subsequently tested for wound healing and capillary-like tube formation capabilities. To study the effects of MK-2947 on EndoMT, the same cells were assayed for the expression of endothelial and mesenchymal/myofibroblast markers by quantitative real-time PCR, western blotting and immunofluorescence, as well as for their contractile ability by collagen gel contraction assay. Phosphorylation of ERK1/2 was assessed by western blotting.

Results

Treatment with MK-2947 did not affect viability/proliferation of H-MVECs, while it significantly increased the proliferation of SSc-MVECs (p<0.001 vs. basal). Compared to basal condition, the MK-2947 challenge ameliorated both wound healing capability (p<0.001) and angiogenic performance (number of nodes: p<0.01; segments: p<0.001; meshes: p<0.01; and junctions: p<0.001) of SSc-MVECs. Upon stimulation of sGC, SSc-MVECs exhibited increased gene expression of proangiogenic matrix metalloproteinase (MMP)-9 (p<0.05) and decreased expression of both antiangiogenic MMP-12 (p<0.05) and pentraxin-3 (p<0.001) respect to basal SSc-MVECs. A significant increase in both gene and protein expression of the endothelial markers CD31 and VE-cadherin, and a parallel decrease in the expression of the mesenchymal/myofibroblast markers α-SMA, S100A4, and type I collagen were found in MK-2947-treated SSc-MVECs. MK-2947 also downregulated the EndoMT-driving transcription factor SNAIL1 in SSc-MVECs. Stimulation with MK-2947 was able to significantly counteract the intrinsic ability of myofibroblast-like SSc-MVECs to contract collagen gels (p<0.001) and effectively reduce phosphorylated-ERK1/2 protein levels (p<0.01) respect to basal cells.

Conclusion

Stimulation of sGC effectively ameliorates the angiogenic performance and blunts the pathogenic myofibroblast-like profibrotic phenotype of SSc-MVECs.

References

[1]Manetti M, et al. Endothelial-to-mesenchymal transition contributes to endothelial dysfunction and dermal fibrosis in systemic sclerosis. Ann Rheum Dis. 2017;76:924–34.

[2]Romano E, et al. New insights into profibrotic myofibroblast formation in systemic sclerosis: when the vascular wall becomes the enemy. Life (Basel). 2021;11:610.

Disclosure of Interests

Eloisa Romano: None declared, Irene Rosa: None declared, Bianca Saveria Fioretto: None declared, Dilia Giuggioli: None declared, Mirko Manetti Speakers bureau: has received consulting fees or honorarium from MSD, Marco Matucci-Cerinic Speakers bureau: has received consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: has received consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche

LABEC, the INFN ion beam laboratory of nuclear techniques for environment and cultural heritage

The LABEC laboratory, the INFN ion beam laboratory of nuclear techniques for environment and cultural heritage, located in the Scientific and Technological Campus of the University of Florence in Sesto Fiorentino, started its operational activities in 2004, after INFN decided in 2001 to provide our applied nuclear physics group with a large laboratory dedicated to applications of accelerator-related analytical techniques, based on a new 3 MV Tandetron accelerator. The new accelerator greatly improved the performance of existing Ion Beam Analysis (IBA) applications (for which we were using since the 1980s an old single-ended Van de Graaff accelerator) and in addition allowed to start a novel activity of Accelerator Mass Spectrometry (AMS), in particular for ¹⁴C dating. Switching between IBA and AMS operation became very easy and fast, which allowed us high flexibility in programming the activities, mainly focused on studies of cultural heritage and atmospheric aerosol composition, but including also applications to biology, geology, material science and forensics, ion implantation, tests of radiation damage to components, detector performance tests and low-energy nuclear physics. This paper describes the facilities presently available in the LABEC laboratory, their technical features and some success stories of recent applications.

SAT0282 ASSOCIATION BETWEEN A VARIANT OF THE SRP55 SPLICING FACTOR GENE AND SYSTEMIC SCLEROSIS IN AN ITALIAN POPULATION

Background:

In systemic sclerosis (SSc), alternative splicing of the last exon (exon 8) of vascular endothelial growth factor (VEGF)-A pre-mRNA is a key element in the switch from proangiogenic to antiangiogenic VEGF-A isoforms. The mRNA-binding protein serine/arginine protein 55 (SRp55, also known as SFRS6) is a key regulatory splicing factor that promotes distal splice-site selection in the exon 8 region of VEGF-A pre-mRNA and subsequent upregulation of the exon 8b-containing VEGF165b antiangiogenic isoform. Overexpression of both VEGF165b and SRp55 has been implicated in SSc-related angiogenesis impairment and peripheral vascular damage. Moreover, differential splicing of the VEGF-A gene has been shown to be critical for development of pulmonary fibrosis. Of note, previous studies reported the lack of sequence variations in the VEGF-A alternatively spliced region, while a single nucleotide polymorphism (SNP) in theSRp55gene (rs2235611) has been associated with susceptibility to disturbed ocular angiogenesis in proliferative diabetic retinopathy.

Objectives:

This case-control pilot study examined the possible implication ofSRp55rs2235611 SNP in the genetic predisposition to SSc susceptibility and clinical phenotype.

Methods:

A total population of 872 white Italian individuals (414 SSc patients, 458 controls) was studied. All patients were classified as limited and diffuse cutaneous SSc (lcSSc and dcSSc, respectively) and were clinically evaluated for the presence of autoantibodies (anticentromere, anti-Scl70 antibodies), pulmonary fibrosis and digital ulcers. TheSRp55rs2235611 SNP was genotyped by TaqMan Real-Time PCR.

Results:

SRp55rs2235611 genotype distribution and allele frequency were similar in SSc and healthy controls, though a trend toward significance was observed for genotype distribution (p=0.07). TheSRp55rs2235611 AA genotype significantly influenced the predisposition to SSc (OR 2.55, 95% CI 1.11 to 5.57, p = 0.03), and to both lcSSc (OR 2.80, 95% CI 1.16 to 6.84, p = 0.02) and dcSSc (OR 3.42, 95% CI 1.20 to 9.72, p = 0.02) subtypes. TheSRp55rs2235611 A minor allele and AA genotype showed a significant risk association with susceptibility to SSc-related pulmonary fibrosis (A allele: OR 1.39, 95% CI 1.00 to 1.93, p = 0.046; AA genotype: OR 3.95, 95% CI 1.48 to 10.54, p = 0.006). A trend toward an association between the AA genotype and anti-Scl70 antibody-positive SSc was also found (OR 2.82, 95% CI 0.95 to 8.37, p = 0.06). Both rs2235611 A allele and AA genotype were significantly associated with the SSc subset without digital ulcers (A allele: OR 1.33, 95% CI 1.01 to 1.75, p = 0.04; AA genotype: OR 3.26, 95% CI 1.32 to 8.03, p = 0.01).

Conclusion:

TheSRp55rs2235611 polymorphism is associated with susceptibility to SSc and, in particular, with SSc-related pulmonary fibrosis and peripheral vascular phenotype, consistent with a role of VEGF-A pre-mRNA alternative splicing in the development of pulmonary fibrosis and impairment of angiogenesis. Further replication studies are warranted to confirm our findings in independent SSc cohorts.

Disclosure of Interests:

Eloisa Romano: None declared, Mirko Manetti: None declared, Joanna Kosalka-Wegiel: None declared, Bianca Saveria Fioretto: None declared, Irene Rosa: None declared, Elena Sticchi: None declared, Serena Guiducci: None declared, Silvia Bellando-Randone: None declared, Lidia Ibba-Manneschi: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim

LAI versus oral: A case-control study on subjective experience of antipsychotic maintenance treatment

BACKGROUND

To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects.

METHODS

Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1).

RESULTS

Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period.

CONCLUSIONS

Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.

LAI versus oral antipsychotic maintenance treatment of schizophrenia: A case-control study on subjective experience of treatment

Introduction

Limited research has been devoted to the subjective impact of switching antipsychotic maintenance treatment (AMT) from oral to LAI formulation in schizophrenia.

Objective

To compare LAI AMT with oral AMT in terms of subjective experience of treatment, taking into account the effects on psychopathology.

Methods

Twenty outpatients (7 males, mean age 40.55 ± 11.00 years) with remitted schizophrenia treated with either olanzapine or paliperidone and switching from oral to LAI AMT were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matched for the main socio-demographic, clinical and treatment variables made up the controls (oral-AMT group). All participants were assessed by means of the PANSS and of the SWN-K at baseline (T0) and after 6 months (T1).

Results

Between T0 and T1, general psychopathology of the PANSS and all but one of the SWN-K dimensions (except for “social integration”), showed significantly higher percent improvements in the LAI-AMT group compared to the oral-AMT group. After 6 months (T1), the LAI-AMT group showed significantly lower PANSS total and general psychopathology scores, as well as higher mean score of perceived “mental functioning” compared to the oral-AMT group. Item analysis of the general PANSS at T1 showed significant differences between the two groups in anxiety, tension, depression, guilt feelings, poor attention, and active social avoidance.

Conclusions

Our data on switching from oral to LAI AMT in remitted schizophrenia suggest a better efficacy of the latter in terms of improvement of general psychopathology and subjective experience of treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Can practice of Dancesport as physical activity be associated with the concept of "successful aging"?

AIM

Regular and structured physical activity is known to be effective in preventing and/or reducing the physical and mental decline associated with aging. Indeed, such usefulness of physical activity has been associated with the concept of "successful aging". The aim of the present study was to evaluate the possible physical and cognitive effects deriving from the practice of Dancesport in comparison with the participation in adapted physical activity (APA) programs and sedentarity.

METHODS

A total of 150 healthy older adults were enrolled, consisting of three groups: 1) Dancesport (non-competitive Latin American and Standard dancers); 2) APA (subjects practicing a multicomponent training program adapted to elderly); 3) control (sedentary subjects). All participants were assessed with cognitive computerized tests and underwent motor tests (Tinetti Test [TT] and Sit and Reach [SR] Test), and filled out a questionnaire to evaluate leisure cognitive activities and Short Form-12 (SF-12) questionnaire to assess quality of life.

RESULTS

Subjects practicing Dancesport and APA performed significantly better in all proposed tests than sedentary subjects. In particular, dancers reported better scores in both cognitive and motor tests as well as in SF-12 compared to APA.

CONCLUSION

Given its peculiar characteristics, Dancesport represents a feasible, attractive and alternative physical activity to preserve cognitive and physical functions during aging. Increased self-esteem, social contact and psychophysical wellness significantly ameliorate the quality of life during aging.

Severe fibrotic changes and altered expression of angiogenic factors in maternal scleroderma: placental findings

OBJECTIVE

Pregnant women with systemic sclerosis (SSc; scleroderma) have an increased risk of premature delivery and small full-term infants. During placental development, angiogenesis and vascular remodelling are essential for a successful pregnancy outcome. An analysis was made of the pathological changes and expression of angiogenic factors in SSc placentas.

METHODS

Placenta biopsies were obtained from three patients with SSc and four healthy uncomplicated pregnancies after delivery at 34-38 weeks of gestation. The sections were stained with Masson's trichrome and phosphotungstic-acid-haematoxylin and immunostained for connective tissue growth factor (CTGF), alpha-smooth muscle actin (alpha-SMA), vascular endothelial growth factor (VEGF), placenta growth factor (PlGF) and receptors VEGFR-1 and VEGFR-2.

RESULTS

The pathological findings were signs of decidual vasculopathy, increased syncytiotrophoblast knotting, placental infarcts and villous hypoplasia. Severe and diffuse perivascular and stromal fibrosis of decidua and chorionic villi, and extensive deposition of fibrinoid material around decidual vessels and in intervillous spaces were observed. Strong CTGF expression in the vessel wall, decidual cells and fibroblasts and alpha-SMA+ myofibroblasts were found. VEGF and VEGFR-2 expression was stronger in SSc than in healthy placentas, while VEGFR-1 expression was similar to controls. PlGF immunopositivity was weaker in SSc.

CONCLUSION

In SSc placentas, severe fibrosis and abnormal vascular remodelling were detected. This may result in reduced blood flow leading to deep sufferance of maternal placenta and possible premature delivery.

Association between a stromal cell-derived factor 1 (SDF-1/CXCL12) gene polymorphism and microvascular disease in systemic sclerosis

Objective:

To investigate the possible implication of SDF1-3′ polymorphism in systemic sclerosis (SSc) susceptibility or clinical phenotype, or both.

Methods:

150 patients with SSc and 150 controls were enrolled. Skin involvement, autoantibodies, interstitial lung disease, pulmonary arterial hypertension (PAH), scleroderma renal crisis, past and/or current skin ulcers were assessed. Genotyping was performed by PCR-RFLP.

Results:

Genotype distribution and allele frequency were similar in SSc and controls. SDF1-3′A allele and SDF1-3′GA/AA genotype frequencies were significantly higher in SSc-PAH than in SSc-non-PAH (33.3% vs 18.3%, p = 0.01) and in SSc with skin ulcers than in SSc without ulcers (27.3% vs 16.9%, p = 0.03). The SDF1-3′A allele influenced the predisposition to SSc-related PAH (OR = 2.52, 95% CI 1.11 to 5.69, p = 0.02) and skin ulcers (OR = 2.31, 95% CI 1.18 to 4.52, p = 0.01). After adjustment for age and gender, the SDF1-3′A allele remained a susceptibility factor for the SSc-related vascular manifestations (PAH: OR = 2.37, 95% CI 1.04 to 5.42, p = 0.04; ulcers: OR = 2.33, 95% CI 1.78 to 4.62, p = 0.01).

Conclusion:

The SDF1-3′A allele is significantly associated with microvascular involvement in SSc.

The -670G>A polymorphism in the FAS gene promoter region influences the susceptibility to systemic sclerosis

OBJECTIVE

To evaluate the role of the single-nucleotide polymorphism (SNP) at position -670 in the FAS gene promoter (FAS-670G>A) in influencing the susceptibility, clinical features and severity of systemic sclerosis (SSc).

METHODS

350 white Italian SSc patients (259 with limited cutaneous SSc (lcSSc) and 91 with diffuse cutaneous SSc (dcSSc)) and 232 healthy individuals were studied. Patients were assessed for the presence of autoantibodies (anticentromere, anti-topoisomerase I (anti-Scl-70) antibodies), interstitial lung disease (ILD), pulmonary arterial hypertension and scleroderma renal crisis. FAS-670G>A SNP was genotyped by PCR restriction fragment length polymorphism assay. Serum levels of soluble FAS (sFAS) were analysed by ELISA.

RESULTS

A significant difference in FAS-670 genotype distribution was observed between SSc patients and healthy individuals (p = 0.001). The frequency of the FAS-670A allele was significantly greater in SSc than in controls (p = 0.001). No significant difference in genotype distribution and allele frequencies was observed between lcSSc and dcSSc, although a greater frequency of the FAS-670A allele was found in dcSSc. The FAS-670AA genotype significantly influenced the predisposition to SSc (OR 1.97, 95% CI 1.35 to 2.88, p = 0.001) and to both lcSSc (OR 1.84, 95% CI 1.23 to 2.75, p = 0.003) and dcSSc (OR 2.37, 95% CI 1.41 to 3.99, p = 0.001). FAS-670A allele frequency was greater, although not significantly, in anti-Scl-70 antibody-positive dcSSc and ILD dcSSc. sFAS was significantly higher in patients and controls carrying the FAS-670AA genotype compared with those carrying the FAS-670GG genotype (p = 0.003 in SSc, p = 0.004 in controls).

CONCLUSION

The FAS-670A allele is significantly associated with susceptibility to SSc, suggesting a role for a genetic control of apoptosis in the pathogenesis of the disease.

Differential expression of tissue kallikrein in the skin of systemic sclerosis

Systemic sclerosis (SSc) is characterised by ischemic damage, impaired angiogenesis and skin fibrosis. Tissue kallikrein (t-kallikrein) is involved through kinins in inflammation, vasorelaxation and angiogenesis. T-kallikrein is synthetised by endothelial, smooth muscle, and inflammatory cells and, in skin, also by dark cells of the sweat glands, where it is involved in sweat formation. Our aim was to analyse, by immunohistochemistry and RT-PCR, the expression of t-kallikrein in the skin of patients with different SSc subsets, limited (lSSc) and diffuse (dSSc), and phases, early and advanced. Skin biopsies were taken from 18 SSc patients and 10 controls. Immunohistochemistry was performed on paraffin sections with an antibody against human urinary t-kallikrein. For RT-PCR, cDNA from skin biopsies was amplified using primers specific for human t-kallikrein. In the control skin, dark cells of the secretory units of sweat glands showed immunopositivity for t-kallikrein as well as blood vessels. In the lSSc skin, immunoreactivity was observed only in some glands, with weak staining in the advanced phase. In early lSSc skin, immunoreactivity was observed in microvessel walls and in the inflammatory infiltrate. In dSSc skin, dark cells of the glandular fundus units, and the few remaining vessels showed scarcity (early phase) or lack (advanced phase) of immunoreactivity for t-kallikrein. RT-PCR confirmed a decrease of t-kallikrein mRNA levels from early to advanced phase in SSc subsets, reaching its lowest level in advanced dSSc. In conclusion, immunohistochemical and biomolecular results indicate that t-kallikrein is decreased in the skin of SSc patients and decreases progressively from the early to advanced phase of lSSc and dSSc. The decreased expression of t-kallikrein may be involved in the impairment of the sweating process, vessel functionality and angiogenesis.

A prevalence study of carotid atherosclerotic disease in patients aged above 60

The results of Doppler sonography and the echotomographic evaluation of extracranial arteries performed on 139 asymptomatic patients aged above 60 are presented. Atheromatous lesions were found in 54 (38.85%) of the subjects, though most had no hemodynamic effects. Statistical analysis showed an increase in both number and gravity of lesions with advancing age in females alone. No significant association was found between risk factors and atheromatous lesions, except for smoking in males.

[Dynamic ECG in cerebral ischemic vasculopathies]

Fifty-four subjects suffering from TIA or Stroke underwent normal ECG and Holter ECG ten days after ischemic cerebral event in order to point out cardiac dysrhythmias as possible causes of TIA or Stroke. Holter ECG proved positive in 70.3% of subjects versus 38.8% of normal ECG (p < 0.001). We underline the utility of cardiological valuation in patients suffering from TIA or Stroke in order to search for cardiac causes of ischemic cerebral events and to prevent relapses.

Clinical and electrophysiological findings in two cases of Miller Fisher syndrome

Clinical, radiological and electrophysiological data in two patients with 'Miller Fisher syndrome' (MFS), characterized by ataxia, ophthalmoplegia and areflexia are reported. Of the many tests performed only the electrophysiological findings provided any clue to the site of the lesions and the structure involved, showing a significant pattern of brainstem dysfunction. The authors discuss the role of central and peripheral lesion theory in the light of these data and stress that electrophysiological findings lend considerable weight to the former and support the hypothesis that MFS should be recognize as a distinct clinical entity.

A pilot study with monosialoganglioside GM1 on acute cerebral ischemia

Reported here are the results of an open controlled study on the use of GM1 in cases of ischemic strokes in its acute phase. A statistically significant improvement was observed in cases treated with GM1 for neurological deficits (assessed by Mathew's rating scale, modified by Fritz-Werner) at 21, 60 and 120 days and for disability at 120 days.

[Relation between neurologic damage and collateral circulation detected by Doppler CW in occlusive pathology of the internal carotid]

76 patients affected by acute ischemic encephalopathy due to i.c.a. occlusion have been examined through a Doppler nosography, in order to evaluate the influence of the type of collateral circle on the neurologic damage. Collateral circles between the external and internal carotid arteries were established through the ophthalmic artery in 80% of cases (A) and through the Willis circle in 70% of cases (B). Those two types of compensation do not seem to have prognostic value with regard to disability; on the contrary a remarkable difference was observed in the type of pathology (A = Stroke 40%, RIA 60%; B = 77%, RIA 23%).