Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience

Objective

The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation.

Methods

This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI).

Results

NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome.

Conclusion

SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.

Early postextraction implants may achieve osseointegration in the absence of primary stability. A pilot study

This pilot study aimed at investigating if implants without primary stability may osseointegrate and support functional prosthesis. Patients received one Trabecular Metal implant each in posterior sockets two months after tooth extraction, combined with xenograft and a resorbable membrane. Implants were divided in three groups, based on the primary stability assessed by resonance frequency analysis. Implant stability quotient (ISQ) was measured at placement, and re-assessed five months later (at uncovering), and after 6 months of function. Marginal bone loss was radiographically evaluated. After checking normality of the distributions, Student's t-test was used for statistical comparisons. Twenty-five consecutive patients were included. At placement, mean ISQ significantly differed among groups, being undetectable (n=8 implants), 65.00±4.25 (standard deviation, n=6) and 77.95±3.13 (n=11) in the very low, medium and good primary stability groups, respectively. After five months of healing, mean ISQ had increased to >70 in all groups. All implants successfully osseointegrated and were restored as planned. Six months after loading, no significant difference in mean ISQ (range 79.19-81.92), and in mean marginal bone level change (range 0.21 to 0.28 mm) was observed among the three groups. Rehabilitation of wide postextraction defects may achieve successful outcomes even in the absence of primary stability.

Maternal and postnatal high-fat diets with high ω6 : ω3 ratios affect the reproductive performance of male offspring in the mouse

High-fat diets (HFDs) are an acknowledged risk factor for male subfertility, but the underlying mechanisms remain unclear. In the present study we compared the effects of two HFDs with different ω6:ω3 ratios, one enriched with soy oil (SOD; ω6:ω3=9.62) and another enriched with sunflower oil (SFOD; ω6:ω3=51.55), with those of a commercial diet (CD; ω6:ω3=19.87), supplied from pregnancy to adulthood, on morphometric parameters and reproductive performance in adult male mice (recommended ω6:ω3 for rodents=1-6). Bodyweight was significantly higher in the SFOD than CD group, and relative testicular weight was significantly lower in the SFOD than the other two groups. SFOD altered sperm performance: it reduced sperm viability (mean±s.e.m.; 76.00±1.35% vs 82.50±1.45% and 80.63±1.00% in the SFOD vs CD and SOD groups respectively; P<0.05) and increased the percentage of immature spermatozoa (71.88±7.17% vs 51.38±5.87% and 48.00±5.72% in the SFOD vs CD and SOD groups respectively; P<0.05). The epididymal ω6:ω3 ratio was higher in the SFOD versus CD and SOD groups, whereas the unsaturation index was higher in the SOD and SFOD groups than in CD group. Sperm membrane integrity was diminished in both the SOD and SFOD groups, but there was no difference in sperm reactive oxygen species production in these two groups compared with the CD group. The fertilisation rate was lower in the SFOD compared with the CD and SOD groups. In conclusion, although both HFDs affected sperm quality, the fertilising ability was more altered by the excessive dietary ω6:ω3 ratio than by the net ω6 content.

Mouse plasma progesterone levels are affected by different dietary ω6/ω3 ratios

An imbalance in the dietary polyunsaturated fatty acids (PUFAs) ω6/ω3 ratio, could influence negatively the reproductive performance. The aim of the study was to assess the effects of chronic administration of diets enriched with soybean or sunflower oils with different ω6/ω3 ratios on the reproductive parameters of adult female mice. Mice were fed different diets for 90 days: a commercial diet (CD), a 5 or 10% soy oil-enriched diet (SOD5 and SOD10, respectively), and a 5 or 10% sunflower oil-enriched diet (SFOD5 and SFOD10, respectively). The parameters evaluated were: body weight and food intake, estrous cycle, plasma progesterone concentration, ovulation rate, and oocyte quality. Progesterone concentrations (ng/ml) were significantly higher in the SFOD10: 14.9±2.8 vs CD: 5.4±1.2; SOD5: 5.6±1.1 and SFOD5: 4.6±1.4. Additional parameters evaluated were not affected. However, metestrous and luteal phases were shorter in subjects receiving SOD and longer in those under SFOD diets. In SFOD, there was a trend towards a smaller number of recruited oocytes compared to CD and SOD and a higher percentage of cleaved oocytes were quantified in SOD diets. A 3-month supply of a diet with elevated LA ω6/ALA ω3 ratio to adult female mice affects their reproductive physiology, modifying progesterone production, ovulation rate, and/or oocyte quality. Although some differences in the response to diets have been observed in several mammalian species, the present findings must be taken into consideration when a diet for optimizing reproductive capability is indicated.

Gamma-secretase-dependent amyloid-beta is increased in Niemann-Pick type C: a cross-sectional study

OBJECTIVE

Niemann-Pick disease type C (NPC) is an inherited disorder characterized by intracellular accumulation of lipids such as cholesterol and glycosphingolipids in endosomes and lysosomes. This accumulation induces progressive degeneration of the nervous system. NPC shows some intriguing similarities with Alzheimer disease (AD), including neurofibrillary tangles, but patients with NPC generally lack amyloid-β (Aβ) plaques. Lipids affect γ-secretase-dependent amyloid precursor protein (APP) metabolism that generates Aβ in vitro, but this has been difficult to prove in vivo. Our aim was to assess the effect of altered lipid constituents in neuronal membranes on amyloidogenic APP processing in humans.

METHODS

We examined Aβ in CSF from patients with NPC (n = 38) and controls (n = 14). CSF was analyzed for Aβ(38), Aβ(40), Aβ(42), α-cleaved soluble APP, β-cleaved soluble APP, total-tau, and phospho-tau.

RESULTS

Aβ release was markedly increased in NPC, with a shift toward the Aβ(42) isoform. Levels of α- and β-cleaved soluble APP were similar in patients and controls. Patients with NPC had increased total-tau. Patients on treatment with miglustat (n = 18), a glucosylceramide synthase blocker, had lower Aβ(42) and total-tau than untreated patients.

CONCLUSION

Increased CSF levels of Aβ(38), Aβ(40), and Aβ(42) and unaltered levels of β-cleaved soluble APP are consistent with increased γ-secretase-dependent Aβ release in the brains of patients with NPC. These results provide the first in vivo evidence that neuronal lipid accumulation facilitates γ-secretase-dependent Aβ production in humans and may be of relevance to AD pathogenesis.

[The tolerability and therapeutic efficacy of rifabutin in the treatment of pulmonary tuberculosis]

We treated in our unit 25 patients (15M--10F) affected by pulmonary tuberculosis (TB) with rifabutin (RBT). Chronic liver disease, multidrug-resistant TB and HIV infection were featuring the clinical history of our selected patients. The treatment was carried out using a 150 mg/day dose of RBT, or 300 mg/day in case of MDR (multiple-drug-resistance)-TB or chronic TB. Rifabutin, isoniazid, ethambutol, and a fourth anti-mycobacterium drug were used when treating MDR-TB. Chest X-ray, haematological and bacteriological tests were performed on a monthly basis during the patients' follow up. No side effects were observed; only in two cases, both females, leukopenia occurred, but was not such a reason to modify our treatment plan. As a matter of fact, RBT is well tolerated by patients and it is particularly effective in bacterial eradication. In our experience, RBT did not provide the expected results only in one patient, affected by chronic TB.

Organization of the gene for the alpha-subunit of mouse beta-N-acetylhexosaminidase (HEXa)

Genomic clones spanning the mouse HEXa gene were isolated and the exon-intron organization determined. The locations of all exon-intron junctions were identical to those of the human HEXa gene but the large intron 1 was shorter in the mouse (14Kb) than in the human gene (18Kb).