Head down tilt 15° in experimental intracerebral hemorrhage: a randomized noninferiority safety trial

BACKGROUND AND PURPOSE

Head down tilt 15° (HDT15°), applied before recanalization, increases collateral flow and improves outcome in experimental ischemic stroke. For its simplicity and low cost, HDT15° holds considerable potential to be developed as an emergency treatment of acute stroke in the prehospital setting, where hemorrhagic stroke is the major mimic of ischemic stroke. In this study, we assessed safety of HDT15° in the acute phase of experimental intracerebral hemorrhage.

METHODS

Intracerebral hemorrhage was produced by stereotaxic injection of collagenase in Wistar rats. A randomized noninferiority trial design was used to assign rats to HDT15° or flat position (n = 64). HDT15° was applied for 1 h during the time window of hematoma expansion. The primary outcome was hematoma volume at 24 h. Secondary outcomes were mass effect, mortality, and functional deficit in the main study and acute changes of intracranial pressure, hematoma growth, and cardiorespiratory parameters in separate sets of randomized animals (n = 32).

RESULTS

HDT15° achieved the specified criteria of noninferiority for hematoma volume at 24 h. Mass effect, mortality, and functional deficit at 24 h showed no difference in the two groups. HDT15° induced a mild increase in intracranial pressure with respect to the pretreatment values (+2.91 ± 1.76 mmHg). HDT15° had a neutral effect on MRI-based analysis of hematoma growth and cardiorespiratory parameters.

CONCLUSIONS

Application of HDT15° in the hyperacute phase of experimental intracerebral hemorrhage does not worsen early outcome. Further research is needed to implement HDT15° as an emergency collateral therapeutic for acute stroke.

The profile of people living in extreme poverty in the region of Crete

Background

The financial crisis of the last decade has increased the number of people living in extreme poverty in Greece. Until today, there is no research evidence on the bio-psycho-social needs of the population. The current study, among other, aimed at investigating the living and working conditions, the health and mental health status of these people and produced recommendations for health care policy and planning.

Methods

A cross-sectional study was carried out in Crete Region with adult beneficiaries of material support benefits (according to income-related criteria). The study was part of the program FAED, which was co-funded by the EU and offered material support (e.g. food, material for personal hygiene, etc. to more than 17.000 beneficiaries in Crete region within 2016-2017. A structured questionnaire extracted information on various aspects including, working, housing and living conditions, health and mental health status.

Results

798 individuals (46.5% male; 43.3 years) consented to participate and completed the questionnaire. Mean time of unemployment was 4.2 years. 26.8% was accommodated by relatives, 23.5% rented a house and 18% lacked heating. Nearly half of the participants reported a chronic disease (47.0%), 24.1% reported disability certified by health authorities. 4.9% had severe alcohol-related problems, 50.6% had mild to severe depression symptoms and 40.3% mild to severe symptoms of anxiety disorder. 12.0% totally lacked a support network for daily practical and emotional issues.

Conclusions

Personal psychosocial needs seem to have been neglected because of complex family needs. Socioeconomic deprivation seems to have exacerbated chronic disease management due to neglect of health care needs. A huge burden of mental diseases is evident necessitating community mental health care.

Key messages

Mapping of bio-psychosocial needs is important for social policy and health care planning. Integrated care is necessary to meet the complex needs of people living in extreme poverty.

Immunohistochemical evaluation of the mTOR pathway in intra-oral minor salivary gland neoplasms

OBJECTIVES

The aim of this study was to investigate the expression of upstream and downstream molecules of the oncogenic mTOR signaling pathway in intra-oral minor salivary gland tumors (SGTs).

MATERIALS AND METHODS

Tissue samples consisted of 39 malignant and 13 benign minor SGTs, and 8 controls of normal minor salivary glands (NMSG). An immunohistochemical analysis for phosphorylated Akt, 4EBP1 and S6 (total and phosphorylated), and eIF4E was performed.

RESULTS

Expression of pAkt and 4EBP1 was observed in all SGTs and in most NMSG. p4EBP1 was detected in almost all SGT cases, NMSG being negative. S6 immunoreactivity was observed in 37.5% of NMSG, 92.3% of benign and 100% of malignant SGTs, while pS6 expression was observed in 77% of benign and 95% of malignant SGTs, but not in NMSG. Finally, eIF4E was expressed in 12.5% of NMSG, 69.2% of benign, and 76.9% of malignant tumors. All molecules studied had statistically significantly lower expression in NMSG compared with SGTs. Moreover, malignant neoplasms received higher scores compared with benign tumors for all molecules with the exception of eIF4E.

CONCLUSION

The mTOR signaling pathway is activated in SGTs, especially in malignancies. Therefore, the possible therapeutic role of targeting the mTOR pathway by rapamycin analogs in SGTs needs further investigation.

Primary and Secondary Prevention of Acute Coronary Syndromes: The Role of the Statins

Poor prognosis is strongly associated with Acute Coronary Syndrome (ACS) and, even though a number of treatment strategies are available, the incidence of subsequent serious complications after an acute event is still high. Statins are hypolipidemic factors and recent studies have demonstrated that they have a protective role during the process of atherogenesis and that they reduce mortality caused by cardiovascular diseases. This review tries to reveal the function of the statins as a component of the primary and secondary action of acute coronary syndrome and to describe the lifestyle changes that have the same effect as the use of statins.

[High resolution computerized tomography in cystic fibrosis. Clinico-radiologic correlations in 25 patients]

Twenty five patients with a clinical and radiological diagnosis of cystic fibrosis underwent high resolution Computed Tomography (HRCT) with the aim to study pulmonary parenchymal localization of disease. Both patients with initial pulmonary alterations and patients in a more advanced phase of the disease were studied. HRCT proved an excellent method for detecting very early lesions such as bronchiolar ectasia and bronchiolar obstruction by mucous accumulation. Moreover, HRCT proved to be very useful in detecting centrolobular and panlobular parenchymal lesions, with diagnostic information on axial and peripheral interlobular connective tissue. HRCT provided a better spatial definition of bronchiectasia and subpleural air if compared to conventional radiology. It also allowed for correct diagnosis of pneumothorax and detection of pleural fibrosis as a result of iatrogenic complications.

Food allergy in cystic fibrosis

Food allergy was investigated in 20 children with cystic fibrosis (CF), who still suffered from diarrhea and failed to thrive, in spite of adequate diet and enzyme treatment (group A). The study also included two age-matched control groups, comprising 10 CF children without intestinal symptoms and/or failure to thrive (group B), and 20 healthy children (group C). Skin tests were positive and total IgE higher than the mean + 2SD respectively in 14/20 and 11/20 patients of group A, in 3/10 and 2/10 patients in group B and in none in group C. The specific IgE were present in 6/14 children in group A whose skin tests were positive and in none in group B. There was no significant difference between group A and group B (p > 0.05). The levels of specific antibodies IgG, IgA and IgM were overall higher than the mean + 2SD of the normal in 18/20 in group A, in 6/10 in group B and in none in group C. The measurement by ELISA of specific antibodies for cow milk and egg proteins showed a statistically significant difference for casein, beta-lactoglobulin and ovalbumin between the IgG (p < 0.05) and IgA (p < 0.001) levels in group A and the other groups (B and C). Symptoms improved in 90% of CF patients (group A) when the implicated foods were eliminated from the diet and in 78% the oral provocation test resulted positive. The occurrence of food allergy must be considered in CF patients who do not improve with the conventional treatment. In these patients immunological investigations, in particular the measurement of IgG, IgA and IgM specific antibodies, are useful for diagnosis and in selecting an appropriate diet leading to an improvement in nutritional status.

Effect of a medium dose of ursodeoxycholic acid with or without taurine supplementation on the nutritional status of patients with cystic fibrosis: a randomized, placebo-controlled, crossover trial

Ursodeoxycholic acid administration has been reported to improve cholestasis and inflammatory activity in primary biliary cirrhosis and, in an uncontrolled study, also in young adults with cystic fibrosis (CF) and chronic cholestasis. As an improvement in nutritional status was also observed in these young adult patients, we investigated whether the administration of a medium dose of ursodeoxycholic acid ameliorates the nutritional status of malnourished young adult CF patients with chronic liver disease. The study included 51 patients (27 male patients and 24 female patients; age range, 8-32 years; median, 14) with body mass percentiles < 90%. Patients were randomly assigned to receive either ursodeoxycholic acid (10-12 mg/kg/day) alone or with taurine (18-22 mg/kg/day). Patients were followed in a crossover fashion within each group; 6 months of treatment was randomly alternated with 6 months of placebo. Nine patients dropped out before concluding the study. Liver function tests, nutritional status, and coefficients of fat absorption were determined at entry and after each 6 months of placebo or treatment. Nutritional status and fat absorption were not significantly modified by either treatment. Liver function tests improved after ursodeoxycholic acid administration only in patients with concomitant chronic liver disease. Our findings indicate that 6 months of therapy with a medium dose of ursodeoxycholic acid, either alone or with taurine, does not improve the nutritional status of young malnourished CF patients. Higher doses given for longer periods might be worth investigating.