Gender differences in microRNA expression in levodopa-naive PD patients

Gender is an important factor influencing epidemiological and clinical features of Parkinson's disease (PD). We aimed to evaluate gender differences in the expression of a panel of miRNAs (miR-34a-5p, miR-146a, miR-155, miR-29a, miR-106a) possibly involved in the pathophysiology or progression of disease. Serum samples were obtained from 104 PD patients (58 men and 46 women) never treated with levodopa. We measured levels of miRNAs using quantitative PCR. Correlations between miRNA expression and clinical data were assessed using the Spearman's correlation test. We used STRING to evaluate co-expression relationship among target genes. MiR-34a-5p was significantly upregulated in PD male patients compared to PD female patients (fc: 1.62; p < 0.0001). No correlation was found with age, BMI, and disease severity, assessed by UPDRS III scale, in male and female patients. MiR-146a-5p was significantly upregulated in female as compared to male patients (fc: 3.44; p < 0.0001) and a significant correlation was also observed between disease duration and mir-146a-5p. No differences were found in the expression of miR-29a, miR-106a-5p and miR-155 between genders. Predicted target genes for miR-34a-5p and miR-146-5p and protein interactions in biological processes were reported. Our study supports the hypothesis that there are gender-specific differences in serum miRNAs expression in PD patients. Follow-up of this cohort is needed to understand if these differences may affect disease progression and response to treatment.

Mechanisms and pharmacology of neuropathic pain in multiple sclerosis

The neuropathic pain of multiple sclerosis is quite prevalent and severely impacts quality of life. A few randomized, placebo-controlled, blinded clinical trials suggest that cannabis- and anticonvulsant-based treatments provide partial pain relief, but at the expense of adverse events. An even smaller, but emerging, number of translational studies are using rodent models of experimental autoimmune encephalomyelitis (EAE), which exhibit pain-like behaviors resembling those of Multiple sclerosis (MS) patients. These studies not only support the possible effectiveness of anticonvulsants, but also compel further clinical trials with serotonin-norepinephrine reuptake inhibitors, the immunosuppressant drug rapamycin, or drugs which interfere with glutamatergic neurotransmission. Future behavioral studies in EAE models are essential toward a new pharmacotherapy of multiple sclerosis pain.

Corticosteroid transdermal delivery to target swelling, edema and inflammation following facial rejuvenation procedures

BACKGROUND AND AIM

The use of transdermal therapeutic systems has spread worldwide since they allow effective local drug delivery. In the present study, we investigated the efficacy and safety of a new betamethasone valerate medicated plaster (Betesil®) to manage facial swelling, edema, inflammation, ecchymosis, and hematoma, when applied immediately after a facial rejuvenation procedure.

MATERIALS AND METHODS

We applied the plaster to the skin of 20 healthy patients for 12 hours immediately after hyaluronic acid-based procedure performed with the aim of erasing facial wrinkles of perioral and nasolabial folds and improving chin and eye contour. A further 20 patients underwent the same cosmetic procedure, but they were treated with an aescin 10% cream (applied immediately after the procedure, in the evening, and the morning after) and served as control group.

RESULTS

Betesil® application resulted in a significant improvement in swelling/edema/inflammation score, if compared with aescin 10% cream (P < 0.01). As for facial ecchymosis and hematoma around the needle injection track, only two patients in the active treatment group displayed minimal ecchymosis and hematoma. In the control group, two patients presented minimal ecchymosis and three slight hematoma. However, using the ecchymosis/hematoma score, no significant difference between Betesil® and aescin 10% cream groups was observed. Patients' satisfaction was significantly higher among subjects receiving Betesil®, if compared to patients receiving aescin 10% cream (P < 0.01).

CONCLUSION

The present study supports the use of Betesil® plaster immediately after facial cosmetic procedures in order to safely control swelling, edema, and inflammation.

A Pilot Study to Compare Two Different Hyaluronic Acid Compounds for Treatment and Knee Osteoarthritis

Osteoarthritis is characterized by progressive articular cartilage degeneration, changes in subchondral bone and synovial inflammation, leading to pain and disability. Viscosupplementation with hyaluronic acid has been widely investigated due to the viscoelastic properties of this compound to manage pain improving the ability to perform daily activities in patients affected by osteoarthritis. In the present study we investigated the clinical effectiveness of viscosupplementation with a new highly cross-linked hyaluronic acid, Variofill®, in patients affected by bilateral knee osteoarthritis in comparison with the widely used Synvisc®. A total of 20 patients, aged between 24–74 years and affected by bilateral knee osteoarthritis, participated in this pilot randomized triple-blind clinical study. They received two injections (2 ml each) of Synvisc® in their left knee and 2 injections (2 ml each) of Variofill® in their right knee spaced 15 days apart. Visual Analogue Scale and Western Ontario McMaster Universities Osteoarthritis Index score were used to evaluate the efficacy of hyaluronic acid injections before and 3 and 6 months after treatment. Both treatment regimens resulted in a significant improvement vs baseline in all endpoints at 3 and 6 months (p < 0.001). Treatment with Variofill® resulted in a high percentage improvement in Visual Analogue Scale pain, Western Ontario McMaster Universities Osteoarthritis Index score pain and physical activity, when compared to Synvisc® viscosupplementation, at 6 months (p < 0.05). These results are encouraging for larger clinical trials with Variofill® in larger cohorts of patients affected by osteoarthritis of the knee.

The "Swiss-cheese Doppler-guided laser tonsillectomy": a new safe cribriform approach to intracapsular tonsillectomy

Outpatient laser ablation of palatine tonsils is a very interesting procedure that has been recently introduced as a routine in head and neck surgery departments. The aim of this study was to describe a new strategy using a Doppler-guided fibre optic neodymium-yttrium–aluminium–garnet (YAG) laser to remove up to 80 % of tonsillar tissue, as assessed in the long-term postoperative clinical evaluation of the volume of the tonsils at the follow-up, and leaving the capsule in place, thus avoiding any haemorrhagic complication and minimize pain. A total of 20 patients (men, n = 13; women, n = 7), aged between 6 and 63, were recruited for the procedure. They were affected by chronic hypertrophic tonsillitis with a recurrent fever and other symptoms that were related to oral inflammation. Among the 20 patients, no serious adverse events, including haemorrhage-related complications, were observed. Treatment was well tolerated, even in patients displaying an overall low pain threshold. No dropout or uncompleted procedure occurred in the present study. Minor complications included sore throat, moderate oedema, mild acute pharynx inflammation, slight peritonsillar exudate and local burning. The postoperative pain, measured by Scott–Huskisson visual analogue scale, was between 5 and 40 mm and was easily counteracted by means of external ice packages and nonsteroidal anti-inflammatory drugs, according to the individual patient’s need. During the 12–36-month follow-up patients showed improved symptoms (n = 7) and complete recovery (n = 13). A relapse episode was observed in two patients. This study supports fibre optic laser neodymium-YAG tonsil surgery, named “cribriform intracapsular tonsillectomy” or “Swiss-cheese laser tonsillectomy”, as an effective alternative to the traditional cold knife approach or electrosurgery. This approach could become the gold standard for tonsil surgery in the third millennium for safety reasons, acceptable cost–benefit ratio, the precise targeting of the beam across the affected tissues and the short- and long-term recovery.

[First investigation on some aspects of Italian physicians: a statistical study]

Physicians are often under increasing pressure and have a stressful lifestyle due to the high level of responsibility that characterizes their profession. Lack of free time and poor or even absent personal relationships may lead them to suffer from anxiety, depression, drug abuse and addiction, alcoholism and, in a worst case scenario, to suicide. The project "Medico-Cura-Te-Stesso" aims at taking care of the physicians' well-being, even if they are retired, who often underestimate the importance of their health status. Here we report the results of a survey, conducted on a sample of 251 physicians, concerning their illnesses, the drugs they use to cure themselves, prevention, overweight and its association with physical activity and diet, their artistic recreational activities and management of their free time.

[Deep Oscillation: therapeutic-rehabilitative experiences with a new electrostatic device]

AIM

Deep Oscillation® is an apparatus that produces low frequency electromagnetic radiations able to modulate immune reactions and, therefore, applicable to pain, tumour and inflammation treatments. The aim of this study is to evaluate how the Deep Oscillation® therapy works on conventional therapy resistant patients as the apparatus can be applied either to trauma derived fom surgical wounds or on sports post-traumatic oedema, low back pain and/or sciatalgic pain and cervicobrachial pain.

METHODS

In the first part of the study, 34 cases of recent surgical wounds have been treated with Deep Oscillation® with 3 times a week visits for 20 minutes. In the same way 30 cases of sports post-traumatic oedema, 20 cases of low back pain and/or sciatalgic pain and 10 cases of cervicobrachial pain were treated. Among these patients, 15 cases had also undergone contemporaneous nonsteroidal anti-inflammatory drugs intravenous drip, electrolytes and vitamins to verify the probable synergetic efficacy of both treatments.

RESULTS

The results confirm that in some cases the Deep Oscillation® treatment is effective since the first/third therapy up to the restitutio ad integrum. It has also been demonstrated that the maximum efficiency of the Deep Oscillation® and nonsteroidal anti-inflammatory drugs synergetic treatment is probably due to the electromagnetic radiations able to facilitate the pharmacological uptake.

CONCLUSION

This study confirms the capacity of the electrostatic energy, released by Deep Oscillation®, to stimulate the patient's neurosensory system, raising his pain threshold and facilitating his pharmacological uptake and restoring his functional recovery more quickly.

Short review on face rejuvenation procedures: focus on preoperative antiseptic and anesthetic delivery by JetPeel™-3 (a high pressure oxygen delivery device)

AIM

Nowadays there is great attention in trying to slow and reverse the facial aging process. Esthetic medicine has been primarily based on the surgical approach for many years, but now, in order to solve the problem of aging skin, there is an increasing interest into non-invasive, possibly painless, procedures that can guarantee the patient a quick recovery. In this perspective the use of chemical peeling and dermabrasion, to achieve skin rejuvenation, is growing worldwide. These techniques are also relevant to treat skin pigmentation irregularities and to remove keratoses, lentigines, acne and other skin related conditions. One of the most interesting, safe and painless devices, useful for the effective antiaging face treatment, is JetPeel™-3. The aim of this study was to assess the device efficacy starting from a short review on face rejuvenation procedures.

METHODS

The basic action mechanism of this medical device is a constant high pressure air flux delivery, including oxygen, mixed with different chemical compounds such as peeling molecules, antioxidants, vitamins and hyaluronic acid, which are mechanically forced across the skin surface. Here we report a new approach in the clinical use of JetPeel™-3, tested in 20 adult volunteers, consisting in the addition to the standard protocol of an anesthetic, carbocaine and a sterilizing and disinfectant agent, that is chlorexidine. In fact disinfection and sterilization of the skin surface is a peculiar step for every antiaging or therapeutic procedure. The procedure has been completed with multiple hyaluronic acid injections of the skin in order to achieve face rejuvenation. The anesthetic power of the JetPeel™-3-carbocaine protocol has been compared to the Emla cream one.

RESULTS

The spontaneous pain sensation perceived by the patients in the hemiface treated with JetPeel™-3 was significantly lower compared to the hemiface treated with Emla cream (P<0.001) showing, consequently, that JetPeel™-3-carbocaine protocol had the best anesthetic performance either in dermal, subdermal or subcutaneous injections compared with Emla cream.

CONCLUSION

JetPeel™-3 has proved to be a good non-invasive approach and its use is recommended since it induces local anesthesia in a short time.

[Food intolerance: reliability and characteristics of different diagnostic alternative tests]

The expression "food intolerance" dates back to the ancient Greece and can be generally defined as a sum of unpleasant symptoms of varying etiology that can onset in some patients after the ingestion of various food products. Adverse reactions to food can be divided into toxic and non-toxic. The last ones are classified as immunologically mediated, called "allergies", and non-immunologically mediated, commonly defined as "intolerances". The gut wall is directly involved in these adverse reactions to some foods, since it plays a key role in food absorption and in the regulation of the immunitary system. In this paper we discuss food intolerances and allergies, evaluating the available diagnostic methods and their scientific reliability and focusing on IgG analysis based immunoenzymatic test which is the most relevant test for intolerance diagnosis.

[Overweight and surgical procedures: a proposal for a compatible dietary regimen]

INTRODUCTION

The very low calorie protein diet essentially supplies a low content of carbohydrates and lipids, and a higher protein intake to produce a rapid weight loss.

AIM

This study aims at evaluating the effect of a high protein low calorie diet on glycaemia, creatinine, triglycerides, cholesterol, VLDL, HLDL, systolic and diastolic blood pressure.

MATERIALS AND METHODS

We have selected 30 surgical patients with a body mass index equal to 30-50 who underwent a high protein low calorie diet for 40 days a s a complications-preventive strategy before operation. The calories supplied have been in the range of 800-1200 accordingly to the individual workload and urgent need to lose weight.

RESULTS

After a diet of 40 days, all the patients showed a definite weight loss and significant glycaemia, creatinine, triglycerides, cholesterol, VLDL and HLDL improvement. In the hypertensive patients, systolic and diastolic blood pressure decreased significantly.

DISCUSSION

The very low calorie diet is quite effective to lose [corrected] weight before surgical procedures. This dietary regimen, from a physiological perspective, improves electrolyte balance supporting lean mass preservation and reducing the patient's weakness and hunger,without any wound healing impairiment or weakness. Therefore it is an excellent preventive measure against overweight-due complications and it is advisable and safe as prophylactic measure.

A preliminary study of the local treatment of preneoplastic and malignant skin lesions using methyl jasmonate

BACKGROUND

Jasmonates are plant stress hormones. These small hydrophobic compounds exhibit anti-cancer activities, in vitro and in vivo, against cancer cells of various histological origins. Moreover, they show a selective activity against transformed cells and affect drug-resistant cells as well.

AIM

The aim of this study was to evaluate the activity of a powerful jasmonate derivative, that is methyl jasmonate.

MATERIAL AND METHODS

Methyl jasmonate was applied topically on cancerous and pre-cancerous skin lesions from eight patients.

RESULTS

Methyl jasmonate did not cause any meaningful local or systemic side effects. Three patients exhibited positive responses. Two patients had complete recovery and one had a recurrence of the lesion three months post treatment.

CONCLUSIONS

Methyl jasmonate is a potentially promising novel topical treatment for prcancerous and cancerous skin lesions. Methyl jasmonate should be evaluated in a larger series of patients.

A telephone interview to assess alkylglycerols' effectiveness in preventing influenza-like symptoms in Modena, Emilia Romagna, Italy, in the season 2009-2010

OBJECTIVES

Influenza has been related to high morbity and, in children and adults over 60 years, high mortality. It brings a great burden on medical centers, which have to sustain and provide numerous patients with continuous care, especially in winter when influenza reaches the highest peak. Vaccination is still the main preventive measure to avoid serious epidemics. We propose a retrospective phone interview to assess the effect of alkylglycerols, taken immediately before the peak of influenza, to boost the immunitary system.

MATERIALS AND METHODS

A group of patients from Modena (Emilia Romagna, Italy) were included in this study. Fifty two patients were instructed to take Alkyrol®500 per os, twice a day, during the two principal meals. Sixty patients were chosen from the same familiar nucleus of the treated subjects and they were used as controls since they all had undergone traditional vaccination against H1N1 influenza.

RESULTS

Forty two out of 52 patients, treated with alkylglycerols did not report any influenza-like symptoms, while 10 out of 52 showed mild influenza-like symptoms which disappeared after 48-72 hours without the use of any drug. In the control group, 20 out of 60 patients did not show any influenza-like symptoms, while 40 out of 60 patients did.

CONCLUSIONS

Alkylglycerols may bring therapeutical benefits, support the immunitary system and prevent influenza-like symptoms. Further clinical studies are needed, not only to understand if alkylglycerols can be a valid alternative to vaccination to prevent influenza, but also to study their possible application to treat other pathological conditions.

[Second opinion clinic: is the Web Babel Syndrome treatable?]

The term "second opinion" has been widely used, since the 70's in the American hospitals with the aim of reducing the skyrocketing costs of the patients' healthcare, improving their diagnosis, the patient's care and his healing process at the same time. In this paper, after a short review of the "second opinion" impact on different medical fields, we give the reasons why, nowadays, patients are strongly addressed towards a second opinion seeking behaviour. In fact, due to the spreading of the world wide web, the patient can obtain any kind of medical information, even if it is an unqualified one. This fact leads the patient to carry out an obsessive search that can result in confusion and disorientation. We have defined this psychological distress the "Web Babel Syndrome". Building upon these foundations, we strongly support a "second opinion medical clinic" that can face the patient's needs and help those patients with impending single or multiple unresolved illnesses. They need a multispecialty diagnostic or therapeutic medical or surgical approach in order to heal properly or achieve a better quality of life.

Therapeutical use of probiotic formulations in clinical practice

BACKGROUND & AIMS

The spreading of gastrointestinal diseases is growing all over the world. Although for some of them an effective therapeutic approach has been found, palliation rather than cure is very frequent due to a partial knowledge of their aetiology and pathogenesis. This review, analyzing the main clinical studies, aims at being a state of the art update of the use of probiotic formulations in daily practice.

METHODS

In this review we include all the most significant clinical trials involving the use of probiotic formulations for the treatment of several pathologies.

RESULTS

Dysbiosis has been observed in irritable bowel syndrome patients. Probiotics may exert a beneficial effect on Crohn's disease affected patients who have shown gut microbiota antigens and altered wall permeability. Moreover some probiotic formulations seem to enhance the therapy for Helicobacter Pylori reducing its pathogenic potential. Intestinal ecology imbalance has been also linked to cancer induction, allergy, skin and urogenital diseases. In addition probiotics administration seems to be particularly useful to ease post-operative complications.

CONCLUSION

Further future clinical trials, involving large numbers of patients, will be mandatory to achieve definite evidence of the preventive and curative role of probiotics in medical practice.

The obese patient: clinical effectiveness of a high-protein low-calorie diet and its usefulness in the field of surgery

Obesity has become a concern of epidemic proportion involving globally both children and adults. Although genetically linked, lack of physical activity and the outstanding growing of the food market are the main behavioral causes of obesity. Furthermore, it is related to several diseases which may impair the life quality, but also lead to death. Atkins nutritional approach has become really popular since the publication of Dr Atkins' first book "Dr. Atkins' Diet Revolution" in 1972. This approach, although very criticized by some dieticians, has been used as a model for a lot of high-protein, low-carbohydrate diets that are nowadays widely used. The evidence that obese people experience a more adverse outcome in a medical and surgical Intensive Care Unit, compared with non-obese pairs, has risen the issue of the importance of an appropriate feeding. Could obese people benefit from a high-protein diet? Is this approach related to adverse effects? Can a high-protein diet bring benefits to obese patients undergoing surgery? This review deals with this matters reporting the use of high-protein diets in clinical trials involving obese subjects.

Antioxidant therapy effectiveness: an up to date

Antioxidants are chemical compounds that giving an electron to free radical molecules convert them to an harmless configuration, avoiding damaging chain reaction, which can involve lipids, proteins enzymes carbohydrates, DNA, cell and nuclear membranes up to the cell death. Being either exogenous or endogenous they are addressed to prevent the oxidation induced damage, a process that causes damage in all tissues through free radicals chemical reactivity. A lot of natural, nutraceutical or chemical compounds are being actually marketed with a lot of different claims and are prescribed by doctors or sold over the counter. Unfortunately, in the medical literature many heterogeneous published articles support the use of this class of drugs, but most of them cannot be compared or pooled to achieve statistical significance of effectiveness. Our review aims at defining the state of the art of antioxidant therapy, with specific reference on the evidence based clinical use.