Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data.

Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

Energy expenditure and nutritional adequacy of rehabilitation paraplegics with asymptomatic bacteriuria and pressure sores.

OBJECTIVE: To measure resting energy expenditure (REE) in a group of people with postacute paraplegia, quantify the impact of asymptomatic bacteriuria and pressure sore(s) on patients' metabolic rate, and estimate the adequacy of patients' nutritional intakes to preserve patients' protein levels. MATERIAL AND METHODS: Ten males with post-acute paraplegia aged 42.1+/-18.7 years. We evaluated: height, body mass index (BMI), resting energy expenditure (REE), total daily calorie requirement (E), 24-h urine creatinine excretion (Cru), creatinine index (CI), and nitrogen balance (NB). RESULTS: Subjects with paraplegia showed high erythrocyte sedimentation rates. As a group, they had normal resting calorie consumption when REE was normalized for unit of urine creatinine (REE/Cru), it was higher in patients than in controls. Six of the 10 patients had a low calorie intake: of these only three had a negative nitrogen balance. CONCLUSION: In conclusion, the resting energy expenditure of the subjects with significant bacteriuria and pressure sore(s) of 23.7 kcal/kg/day suggests that a large portion of patients may have an inadequate calorie protein intake to preserve their nutritional status. The clinical significance of this study is that 28.5 kcal/kg/day may be the lower calorie threshold to meet the metabolic demands of people with apyretic paraplegia with bacteriuria and pressure sore(s).

[Visual reaction times in a group of patients with single cerebrovascular lesions in rehabilitation]. / Studio dei tempi di reazione visivi in un gruppo di pazienti con lesione cerebrovascolare singola in fase riabilitativa.

UNLABELLED: Approximately fifty percent of stroke survivors have neurological deficits. The evaluation of reaction times permits a study of psychomotor performance, which could be very important for a good rehabilitation outcome. AIM: The aim of the study was the evaluation of visual reaction times in a group of patients with cerebrovascular lesions, during inpatient hospitalisation in a rehabilitation centre. MATERIALS AND METHODS: 46 right-handed patients (34M, 12F) with unilateral cerebrovascular lesion, confirmed by CT or MRI, were enrolled in the study. In each patients visual Simple Reaction Times (SRT) and Multiple Choice Reaction Times (MCRT) were studied. The patients were asked to react by using the hand ipsilateral to the side of the cerebral lesion. Functional impairment of walking, upper limb and hand were measured by a tailored clinical scale with score ranging from 1 to 12. Depression was measured by a modified version of Hamilton scale, tailored for this kind of patient. RESULTS: 13 of 46 patients (28.2%) showed a pathologic reaction time. There was a lack of correlation between reaction times and age, aphasia, lesion size, time from stroke, functional impairment. Patients with hemorrhagic lesions had significantly lower SRT and MCRT. The subgroup of patients with pathologic reaction times were significantly more depressed than patients with normal reaction times. CONCLUSION: Judging from the present set of results: a) patients with hemorrhagic lesions have lower reaction times; b) the prolongation of reaction times and post-stroke depression appear to be related in stroke patients. This relationship seems to suggest that post stroke depression can negatively affect functional recovery also by means of an impairment of psychomotor performance.

Monitoring of heavy metal deposition in Northern Italy by moss analysis.

A survey of heavy metal deposition in the mountainous territories of Northern Italy was carried out in 1995-96. Moss samples (mainly Hylocomium splendens) were collected in a dense network of sites (about 3.2 sites/1000 km(2)) and the data of metal concentrations in moss tissues were statistically correlated with environmental and climatic factors, as well as with bulk deposition of elements and elemental concentrations in the soil. Three main geographic patterns of metal concentration in mosses could be defined: (1) Fe, Ni, and Cr, all derived both by soil particulates and anthropogenic emissions connected with ferrous metal manufacturing, were mostly concentrated in Northwestern Italy; (2) Cu and Zn, as typical multi-source elements, showed rather high concentrations with little ranges of variation over the whole area and small peaks reflecting local source points; (3) Cd and Pb reflected long-distance transport and showed highest concentrations in the regions with highest precipitation, especially in the Eastern Alps.

Ion chromatographic determination of bromate in drinking water by post-column reaction with fuchsin.

Bromate deriving from ozonation treatment of bromide containing waters are analyzed by ion-exchange chromatography with spectrophotometric detection after post-column reaction with fuchsin in low pH medium. An anion-exchange column was used with 2.7 mM carbonate-0.3 mM hydrogencarbonate eluent. The eluent from the column was then allowed to react with a SO2-reduced fuchsin solution and then with a diluted HCl solution at 65 degrees C. The developed colour of the final product was measured spectrophotometrically at 530 nm. Linearity was checked up to 50 micrograms/l with a 200-microliter injection loop (r2 = 0.9997) and up to 100 micrograms/l of bromate with 100 microliters loop (r2 = 0.9939). Nitrate, sulfate, bromide, phosphate, fluoride did not interfere at 100 mg/l concentration level; only nitrite at concentration levels greater than 3 mg/l caused partial overlapping with bromate peak, but this value is not likely to occur in common drinking water. The detection limit (3 sigma) is 0.1 microgram/l (1 microgram/l propagation error approach).

Detrusor instability as an energy-saving device in prostatic obstruction.

PURPOSE: We assessed whether voiding dynamics differ in patients with infravesical obstruction from benign prostatic hyperplasia between those with detrusor instability and those with stable bladders. MATERIALS AND METHODS: A total of 50 such patients with (25) and without (25) detrusor instability was investigated urodynamically by cystometry and pressure-flow study. RESULTS: In the unstable group there was greater obstruction (as assessed by the linear passive urethral resistance relation pressure-flow nomogram) but the detrusor expended less energy (p = 0.001) for voiding the unit volume (54.4 +/- 22.8 mJ./ml versus 74.4 +/- 31.8 mJ./ml. in the stable series). Spared energy was converted into more powerful micturition contractions and more efficient voiding, with a mean maximum contraction power and mean fraction of bladder volume voided of 17.9 +/- 4.9 microW./mm.2 and 93 +/- 11%, respectively, in the unstable population versus 12.7 +/- 2.1 microW./mm.2 (p < 0.001) and 79 +/- 13% (p < 0.001) in the stable subjects. CONCLUSIONS: Detrusor instability possibly works within physiological limits as an energy-saving device, preventing voiding efficiency in patients with prostate disease from decreasing too much with increasing obstruction.

[A computerized endurance test: efficacy of pelvic floor rehabilitation treatment in patients with stress incontinence]. / Test di endurance computerizzato: efficacia del trattamento riabilitativo del pavimento pelvico in pazienti affette da stress incontinence.

In the present study the authors wanted to transfer rigorous methods of study, already in use in other sectors (sports, medicine, isokinetic work, etc.) of the validity of interventions made and their effectiveness, into an "emerging" field, that of perineal rehabilitation. 15 female patients, aged between 35 and 45, affected by stress incontinence underwent a baseline clinico-instrumental evaluation of the perineal floor including a computerized test of endurance. The patients then embarked upon a standardized rehabilitative perineal training lasting a month and at the end underwent an identical evaluation as that performed at the outset. Statistical analysis of the results obtained showed an objective improvement in the parameters considered (endovaginal pressure and its variations during a series of intermittent static contractions) quantitatively supporting clinical evidence.

S- aminoethyl- l -cysteine transaminase from bovine brain: purification to homogeneity and assay of activity in different regions of the brain.

A transminase acting on cystathionine, S-aminoethylcysteine and glutamine has been purified to homogeneity from bovine brain by ammonium sulfate precipitation. DE-52 chromatography, octyl-Sepharose chromatography, hydroxylapatite chromatography and gel filtration. The enzyme was purified 4700 times over the bovine brain homogenate and the overall recovery of the enzyme activity was about 18%. As demonstrated by polyacrylamide gel electrophoresis under native or denaturing conditions, the enzyme has a molecular mass of 100 kDa and is composed of two subunits with approximately identical weight. A single active peak was obtained at pH = 5.24 by chromatofocusing of a homogeneous enzyme preparation. K(m) values for S-aminoethylcysteine have been calculated using various ?-keto acids as amino acceptor and K(m) for glutamine has been determined with ?-keto-?-methiolbutyric acid as cosubstrate. The occurrence of the enzyme activity in some bovine brain regions was also studied.

Gas-chromatographic mass-spectrometric detection of 1,4-hexahydrothiazepine-3,5-dicarboxylic acid (cyclothionine) in bovine brain.

Cystathionine has been reported to undergo enzymatic changes leading to the formation of seven membered cyclic products (Ricci, G., Santoro, L., Achilli, M., Matarese, R. M., Nardini, M., and Cavallini, D. (1983) J. Biol. Chem. 258, 10511-10517; Cavallini, D., Costa, M., Pensa, B., and Coccia, R. (1985) Biochem. Int. 10, 641-646). Gas-chromatographic and mass-spectrometric evidence reported in this paper indicates that the cyclic derivative of cystathionine, 1,4-hexahydrothiazepine-3,5-dicarboxylic acid, here simply named cyclothionine, is a normal component of bovine brain. This finding together with the detection of the same compound in the urine of cystathioninuric patients (Kodama, H., Sasaki, K., Mikasa, H., Cavallini, D., and Ricci, G. (1984) J. Chromatogr. 311, 183-188) supports the conclusion that cystathionine, apart from its role in trans-sulfuration, is converted also into cyclic compounds whose biochemical significance is as yet unknown.

[The peripheral component during dynamic muscular exertion: study of a group of basketball players]. / La componente periferica nel corso dell'esercizio muscolare dinamico: studio su un gruppo di cestisti.

The peripheral factor (PF), i.e. the ratio: artero-venous oxygen extraction to total peripheral resistences, has been studied in a total of 8 professional basket players under controlled work-load conditions. The results obtained by continuous monitoring heart rate, oxygen consumption, pulmonary ventilation, arterial blood pressure etc, have shown that from 0 to 150 watt work-load, the PF increases linearly showing a slope of 83 degrees, whereas from 150 to 200 watt the pendence reduces up to 45 degrees. The absolute value of PF from a resting value of 3.83 mlo2 X min-1 X mmHg-1 increases up to 21,64 (at 150 watt) and to a maximum of 23.45 mlo2 X min-1 X mmHg-1 at 200 watt. The slope of the first range of load (83 degrees) is quite similar to what previously observed in endurance athletes (cyclists) whereas the 45 degrees angular coefficient indicates that the increased energy demand in basket-players can be obtained only with a large cardiac load.

Similarity of the oxidation products of L-cystathionine by L-amino acid oxidase to those excreted by cystathioninuric patients.

L-Cystathionine is oxidized by snake venom L-amino acid oxidase at a rate about half that with L-leucine at pH 8.5. The appearance of an absorbance at 296 nm and quantitation of the products of oxidation in the presence of catalase indicate formation in the solutions of a seven-membered ketimine ring produced by cyclization of the monoamino monoketo derivative of cystathionine. A limited double deamination has also been observed. In the absence of catalase, S-(carboxymethyl)homocysteine and S-(beta-carboxyethyl)cysteine have been identified together with ninhydrin-unreactive compounds yielding the above mentioned carboxy compounds upon hydrolysis with HCl. Authentic samples of the monoamino monoketo analogs of cystathionine have been prepared and compared with the enzymatic products. Cyclization of the synthetic products into the ketimine ring is pH-dependent as established by UV spectrum and other assays. Compounds derived from either the oxidation or the reduction of the ketimine have been prepared. It was found that many products of enzymatic and chemical changes of cystathionine and its ketimine described in the present paper are identical with those identified in the urine of cystathioninuric patients. This result indicates the occurrence in humans of secondary metabolic routes of cystathionine centered on the production of cystathionine ketimine, in equilibrium with the open form, which in cystathioninurics is revealed by the lack of cystathionase.

L-lanthionine oxidation by snake venom L-amino acid oxidase.

L-Lanthionine is oxidized by snake venom L-amino acid oxidase with the release of one mole of ammonia per mole of lanthionine. Spectrophotometric, chromatographic, and analytical properties are all consistent with the identification of the mono-keto derivative of lanthionine as the first enzymatic product of the reaction. This then cyclizes into a dihydrothiazine dicarboxylic acid which is further subject to spontaneous changes. Authentic samples of the thiazine derivative have been prepared by interacting L-cysteine with bromopyruvic acid. The properties of the synthetic product are described and compared with those exhibited by the enzymatic product.