One-year efficacy of a lifestyle behavioural intervention on physical and mental health in people with severe mental disorders: results from a randomized controlled trial.

This multicentric randomized controlled trial (RCT), carried out in six Italian University mental health sites, aims to test the efficacy of a six-month psychosocial intervention (LYFESTYLE) on Body Mass Index (BMI), body weight, waist circumference, fasting glucose, triglycerides, cholesterol, Framingham and HOmeostasis Model Assessment of insulin resistance (HOMA-IR) indexes in patients with schizophrenia, bipolar disorder, and major depression. Moreover, the efficacy of the intervention has also been tested on several other physical and mental health domains. Patients were randomly allocated to receive the six-month experimental intervention (LIFESTYLE) or a behavioural control intervention. All enrolled patients were assessed at baseline and after one year. We recruited 401 patients (206 in the experimental and 195 in the control group) with a diagnosis of schizophrenia or other psychotic disorder (29.9%), bipolar disorder (43.3%), or major depression (26.9%). At one year, patients receiving the experimental intervention reported an improvement in body mass index, body weight, waist circumference, HOMA-IR index, anxiety and depressive symptoms and in quality of life. Our findings confirm the efficacy of the LIFESTYLE intervention in improving physical and mental health-related outcomes in patients with severe mental illnesses after one year.

Tracheocutaneous fistula in patients undergoing supracricoid partial laryngectomy: the role of chronic aspiration.

The aim of the present retrospective controlled study was to analyse and compare risk factors for tracheocutaneous fistula in patients who received tracheostomy after supracricoid partial laryngectomy with those who received tracheostomy for other causes. We enrolled 39 patients with tracheocutaneous fistulas who were divided into two groups. The first received temporary tracheostomy for supracricoid partial laryngectomies (n = 21), while the control group consisted of patients who received temporary tracheostomy for other causes (n = 18). Risk factors believed to play a role in the pathogenesis of tracheocutaneous fistula were examined including advanced age, cardiopathy, local infections, radiotherapy, elevated body mass index, malnutrition, decannulation time and aspiration grade. The Leipzig and Pearson scale score was significantly higher in the supracricoid partial laryngectomy group (p = 0.006 and 0.031 for univariate and multivariate analyses, respectively). The penetration/aspiration scale score was significantly higher in the supracricoid partial laryngectomy group as determined by univariate analysis (p = 0.014). The decannulation time was significantly lower in the supracricoid partial laryngectomy group (p = 0.004 and 0.0004 for univariate and multivariate analyses, respectively). The number of surgical closures for tracheocutaneous fistula was significantly higher in the supracricoid partial laryngectomy group by univariate analysis (p = 0.027). These results suggest that chronic aspiration and related cough may be important pathogenic factors for tracheocutaneous fistula and could be responsible for the significantly higher rates of closure failure in patients after supracricoid partial laryngectomy.

Transit time of swallowing after subtotal laryngectomy.

INTRODUCTION: The aim of subtotal laryngeal surgery (Cricohyoidopexy = CHP and Cricohyoidoepiglottopexy = CHEP) is to create a simplified but functional neolarynx. The neolarynx permits the passage of air, the closure of the airway, and ensures phonation through the vibration of the cricoid and arytenoid mucosa; furthermore, it allows the recovery of swallowing, optimizing the closure of the neoglottis with the movement of the remaining arytenoids. The aim of the present study was to evaluate, on a long-term basis, the efficiency of the swallowing function comparing swallowing times in CHEP and CHP with and without functional neck dissection (FND). MATERIALS AND METHODS: A radiological study was conducted on 48 patients selected from a group of 253, who underwent subtotal laryngectomies at the "G. Ferreri" Department of Otorhinolaryngology, Audiology and Phoniatrics of the University of Rome "La Sapienza". The selection of the 48 patients was carried out based on the following criteria: type of surgery, date of surgery (follow up of at least 12 months), patients who were not treated with radiotherapy before or after surgery, patients who were also examined with fibrolaryngoscopy and videofluoroscopy, patients not affected by motor deficits involving phonatory and swallowing regions (stroke, lesions of the central nervous system), negative follow up (no evidence of disease). The parameters for evaluating the functional recovery were the times the nasogastric tube and tracheotomy tube were kept in place. The functional recovery times of the groups thus formed were compared to one another Through videofluoroscopy the authors evaluated oral transit times (OTT) and pharyngeal transit times (PTT) as parameters of deglutition. RESULTS: The results consistently showed that swallowing time remains under one second as in individuals with normal swallowing functions. CONCLUSION: The study of deglutition times, conducted at least 12 months after surgery, does not show any substantial differences between CHEP and CHP with reference to pharyngeal transit and oral transit times.

Dysphagia in multiple sclerosis - prevalence and prognostic factors.

The aim of the study was to analyse swallowing function and to identify reliable prognostic factors associated with dysphagia in a consecutive series of patients with multiple sclerosis (MS). Swallowing examination was performed by means of indirect and direct methods (fiberendoscopic evaluation) in 143 consecutive patients with primary and secondary progressive MS. Dysphagia was found in 49 patients (34.3%). A close relationship with dysphagia was found in the patients with severe brainstem impairment (OR=3.24; 95% CI 1.44-7.31) as compared to the patients without. There was also a significant correlation with pronounced severity of illness (OR=2.99; CI 1.36-6.59). Compensatory strategies were sufficient to resolve the dysphagia in 46 cases (93.8%). The potential risk of aspiration and malnutrition and the high efficacy of swallowing rehabilitation suggests that all MS patients should have a careful evaluation of deglutition functionality, especially those with brainstem impairment and a high grade of disability level.

Understanding the structural properties of a homologous series of bis-diphenylphosphine oxides

A homologous series of bis-diphenylphosphine oxides (C6H5)2PO(CH2)(n)PO(C6H5)2 (with n = 2-8; denoted 2-8] have been investigated to explore the effects of a range of competing and cooperative intermolecular and intramolecular interactions on the structural properties in the solid state. The important factors influencing the structural properties include intramolecular aspects such as the conformation of the aliphatic chain and the intramolecular interaction between the two P=O dipoles in the molecule, and intermolecular aspects such as long-range electrostatic interactions (dominated by the arrangement of the P=O dipoles), C-H...O interactions, C-H...pi interactions and pi...pi interactions. Compounds 3 and 5 could be crystallized only as solvate co-crystals (3 water and 5 x (toluene)2], whereas the crystal structures of all the other compounds contain only the bis-diphenylphosphine oxide molecule. The crystal structures have been determined from single-crystal X-ray diffraction data, with the exception of 7 (which has been determined here from powder X-ray diffraction data) and 4 (which was known previously). The compounds with even n represent a systematic structural series, exhibiting characteristic, essentially linear P=O...P=O...P=O dipolar arrays, together with C-H...O and C-H...pi interactions. For the compounds with odd n, on the other hand, uniform structural behaviour is not observed across the series, although certain aspects of these crystal structures contribute in a general sense to our understanding of the structural properties of bis-diphenylphosphine oxides. Importantly, for the compounds with odd n, there is "frustration" with regard to the molecular conformation, as the preferred all-anti conformation of the aliphatic chain gives rise to an unfavourable parallel alignment of the two P=O dipoles within the molecule. Clearly the importance of avoiding a parallel alignment of the P=O dipoles becomes greater as n decreases. Local structural aspects (investigated by high-resolution solid-state 31P NMR spectroscopy) and thermal properties of the bis-diphenylphosphine oxide materials are also reported.

Using polarization effects to alter chemical reactivity: A simple host which enhances amine nucleophilicity

The rational design of a bis(phosphine oxide) host which is capable of binding a benzylic amine is presented. The ability of this host to increase the rate of addition of 4-fluorobenzylamine to N-phenylmaleimide is rationalized in terms of the enhancement of the nucleophilicity of the benzylic amine.

Functional results of sub-total laryngectomy.

Sub-total laryngectomy (crico-hyoido-pexy and crico-hyoido-epiglotto-pexi), while achieving a radical oncological control results in a functional neolarynx efficacious in swallowing as well as in phonatory activities. 102 out of the 122 patients, treated with sub-total laryngectomy, underwent functional evaluations: the results appear to be extremely variable within each group. A better performance in crico-hyoido-epiglotto-pexi (CHEP) rather than in crico-hyoido-pexi (CHP) has been observed in these patients. However, a good life quality and social rehabilitation was assured to patients in both cases.

[Functional recovery in subtotal laryngectomies]. / Il recupero funzionale nelle laringectomie subtotali.

Subtotal laryngectomy, a valid treatment for carefully selected patients, is a safe oncologic procedure which preserves the cricoid-arytenoid unit creating a successful "neo-larynx" with valid phonatory and deglutition functions. At the E.N.T. Clinic of "La Sapienza" University of Rome from Jan. 1984 to Feb. 1992, 85 subjects underwent subtotal laryngectomy, 50 of which then underwent phoniatric examination. The remaining patients were not suitable candidates because of the trachealis cannula (14), or because they were lost at follow up (16). A total of 50 male subjects were examined. Twenty-eight underwent crico-hyoid-pexia, while 22 patients underwent crico-hyoid-epiglotto-pexia. Attention is drawn to the results which appear to be extremely variable with regard to each study group. We obtained better results with crico-hyoid-epiglotto-pexia than with crico-hyoid-pexia and we guaranteed a good social re-insertion in all cases.

[Latero-cervical adenopathies due to occult tumors: clinical experience and considerations on the therapeutic treatment]. / Le adenopatie latero-cervicali da tumore occulto: esperienza clinica e considerazioni sul trattamento terapeutico.

The treatment of patients with occult primary tumors presenting cervical metastases is still controversial. Thus the treatment of 10 patients with cervical metastases from unknown primary sites observed from 1978 to 1987 is reviewed. The average age of these patients was 56 years with a male: female ratio of 9:1. Any patients previously treated for cephalic or extracephalic neoplasms were excluded from the study as were those with lymphomas. According to TNM classification (1978) 7 cases (70%) were N1, one (10%) was N2 and two (20%) were N3. Only in one case were the cervical metastases multiple and unilateral, in one case (N2) they were bilateral. Histopathological diagnosis was performed with open biopsy in all cases prior to radical or conservative neck dissection. Five patients (50%) had metastases from epidermoid carcinoma, two (20%) from undifferentiated carcinoma (non nasopharyngeal), one (10%) from a papillary thyroid carcinoma, one (10%) from undifferentiated nasopharyngeal carcinoma and one (10%) from adenocarcinoma. The neck locations of the metastases were as follows: 3 (30%) at the upper cervical nodes (as was the N2 case), 3 (30%) at the mid-jugular nodes, 1 (10%) at the lower cervical nodes, 1 (10%) at the supra-clavicular nodes and 1 (10%) at the jugulo-digastric node. In the only case of multiple and unilateral nodes (10%) a contemporary involvement of the mid-jugular and lower cervical nodes was observed. A complete history was taken and a general physical and E.N.T. examination, X-ray, radioisotope and endoscopic studies were performed for all patients. In all cases treatment was: surgery on N + radiation therapy on the most common sites of unknown primary tumors. In particular, 7 conservative neck dissections (bilateral in one case), 2 radical neck dissections and 1 modified radical neck dissection were performed. The survival rate was 60% at 3 years and 40% at 5 years; it may be due to the radical treatment and to the high number of N1 and epidermoid carcinomas. In conclusion some considerations about the treatment of this pathology were reported.

Renal alpha-adrenoceptors and sodium excretion in the dog.

The purpose of this study was to characterize the age-dependent role of alpha-adrenergic activity on renal vascular resistance (RVR) and renal blood flow (RBF) and the role of alpha 2-receptors in sodium transport. Intrarenal infusion of phentolamine in hydropenic anesthetized pups and adult dogs increased RBF and glomerular filtration rate (GFR) only in pups. The effect was most marked in the youngest pups (15.67 +/- 0.67 days). At 1.0 micrograms X kg-1 X min-1, phentolamine increased RBF from 1.38 +/- 0.04 to 1.64 +/- 0.04 ml X min-1 X g kidney wt-1 and GFR from 0.19 +/- 0.01 to 0.23 +/- 0.01 ml X min-1 X g kidney wt-1. Absolute (UNaV) and fractional (FENa) sodium excretions increased in all animals, but mean percent increases were greatest in adult dogs. Intrarenal yohimbine infusion in adult dogs (10-100 micrograms X kg-1 X min-1) produced a dose-related increase in UNaV and FENa without affecting RBF and GFR. UNaV increased from 0.22 +/- 0.05 to 0.54 +/- 0.12 mueq X min-1 X g kidney wt-1 and FENa increased from 0.32 +/- 0.05 to 0.63 +/- 0.06% at the dose of 100 micrograms X kg-1 X min-1. These studies confirm a modest role for alpha-adrenoreceptors in the high RVR characteristic of newborn pups and provide evidence for a role of alpha 2-adrenoceptors in the renal transport of sodium; the extent of the contribution of renal alpha-adrenergic system could not be tested in this experiment.

Dopamine receptors in the proximal tubule of the rabbit.

Our laboratory has characterized dopamine receptors in glomeruli and tubular homogenates. Since the heterogeneity of kidney homogenates limits the interpretation of these studies, the [3H]haloperidol binding site and adenylate cyclase sensitivity to dopamine were studied in the isolated proximal convoluted tubule and pars recta of the rabbit kidney. [3H]Haloperidol binding sites were saturable, stereoselective, and of high affinity. The apparent dissociation constant was 31.5 X 10(-9) M (+/- 8.5) and the maximum receptor density was 0.31 X 10(-15) M (+/- 0.08) per millimeter. In pars recta specific binding was 53% of total [3H]-haloperidol binding. Dopamine stimulated adenylate cyclase activity in a dose-related manner, which was inhibited by cis-flupenthixol but not by trans-flupenthixol or (-)-propranolol. Moreover, the stimulatory effect of the dopamine 1 (D1) agonist SKF 82526 on adenylate cyclase activity was blocked by the D1 antagonist SCH 23390. Dopamine receptors in the proximal convoluted tubule appear to be of the D1 subtype since they are linked to stimulation of adenylate cyclase. This is further substantiated by the stereoselectivity for (+)-sulpiride (a D1 antagonist), which had a greater affinity for the [3H]haloperidol binding site than (-)-sulpiride (a D2 antagonist).

Autoantibodies in minimal change nephrotic syndrome.

The presence of low level antibody (AAb) activity and circulating immune complexes (CIC) were studied in 17 patients with minimal change nephrotic syndrome (MCNS). Study groups include 12 MCNS without mesangial deposits (Group I) and 5 MCNS with mesangial deposits (Group II). In Group I reactivity against normal tissue antigens was demonstrated (kidney tubular microsomal antigen - 8, smooth muscle - 5, gastric cell - 5). In Group II reactivity against kidney basement membrane was demonstrated in all five patients. CIC were detected in eight (Group I - 6, Group II - 2). Dissociation of the CIC showed that they all contained antibodies with a corresponding autoantibody activity which could be removed by prior incubation with their complexed antigen. The presence of these AAb's and their formation of CIC may indicate their role in initiating a primary immunological insult to the kidney.

Gold-associated nephropathy.

Renal biopsy specimens from 11 cases of gold-associated nephropathy were studied by light, immunofluorescence, and electron microscopy. Seven biopsy specimens disclosed the typical glomerular lesions of membranous nephropathy. Four cases disclosed other patterns of glomerular injury, including minimal-change nephrotic syndrome. Although a membranous pattern of immune complex deposition is the most frequent type seen in gold nephropathy, our data indicate that other patterns of immune complex deposition may occur in renal biopsy specimens of patients receiving gold therapy.

The influence of age on acute renal toxicity of uranyl nitrate in the dog.

The influence of age upon uranyl nitrate (UN) induced acute renal failure (ARF) was evaluated in 30 canine puppies 1-2 wk and 3-5 wk old. Renal function and morphologic studies were performed 2 h (initiation phase) and 24 h (maintenance phase) after UN administration. Age-matched controls received vehicle alone. Administration of UN to 1-2-wk-old puppies produced no changes in whole kidney glomerular filtration rate (GFR), despite a significant reduction in renal plasma flow (RPF) (P less than 0.01). In contrast, during the maintenance phase, GFR was 60% lower than in the control group (P less than 0.02) whereas values for RPF were nearly identical to control values. In 3-5-wk-old puppies the magnitude of response to the heavy metal was much greater and GFR was nearly completely suppressed during the maintenance phase. This major alteration of GFR was independent of changes in RPF, because RPF remained similar to control values. Morphologic alterations consistent with the nephrotoxic effects of UN were observed in the proximal tubules of the most differentiated nephrons. These age-related morphologic alterations correlated well with the functional response (GFR) observed after UN administration, i.e., a proportionately greater degree of both morphologic and functional alterations followed the administration of the heavy metal in the oldest group of puppies.

Competition between two microbial populations in a nonmixed environment: effect of cell random motility.

In a nonmixed environment, bacterial population growth can be influenced significantly by cell motility properties as well as by growth kinetic properties. Therefore, in a situation of competition between two bacterial populations for a single chemical nutrient in a nonmixed environment, the outcome may depend upon the respective cell motility properties. In this article, the authors have presented a simple mathematical model for competitive growth of two randomly motile (i.e., possessing no chemotactic behavior) populations in a finite nonmixed region. An understanding of the behavior of this model should provide insight into the behavior of a number of common microbial competition problems. Analysis of this model yields the following results: (1) There may be as many as three possible non-trivial steady-state (or long-time) configurations: when species 1 survives, species 2 dies out; when species 2 survives, species 1 dies out; and species 1 and species 2 coexist. (2) The coexistence state can exist even though one species possesses a smaller intrinsic growth rate constant at all nutrient concentrations, if that same species is sufficiently less motile than the other species. (3) In fact, the species with the smaller maximum specific growth rate may grow to a larger population than the other. (4) The possibility of coexistence can be decided essentially from the results for single population growth.

Alpha-adrenoceptors in the developing kidney.

The maturation of renal alpha-adrenoceptors was investigated in dogs. Alpha-adrenoceptors were characterized by radioligand binding using the alpha-1-adrenergic antagonist, [3H]-WB-4101. In renal plasma membranes obtained from the outer cortex of neonates, the binding of the ligand was rapid, reversible, of high affinity, saturable, and stereoselective. The competition studies with adrenergic agonists and antagonists were indicative of alpha-receptors. In puppies less than 1-w-old, the binding affinity of [3H]-WB-4101 (Kd = 0.638 +/- 0.17 nM) was greater than 3-5 week-old puppies (Kd 1.573 +/- 0.315 nm); (P less than 0.05), but receptor number was similar (63.75 +/- 19.1 versus 79.10 +/- 5.99 fmole/mg protein). No consistent specific binding could be demonstrated in plasma membranes obtained from inner cortex of medulla. In the adult dog, no consistent specific binding could be demonstrated for plasma membranes obtained from any region of the kidney. These studies indicate that during maturation there is a decrease in alpha-adrenoceptor density and affinity in membranes from the outer cortex of the kidney.

Ontogeny of myocardial adrenoceptors II. Alpha adrenoceptors.

The maturation of myocardial alpha adrenoceptors was investigated in dogs. Alpha adrenoceptors were characterized by radioligand binding using [3H]-WB4101. In neonatal cardiac membranes, the binding of the ligand was rapid, reversible, of high affinity, saturable and stereoselective. The competition studies with adrenergic agonists and antagonists were indicative of alpha adrenoceptors. In adult dog cardiac membranes, consistent specific binding of the ligand could be demonstrated. These studies indicate that there is a decrease in alpha adrenergic receptor density of canine cardiac membranes during maturation.

The glomerular basement membrane in benign familial hematuria.

A total of nineteen children were studied because of asymptomatic hematuria. all had normal renal function, and immunologic and urologic studies. Renal tissue was obtained by percutaneous biopsy and examined by light, immunofluorescence and electron microscopy. On electron microscopy, thickness of the glomerular basement membrane (BGM) was found to distinguish benign familial hematuria (BFH - 10 cases) from non familial idiopathic recurrent hematuria (IRH - 9 cases). Measurements were taken in areas of peripheral glomerular capillary loops (minimum of five) where both cell membranes could be resolved to insure tht determinations were uniform and represented ideal cross sections. The mean thickness +/- SE of GBM in IRH of 303.3 +/- 16.9 nM was greater than that noted in BFH of 207.1 +/- 11.99 nM (P less than .002). The mean thickness +/- SE of the lamina densa in IRH of 236 +/- 15.36 nM was significantly greater than that observed in BFH of 128.5 +/- 11.7 nM (P less than .001). In both BFH and IRH the GBM and LD were uniform in thickness (CV = 20%) and qualitatively normal. The uniform attenuation observed in BFH can be used to distinguish this condition from IRH.