Screening of frailty in elderly patients with disability by the means of Marigliano-Cacciafesta polypathology scale (MCPS) and Canadian Study of Health and Aging (CSHA) scales.

Frailty is an age-related condition, characterized by a decreased homeostatic reserve and increased vulnerability to stressful events, with high risk of adverse outcomes. The aim of this study was to compare the evaluation of the frailty by the means of the MCPS and the Rockwood criteria. We enrolled 98 patients (mean age ± standard deviation, m ± SD, 80.7 ± 7.0 years) and 20 controls (82.7 ± 3.4 ys), who attended our outpatient clinic for the evaluation of disability and the renewal of driving license, respectively. The multidisciplinary geriatric assessment (MGA) was performed including the administration of the following scales for frailty: MCPS scale (range 0-245), CSHA-Rules-Based Definition of Frailty (CSHA-RBDF) (range 0-3) and CSHA-Clinical Frailty Scale (CSHA-CFS) (range 0-7). The patients and controls showed MCPS=52.39 ± 11.36 and 4.6 ± 3.28, CSHA-RBDF=2.27 ± 0.62 and 0.10 ± 0.44, CSHA-CFS=6.22 ± 0.75 and 2.95 ± 0.51, respectively (p<0.000001). Frailty scores were higher in female than in male (p=0.065 for CSHA-RDBF and p<0.05 for CSHA-CFS). The MCPS scores were significantly related to both CSHA-RDBF (r=0.753, p<0.001) and CSHA-CFS scores (r=0.793, p<0.001). The frailty scales were significantly related to disability, cognitive impairment and polypathology. In conclusion, the frail patient may be a carrier of multiple chronic pathologies and/or of physical/cognitive decline. The frail patient has to be considered the elective geriatric patient, characterized by a continuous multidimensional care requirement. MCPS is an useful tool for the frailty screening and to set up a tailored program of geriatric rehabilitation, in order to prevent or reduce the development of frailty-related complications.

The evaluation of the presence of comorbidity by the Marigliano-Cacciafesta polypathology scale (MCPS) and the cumulative illness rating scale (CIRS) in elderly subjects with disability.

Multiple factors associated with the frailty syndrome may be involved in the appearance of disability, including the presence of comorbidity. The CIRS is commonly used for the evaluation of comorbidity, consisting of two parts: the comorbidity index (CI) and the severity index (SI). A multidimensional scale, the MCPS, has been recently developed, predicting the risk to develop disability. Fifty-nine subjects were examined by a structured multidimensional geriatric assessment. The MCPS and CIRS was significantly correlated (r=0.410; p<0.01 with the CI; and r=0.443, p<0.001 with the SI). The patients were divided in two groups, according to the MCPS score. The mean activities of daily living (ADL) and instrumental activities of daily living (IADL), as well as the corrected mini-mental state examination (MMSE) score (+/-S.E.M.) were: 3.19+/-0.26; 0.28+/-0.04 and 24.00+/-1.14 in moderate-severe polypathology (n=21); 2.16+/-0.22; 0.13+/-0.02 and 21.23+/-0.72 in severe polypathology (n=38) (p<0.001, p<0.01 and p<0.05), respectively. The MCPS score was correlated with the main indices of disability. In conclusion, we found that the MCPS is a useful tool in order to quantify and classify the presence of comorbidity, with results significantly related to that obtained with the CIRS. The MCPS offers an important stratification of the patients on the base of a well-established classification, not supplied by the CIRS.

Effect of pure bovine brain-derived gangliosides on normal human B cell proliferation in vitro.

Pure gangliosides obtained from bovine brain including GM1, GD1b, GT1b and asialo-GM1 (GA1) did not induce normal human B cell proliferation in vitro. No B cell proliferation was observed either when GM1 was tested in the presence of interleukin-2 (IL-2), IL-4 or IL-6. Furthermore, the proliferative responses of human B cells induced by Staphylococcus aureus Cowan I (SAC), a T cell-independent B cell mitogen, were inhibited by these gangliosides. The degree of inhibition was influenced by ganglioside-bound sialic acid, although sialic acid per se was not inhibitory. Strongest inhibition was observed in the presence of GT1b (EC50 8.8 microM/10(5) B cells) and lowest in the presence of GA1 (EC50 129.5 microM/10(5) B cells) with intermediate values for GM1 and GD1b. GM1 inhibition of SAC-induced B cell proliferation did not represent cytotoxic effects and was still evident when GM1 was added 24-48 h after the beginning of the cultures. GM1 inhibition of SAC-induced proliferation was not reversed by the addition of IL-2, IL-4, IL-6 or their combination. In addition, GM1 inhibited the ILs-driven proliferative responses of SAC-induced B cell blasts. However, no inhibition of Epstein-Barr virus-induced B cell proliferative responses was observed. In conclusion, these results show that bovine brain-derived gangliosides do not induce proliferative responses of normal human B cells but, on the contrary, inhibit B cell responses induced by SAC.

A mechanism of T cell regulation of Epstein-Barr virus latency.

The tumorigenic potential of B lymphocytes latently infected with EBV is effectively controlled by T cell immunity. The mechanisms of this T cell regulation, however, are incompletely understood. In this study, T lymphocytes were found to proliferate in response to serum-free supernatants of EBV-immortalized cells and to deplete them of growth factors required by the immortalized B cells for autocrine growth. Lactic acid was reported to account for approximately 90% of the autocrine growth factor activity in serum-free supernatants of EBV-immortalized cell lines. Synthetic lactic acid was now found to promote growth in activated T cells. In addition, B cell suppression resulting from coculture of EBV-infected B cells with autologous T cells was reversed by the addition of supernatants from EBV-immortalized cell lines. Thus, T cell competition for growth factors produced and utilized by EBV-immortalized B cells for continuous proliferation may represent an important and novel regulatory mechanism for the maintenance of EBV latency in B lymphocytes.

A two-stage culture system for the induction of antibody-forming cell clones in cultures of normal human blood lymphocytes.

A two-stage culture method is described for the induction of a specific antibody response to sheep red cells (SRC) in microcultures at limiting dilutions of human peripheral blood lymphocytes (PBL). PBL from normal donors were cultured for 4 days with antigen and EBV using well defined conditions. The cells were then distributed in 10 microliter microcultures at different cell densities in order to estimate the frequency of responding units. The culture wells were tested for the presence of anti-SRC antibody by the spot test. The results show that the expression of antibody-forming cell clones in the second stage microcultures is strictly dependent on the presence of both antigen and EBV during the first stage cultures. The efficiency of the system was improved by the addition of 4% polyethylene glycol (PEG, MW 6000) in the first stage and its removal in the second stage and by the use of human serum (instead of fetal calf) in both stages. This approach permits the separation of different cellular events, occurring when human B cells are stimulated by antigen and represents a useful approach for studying the mechanisms of the specific immune response in man.

Long term antibody production in cultures of peripheral blood lymphocytes.

Antigen stimulated cultures of rabbit and human peripheral blood lymphocytes (PBL) were maintained in active antibody synthesis for at least a month. When rabbit PBL were used, the response to a particulate antigen (SRC) was not affected by a change of medium and/or by disruption of the cell to cell contact during culture. On the other hand, the response to a soluble antigen (OA) was markedly increased by changing the medium after the onset of the response. When human PBL were used, any handling that caused disruption of cellular contacts was detrimental for continuation of the specific response. In both the rabbit and the human system the overall cell number did not increase during culture, but an enrichment in the specific cells occurred. These cultures represent a powerful tool both for studies of late events of the immune response and for the aim of establishing antibody producing cell lines.

Rhabdomyoma purum of the larynx.

A case of pure well-differentiated rhabdomyoma of the larynx occurring in a 50-year-old male is reported. The lesion was localized to the interarytenoid region. From an accurate revision of the world literature on the subject it appears that the cases so far described number only seven, including the one in the present report. Furthermore, the differential histological and histochemical criteria for distinguishing rhabdomyoma from granular cell Schwannoma are discussed and tabulated, as the two neoplasms may be easily confused. In our case, there has been no evidence of recurrence of the tumour for more than 1 year, which is in accordance with the previous cases reported in the literature.