P260Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiography.

BACKGROUND: Strenuous and chronic exercise training can have detrimental effects on cardiac morphology and function. Our aim was to evaluate the cardiac adaptation between 2 different specialties' endurance athletes: marathon runners (M) and ultra-trailers (UT). METHODS: 47 M (age 45±7, men 32; training: 18 (9-53) years*days/week), 41 UT (age 42±9, men 38, training: 30 (15-66) years*days/week) were submitted in rest condition to conventional 2D echocardiography and Speckle-Tracking echo (STE) (Beyond Diogenes 2.0, AMID) during agonistic season and compared with 15 age matched sedentary individuals (S) (age 43±6, men 10). RESULTS: Left ventricle (LV) global longitudinal strain (GLS) and global radial strain (GRS) were increased in M and UT compared to S (see table) without differences in LV anatomy and function. Right ventricle (RV) end-diastolic area (p=0.026), fractional area changing (p=0.008) and RV GLS were increased in UT compared to M. Moreover UT showed larger right atrium (RA) volume compared to M (p=0.03) and S (p=0.003). RA GLS was reduced in UT compared to M while the RA Global Circumferential Strain was significantly increased in UT. After adjusted for age, sex and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M; while when compared to S subjects, UT showed increased RA volume (OR 1.048; CI 1.002-1.096) and RV GLS (OR 0.667; CI 0.490-0.907). CONCLUSION: UT showed higher RV and RA morphological and functional remodeling in comparison with M. 2D-STE is a useful tool to investigate the deformation dynamic in different sport specialties. Further studies will be necessary to clarify the long-term consequences for cardiac health due to myocardial perturbations.MUTSpLV GLS-28.59±3.43*-27.64±4.18*-24.82±4.53<0.05LV GRS69.85±8.94*66.59±11.19*56.27±16.25<0.001RV GLS-25.60±10.54-30.41±4.38*-27.10±4.64<0.05RA GLS37.15±13.4931.65±9.60*35.37±9.99<0.05RA GCS17.46±6.4222.28±8.97*23.37±6.47<0.01.

Onabotulinumtoxin A for prophylaxis in chronic migraine: preliminary data from Headache Regional Centre of Aosta Valley.

Chronic migraine (CM) is a complex neurological disorder associated with substantial disability that affects approximately 2 % of general population. Onabotulinumtoxin A is employed for patients suffering from CM refractory to common therapeutic prophylaxis. Since May 2013, we have selected 22 patients referring to our headache centre with a history of CM which meets the diagnostic criteria of ICHD-3 beta (2013). The patients have been treated with onabotulinumtoxin A injection in 31 sites according to the protocol of the PREEMPT study at the total dosage of 155 U/treatment every 3 months. So far, eight patients have been subjected to three treatment sessions, five patients to two treatments and nine patients to one treatment. Three patients dropped for low compliance, but there were no serious adverse events. The frequency of headache days, the intensity of headache and the headache disability have been measured using headache diary, migraine disability assessment (MIDAS) questionnaire and headache impact test (HIT)-6 score. Data concerning the 13 patients who have been submitted to at least two treatment sessions have already shown a decrease of headache days of 20.64 % after the first treatment; MIDAS and HIT-6 scores have been significantly improved with a reduction of the scores, respectively, of 38.45 % for MIDAS and of 6.95 % for HIT-6. These are preliminary results because the observation time, the number of treatment sessions and the number of patients treated are still few.

[Work at high altitudes: risk factors and health surveillance]. / Il lavoro in alta quota: fattori di rischio e sorveglianza sanitaria.

Work at high altitude (elevation equal to or greater than 3000 m above sea level) results in a physiological adaptation of the human organism to changing environmental conditions. The main problem related to the altitude is represented by the reduction of partial pressure of oxygen (hypoxia). Our study takes into consideration occupational risk factors: those related to physical environment of high altitude; those related to the worker; those related to the characteristics of the job. It is finally addressed the decision making process related to the formulation of the judgment of suitability for performance of work activities at high altitude. The health protocol proposed requires an accurate anamnestic investigation aimed at gathering information on pre-existing pathophysiological conditions that need, once identified, clinical and instrumental tests specific and targeted. These clinical protocols are analyzed and proposed for the main pathophysiologic conditions that pose a risk to health at high altitude.

Is there a prognostic role for C-reactive protein in ischemic stroke?

OBJECTIVES: We investigated the relationship between C-reactive protein (CRP)-values in the acute phase of stroke and the risk of further fatal and non-fatal ischemic events. MATERIALS AND METHODS: We analysed 462 consecutive incident ischemic strokes. Patients were divided into two subgroups on the basis of a CRP cut-off level of 9 mg/l. Primary end points were any new vascular fatal and non-fatal event recorded during the follow-up period. RESULTS: During a follow-up of 2.27 years, in 132 patients occurred a primary end point. Patients with CRP values > or = 9 mg/l had more frequently primary end point. The hazard ratio (HR) for cardiovascular events was 3.59; 1.93 for cerebrovascular events; 7.43 for vascular deaths and 5.78 for death from any cause. Cox proportional hazard multivariate analysis identified CRP values > or = 9 (HR = 4.19, 95% CI: 1.85-9.50, P = 0.001), the lack of secondary prevention therapy at discharge (HR = 4.35, 95% CI: 1.87-10.1, P = 0.001), age >70 years (HR = 3.09, 95% CI: 1.04-9.24, P = 0.04) as independent predictors of fatal events. CONCLUSIONS: CRP levels > or = 9 mg/l, evaluated in incident ischemic stroke within 24 h, predict a higher risk of further ischemic events and mortality.

A possible case of unruptured middle cerebral artery aneurysm presenting as epileptic seizures.

We report the case of a 73-year-old man with an unruptured aneurysm of the left middle cerebral artery. The initial sign was complex partial seizures. A standard scalp electroencephalogram was normal while neuropsychological tests revealed a slight deficit of episodic memory. Brain MRI showed an aneurysm at the left middle cerebral artery bifurcation. Cerebral angiography confirmed the presence of a saccular aneurysm at the left middle cerebral artery bifurcation, with a maximum diameter of 12 mm. This case had two main characteristic features: seizures had a quite late onset and were the only symptom the patient experienced.

Activated lymphocytes in glioblastoma: significance for anti-tumoral immunity.

Interaction between immune cells and tumoral cells of a case of glioblastoma was studied. Tissue fragments obtained during neurosurgery from different areas of the tumor were examined before and after rIL-2 treatment in vitro. The same morphofunctional type of cells usually activated by rIL-2, which show antitumoral reactivity, was observed both in the glioblastoma imprints and in tumoral fragments cultured with rIL-2. This cytokine stimulated the proliferation of tumor infiltrating lymphocytes in vitro. This preliminary study shows that IL-2 potentiates the differentiation of HMS cells in peripheral blood which probably pass through the blood brain barrier and infiltrate the tumor.

[Acute puerperal uterine inversion: a report of 3 cases and an analysis of 358 cases in the literature]. / L'inversione uterina puerperale acuta: presentazione di 3 casi ed analisi di 358 casi della letteratura.

Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a "glove-finger" introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. The research carried out in the archives of the Department Obstetrics and Gynaecology of the University of Rome "La Sapienza" has showed, for the 20 years 1968-1988, 3 cases of uterine inversion out of a total of 69,677 childbirths. The uterine inversion was immediately diagnosed and in all the 3 cases a method of replacement by central taxis was practiced. In 2 cases, despite the packed tamponade, there was a recidivist or persistent uterine inversion of 1 degree, and in both cases a surgical reduction by laparatomy was practiced. In 1 of the 2 cases a hysterectomy was needed because of the persisting metratonia and metrorrhagia. The III case was treated with a manual replacement, a uterus massage from outside keeping the organ, with fist inside the cavity, in forced anteflexion in order to reach a good contractile activity. In 2 of the 3 cases the placental stage was operative, manual in 1 case and with fundal pressure applied abdominally in the other. We have found and analysed, in the international literature, 358 cases described from 1939 to 1989. The homogeneous data have been grouped in 21 tables for an easier visualization. Frequency varies from 1 out of 1,200 childbirths to 1 out of 57,393 childbirths. The medium value has been 1 out of 5,903 in the period from 1939 to 1989. The most significant data emerging from the analysis of the 358 cases of uterine inversion concern the placental stage. This was spontaneous in a number of cases equivalent to 28.9%; the number of fundal pressure applied abdominally was up to 30.9%; tractions over funicle up to 22.3%; manual delivery of the placenta up to 17.9%. Eighty-nine percent of cases were diagnosed by simple inspection, whilst for the resting ones an exploration was needed. For most of the cases the treatment was immediate (77%) especially by means of manual reduction vaginally (88%). Hysterectomy was needed for 14 cases that is up to 4.24%.(ABSTRACT TRUNCATED AT 400 WORDS)

Myelin basic protein purification in non denaturing conditions.

The utilization of denaturing methods for protein purification causes the irreversible loss of quaternary and tertiary structure together with consistent changes in the secondary structure. These modifications reflect on protein antigenicity. MBP is a myelin protein which is bound to membrane-phospholipids. Its tertiary structure is specific for this kind of interaction which determines its native conformation. MBP was obtained in two forms: denatured and non denatured. The latter has been purified using the non-ionic detergent beta-octil-D-glucopyranoside which is able to preserve protein tertiary structure separating it from the bilayer phospholipids. Non denaturated MBP could be useful in antibody and/or lymphocyte activity detection studies in various human pathological processes.

Plasma and semen androgens in normospermic and dysspermic subjects.

The seminal and plasmatic concentrations have been examined of testosterone, 5 alpha-dihydrotestosterone, and delta 4-androstenedione in normospermic and dysspermic subjects. The results obtained did not provide evidence of significant differences of androgen levels in fertile, hypofertile and sterile men.