Extra-virgin olive oil for potential prevention of Alzheimer disease.

Observational epidemiological studies provide valuable information regarding naturally occurring protective factors observed in populations with very low prevalences of vascular disease. Between 1935 and 1965, the Italian-American inhabitants of Roseto (Pennsylvania, USA) observed a traditional Italian diet and maintained half the mortality rates from myocardial infarction compared with neighboring cities. In the Seven Countries Study, during 40years (1960-2000) Crete maintained the lowest overall mortality rates and coronary heart disease fatalities, which was attributed to strict adherence to the Mediterranean diet. In the French Three-City Study, a ten-year follow-up (2000-2010) showed that higher consumption of olive oil was associated with lower risk of death, as well as protection from cognitive decline and stroke. A large number of population-based studies and intervention trials have demonstrated that the Mediterranean diet is associated with lower prevalence of vascular disease, obesity, arthritis, cancer, and age-associated cognitive decline. Many of these effects are the result of consumption of fruits, seeds, legumes and vegetables but olive oil is the chief dietary fat in Mediterranean countries and the main source of monounsaturated fatty acids, as well as an important source of beneficial polyphenols and other antioxidants. Considering the critical role of vascular factors in the pathogenesis of late-onset Alzheimer disease it seems appropriate to focus on disease modification through proven dietary therapy. The authors base their hypothesis on meta-analyses of epidemiological data, numerous experimental studies, and a comprehensive review of the mechanisms of action of extra-virgin olive oil and its components in the prevention of vascular disease. In addition, extra-virgin olive oil has had positive effects on experimental animal models of Alzheimer disease. We therefore propose that extra-virgin olive oil is a promising tool for mitigating the effects of adverse vascular factors and may be utilized for potential prevention of late-onset Alzheimer disease.

Comparison of In Vivo and Ex Vivo MRI of the Human Hippocampal Formation in the Same Subjects.

Multiple techniques for quantification of hippocampal subfields from in vivo MRI have been proposed. Linking in vivo MRI to the underlying histology can help validate and improve these techniques. High-resolution ex vivo MRI can provide an intermediate modality to map information between these very different imaging modalities. This article evaluates the ability to match information between in vivo and ex vivo MRI in the same subjects. We perform rigid and deformable registration on 10 pairs of in vivo (3 T, 0.4 × 0.4 × 2.6 mm3) and ex vivo (9.4 T, 0.2 × 0.2 × 0.2 mm3) scans, and describe differences in MRI appearance between these modalities qualitatively and quantitatively. The feasibility of using this dataset to validate in vivo segmentation is evaluated by applying an automatic hippocampal subfield segmentation technique (ASHS) to in vivo scans and comparing SRLM (stratum/radiatum/lacunosum/moleculare) surface to manual tracing on corresponding ex vivo scans (and in 2 cases, histology). Regional increases in thickness are detected in ex vivo scans adjacent to the ventricles and were not related to scanner, resolution differences, or susceptibility artefacts. Satisfactory in vivo/ex vivo registration and subvoxel accuracy of ASHS segmentation of hippocampal SRLM demonstrate the feasibility of using this dataset for validation, and potentially, improvement of in vivo segmentation methods.

Progression of alpha-synuclein pathology in multiple system atrophy of the cerebellar type.

AIMS: The aim of this study was to identify early foci of α-synuclein (α-syn pathology) accumulation, subsequent progression and neurodegeneration in multiple system atrophy of the cerebellar type (MSA-C). METHODS: We analysed 70-µm-thick sections of 10 cases with MSA-C and 24 normal controls. RESULTS: MSA-C cases with the lowest burden of pathology showed α-syn glial cytoplasmic inclusions (GCIs) in the cerebellum as well as in medullary and pontine cerebellar projections. Cerebellar pathology was highly selective and severely involved subcortical white matter, whereas deep white matter and granular layer were only mildly affected and the molecular layer was spared. Loss of Purkinje cells increased with disease duration and was associated with neuronal and axonal abnormalities. Neocortex, basal ganglia and spinal cord became consecutively involved with the increasing burden of α-syn pathology, followed by hippocampus, amygdala, and, finally, the visual cortex. GCIs were associated with myelinated axons, and the severity of GCIs correlated with demyelination. CONCLUSIONS: Our findings indicate that cerebellar subcortical white matter and cerebellar brainstem projections are likely the earliest foci of α-syn pathology in MSA-C, followed by involvement of more widespread regions of the central nervous system and neurodegeneration with disease progression.

Relationship between APOE Genotype and Structural MRI Measures throughout Adulthood in the Study of Health in Pomerania Population-Based Cohort.

BACKGROUND AND PURPOSE: The presence of the apolipoprotein E ε4 allele is the strongest sporadic Alzheimer disease genetic risk factor. We hypothesized that apolipoprotein E ε4 carriers and noncarriers may already differ in imaging patterns in midlife. We therefore sought to identify the effect of apolipoprotein E genotype on brain atrophy across almost the entire adult age span by using advanced MR imaging-based pattern analysis. MATERIALS AND METHODS: We analyzed MR imaging scans of 1472 participants from the Study of Health in Pomerania (22-90 years of age). We studied the association among age, apolipoprotein E ε4 carrier status, and brain atrophy, which was quantified by using 2 MR imaging-based indices: Spatial Pattern of Atrophy for Recognition of Brain Aging (summarizing age-related brain atrophy) and Spatial Pattern of Abnormality for Recognition of Early Alzheimer Disease (summarizing Alzheimer disease-like brain atrophy patterns), as well as the gray matter volumes in several Alzheimer disease- and apolipoprotein E-related ROIs (lateral frontal, lateral temporal, medial frontal, and hippocampus). RESULTS: No significant association was found between apolipoprotein E ε4 carrier status and the studied ROIs or the MR imaging-based indices in linear regression models adjusted for age, sex, and education, including an interaction term between apolipoprotein E and age. CONCLUSIONS: Our study indicates that measurable apolipoprotein E-related brain atrophy does not occur in early adulthood and midlife and suggests that such atrophy may only occur more proximal to the onset of clinical symptoms of dementia.

Advanced brain aging: relationship with epidemiologic and genetic risk factors, and overlap with Alzheimer disease atrophy patterns.

We systematically compared structural imaging patterns of advanced brain aging (ABA) in the general-population, herein defined as significant deviation from typical BA to those found in Alzheimer disease (AD). The hypothesis that ABA would show different patterns of structural change compared with those found in AD was tested via advanced pattern analysis methods. In particular, magnetic resonance images of 2705 participants from the Study of Health in Pomerania (aged 20-90 years) were analyzed using an index that captures aging atrophy patterns (Spatial Pattern of Atrophy for Recognition of BA (SPARE-BA)), and an index previously shown to capture atrophy patterns found in clinical AD (Spatial Patterns of Abnormality for Recognition of Early Alzheimer's Disease (SPARE-AD)). We studied the association between these indices and risk factors, including an AD polygenic risk score. Finally, we compared the ABA-associated atrophy with typical AD-like patterns. We observed that SPARE-BA had significant association with: smoking (P<0.05), anti-hypertensive (P<0.05), anti-diabetic drug use (men P<0.05, women P=0.06) and waist circumference for the male cohort (P<0.05), after adjusting for age. Subjects with ABA had spatially extensive gray matter loss in the frontal, parietal and temporal lobes (false-discovery-rate-corrected q<0.001). ABA patterns of atrophy were partially overlapping with, but notably deviating from those typically found in AD. Subjects with ABA had higher SPARE-AD values; largely due to the partial spatial overlap of associated patterns in temporal regions. The AD polygenic risk score was significantly associated with SPARE-AD but not with SPARE-BA. Our findings suggest that ABA is likely characterized by pathophysiologic mechanisms that are distinct from, or only partially overlapping with those of AD.

Mediterranean diet and cognitive function: the SUN project.

OBJECTIVE: Our aim was to evaluate the association between adherence to the Mediterranean Diet (MedDiet) and cognitive function in 823 participants (62 ± 6 years at baseline) from a Spanish prospective cohort (SUN project). METHOD: A validated 136-item food frequency questionnaire was used to assess the adherence to the MedDiet at baseline. The 10-point (0 to 9) MedDiet Score was used to categorize adherence to MedDiet. Cognitive function was assessed twice at follow-up with a mean follow-up time between exposure and outcome assessment of 6 and 8y using the Telephone Interview of Cognitive Status-modified (TICS-m, range 0 to 54 points). ANCOVA models were used to assess the association between adherence to the MedDiet and cognitive decline. RESULTS: In the multivariable-adjusted analysis of 2-year changes, a higher cognitive decline was observed among participants with low or moderate baseline adherence to the MedDiet than among those with better adherence (adjusted difference = -0.56 points in TICS-m, 95% CI = -0.99 to -0.13). CONCLUSION: A higher adherence to the MedDiet might be associated with better cognitive function. However, observed differences were of small magnitude and further studies are needed to confirm this finding.

Levedura de cana-de-açúcar spray dry na alimentação de suínos na fase de crescimento e terminação / Sugar cane spray dry yeast on growing and finishing pigs feeding

Foi estudado o valor nutricional (digestibilidade total e ileal) de duas leveduras spray dry (cana-de-açúcar - LEV35 e cerveja+cana-de-açúcar - LEV40) e o efeito da sua inclusão em rações para suínos na fase de crescimento e terminação. Os valores de ED (kcal/kg) da LEV35 e da LEV40 foram 3.496 e 3.901 e EM (kcal/kg) foram 3.475 e 3.862, respectivamente. Os valores de lisina, metionina+cistina e treonina digestível para a levedura de cana-de-açúcar e da levedura de cerveja+cana-de-açúcar são 2,66 e 2,64, 1,11 e 1,03, 1,95 e 1,92, respectivamente. No desempenho foram utilizados 40 suínos com peso inicial de 34,39± 7,57kg (crescimento) e de 62,45± 5,68kg (terminação), distribuídos em delineamento inteiramente casualizado com cinco níveis de inclusão (0, 5, 10, 15 e20%) da LEV35. Na fase de crescimento, houve piora do GDP e da CA com o aumento da inclusão. Na fase de terminação, porém, houve efeito quadrático para o CDR, sendo o melhor nível 3.32%. Da mesma forma, ocorreu piora linear para o GDP, CA, peso de carcaça quente, rendimento de carcaça fria e peso de pernil. Os resultados sugerem que a adição de níveis crescentes da LEV35 pode prejudicar o desempenho dos suínos.

The nutritional value of two spray dry yeast (sugar cane - SCYSD and brewer+sugar cane - BYSD) and their inclusion effects on growing and finishing pigs feeding was studied. The DE (kcal/kg) values for SCYSD and BYSD were 3.496 and 3.901 and for ME (kcal/kg) they were 3.475 and 3.862. The values of digestible lysine, methionine+cistine and threonine for SCYSD and BYSD were: 2.66 and 2.64%; 1.11 and 1.03%: 1.95 and 1.92%. 40 pigs with initial weight of 34.39±7.57kg (growing) and 62.45±5.68kg (finishing), allotted in a completely randomized design with five levels of SCYSD inclusion were used in the performance assay. In the growing phase, there was an impairing on DWG and F:G, however, in the finishing phase, DFI presented a quadratic effect, being 3.32% the best level and linear reduction of DWG, F:G, slaughter weight, hot carcass weight, cold carcass yield and ham weight. The results suggest that increasing levels of SCYSD may impair the performance of growing and finishing pigs.

Method of using increasing levels of substitution of the basal diet by test feedstuffs in pig digestibility trials / Metodologia de uso de níveis crescentes de substituição da ração referência pelo alimento teste em ensaios de digestibilidade com suínos

Two experiments were carried out to study the methodology of using increasing levels of substitution of the basal diet with fibrous test feedstuffs (sticky coffee hull - SCH) in digestibility trials with pigs. In Experiment 1, a digestibility trial was conducted using 30 crossbred barrows, allotted in a randomized block design. In Experiment 2, 42 growing and 42 finishing pigs were used, allotted in a completely randomized design, with six diets and seven replicates, with one animal per experimental unit. The six diets consisted of: a control diet, four diets using SCH ME values as obtained in Experiment 1 plus a diet using SCH ME value estimated by linear regression equation for 15% substitution. The digestibility study indicated that the use of increasing levels of substitution (7, 14, 21 and 28%) reduced SCH digestibility. ME values, as-fed basis, were 2,456, 2,377, 2,247 and 1,945kcal/kg. The overall results indicate that higher levels of substitution overestimate the energy value and that the method of increasing levels of substitution of the basal diet with feedstuffs test can be used to more accurately estimate the energy values of fibrous feedstuffs for pigs. For growing and finishing pigs respectively, up to 28% and 15% of sticky coffee hull can be used without impairing pig performance and economic feasibility.

Dois experimentos foram realizados para se estudar a metodologia de uso de porcentagens crescentes de substituição da ração referência pelo alimento teste fibroso (casca de café melosa - CCM), em ensaios de digestibilidade com suínos. No Experimento I, foi realizado um ensaio de digestibilidade utilizando 30 machos castrados, distribuídos em delineamento de blocos ao acaso. No Experimento II, foram utilizados 42 suínos na fase de crescimento e 42 suínos na fase de terminação, distribuídos em delineamento inteiramente ao acaso, com seis rações, sete repetições e um animal por unidade experimental. As seis rações foram: uma ração controle, quatro rações usando os valores de energia metabolizável (EM) da CCM obtidos no Experimento I e uma ração com EM da CCM estimada por equação de regressão linear para 15% de substituição. Os estudos de digestibilidade indicaram que o uso de porcentagens crescentes de substituição - 7, 14, 21 e 28% - reduziu a digestibilidade da CCM. Os valores de EM, na matéria natural, obtidos para a CCM foram 2.456, 2.377, 2.247 e 1.945kcal/kg. Os resultados indicam que porcentagens mais elevadas de substituição superestimam o valor energético e que a crescente substituição da ração referência pelo alimento teste pode ser utilizada para estimar, de forma mais precisa, os valores energéticos de alimentos fibrosos para suínos. Para suínos em crescimento e em terminação, pode-se usar, respectivamente, até 28% e 15% de casca de café melosa sem prejudicar o desempenho e a viabilidade econômica.

Avaliação nutricional de soja integral desativada e desempenho de leitões na fase de creche / Nutritional evaluation of disabled whole soybean and performance of piglets on nurse phase

Dois experimentos foram realizados para determinar o valor nutricional e verificar o desempenho de leitões dos 6 aos 15kg, alimentados com dietas que continham dois tipos de soja integral desativada, caracterizada pela presença (SC) ou não de casca (SS). No ensaio de digestibilidade total, foram utilizados 15 leitões machos, castrados, com média de peso inicial de 7,36±1,71kg, alojados em gaiolas de metabolismo. Exceto para energia bruta (EB), não foram observadas diferenças entre tratamentos nos coeficientes de digestibilidade da matéria seca, da proteína bruta, do extrato etéreo e da matéria orgânica, e no coeficiente de metabolização da EB entre as duas sojas avaliadas. Os teores de energia digestível e energia metabolizável na matéria natural para SC e SS foram: 3.979 e 4.300kcal/kg; 3.768 e 4.111kcal/kg, respectivamente. No experimento de desempenho, foram utilizados 56 leitões, desmamados aos 21 dias de idade, com média de peso inicial de 6,19±0,67kg. Neste experimento, os leitões receberam os dois tipos de soja integral desativada em três porcentagens de inclusão. Não foram observadas diferenças para as variáveis de desempenho com a inclusão da soja desativada às dietas. Concluiu-se que os tipos e as porcentagens de inclusão da soja podem ser utilizados na dieta de leitões.

Two experiments were carried out to determine the nutritional value and to verify the piglets performance from 6 to 15kg, fed diets with two types of disabled whole soybeans characterized by shell presence (CS) or not (SS). In the digestibility assay 15 castrated male piglets were used, with average weight of 7.36±1.71kg, housed in metabolism cages. Except for gross energy (EB), no differences between treatments were observed for the dry matter digestibility, crude protein, ether extract and organic matter, and for the coefficient of metabolism of EB between the two soybeans evaluated. The values of digestible energy (DE), as well the metabolizable energy (ME) on fed basis for SC and SS were: 3,979 and 4,300kcal/kg, 3,768 and 4,111kcal/kg, respectively. In the performance experiment 56 weaned piglets were used, at 21 days of age with initial body weight of 6.19±0.67kg. No differences were observed in the performance variables with the inclusion of SS and SC disabled soybeans in the diets, concluding that the studied soybeans can be used for piglet diets.

[Headache in the emergency department]. / Cefalea en urgencias.

Headache is among the most frequent neurological symptoms in the Emergency department. Although most of the patients suffer from primary headaches (migraine), an acute headache might be the only symptom of a serious disease, such as subarachnoid haemorrhage. The physician's task is to make the diagnosis, carry out an appropriate selection of the patients who require further diagnostic evaluation and relieve the pain. An accurate history will identify most of the patients with secondary headaches. Clinicians should suspect secondary causes in sudden onset headache, headache in patients aged over 50 years, and also in those patients with abnormalities on neurological examination.

Cefalea en urgencias / Headache in the emergency department

Las cefaleas son un motivo común de consulta en los servicios de urgencias. La mayoría de los pacientes presentan cefaleas primarias (migraña y cefalea tensional), pero el dolor de cabeza puede ser el síntoma de una enfermedad que comprometa la vida del individuo como la hemorragia subaracnoidea. El abordaje diagnóstico del paciente con cefalea consiste en diferenciar los pacientes con cefalea primaria de los que presentan una etiología secundaria, valorar la necesidad de solicitar exploraciones complementarias y tratar adecuadamente el dolor. La anamnesis permite diferenciar las cefaleas primarias de las secundarias en la mayoría de los casos. Existen una serie de síntomas de alarma que obligan a excluir causas secundarias. En los pacientes con cefalea de inicio súbito, cuando se inicia por encima de los 50 años o en aquellos pacientes con exploración neurológica anormal, debe sospecharse una etiología secundaria (AU)

Headache is among the most frequent neurological symptoms in the Emergency department. Although most of the patients suffer from primary headaches (migraine), an acute headache might be the only symptom of a serious disease, such as subarachnoid haemorrhage. The physician’s task is to make the diagnosis, carry out an appropriate selection of the patients who require further diagnostic evaluation and relieve the pain. An accurate history will identify most of the patients with secondary headaches. Clinicians should suspect secondary causes in sudden onset headache, headache in patients aged over 50 years, and also in those patients with abnormalities on neurological examination (AU)

[Classification of sleep disorders]. / Clasificación de los trastornos del sueño.

Sleep disorders are frequent processes, both as a symptom associated with other diseases and as independent disorders. However, only in the last 4 decades has Sleep medicine gained its position among the medical specialties. In fact, it was only in these years that significant advances were obtained in the study of the etiology and treatment of these disorders. Similarly, the different classifications have been evolving over the years. First, they were based upon the clinical symptom; later on, more emphasis was given to the diseases. Finally, in 2005, the new classification was once again based on the symptoms. More than 90 disorders are listed in this latest classification, and an attempt is made to include the symptoms and the diseases of sleep, as well as those in which sleep disorders are fundamental. It is essential to have a clear idea of this complete classification of sleep disorders in order to deal with these patients appropriately.

Clasificación de los trastornos del sueño / Classification of sleep disorders

Los trastornos del sueño son una patología muy frecuente tanto aislada, propia como tal, o asociada a otros trastornos. Sin embargo, es una parte de la medicina relativamente nueva, dado que ha sido en los últimos 40 años cuando se ha trabajado realmente en ella, y se han producido los avances tanto diagnósticos como terapéuticos. Las clasificaciones de estas enfermedades han ido sufriendo cierta evolución, fijándose primero en los síntomas, y luego en las enfermedades. La nueva clasificación del 2005 vuelve a basarse en los síntomas. En ella se incluyen más de 90 enfermedades del sueño, y se intentan incluir tanto los síntomas, como las enfermedades propiamente del sueño y aquellas en las que los trastornos del sueño son fundamentales. Conocer y dominar esta completa clasificación es esencial para poder manejar adecuadamente estos pacientes

Sleep disorders are frequent processes, both as a symptom associated with other diseases and as independent disorders. However, only in the last 4 decades has Sleep medicine gained its position among the medical specialties. In fact, it was only in these years that significant advances were obtained in the study of the etiology and treatment of these disorders. Similarly, the different classifications have been evolving over the years. First, they were based upon the clinical symptom; later on, more emphasis was given to the diseases. Finally, in 2005, the new classification was once again based on the symptoms. More than 90 disorders are listed in this latest classification, and an attempt is made to include the symptoms and the diseases of sleep, as well as those in which sleep disorders are fundamental. It is essential to have a clear idea of this complete classification of sleep disorders in order to deal with these patients appropriately