Prognostic factors in multiple sclerosis rehabilitation.

AIM: The aim of our study was to evaluate the effectiveness of inpatient multidisciplinary rehabilitation treatment in multiple sclerosis (MS) and identify reliable prognostic factors. METHODS: Two hundred patients were enrolled for this study (65% females), with a mean age of 49.77+11.32 years and a mean disease duration of 17.33+10.15 years. RESULTS: The results of rehabilitation were assessed in the whole sample, as well as by comparing three subgroups, divided according to their basal Expanded Disability Status Scale of Kurtzke (EDSS) score: a ''mild'' group (EDSS score 2-5.5), a ''moderate'' group (EDSS 6-6.5), and a ''severe'' group (EDSS 7-8.5). All three subgroups of patients showed a significant improvement in functional status in both the Barthel Index and Rivermead Mobility Index (Wilcoxon Test) at discharge. However the effectiveness observed in patients with mild and moderate MS in both ADL and mobility was significantly higher than that observed in patients with the severe form. CONCLUSIONS: A multidisciplinary rehabilitative approach should be recommended for patients with a short disease duration and a relatively moderate disability.

Pain in multiple sclerosis: a clinical and instrumental approach.

BACKGROUND: Pain is a frequent and disabling symptom in multiple sclerosis (MS) patients. In this study we assess the frequency and intensity of pain, as well as its impact on the quality of life and activities of daily living, in a sample of MS patients. METHODS: One hundred and twenty eight MS patients underwent a neurological examination, a structured interview designed to assess pain, and a Medical Outcome 36-item Short Form Health Survey. Functional status was assessed by means of the Barthel Index (BI) and Rivermead Mobility Index. We also assessed the presence of depression, by means of the Montgomery and Asberg Depression Rating Scale, and fatigue, by means of the Fatigue Severity Scale. An algometer was used to measure thermal and discomfort thresholds in all of the patients and a group of 61 age- and sex-matched healthy subjects. RESULTS: Pain was present in 61 patients. No differences were found between patients with and those without pain in disease duration, disease form or Expanded Disability Status Scale and its functional systems. Patients with pain had a lower vitality score (p = 0.008), mental health score (p = 0.03) and physical (p < 0.001) and mental composite scores (p = 0.01) than patients without pain. Furthermore, there was a significant difference between patients with and those without pain in the BI (p = 0.04). Both thermal and discomfort thresholds, as assessed by means of the algometer, were statistically lower in MS patients than in controls, whereas no difference was observed between patients with and those without pain. There was a statistically significant improvement in the thermal threshold in patients with pain who were treated pharmacologically when compared with those who were not treated (p = 0.049). CONCLUSION: The results of this study provide further evidence of the negative impact that the presence of pain has on both the quality of life and activities of daily living in MS patients. The lower thermal and discomfort thresholds observed in our MS patients, compared with controls, may represent a predisposition to develop pain during the course of the disease.

Effects of combined dietary supplementation on oxidative and inflammatory status in dyslipidemic subjects.

BACKGROUND AND AIM: Dyslipidemia is one of the main risk factors for atherosclerosis, usually the underlying cause of cardiovascular diseases which are the major cause of morbidity and mortality in developed countries. The aim of this study was to assess the effects and the advantages of a combined dietary supplementation with PUFA n-3, vitamin E, niacin and gamma-oryzanol on lipid profile, inflammatory status and oxidative balance. METHODS AND RESULTS: Fifty-seven dyslipidemic volunteers were randomly assigned to receive: placebo (group A, 19 subjects); PUFA n-3 and vitamin E (group B, 18 subjects); the same as B plus gamma-oryzanol and niacin (group C, 20 subjects). Lipid profile, reactive oxygen species (ROS), total antioxidant capacity (TAC), vitamin E, interleukin 1-beta (IL1-beta), tumor necrosis factor (TNF-alpha) and thromboxane B2 (TXB2) were determined at baseline (T0) and after four months (T1). All dyslipidemic subjects showed, at baseline, oxidative stress and, after four months, all biochemical markers improved significantly in groups treated with dietary supplementation. Particularly in group C all lipid patterns improved significantly. CONCLUSIONS: Our findings demonstrate that the strategy of combining different compounds, which protect each other and act together at different levels of the lipid chain production, improves lipid profile, inflammatory and oxidative status, allowing us to reduce the dose of each compound under the threshold of its side effects.

Gait abnormalities in minimally impaired multiple sclerosis patients.

Subclinical evidence of gait abnormalities were identified in a group of seven patients with multiple sclerosis, EDSS scored 0 - 2, without functional limitations. A movement analysis technique was used to identify gait parameters indicative of impaired motor function during walking. Abnormalities related primarily to time-distance parameters (reduced speed of progression, shorter strides, prolonged double support phase) and muscular function (premature recruitment of gastrocnemius and late relaxation of tibialis anterior during stance phase) were identified regardless the severity of the clinical score. The gait analysis procedure was able to provide the clinician with evidence of motor abnormalities prior to functional disturbance observable by a trained physician. These minimal dysfunctions may have resulted from reflex mechanisms impaired by delayed transmission through long loop pathways or else as a result of a nonspecific protective gait strategy to improve balance control. The technique described in this study may be useful to identify earlier starting points for follow-up and physiotherapy.

Direct measurement of electrostriction in optical fibers.

The electrostriction contribution to the nonlinear refractive index in optical fiber was theoretically calculated and measured. Nonlinearity was induced directly by insertion of the optical fiber into an intense external electric field. With this technique both the Kerr and the electrostrictive contributions to the intensity dependence of the nonlinear refractive index in a step-index fiber were measured. Good agreement between calculated and measured values was observed. These results should confirm and explain the differences observed in measurement of n(2) at different bit rates.

[Prenatal biophysical monitoring: stress tests]. / Monitoraggio biofisico prenatale: stress tests.

Intrapartum fetal monitoring has provided a method by which the clinician can more accurately determine the status of the fetus during labor. More recently, investigations have been directed toward antepartum FHR monitoring studies to determine fetal well-being prior to the onset of labor. In this study, the results of "stress" monitoring are presented. The Authors have used three types of stress-tests: 1) oxytocin stress test 2) step-test 3) Oxygen stress test. The positive tests appears to correlate meaningfully with intrauterine compromise and neonatal status.