Oxidative stress reduction by icodextrin-based glucose-free solutions in peritoneal dialysis: Support for new promising approaches.

BACKGROUND: Oxidative stress (OxSt) and inflammation are common in CKD and are known CV and mortality risk factors. In peritoneal dialysis (PD) OxSt and Inflammation even increase due to the use of glucose-based solutions. PATIENTS AND METHODS: This study analyzed in 15 PD patients the effect of 3 and 6 months of treatment with icodextrin-based glucose-free solutions on OxSt and inflammation, evaluating p22phox protein expression (Western blot), NADPH oxidase subunit, essential for OxSt activation, MYPT-1 phosphorylation state, marker of RhoA/Rho kinase pathway (ROCK) activity, involved in the induction of OxSt (Western blot) and Malondialdehyde (MDA) production (fluorimetric assay). Interleukin (IL)-6 blood level (chemiluminescence assay) has been measured and used as a marker of inflammation. RESULTS: p22phox protein expression, MYPT 1 phosphorylation, and MDA were reduced after 3 months from the start of icodextrin (1.28 ± 0.18 d.u. vs. 1.50 ± 0.19, p = 0.049; 0.89 ± 0.03 vs. 0.98 ± 0.03, p = 0.004; 4.20 ± 0.18 nmol/mL vs. 4.84 ± 0.32 nmol/mL, p = 0.045, respectively). In a subgroup of 9 patients who continued the treatment up to 6 months, MYPT-1 phosphorylation was further reduced at 6 months compared to baseline (0.84 ± 0.06 vs. 0.99 ± 0.04, p = 0.043), while p22phox protein expression was reduced only at 6 months versus baseline (1.03 ± 0.05 vs. 1.68 ± 0.22, p = 0.021). In this subgroup, MDA was reduced at 6 months versus baseline (4.03 ± 0.24 nmol/mL vs. 4.68 ± 0,32, p = 0.024) and also versus 3 months (4.03 ± 0.24 vs. 4.35 ± 0.21, p = 0.008). IL-6 level although reduced both at 3 and 6 months, did not reach statistical significance. CONCLUSIONS: The reduction of OxSt with icodextrin-based PD solutions, although obtained in a small patients cohort and in a limited time duration study, strongly supports the rationale of using osmo-metabolic agents-based fluids replacing glucose-based fluids. Ongoing studies with these agents will provide information regarding preservation of peritoneal membrane integrity, residual renal function, and reduction of CVD risk factors such as OxSt and inflammation.

Digital Health Service for Identification of Frailty Risk Factors in Community-Dwelling Older Adults: The SUNFRAIL+ Study Protocol.

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio-psycho-social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

Oxidative stress, inflammation, and peritoneal dialysis: A molecular biology approach.

The key role of oxidative stress (OxSt) and inflammation for the induction of cardiovascular disease, the leading cause of excess morbidity/mortality in chronic kidney disease and dialysis patients, is known and both the activations of NADPH oxidase and RhoA/Rho kinase (ROCK) pathway are pivotal for their effects. While specific hemodialysis procedures, such as hemodiafiltration with on-line reinfusion of ultrafiltrate and/or the use of vitamin E-coated dialyzers, are beneficial for OxSt and inflammation, studies in peritoneal dialysis (PD) are instead scarce and results seem not favorable. In nine patients under PD OxSt in terms of mononuclear cell protein level of p22phox (Western blot), subunit of NADPH oxidase, essential for the generation of OxSt, and MYPT-1 phosphorylation state (Western blot), a marker of ROCK activity, have been measured at the beginning and after 3 and 6 months of PD. Blood levels of interleukin 6 (IL-6), ferritin, and albumin have been considered for evaluating the inflammatory state. p22phox protein expression, MYPT-1-phosphorylation, and ferritin level were increased both at baseline vs healthy subjects (P = .02, P < .0001, P = .004, respectively) and vs baseline after 3 and 6 months of peritoneal dialysis (P = .007, P < .001, P = .004, respectively). Albumin was lower after 6 months of PD (P = .0014). IL-6 was increased at baseline vs reference values and remained unchanged at 3 and 6 months. OxSt and inflammation increase during PD confirming via molecular biology approach a report at biochemical level. To improve OxSt state in PD, a multitarget approach is necessary. It might include the use of more physiologic pH, low glucose degradation products, low lactate and iso-osmolar PD solutions, patients' strict glycemic control, optimal volume management, and antioxidant administration, such as N-acetylcysteine.

[What, how and why people fall in hospital? Study in a Northern Italian Hospital]. / Quanto, come e perché si cade in ospedale? Indagine in un'ASL piemontese.

INTRODUCTION: According to the World Health Organization (WHO), falls and falls related-injuries are a main issue for health and social systems in Europe and all over the world, particularly considering that life is lengthening. OBJECTIVE: To describe incidence, causes and falls modalities in a Northern Italian Hospital following the organizational changes set up in 2008. METHODS: The survey consists of two steps: 1. definition of expected situation according to the literature and other similar contexts; 2. examination of the fall report forms between July 1, 2010 and June 30, 2011. RESULTS: In this period the incidence of falls has been 0.8% and in 69% of cases patients' intrinsic factors have been identified to be the cause, followed by extrinsic factors (7.4%), organizational factors (5.4%) and inter-professional communication difficulties (3.1%). CONCLUSION: Falls have a multi-factorial etiology, therefore the most effective approach should be multidimensional. A simultaneous action on three levels, organizational, staff/communication and patient, would be needed.

Rehabilitation of aphasia.

Aphasia is one of the most striking cognitive sequels of strokes and other cerebral lesions, and attempts to rehabilitate aphasic patients have been undertaken for many years. Following a brief overview of the epidemiology and the clinical characteristics of aphasia, the chapter presents the major traditional approaches to rehabilitation. They include the stimulation approach (also called classic), the behavior modification approach, Luria's approach (functional reorganization), the pragmatic approach, as well as the neurolinguistic approach. The next section illustrates some of the current approaches to aphasia rehabilitation, specifically the syndromic approach (also called neoassociationist), the cognitive neuropsychological approach, and the social approach. The chapter then provides examples of specific methods. While all intervention strategies may be classified, more or less correctly, into one or another of the above categories, it is not possible to mention the hundreds of specific interventions to be found in the literature, some of which have been described only briefly and in reference to a single case. The chapter concludes with a review of efficacy studies on aphasia therapy. Despite some opinions to the contrary, the current consensus is that sufficient experimental evidence of efficacy exists to recommend treatment of aphasia.

[The role of bioelectrical impedance in peritoneal dialysis]. / Il ruolo della bioimpedenza in dialisi peritoneale.

Dialysis must control the bodys fluid content accurately in order to maintain optimal health. Determination of body hydration and nutritional status are significant problems in dialysis patients. In practice, clinical evaluation is usually used to estimate the ultrafiltration target, since accurate knowledge of dry weight is lacking. PD over-hydration is more common than in HD. The only commonly used, practical and objective measurements we have to guide fluid removal are very inaccurate. Several methods have been proposed for non-clinical dry weight assessment; unfortunately these methods suffer from several shortcomings, such as poor specificity (natriuretic peptides), operator dependence (inferior vena cava diameter measurements) and poor correlation with extra cellular volume (continuous blood volume measurement). Recent study has validated bioimpedance (BIA) as an objective measure of fluid and nutritional status in dialysis patients. There are a number of different methods suitable for routine use available to the clinician. This review analyze the role of the different BIA techniques in peritoneal dialysis.

Therapy efficacy in chronic aphasia.

There is good evidence that aphasia therapy is effective if sufficiently prolonged or intensive and that chronic aphasic individuals can also benefit from therapy, but data on chronic aphasia are scanty. The aim of this retrospective study was to investigate whether chronic aphasia benefits from a very intensive therapeutic regimen. We revised the files (January 2000 to December 2008) of the chronic subjects whom we suggested have periodic sessions in our Unit (generally once a week) and 2-3 hours daily of homework with the help of a family member, supervised and controlled by the speech-therapist. Treatment would go on as long as amelioration is evident. Results for 23 chronic aphasic subjects are reported. All subjects had undergone previous therapy and 10 had been dismissed because no further recovery was expected. Recovery was significant in oral and written nouns and actions naming, oral and written sentence production and Token Test scores. Only 4 subjects did not improve. Severity of the disorder did not predict success or failure. We conclude that recovery was due to the intense work done. Further, we believe such a regimen could be successful in a number of patients for whom a less intensive regimen would not be effective.

[Nursing managers: study to assess the expectations of nursing coordinators in a Northern Italian Hospital]. / Il dirigente del Servizio Infermieristico: inchiesta sulle attese dei coordinatori infermieristici di un'ASL piemontese.

In modern health-care , nursing managers play a strategic role in improving the quality of care and the skills of carers, since management and leadership strategies are known to be decisive in the deployment of resources and professional development. The aim of this study is to present the opinions and expectations of nursing coordinators regarding their managerial role. During the creation of a nursing service unifying the management of 3 local health authorities in Northern Italy, with different organizational and professional features, nursing coordinators were asked to fill in a questionnaire. Results showed that a priority aspect of the managerial role is to assess the appropriateness of care and the use of resources Their answers showed that they hoped for a style of management founded on aspects related to clinical government. For the style of leadership, they emphasized dedication to work, participation of staff in decision-making, group information and providing support in areas needing improvement. Although the study was territorial , it confirmed international guide-lines regarding the policies which give value to investments in the quality of organization and can be considered a point of reference for planning and creating future nursing services.

Speaking of events: the case of C.M.

C.M. is an agrammatic patient who on assessment tests shows a disproportionate difficulty when producing verbs compared with nouns. In three experiments, we investigated whether C.M. also has difficulties with nouns referring to events and whether event nouns and verbs show similar patterns of disruption. Experiment 1 suggested that she is sensitive to argument structure complexity and has a greater impairment in the production of event nouns and verbs than object nouns. Experiment 2 revealed that C.M. finds derivationally complex words, such as event nouns, difficult to produce. However, morphological complexity does not completely explain C.M.'s problems with event nouns. In Experiment 3, an assessment of C.M.'s ability to use different aspects of semantic and syntactic knowledge relative to event nouns and verbs showed an almost identical performance with the two types of words. The relevance of the findings with respect to models of word production is considered.

Spontaneous recovery from acalculia.

A topic much considered in research on acalculia was its relationship with aphasia. Far less attention has been given to the natural course of acalculia. In this retrospective study, we examined the relationship between aphasia and acalculia in an unselected series of 98 left-brain-damaged patients and the spontaneous recovery from acalculia in 92 acalculic patients with follow-up. There was a significant association between aphasia and acalculia although 19 participants exhibited aphasia with no acalculia and six acalculia with no aphasia. We observed significant improvement between a first examination carried out between 1 and 5 months post-onset and a second examination carried out between 3 and 11 months later (mean: 5 months). The mechanisms of spontaneous recovery are discussed.

Perseveration or the Tower of Babel.

The purpose of this article is twofold: (1) to present a study of perseveration in a continuous series of 50 left brain-damaged aphasic subjects and (2) to describe the treatment of 2 patients with high rates of perseveration. In the group of 50 subjects, 20 showed two or more perseverations in one or more language tasks. No difference in number of perseverations was found between fluent and nonfluent subjects, but perseverations in global aphasic subjects with stereotyped speech were less varied than they were in fluent aphasic subjects and were not unlike other types of recurrent utterances. Of the two patients who received treatment, subject 1 had severe semantic disruption and perseverated in all production and comprehension tasks, except in repetition, reading aloud, and writing to dictation, all of which could be performed by the undamaged sublexical routines. Treated subject 2 had writing disorders that were ascribed to damage to the output buffer. She perseverated in all writing tasks. Rehabilitation of the semantic system in subject 1 and of the output buffer in subject 2 greatly reduced the number of perseverations in both subjects. It is argued that recovery of the underlying functional damage reduces the perseverative behavior.

A cross-linguistic data bank for oral picture naming in Dutch, English, German, French, Italian, Russian, Spanish, and Swedish (PEDOI).

The well established effect of word frequency on adult's picture naming performance is now called into question. This is particularly true for variables which are correlated with frequency, as is the case of age of word acquisition. Since the work of [Carrol and White, 1973] there is growing agreement among researchers to confer an important role in lexical access to this variable. Indeed, it has been shown ( [Hodgson and Ellis, 1998]) that for normal English-speaking adults only the variables 'age-of-acquisition' and 'name agreement' are independent predictors of naming success among the various variables considered. However, when brain-damaged subjects with and without degenerative pathologies are studied, word frequency and word length as well as concept familiarity all give significant effects ( [Hirsh and Funnell, 1995]; [Lambon Ralph et al., 1998]; [Nickels and Howard, 1995]). Finally, it has been suggested that the production of specific error types may be related to such variables. According to [Nickels and Howard, 1994] the production of semantic errors is specifically affected by 'imageability' and in the recent study by [Kremin et al., 2001] 'age of acquisition' predicts (frank) word finding difficulties.

Semantic errors in naming, repetition, spelling and drawing from memory: a new Italian case.

Semantic errors in aphasic patients are frequent and their study has helped understanding the structure and processing of the lexical/semantic system. Most of the patients with semantic errors in reading and writing are English-speaking and it has been argued that this depends on the type of the orthographic systems: in opaque orthographies semantic errors are more frequent than in transparent orthographies. The paper reports the case of an Italian patient, AM, with semantic damage and semantic errors in comprehension and production tasks, except reading aloud. AM was also impaired in non-word repetition and writing but his reading of non-words was only mildly impaired. The absence of semantic errors in reading and the co-occurring absence of severe damage to the non-lexical reading route is consistent with interaction between lexical and non-lexical processing. The discussion addresses the question of the relative frequency of semantic errors in reading and writing tasks in languages with different types of orthographies.