Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data.

Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

The epidemiology of amyotrophic lateral sclerosis in the Mount Etna region: a possible pathogenic role of volcanogenic metals.

BACKGROUND AND PURPOSE: Trace elements (TEs) may play a role in the pathogenesis of amyotrophic lateral sclerosis (ALS) and volcanic degassing is the major natural source of TEs. Mount Etna, in the province of Catania, is the largest active volcano in Europe. Our aim was to assess the incidence of ALS in the province of Catania during 2005-2010 and its spatial distribution with respect to volcanic gas deposition. METHODS: Cases from all neurological centres of the province of Catania and of the boundary provinces were retrospectively collected. Patients who had onset during 2005-2010 and fulfilled the El Escorial revised diagnostic criteria were included. The incidence of ALS was estimated for the entire province and separately for the population living on the eastern and western flank of Mount Etna, respectively, the most and least exposed areas to volcanogenic TEs, considered as a possible risk factor for ALS. RESULTS: One hundred and twenty-six (57 men) ALS patients were enrolled. The mean annual crude incidence rate was 2.0/100 000 person-years (95% confidence interval 1.7-2.4). A higher incidence rate was found in the population living on the eastern flank compared to the western flank (2.4/100 000 and 0.9/100 000 respectively) with a relative risk of 2.75 (95% confidence interval 1.64-4.89; P < 0.001). CONCLUSIONS: The incidence of ALS in the province of Catania is close to those reported worldwide. The incidence was higher amongst the population living on the eastern flank of Mount Etna, which could be interpreted as a possible role of volcanogenic TEs. Further research on TEs and genetic factors is necessary to support this assumption.

Role of videofluorography swallow study in management of dysphagia in neurologically compromised patients.

PURPOSE: The aim of this study was to demonstrate the key role of the videofluorography swallow study (VFSS) in the management of patients with dysphagia and varying degrees of neurological deficit. MATERIALS AND METHODS: In 1 year (March 2004-March 2005) 47 patients with oropharyngeal dysphagia due to different types of neurological deficit and who required rehabilitation were studied. All patients underwent: (1) clinical history assessment, (2) speech therapy assessment and (3) VFSS using digital fluoroscopy (25 frames per second). Patients were divided according to the Waxman classification into seven levels of dysphagia, and the most suitable type of feeding was selected (normal diet, restricted diet, artificial nutrition). At discharge, the possibility of changing the dietary regimen followed in hospital was evaluated based on clinical progress, radiological follow-up and the degree of improvement obtained. RESULTS: VFSS confirmed aspiration in 21/47 (44%) patients, of whom four (8%) had not been suspected at clinical-speech therapy assessment. In 13/47 (28%) patients, VFSS identified changes at the oral (three patients) or pharyngeal stage (three patients) or both (seven patients) but with no signs of silent aspiration. In the remaining 13 (28%) patients, VFSS did not show any changes in swallow dynamics. On the basis of these data, together with the follow-up at the end of rehabilitation treatment, different nutritional strategies were adopted: artificial nutrition [percutaneous endoscopic gastrostomy (PEG) or nasogastric tube], a restricted-consistency diet or normal diet. CONCLUSIONS: Our experience shows that VFSS precisely classifies the degree of dysphagia that conditions the dietary management of each neurologically compromised patient.

[Symptoms and musculo-skeletal changes among personnel of the State Police exposed to mechanical risk]. / Sintomi ed alterazioni muscolo-scheletriche in personale della Polizia di Stato esposto a rischio biomeccanico.

The aim of this present study was to inquire about spine morfo-functional alterations among policemen with jobs regarded as potentially hazardous, in order to identify preclinical alterations of column and to plan adequate preventive measures. A physiopathologic and working anamnesis was carried out by means of questionnaire about personal data, jobs, reported rachidian symptomatology and presence of orthopedic diseases, given to policemen on duty in Bari. Every chosen worker was subject to orthopedic and neurological examination, radiography of column, Formetric tridimensional examination, telethermography of spine. We stratified the sample on the basis of age and job. Under the jobs we individuated 4 biomechanical hazardous activities, performed separately or together: driving motorcycle, driving car, flying helicopter, video terminal use. The whole sample, formed by 211 subjects, all male, had the average age of 39 years (Standard Deviation: +/- 4). About the reported rachidian symptomatology, only 41 (17, 98%) subjects were asymptomatical, contrary to clinical results, that were normal in almost the entire sample, with the exception of 3 workers (1, 31%), who had neurological clinical alterations. Structural alterations were checked by radiography among 64, 9% of subjects. The Formetric examination found alterations in different tract of rachis, also coexiting between each other. The telethermographic changes affected 63,99% of the sample and involved especially the lumbar tract (38,86%), dorsal region (18%) and cervical zone (7,1%). The relative frequency of dorsal tract increased with growing of age. The morfo-functional changes of the sample seem to depend rather on the performed job, than on degenerative process of age, partly because the average age of the sample is not much elevated and because the enlistment in Italian Police Force is subordinated to verification of optimum conditions, also characterized by absence of anomaly of column. The absence of clinical alteration, in contrast to reported rachidian symptomatology by 82,02% of subjects and with discovered objectivity, demands more clinical attention in presence of symptomatology and proposes supplementary non-invasive techiniques of investigation, as the telethermography and the formetric tridimensional examination.

Toxic acute renal failure in the rat: effects of L-arginine and N-methyl-L-arginine on renal function.

Nitric oxide (NO) is generated from L-arginine (Arg) by different isoforms of nitric oxide synthase (NOS) and plays a major role in maintaining the high basal renal blood flow. NO also is involved in the regulation of glomerular haemodynamics and contractility of mesangial cells. We examined the hypothesis that L-arginine-derived NO modifies toxic ARF in the rat. After a basal period uranyl nitrate (UN) was given intravenously as a bolus injection (25 mg/kg over 5 min) to induce ARF. After the initiation phase of ARF (3 h) saline in the control group (C) and drugs in the experimental groups (I-III, each n = 8) were administered for 60 min. Group I, Arg (300 mg/kg); group II, MeArg (30 mg/kg); group III, Arg + MeArg (300 mg/kg, 30 mg/kg resp.). The experiments were continued for further 60 min following the infusion period. Glomerular filtration rate (GFR, inulin clearance) was reduced 3 h after UN to about 50% of normal values in groups I-III and control group (I, 0.52 +/- 0.06; II, 0.51 +/- 0.05; III, 0.49 +/- 0.05; C, 0.50 +/- 0.07 ml/min). After infusion of Arg GFR had significantly improved (0.64 +/- 0.07), but further declined after MeArg (0.46 +/- 0.06) in relation to control (0.47 +/- 0.07). This negative effect could be overcome by combined administration of Arg + MeArg (0.59 +/- 0.07). One hour after the infusion period these effects were even more pronounced (Arg, 0.71 +/- 0.06; MeArg, 0.43 +/- 0.05; Arg + MeArg, 0.65 +/- 0.07; C, 0.46 +/- 0.05). We conclude that the L-arginine/NO pathway is involved in toxic ARF of the rat.(ABSTRACT TRUNCATED AT 250 WORDS)

[Phase 3 and phase 4 bundle of branch block]. / Blocco di branca in fase 3 ed in fase 4 e linking del blocco in fase 3: descrizione di un caso.

Intermittent left bundle branch blocks are present in the ECGs of 1 patient with mitral valve disease. By occurring either after short or long cycles they represent respectively phase 3 and phase 4 blocks. Such mechanisms emphasize the relationship between automatism and conduction. The occurrence of block and of normal conduction during cycles of the same length, its correlation with the conduction of the previous cycle, demonstrate the presence of a functional linking between successive impulses. This linking may occur every time a potential or active macroreentry circuit exist. In our case the circuit is formed by the 2 bundle branches which join distally in the ventricular septum.

[Ergometric test in the diagnostic and prognostic evaluation of arrhythmia]. / Il test ergometrico nella valutazione diagnostica e prognostica delle aritmie.

One thousand three hundred patient's stress tests were analyzed to value arrhythmia outline and its relationship with anamnesis and clinical data. The patients were divided into two groups: group A, with no arrhythmias at rest, and group B with arrhythmias at rest. All classic nosographic arrhythmias were considered. In some teenager patients with arrhythmias at rest and no organic cardiopathy, anomalies disappeared during stress, showing the benignity of the phenomenon. Supraventricular stress induced arrhythmias has 1.2% of incidence in normal subjects, but 81% in heart disease patients. Supraventricular tachycardia was induced in 6 patients. Ventricular stress induced arrhythmias are found in 4.9%. Two cases of sudden death occurred in our groups.

Amplification of the X-linked Drosophila chorion gene cluster requires a region upstream from the s38 chorion gene.

Genomic sequences controlling follicle cell-specific amplification of the X-linked Drosophila chorion gene cluster were mapped by P element-mediated transformation. Several DNA fragments containing the s38 gene and flanking sequences induced tissue-specific amplification, although replication levels were subject to position effects. Deletion analysis identified a 467-bp region upstream from the s38 transcription start site that contained sequences essential in cis for amplification. The essential region shared 32 bp of imperfect sequence homology with a previously identified region necessary for third chromosome chorion gene cluster amplification. This homologous segment contained a repetitive motif consisting of perfect and imperfect AATAC repeats; it was localized near the boundary of the essential domain since most, but not all, the repeats could be deleted without eliminating transposon-induced amplification. The repetitive region was not required for developmentally regulated s38 transcription, therefore our results identified at least one element required for amplification but not for chorion gene transcription. The homologous repetitive sequences within the amplification-essential regions may constitute part of the replication origins used to differentially replicate the two chorion domains during oogenesis.

Localization of a cis-acting element responsible for the developmentally regulated amplification of Drosophila chorion genes.

Late in oogenesis two clusters of Drosophila chorion genes and flanking DNA sequences undergo specific amplification in ovarian follicle cells. Lines were constructed using P-element-mediated transformation in which DNA segments derived from the chorion gene cluster at 66D on chromosome III had been inserted at new chromosomal locations. Only transposons that contained a specific 3.8 kb genomic segment derived from the cluster underwent amplification during oogenesis, which occurred with apparently normal tissue and temporal specificity. Adjacent nonchorion sequences also underwent amplification. However, the ability of a transposon to replicate differentially was subject to position effect. These studies provide evidence for the existence of a specific, cis-acting element controlling chorion gene amplification, which includes an origin for disproportionate DNA replication. Attempts to induce amplification with subfragments of the 3.8 kb segment were unsuccessful, suggesting that much of this fragment may be required for amplification.

Amplification of rDNA and type I sequences in Drosophila males deficient in rDNA.

rDNA magnification is a heritable change in rDNA content that occurs in D. melanogaster males when chromosomes deficient in rDNA are placed together for several generations. We have examined the restriction endonuclease cleavage pattern of the rDNA from an X chromosome undergoing magnification, and find no evidence for the selective amplification of either uninterrupted rDNA units or those containing insertion sequences. In addition, we observe an amplification of rDNA in the first generation of extremely bobbed male progeny to a level exceeding that of wild-type flies, but that reduces to the wild-type level in subsequent generations. The type I rDNA insertion elements also occur as tandem arrays, independently of rDNA. Southern hybridizations indicate that the majority of these sequences are located in the heterochromatin surrounding the nucleolus organizer on the X chromosome, and we find that they, too, amplify transiently in the first generation of magnifying males.

Independent mobility of cholera toxin binding sites and Thy-1 alloantigen on mouse thymocytes.

The hypothesis that Thy-1.2 carries a carbohydrate antigenic determinant with the same specificity as the monosialoganglioside GM1 was tested by attempting to co-cap Thy-1.2 and GM1 in CBA thymocytes using anti-Thy-1.2 alloantiserum and cholera toxin. Co-capping of these determinants was not observed suggesting that they are on separate molecules. We do not therefore confirm the previous reported association between Thy-1 and GM1 (Thiele, Arndt & Stark, 1977).