Search

We investigated the incidence of first-ever stroke in three Sicilian municipalities over the years 1984–1987. Case ascertainment involved two approaches: a doorto-door two-phase prevalence survey and a study of death certificates. Only first-ever strokes occurring within the study time interval were included, and diagnoses were based on specified criteria. We found 138 subjects who had experienced a first stroke over 73 488 person-years; the average incidence rate (new cases per 1000 population per year) was 1.9 overall, 1.7 in men, and 2.1 in women. Incidence increased steeply with age and was similar in men and women. Incidence was similar in the three study municipalities. The overall case-fatality rate was 35% at 30 days and 22% at one week. Survival after stroke was similar in men and women but better in younger compared to older stroke patients. Comparisons with previous studies suggest the absence of major geographic variations in stroke incidence within Italy.

Micturition disorders are frequent in an advanced course of multiple sclerosis. Historical records of multiple sclerosis patients reveal that urinary symptoms occur with high frequence. In the present study we have investigated all patients who were admitted to our Multiple Sclerosis Center in a 1 year period. AH patients underwent a neurological examination corroborated by MRI investigation. Out of 101 patients, 75 who reported urinary symptoms, underwent neurourodynamic investigation. Sixty of them exhibited functional micturition abnormalities, which were strictly correlated to EDSS, pyramidal and cerebellar functional statuses scores. Detrusor hyperreflexia was the commonest abnormality. Neurourodynamic findings were also correlated to the burden of lesion, although MRI seems to fail in localizing specific neural pathways which control micturition phases. Moreover, urodynamic evaluation can select different groups of MS patients with different degrees of neurological impairment.

The serum levels of the heterodimeric cytokine IL-12 were measured by solid-phase ELISA in a group of healthy subjects, multiple sclerosis (MS) patients with secondary chronic progressive course of the disease and patients suffering from other neurological diseases (OND) Serum levels of IL-12 higher than 5 pg/ml (limit of sensitivity of the assay) were only found in 2/30 (6.7%) of the healthy subjects and none of the 8 subjects with OND. In contrast, IL-12 was found in the majority of CPMS patients’ sera (10/15, 66.7%) with values ranging between 5.5 and 18.6 pg/ml. These results are suggestive for an up-regulated production of IL-12 in CPMS.

In a door-to-door survey of common neurological disorders in Sicily (SNES Project), we administered a screening symptoms questionnaire and a brief neurological examination to detect epileptic patients. All of the subjects effectively resident in the community of Riposto on 1 November 1987 (prevalence day) were investigated (n = 9956). The subjects with a positive questionnaire or a previous diagnosis of epilepsy were extensively examined by a neurologist and then definitively classified for epilepsy by a panel of senior neurologists. The crude prevalence of active and non-active epilepsy was 3.21/1000; the prevalence of active epilepsy alone was 2.71/1000. Of the 27 active cases, sixteen were affected by generalized tonic-clonic seizures, four by absences and four by complex partial attacks. All except two were being treated with antiepileptic drugs, most with phenobarbital. Our prevalence rate is lower than that reported by most authors, but similar to the rates in other Sicilian communities.

In two single-blind studies, we evaluated the effects of a four-week intensive personal ized physical rehabilitation program in moderately advanced inpatients affected by Parkinson's disease (PD). ...

Francesco PattiDepartment of Neurology, University of Catania, Catania, ItalyAbstract: Poor treatment adherence is problematic in many therapy areas, including multiple sclerosis (MS). Several immunomodulatory drugs are available for the treatment of MS, all of which require frequent parenteral administration. Current first-line therapies are two formulations of interferon (IFN) beta-1a, one of IFN beta-1b, and one of glatiramer acetate. Discontinuation of treatment is common, particularly in the first few months after initiation. Although the true effect of poor adherence to MS therapy is not known, it is likely to lead to a fall in treatment efficacy. Many factors influence a patient’s adherence to treatment, including the patient’s MS subtype and disability level, cognitive impairment resulting from MS, perceived lack of efficacy of the prescribed medication, and adverse events associated with MS therapy. This article summarizes the barriers to adherence to MS therapies, and discusses patient management strategies that can be employed to encourage adherence. Future advances in the field of MS treatment will be explored, including the development of orally administered drugs, which may enhance adherence.Keywords: multiple sclerosis, adherence, compliance, interruption, adverse events, efficacy, tolerability, management

Francesco Patti, Angelo PappalardoMultiple Sclerosis Center, University of Catania, Catania, Italy; Physical Medicine and Rehabilitation Unit, Hospital of Acireale, Catania, ItalyAbstract: Multiple sclerosis is a frequent neurologic disease, which causes sensory impairment, fatigue, cognitive deficits, imbalance, loss of mobility, spasticity, and bladder and bowel dysfunction. Several new therapies have been introduced in the past decade, but additional drugs are needed to slow disease progression and reduce disability. Natalizumab (NA) is an α4 integrin antagonist, effective in decreasing the development of brain lesions in experimental models and in several studies of patients with MS. Six randomized controlled trials of NA in MS have been published in the last 10 years. Overall, 2,688 relapsing-remitting MS subjects have been enrolled in these studies. Hence, there are already sufficient data to draw some conclusions about the effectiveness of NA in the treatment of MS, although for definitive considerations it would be reasonable to wait for the observational phase IV studies of clinical practice to complete. Moreover, the medical community is concerned with the safety of NA, particularly with the risk of developing progressive multifocal leukoencephalopathy while on NA therapy. From the analyses of the six cases, it seems that the overall risk is around 1/1,000 and could increase with the number of NA infusions.Keywords: multiple sclerosis, disease-modifying drugs, natalizumab, progressive multifocal leukoencephalopathy

We investigated the prevalence of Parkinson's disease and other types of parkinsonism in a Sicilian population using a door-to-door two-phase approach. This design called for the administration of a brief screening instrument to all subjects who, on November 1, 1987, were residents of Terrasini (Palermo Province), Santa Teresa di Riva (Messina Province), and Riposto (Catania Province), Sicily (N = 24,496). Study neurologists using specified diagnostic criteria extensively investigated those subjects who screened positive. We found 63 subjects affected by Parkinson's disease, 21 with secondary parkinsonism, and seven with unspecified parkinsonism. The crude prevalence per 100,000 population was 371.5 for all types of parkinsonism and 257.2 for Parkinson's disease; for both entities, prevalence increased steeply with age and showed an inconsistent sex pattern. Our prevalence figures for Parkinson's disease are higher than those previously reported in Italy or elsewhere, which may be due, in part, to more complete case-ascertainment.

The effects of sex steroids and prolactin on haloperidol-induced catalepsy were investigated in male rats. Repeated administration with estradiol benzoate (5 micrograms/rat, twice daily for 10 days) significantly potentiated catalepsy induced by 0.25 or 0.5 mg/kg haloperidol, but no effect was observed 10 min or 1 h after a single injection of estradiol benzoate (5 or 50 micrograms/rat). Conversely, a single administration with the catecholestrogen 2-hydroxyestradiol (50 micrograms/rat) significantly increased haloperidol-induced catalepsy, suggesting that catecholestrogens may directly interfere with nigrostriatal dopaminergic transmission. Haloperidol-induced catalepsy has been found to be attenuated in conditions of hyperprolactinaemia resulting from anterior pituitary isograft underneath the kidney capsule. This is consistent with the hypothesis that prolactin may stimulate nigro-striatal dopaminergic function. Results obtained also indicate that medroxy-acetate progesterone, a progesterone derivative, may influence haloperidol-induced catalepsy. Specifically, a single administration with medroxy-acetate progesterone (5 mg/kg, i.p.) enhanced catalepsy but opposite effects were observed after repeated administration of medroxy-acetate progesterone (5 mg/kg, i.p., once a day for 7 days).

Nigral and striatal GABA contents were assayed in male rats treated chronically with haloperidol or sulpiride, two dopamine-receptor blocking agents that have different neuropharmacological spectra in regard to their biochemical, behavioural, and clinical properties. No great difference was observed between the chronic effects of haloperidol and sulpiride on nigral and striatal GABA content. However, low doses (30 micrograms/kg, intraperitoneally) of the dopamine-receptor agonist apomorphine, injected 12 h after the discontinuation of chronic haloperidol or chronic sulpiride treatment, induced opposite changes in nigral GABA levels suggesting the existence of a different "status" of the dopamine receptors during the 12 h-period following the withdrawal of haloperidol or sulpiride.

Sulpiride, a benzamide derivative neuroleptic, was shown to significantly increase glutamic acid decarboxylase activity in substantia nigra and corpus striatum in either acutely or chronically injected male rats. Hypophysectomy completely prevented this effect suggesting an involvement of an anterior pituitary factor in the central action of sulpiride. Prolactin might possibly mediate the effects of sulpiride since it is known to increase prolactin secretion by an action at the level of the anterior pituitary. Consistent with this hypothesis was the finding of a similar increase in nigral and striatal glutamic acid decarboxylase activity in hyperprolactinemic animals in which an anterior pituitary had been implanted under the kidney capsule.

Summary: We have investigated the comparative effects of estradiol benzoate (EB), the antiestrogenclomiphene citrate (CC), and the progesting medroxyprogesterone acetate (MPA) on seizures induced by systemic injection of kainic acid (15 mg/kg i.p.) in male and female rats. Subcutaneous administration for 10 days of EB (10 μg/kg) or high doses of CC (50 mg/kg) significantly potentiated kainate-induced seizures, with the effect being more pronounced in male animals. Doses of 2.5 mg/kg of CC potentiated kainate-induced seizures in male rats but were ineffective in female rats. Low doses of CC (0.5 mg/kg) exhibited a mild anticonvulsant effect in both sexes. repeated administration of MPA (2.5 mg/kg) partially protected female animals against kainate-induced seizures; in male animls, MPA induced a 30% increase in the seizure severity score, although the difference fro the score of control male rats was not significant. These data suggest hat sex steroids influence kainate-induced seizures in a sex-dependent manner and that the effects of the antiestrogen CC are dose dependent. This should be taken into account in view of a possible use of CC and MPA in hormonal therapy for seizure disorders. RESUME one a etudie les effets du benzoate d'oestradiol (EB), de l'antioestrogene citrate de clomifene (CC) et du progestatif acetate de medroxyprogesterone (MPA) sur les crises produites par l'injection d'acide kainique (15 mg/kg par voie intraperitoneale) a des rats mâles et femelles. L'administration sous-cutanee pendant 10 jours d'EB (10 μg/kg), ou des doses elevees de CC (50 mg/kg) potentialisent significativment les crises induites par l'acide kainique, cet effet etant plus prononce chez les mâles. Des doses de 2,5 mg/kg de CC potentialisent les crises induites par l'acide kainique chez les mâles, mais pas chez les femelles. De faibles doses de CC (0,5 mg/kg) ont un effet anticonvulsivant faible dans les 2 sexes. L'administration repetee de MPA (2,5 mg/kg) protege partiellement les femelles contre les crises induites par l'acide kainique. Chez les mâles, le MPA entraine une augmentation de 30% du score de severite des crises, quoique cependant la difference avec le score des mâles de controle ne soit pas significative (p < 0.05).Les donnees suggerent que les steroides sexuels influencent les crises induites par l'acide kainique d'une maniere dependant du sexe, et que les effets de l'antioestrogene CC sont dose-dependants. Cela doit etre pris en consideAration dans l'utilisation possible du CC et du MPA dans le traitement hormonal des epilepsies. RESUMEN En ratas hembras y machos hemos investigado los efectos comparativos del benzoato de estradiol (EB), del antiestrogeno citrato clomifeno (CC) y del progestin acetato medroxiprogesterona (MPA) sobre los ataques inducidos mediante la inyeccion sistomica de acido kainico (15 mg/kg, intraperitonealmente). La administracion subcutonea durante 10 dias de EB (10 μg/kg) o dosis altas de CC (50 mg/kg) potenciaron significativamente los ataque inducidos por el kainato, siendo este efecto mas pronunciado en los animales macho. Dosis de 2.5 mg/kg de CC potenciaron los ataques inducidos por el kainato en los machos pero no produjeron efectos en las hembras. Dosis bajas de CC (0.5 mg/kg) mostraron un efecto anticonvulsivo ligero en ambos sexos. La administracion repetida de MPA (2.5 mg/kg) protegieron parcialmente a las hembras de los ataques inducidos por el kainato; en los machos, el MPA produjo un 30% de incremento en la escala de severidad de los ataques aunque la diferencia con la escala de los machos control no fue significativa (p > 0.05). Toda esta informacion sugiere que los esteriodes, segun el sexo, influencian los ataques inducidos por el kainato de un modo sexo-dependiente y que los efectos del antiestrogeno CC son dosis-dependientes. Estos datos podrian ser tenidos en cuenta en vista de una posible utilizacion del CC y del MPA en la terapeutica hormonal de los trastornos convulsivos. Wir untersuchten die Wirkungen von Oestradiolbenzoat (EB), dem Antioestrogen Clomiphencitrat (CC) und dem Progestinmedroxyprogesteronacetat (MPA) auf Anfalle, die durch die systemische Injektion von Kainsaure (15 mg/kg intraperitoneal) bei mannlichen und weiblichen Ratten hervorgerufen wurden, 10-tagige subkutane Anwendung von EB (10 ug/kg) oder hohe Dosen von CC (50 mg/kg) potenzierten in signifikanter Weise Kain-induzierte Anfalle. Diese Wirkung trat besonders bei mannlichen Tieren auf. Dosen von 2, 5 mg/kg CC potenzierte Kainat-induzierte Anfalle bei maannlichen aber nicht bei weiblichen Ratten. Niedrige Dosen von CC (0, 5 mg/kg) zeigten eine milde antikonvulsive Wirkung bei beiden Geschlechtern. Die wiederholte Anwendung von MPS (2, 5 mg/kg) schutzte weibliche Tiere partiell gegen Kainatinduzierte Anfalle. Bei mannlichen Ratten bewirkte MPA eine 30-prozentige Zunahme der Schwere der Anfalle, obwohl der Unterschied zu dem Score der Kontrolltiere nicht signifikant war (p > 0,05). Diese Ergebnisse legen nahe, daβ Geschlechtssteroide Kainat-induzierte Anfalle in einer geschlechtsabhangigen Art und Weise beeinflussen und daβ die Wirkungen des Antioestrogens CC dosisabhangig sind. Das muβ bei einer moglichen Anwendung von CC und MPA in der Hormontherapie von Anfallsleiden [berucksichtigt werden].

The comparative effects of a 10 day estrogen treatment and estrogen independent hyperprolactinemia on nigral and striatal glutamic acid decarboxylase (GAD, EC 4.1.1.15) activity were investigated in male rats. Data obtained show that estrogen treatment decreases GAD activity in substantia nigra, while an increase was observed in conditions of hyperprolactinemia induced by adenohypophysis homograft or acute and chronic sulpiride injection. The possibility of an opposite modulation of strio-nigral GABAergic system by estrogens and prolactin is suggested.

The effects of acute and chronic injections of haloperidol, sulpiride and apomorphine on serum prolactin (PRL) levels and medial basal hypothalamus (MBH) glutamic acid decarboxylase (GAD) activity were investigated in male rats. Parallel changes in PRL and GAD activity were observed in acutely treated animals. Conversely, a return to normal of the GAD activity associated with high plasma PRL levels was induced by chronic haloperidol and sulpiride treatment. Results are discussed in the light of the possible existence of a hypothetical PRL-gamma-aminobutyric acid (GABA) subsidiary feedback loop.

SYNOPSIS We investigated the therapeutic efficacy of short-term (Asu1,7 )eel-calcitonin treatment in subjects affected by headache. All 47 patients were initially treated for 20 days intramuscularly with vehicle alone (basal values). Subsequently, they received for another 10 days a daily injection of (Asu1,7 )eel calcitonin (40 I.U. per day i.m.). The effectiveness of the treatment was evaluated in terms of changes in frequency, intensity and duration of the migraine attacks, and pain intensity and duration of daily chronic headache. The levels of plasma calcitonin, before, during and at the end of the therapy were evaluated. The clinical results show a significant difference between the observation period (vehicle alone) and the treatment phase with a significant improvement due to (Asu1,7 )eel-calcitonin treatment. In 32 patients plasma calcitonin levels were significantly modified after five days of treatment. Plasma calcium values showed no significant change.

We have recently demonstrated that calcitonin, a putative neuromodulator, may influence extrapyramidal motor system by decreasing nigro-striatal dopaminergic function. Since calcitonin is extensively used in aged patients, we have investigated whether calcitonin might influence extrapyramidal motor behavior (haloperidol-induced catalepsy and apomorphine-induced hyperactivity) in rats of different ages. Intracerebroventricular injection of salmon calcitonin (I μg/kg) prevented apomorphine-induced hyperactivity in 2, 7, 18 or 21 month old rats, but potentiated haloperidol-induced catalepsy only in 2 or 7 month old rats. In addition, in all the animals salmon calcitonin significantly decreased the secretion of prolactin, an anterior pituitary hormone that may act at central level enhancing nigro-striatal dopaminergic activity.

The effects of calcitonin on neurochemical parameters related to the tuberoinfundibular dopaminergic system have been investigated in an attempt to elucidate how calcitonin decreases serum prolactin levels. Intracerebroventricular human or salmon calcitonin injection decreases serum prolactin, medial basal hypothalamic dopamine (DA) and dihydroxyphenylacetic acid (DOPAC) and hypophysial DA and increases hypophysial DOPAC. Results suggest that calcitonin may decrease prolactin secretion via the tuberoinfundibular dopaminergic system.

Haloperidol, sulpiride, domperidone and apomorphine, drugs which influence dopamine (DA) receptors and in turn prolactin (PRL) secretion have been shown to induce parallel changes in medial basal hypothalamic (MBH) glutamate decarboxylase (GAD) activity and serum PRL levels. The possibility that PRL may be involved in the effects of the drugs on MBH GAD activity is suggested in view of the evidence that hypophysectomy completely prevents drug-induced MBH GAD activity changes and that hyperprolactinemia by anterior pituitary homograft results in a significant, although small, change in the enzymatic activity.

Terrestrial environment studies have been essentially concerned with the evolution of soil deposition and soil-plant transfers. Experimentally determined coefficients of distribution in soils are low: 60-80% of Tc remains hydrosoluble during the first months. Technetium emissions resulting from microbiological activity have been quantified. Antagonistic effects on Mo and Tc retention by soils are dependent on their respective concentrations. Four areas of soil-plant transfers have been studied: 1) root absorption kinetics relative to deposition of Tc, 2) interaction of stable Mo (environmental parameter) with the transfer of Tc to plants, 3) interaction of some long-lived radioisotopes (effluent parameters) with the transfer of Tc to plants, and 4) long-term soil-plant transfer and aging of deposited material. Of aquatic systems, only the marine environment has been studied. Under anoxic conditions in the presence of reducing sediments, the distribution coefficients (Kd) were very high (10(3)). Concentration factors (CF) from water to organisms were generally very low (1 to 10); however, CF greater than 1000 have been observed for some biota such as macrophytic brown algae, worms and lobsters. Biochemical analysis showed that Tc was essentially free and partially bonded to proteins. The transfer factors between sediments and species were very low (TF less than 0.5). The biological half-time was determined in some marine organisms that had accumulated Tc from water, food or sediments; the loss is biphasic. Uptake in edible parts was low. The physiochemical form affects the accumulation and loss of Tc. Analyses have quantified 99Tc in marine fauna and biota in the English Channel in relation with releases of the reprocessing plant of La Hague. Brown algae are the best bioindicators for following 99Tc dispersion in marine ecosystems.

Previous data indicate that the injection of dopaminergic drugs induces changes in cerebellar 3',5'-guanosine monophosphate (cGMP) content. Accordingly, we have investigated the effects of haloperidol, sulpiride, or apomorphine on cerebellar prostaglandin (PG) concentration, a parameter related to cGMP content. Results obtained show that dopamine receptor blocking agents, such as haloperidol and sulpiride, significantly decrease cerebellar PGE2 and PGF2 alpha concentrations, while opposite changes are induced by apomorphine, a dopamine receptor agonist.

We investigated the effect of acute or chronic peripheral administration of [Asu1,7]eel-calcitonin on the development of tolerance to the analgesic effect of morphine and on the naloxone-precipitated withdrawal syndrome in morphine-dependent rats. Neither the analgesic effect of acute morphine nor the development of tolerance to the antinociceptive effect of this drug was modified by calcitonin. However, the chronic nut not the acute administration of calcitonin attenuated some signs and symptoms of morphine withdrawal.

SummaryA double-blind, parallel group study was carried out in 50 patients with an anxiety disorder to compare the anxiolytic efficacy and tolerability of a recently developed benzodiazepine, metaclazepam, with that of bromazepam. Patients were allocated at random to receive treatment for 2 weeks with either 15 mg metaclazepam or 4 mg bromazepam per day in two divided doses. Assessments were made using the Hamilton anxiety rating scale (physician) on entry and after 7 and 13-days' treatment, and a visual analogue scale (patients) on entry and at the end of the study. The results showed that there was a significant, marked reduction in anxiety rating scores after 1 and 2 weeks in both groups and a significant improvement in the patients' subjective assessment of their condition after treatment. Few side-effects were reported in either group.

The effects of i.v.c. injection of human and salmon calcitonin on biochemical and behavioral parameters related to the extrapyramidal motor system, were investigated in male rats. Calcitonin injection resulted in a potentiation of haloperidol-induced catalepsy and a partial prevention of apomorphine-induced hyperactivity. Moreover calcitonin induced a significant decrease in nigral GAD activity but no change in striatal DA and DOPAC concentration or GAD activity. The results are discussed in view of a primary action of calcitonin on the striatonigral GABAergic pathway mediating the DA-related behavioral messages of striatal origin.

The effects of different doses of the dopamine (DA) receptor agonist apomorphine on the activity of the gamma-aminobutyric acid (GABA)-synthesizing enzyme glutamic acid decarboxylase (GAD, EC 4.1.1.15) were investigated in rat substantia nigra in comparison with haloperidol and sulpiride, two DA receptor blocking agents. Results obtained show that low doses (10,35 microgram/kg, s.c.) of apomorphine induce a decrease in nigral GAD activity whilst an opposite effect is observed with the highest dose (1000 microgram/kg, s.c.). No significant change is observed following injection of the intermediate doses (100 and 500 microgram/kg, s.c.). Moreover, sulpiride at the dose used (2 mg/kg, i.p.) induces an increase in GAD activity whilst no effect follows systemic injection of the same dose of haloperidol. The results are discussed in light of recent neurochemical and behavioral data.

SYNOPSIS A group of 30 patients (12 M - 18 F) suffering from migraine underwent salmon calcitonin therapy for a period of one month. All patients were treated at first for 30 days with vehicle administration in a daily i.m. injection, as a control. Calcitonin effectiveness was evaluated in terms of changes in frequency, intensity and duration of the migraine attacks. The results show a significant difference between the observation period (vehicle only) and treatment phase, with improvement during the calcitonin treatment.

Multiple sclerosis (MS) is a chronic and progressively debilitating disease of the central nervous system. Treatment of MS involves disease-modifying therapies (DMTs) to reduce the incidence of relapses and prevent disease progression. Glatiramer acetate (Copaxone®) was the first of the currently approved DMTs to be tested in human subjects, and it is still considered a standard choice for first-line treatment. The mechanism of action of glatiramer acetate appears to be relatively complex and has not been completely elucidated, but it is likely that it involves both immunomodulating and neuroprotective properties. The efficacy of glatiramer acetate 20 mg/mL once daily as first-line treatment in relapsing-remitting MS is well established, with ample evidence of efficacy from both placebo-controlled and active-comparator controlled clinical trials as well as real-world studies. There is also a considerable body of evidence indicating that the efficacy of glatiramer acetate is maintained in the long term. Clinical trial and real-world data have also consistently shown glatiramer acetate to be safe and well tolerated. Notably, glatiramer acetate has a good safety profile in women planning a pregnancy, and is not associated with foetal toxicity. Until recently, glatiramer acetate was only approved as 20 mg/mL once daily, but a new formulation with less frequent administration, 40 mg/mL three times weekly, has been developed and is now approved in many countries, including Italy. This review examines the mechanism of action, clinical efficacy, safety and tolerability of glatiramer acetate to provide suggestions for optimizing the use of this drug in the current MS therapeutic scenario.

We study theoretically the optomechanics of a dyed dielectric/metallic nanoshell in Optical Tweezers in a counter-propagating configuration. In addition, we consider the thermophoretic effects due to the interaction between the incident radiation and the nanoparticle metallic component.

A total of 410 patients (342 men and 68 women) addicted to heroin for at least 38 months, with or without previous methadone treatment experience, were treated with sulpiride before the appearance of withdrawal syndrome. The drug was injected intramuscularly in a single administration at a dosage of 600 mg. Successively, sulpiride was injected intramuscularly at a dosage of 200 mg 3 times per day from days 2-21 of hospitalization, and then at a dosage of 100 and 50 mg 3 times per day (days 22-25 and 26-29, respectively). All patients showed a suppression of withdrawal signs and symptoms within 6 days of treatment, as assessed by subjective and objective scores. The effect of sulpiride was compared with that of placebo administered to a control group of 10 heroin addicts. Because prolactin has been shown to reduce the dependence of rats to heroin and the naloxone-precipitated withdrawal syndrome in morphine-addicted animals, the effects of sulpiride on heroin addiction may be related to the hyperprolactinemic action of this drug.

Spoiled perishable products, such as food and drugs exposed to inappropriate temperature, cause million illnesses every year. Risks range from intoxication due to pathogen-contaminated edibles, to suboptimal potency of temperature-sensitive vaccines. High-performance and low-cost indicators are needed, based on conformable materials whose properties change continuously and irreversibly depending on the experienced time-temperature profile. However, these systems can be limited by unclear reading, especially for colour-blind people, and are often difficult to be encoded with a tailored response to detect excess temperature over varying temporal profiles. Here we report on optically-programmed, non-colorimetric indicators based on nano-textured non-wovens encoded by their cross-linking degree. This combination allows a desired time-temperature response to be achieved, to address different perishable products. The devices operate by visual contrast with ambient light, which is explained by backscattering calculations for the complex fibrous material. Optical nanomaterials with photo-encoded thermal properties might establish new design rules for intelligent labels., High-performance and low-cost indicators are important in food and cosmetics industry but market uptake is low due to several challenges such as toxicity, cost and unclear reading. Here, the authors report on optically-programmed, non-colorimetric indicators based on nanotextured organic non-wovens, encoded by controlling their cross-linking degree.

The most suitable setting of rehabilitation for Persons with Multiple Sclerosis (PwMS) has not been identified so far because there is a general lacking of controlled studies. Aim of this study was to evaluate the treatment efficacy in terms of functional independence between two different settings. A randomized, wait-list controlled study was performed at the MS Center of the University of Catania, and Rehabilitation Center of the Hospital of Acireale, Italy. Inclusion criteria were: a) range of age 18–75, b) Expanded Disability Status Scale ≥4.0 and ≤8.0 c) self-reported worsening of standing or walking abilities in the last 6 months. The examining physician was blind to patient allocation program. The Functional Independence Measure (FIM), and the 36-Health Survey Questionnaire (SF-36) data were collected at T0 (baseline) and T1 (follow-up). One-hundred forty-six patients were randomly assigned to three groups. Forty-nine PwMS were allocated in the outpatient treatment group (Group A), 49 patients in the inpatients treatment group (Group B) and 48 patients in the control waiting list (Group C). Both Group A and Group B showed a significant improvement in total FIM scores (p = 0.03, p = 0.008; respectively) at T1 compared to T0. No difference was found between Group A and B with regard to the FIM scores in the intergroup analysis. Group A showed significant improvement at T1 compared to T0 in all sub-items of SF-36 (p

Introduction - Because of the limited information on cervical spondylotic radiculopathy, we conducted a door-to-door two-phase survey in a Sicilian municipality. Material and methods - We first screened for cervical spondylotic radiculopathy among the inhabitants of the municipality : (N= 7653, as of the prevalence day, November 1, 1987). Study neurologists then investigated those subjects suspected to have had a cervical spondylotic radiculopathy. Diagnoses were based on specified criteria. Results - We found 27 subjects affected by CSR (17 definite, 10 possible). Prevalence (cases per 1000 population) was 3.5 in the total population ; it increased to a peak at age 50-59 years and decreased thereafter. The age-specific prevalence was consistently higher in women. Conclusions - Comparison with other prevalence studies shows similar age-specific patterns, but different magnitudes, which may partly reflect methodologic differences across studies.

Interleukin (IL)-1 receptor antagonist (IL-1ra) is a naturally occurring inhibitor of IL-1 which binds to IL-1 receptors without generating immunologic responses. Evidence has recently been provided that the balance between the production of IL-1 and IL-1ra might influence the course of immunoinflammatory diseases such as inflammatory bowel diseases, rheumatoid arthritis (RA) and Lyme arthritis. To assess whether endogenous IL-1ra may also have a role on the course of multiple sclerosis (MS) we presently studied the fluctuation of the serum levels of IL-1ra in patients with relapsing remitting (RR) MS either during remission or exacerbation. Moreover, to evaluate whether the beneficial effect of IFN-β on the course of MS might also be mediated by an increased production of IL-1ra, we measured the levels of circulating IL-1ra in MS patients prior to and after 6 months of continuous treatment with natural human IFN-β (6 000 000 IU three times a week for 6 months). Our results demonstrated that, relative to control subjects, IL-1ra serum levels are ‘normal’ during remitting phases of RR MS but significantly elevated either during exacerbations or in response to IFN-β treatment.

Sembra inevitabile che le nostre società dovranno gestire relazioni sociali, contraddizioni e conflitti inediti, contrassegnati dal movimento delle differenze culturali ed etniche. Questo saggio intende focalizzare, in una prospettiva sociologica, la difficoltà e le trasformazioni che nelle società occidentali conseguiranno alle relazioni multiculturali. This paper intends to focus, in a sociological perspective, the difficulty and the transformations resulted by the multicultural relations in Western societies. The growth of the phenomenon of migratory flows at the global level poses a series of challenges in the governance of multicultural societies, and in particular in integration policies. In recent years, Western societies have rediscovered the social and identity effects of migrations. It seems inevitable that our societies will have to face social relations, contradictions and unprecedented conflict, marked by religious, cultural and ethnic backgrounds

Preliminary evidence suggests that palliative care may be useful for people with severe multiple sclerosis (MS). The aim of this study is to determine the effectiveness of a home-based palliative approach (HPA) for people with severe MS and their carers. This is a single-blind randomized controlled trial with a nested qualitative study. Seventy-five severe MS-carer dyads are being randomized (at three centers, one in each area of Italy) to HPA or usual care (UC) in a 2:1 ratio. Each center has a specially trained team consisting of four professionals (physician, nurse, psychologist, social worker). The team makes a comprehensive assessment of the needs of the dyads. HPA content is then agreed on, discussed with the patient’s caring physician, and delivered over six months. The intervention is not intended to replace existing services. At later visits, the team checks the HPA delivery and reviews/modifies it as necessary. HPA and UC dyads are assessed at home by a blind examiner at baseline, and three and six months later; they also receive monthly telephone interviews. Dyads assigned to UC receive the examiner’s visits and telephone interviews, but not the team visits. Primary outcome measures are changes in symptoms (Palliative care Outcome Scale-Symptoms-MS, POS-S-MS), and quality of life (the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), not assessed in patients with severe cognitive compromise) at three and six months. Other outcomes are changes in patient functional status and mood; changes in carer quality of life, mood and caregiving burden; costs; incorporation with standard care; unplanned hospital admissions; referrals to hospice; and deaths. The experience of participants will be evaluated qualitatively by individual semi-structured interviews (HPA patients and carers) and focus group meetings (HPA patients’ caring physicians). The results of our study will show whether the HPA is feasible and beneficial to people with severe MS and their carers living in the three Italian geographic areas. The nested qualitative study will add to the understanding of the strengths and limitations of the intervention. The trial was registered with Current Controlled Trials (identifier: ISRCTN73082124 ) on 19 June 2014.

Background Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS). The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS. Methods In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis. Results We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5±3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95% CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95% CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p Conclusions Our findings, show no correlation between EA, CD and postpartum relapses and disability. Therefore these procedures can safely be applied in MS patients. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery.