Search

Background: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults. Materials and Methods: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program. Results: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3). Conclusions: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment.

The Italian Cystic Fibrosis Registry (ICFR) is based on a new agreement about the data flow towards the Registry signed on October, 4th 2016 by the Centre for Rare Diseases of the Italian National Institute of Health (NIH), the clinicians of the Italian National Referral and Support Centres for Cystic Fibrosis, the Paediatric Hospital "Bambino Gesù" (Rome), the Italian Cystic Fibrosis Society, and the Italian League for Cystic Fibrosis.The aim of the present Report is to improve the knowledge on cystic fibrosis (CF) through the epidemiological description of Italian patients. The members of the Scientific and Technical Committee have to write a report on data collected by ICFR, in order to contribute to achieve the aims of ICFR itself, i.e., to improve the care of CF patients. In particular, the Report should contribute to the following objectives: - to analyze the medium and long-term clinical and epidemiological trends of the disease; - to identify the main healthcare needs at regional and national level in order to contribute to the healthcare programmes and to the distribution of resources; - to compare Italian data with the international ones.Analyses and results described in the present Report are referred to patients in charge to the Italian National Referral and Support Centres for Cystic Fibrosis in the period 2011-2014. Data were sent by Centres by means of a specific software (Camilla, Ibis Informatica) and has undergone a double quality control (QC): the first by NIH and the second at a European level (before the inclusion of the Italian data within the European Cystic Fibrosis Registry). These QCs assure the completeness and accuracy of data as well as their consistency with European core data.A total of 29 different CF centres (referral, support, and Paediatric Hospital "Bambino Gesù") sent their data to ICFR; data referred to the period 2011-2014. Data regarding Sardinia Region (Southern Italy) are missing; data from Molise (Southern Italy) CF centre refer only to 2014.The present Report has been organized into 10 sections. 1. Demography - number of Italian patients with cystic fibrosis (CF) in 2014 was 4,981 and their median age was 20.4 years; estimated 2014 CF prevalence was 8.2/100,000 residents in Italy; on average, 52.1% of the patients were male and CF distribution showed higher frequency in patients aged from 7 to 35 years. On average, 53.7% of CF patients are aged more than 18 years. 2. Diagnoses - most of the CF patients were diagnosed before two years of age (around 66%); a significant proportion of patients (on average, 12%) was diagnosed in adult age. 3. New diagnoses - new diagnoses were 187 in 2011, 200 in 2012, 160 in 2013, and 135 in 2014. Estimated incidence was 1/4,052 live births in 2011; 1/4,313 in 2012; 1/5,189 in 2013 and 1/8,243 in 2014. 4. Genetics - 99.5% of patients was studied at the molecular level, with identification of 90.1% of Cystic Fibrosis Transmembrane Regulator CFTR mutations; [delta]508F was the most frequent mutation (44.8% in 2014). 5. Lung function - FEV₁ (Forced Expiratory Volume in the first second) scores progressively decreased shortly before the start of adult age, in accordance with the natural history of the disease. Most of the patients between 6 and 17 years of age reported a FEV₁ % ≥ 70% of the predicted value, while the proportion of patients with severe lung disease (FEV₁ %40% of the predicted value) is2% over the period 2011-2014. 6. Nutrition - most critical periods come out during the first 6 months of life and during adolescence. Prevalence of malnourished male aged 12-17 years decreases over the period 2011-2014; an increasing percentage of patient (both male and female) with a suboptimal body mass index value is observed among patients aged more than 18 years 7. Complications - the presence of missing data represents an obstacle in the correct evaluation of prevalence value of complications related to Italian patients within ICFR. Nevertheless, it was estimated that, in 2014, the principal complication in patients aged18 years was hepatopathies (15%), while in patients aged more than 18 years the principal complications were due to hepatopathies (25%) and diabetes (22%). 8. Transplantation - during the period 2011-2014, 135 patients ageed between 7 and 53 years received a double lung transplant; median age at transplantation was 32.5 years. Median duration of waiting list for transplantation is estimated in 11 months. 9. Microbiology - analyses were referred to test performed in 2014. Prevalence of adult patients with Pseudomonas aeruginosa chronic infection is 49.4% compared to 14.5% of paediatric patients; Staphylococcus aureus chronic infection is present in 48% of adult patients and 45.6% of paediatric patients; Burkholderia Cepacia complex is present almost exclusively in adult patients (4.9%); Nontuberculous mycobacteria is present in 0.9% and 0.3% of adult and paediatric patients, respectively; Stenotrophomonas maltophilia infection is present in 4.6% of patients (both adults and paediatric). 10. Mortality - RIFC data show that 176 patients (median age 32 years; 81 males and 95 females) died in the period 2011-2014.The present Report shows that CF population is growing (median age), so paediatric mortality is decreasing. A very low percentage of paediatric population is characterized by complication of pulmonary functions; adult patients are characterized by an increase of age at death (more than 30 years of age). ICFR Report may represent an important tool to analyze clinical and epidemiological trends of the disease as well as to identify the main healthcare needs at regional and national level to contribute to the healthcare programmes and to the distribution of the resources.

INTRODUZIONE E’ noto che un’alterazione del microbioma vaginale con riduzione del numero e della varietà di lattobacilli è associata a maggior rischio di infezioni genitali sessualmente trasmesse. Tra queste l’infezione da Chlamydia trachomatis si distingue non solo per l’elevata incidenza, ma anche per la frequenza e la severità delle sequele. Pochissimi sono ad oggi gli studi mirati a indagare i meccanismi di interazione tra lattobacilli e Chlamydia. Il nostro studio in vitro si propone di analizzare l’interazione diretta tra diversi ceppi di lattobacilli o loro insieme di metaboliti e i corpi elementari di C. trachomatis prima del loro ingresso nelle cellule (killing extracellulare). METODI Diciassette ceppi di lattobacilli sono stati isolati da tamponi vaginali di donne sane in età fertile e coltivati in brodo MRS over-night. Dopo determinazione turbidimetrica della concentrazione di lattobacilli, le colture sono state centrifugate per separare il pellet batterico dal surnatante. Abbiamo quindi messo a contatto i pellet e i corrispettivi surnatanti alle diverse concentrazioni di 5×107, 5×106 e 5×105 con corpi elementari (CE) di Chlamydia, sierotipo D (5×103 CFU). Sono stati valutati 3 diversi tempi di contatto (7, 15 e 60 minuti) a 37°C. Al termine di ogni incubazione abbiamo centrifugato la sospensione per eliminare le cellule batteriche e inoculato il surnatante contenente i CE in tubini contenenti un vetrino sterile su cui erano state coltivate cellule HeLa a confluenza del 100% circa. Dopo 48 ore di incubazione i vetrini sono stati fissati e colorati con anticorpo monoclonale diretto contro LPS di Chlamydia coniugato con fluoresceina (Meridian, Cincinnati, OH, USA). Abbiamo contato il numero di inclusioni al microscopio a fluorescenza in 30 campi (ingrandimento 200×) e confrontato i valori medi con quelli di colture cellulari infettate con la stessa quantità di CE in assenza di contatto con lattobacilli. I risultati sono stati analizzati con test ANOVA. Un valore di p

The Alzheimer Disease Genetics Consortium (ADGC) performed a genome-wide association study of late-onset Alzheimer disease using a three-stage design consisting of a discovery stage (stage 1) and two replication stages (stages 2 and 3). Both joint analysis and meta-analysis approaches were used. We obtained genome-wide significant results at MS4A4A (rs4938933; stages 1 and 2, meta-analysis P (P M) = 1.7 × 10 -9, joint analysis P (P J) = 1.7 × 10 -9; stages 1, 2 and 3, P M = 8.2 × 10 -12), CD2AP (rs9349407; stages 1, 2 and 3, P M = 8.6 × 10 -9), EPHA1 (rs11767557; stages 1, 2 and 3, P M = 6.0 × 10 -10) and CD33 (rs3865444; stages 1, 2 and 3, P M = 1.6 × 10 -9). We also replicated previous associations at CR1 (rs6701713; P M = 4.6 × 10 -10, P J = 5.2 × 10 -11), CLU (rs1532278; P M = 8.3 × 10 -8, P J = 1.9 × 10 -8), BIN1 (rs7561528; P M = 4.0 × 10 -14, P J = 5.2 × 10 -14) and PICALM (rs561655; P M = 7.0 × 10 -11, P J = 1.0 × 10 -10), but not at EXOC3L2, to late-onset Alzheimer's disease susceptibility. © 2011 Nature America, Inc. All rights reserved.

Background: Several diseases and adverse conditions affect the cognitive development of children in Sub-Saharan African. There is need to assess these children to determine which abilities are affected and the severity of the damage so as to plan interventions accordingly. However most psychological tests developed in the West have not been validated in this region making it impossible to know whether they measure what they were intended to in African children. Objective: To examine the construct validity of the Kaufman Assessment Battery for Children, Second Edition (KABCII)in Ugandan children. Methods: Sixty five Ugandan children aged 7 to 16 years (Mean=9.90, SD=2.46) were tested using the KABC-II 44.59 months (SD=2.82) after an episode of cerebral malaria. The KABC-II scales of Sequential Processing, Simultaneous Processing, Planning and Learning were administered. In order to identify which factors result from administering the KABC-II in these children, factor analysis using principal component analysis with Varimax rotation was applied to the subtests making up the above scales. Results: Five factors emerged after factor analysis comprising of subtests measuring Sequential Processing, Simultaneous Processing, Planning and Learning. The fifth scale comprised of subtests measuring immediate and delayed recall. Conclusion: This preliminary study in Ugandan children shows the KABC-II to have good construct validity with subtests measuring similar abilities loading on the same factor. The KABC-II can be used in assessing Ugandan children after a few modifications. Further analysis of its psychometric properties in Ugandan children is required.Key Words: neuropsychology, cross-cultural, Africa, children, validationAfrican Health Sciences 2009; 9(3): 186-192

Despite controversial clinicopathological distinctions between Parkinson's disease with dementia (PDD) and Alzheimer's disease (AD), similar patterns of metabolic reduction in the posterior brain were reported previously using PET with [18F]fluorodeoxyglucose. The current study was designed to examine more specific regional differences in cerebral glucose metabolism between PDD and AD using accurate and objective brain mapping techniques.This study included nine normal subjects, nine PDD patients and nine AD patients. PDD and AD groups were matched carefully for age, sex and general dementia severity as measured by Mini-Mental State Examination and Clinical Dementia Rating scales. Each subject underwent [18F]fluorodeoxyglucose-PET and neuropsychological testing. After anatomic standardization of PET image sets and stereotactic data extraction, absolute and normalized cerebral metabolic rates were assessed by region of interest and pixel-by-pixel analyses.PDD and AD showed global glucose metabolic reduction with similar regional accentuation involving the lateral parietal, lateral temporal and lateral frontal association cortices and posterior cingulate cortex in comparison to normal controls. When comparing between PDD and AD, however, PDD showed greater metabolic reduction in the visual cortex and relatively preserved metabolism in the medial temporal cortex.Although a common feature of metabolic abnormalities in the posterior brain exists in PDD and AD, the presence of regional metabolic differences suggests different degrees and combinations of disease specific underlying pathological and neurochemical processes.

Dynamic [18F]fluorodeoxyglucose (FDG) PET was used in Parkinson's disease patients and normal controls to determine kinetic rate constants for FDG. The goal was to assess whether the metabolic decreases observed in Parkinson's disease are associated with transport or phosphorylation processes or both.Fluorine-18-FDG was administered to 18 Parkinson's disease and 15 normal control subjects. Dynamic PET scanning was performed for 1 h and rate constants were obtained by nonlinear, least-squares analysis. Regional glucose metabolic rate was calculated from the individually fitted rate constants and by two standard static scan analyses.Global CMRglu was decreased in Parkinson's disease (mean reduction 22%), reaching statistical significance in all regions investigated. K1 was significantly reduced in parietal cortex, temporal cortex and striatum while k3 was significantly reduced only in parietal cortex. The rate constant k2 was unchanged.K1, k3 and CMRglu all demonstrated greater deficits across the brain with progression of disease and development of dementia, particularly in the parietal an occipital cortex. This suggested that the metabolic disturbance may be a global dysfunction throughout the brain. Because altered rate constants are specifically taken into account, dynamic measurements has shown to provide higher sensitivity for detecting diminished glucose utilization in Parkinson's disease than static approaches.