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Recent studies suggest an association of affective symptoms with striatal dopaminergic activity in Parkinson's Disease (PD). On the other hand, the psychopathological features of other common Movement Disorders (MD), such as Essential Tremor (ET) and Primary Dystonia, are less explored.
We investigated striatal dopamine transporter (DAT) availability and affective symptoms in these three different MD.
Materials and methods
22 pts with ET, 14 pts with focal dystonia and 34 idiopathic PD pts underwent 123I-FP-CIT SPECT. A control group of 15 healthy subjects was also analyzed.
Psychiatric assessment included the HAM-D scale for severity of depression, the HAM-A scale for anxiety levels, the Snaith Hamilton Pleasure Scale (SHAPS) for anhedonia.
SPECT was carried out 3 hours after 111 MBq 123I-FP-CIT intravenous injection. Specific 123I-FP-CIT binding in the striatum and striatal subregions was calculated based on ROI analysis.
Significant reduction of 123I-FP-CIT binding ratios was found only in PD. Spearman's analysis showed an inverse correlation between anxiety and DAT availability in the left striatal regions of both ET and dystonic patients. On the contrary, a significant positive correlation was found in PD subjects.
This preliminary study provided evidence for an association between pre-synaptic striatal dopaminergic function of the left hemisphere and anxiety in MD, thus confirming the “transnosologic” relevance of dopaminergic dysfunction.
Unexpected findings in PD patients are in contrast with previous results. A down-regulation of DAT could be hypothesized in both ET and dystonic patients. This pattern seems to be concordant with preliminary findings in primary anxiety disorders.
Despite their proven efficacy and tolerability, many patients are often switched among antipsychotics therapies due to the lack of therapeutic response. Many physicians begin to switching antipsychotics with the original intention to discontinue the drug, and, continue with another therapy. Several new antipsychotics available allow us to improve the long- term therapy.
Nineteen year open label study in ‘real world’ setting in 121 inpatients with schizophrenia (DSM-III -> DSM-IV-TR) observed first time in 1992 in a neuropsychiatric centre and subsequently clinically evaluated until 2011; data collected and compared to switching between antipsychotics (from haloperidol to clozapine, risperidone, olanzapine, quetiapine, aripiprazole). At baseline: epidemiogical and biological parameters, PANSS, QLindex and, subsequently, with CGI-S scores during every clinical visit of control [T1 → T7]. The overall analysis carried out with EZAnalyze(c) ver.3.0.
In the clozapine group remission rates were higher than other groups; Interrupted therapy: 27.62% of patients with risperidone, 34.85% with quetiapine. A consistent number of patients (8.04%), who have suspended the ‘first’ therapy with haloperidol, have assumed again the therapy with haloperidol toT7. Outcome was good in 28.4%,intermediate in 50,1% and poor in 21%. CGI-S T7 vs T0 (Severity of illness= p: 0,0066; Global improvement = p: 0,02844; Efficacy index =p: 0,00597)
Study suggested that most clinically stable outpatients with schizophrenia maintain remission states after being switched to atypical antipsychotics; a T7 (19 years) a consistent number of patients assumed again haloperidol with satisfactory rate of 51.18% then previous pharmacological treatments with a atypical antipsychotics.
Negative symptoms constitute an important diagnostic and therapeutic challenge (Galderisi & Maj 2008). Negative symptoms are thought to be part of schizophrenia, at least in some patients (Kirkpatrick 2014). Despite that there are few treatment trials focused on primary negative symptoms (Chue P, Lalon de JK 2014).
Open-observational study to evaluate the efficacy of SGA on negative symptoms, in according to the recommendations of Consensus Development Conference Attendes(CDCA) .
To consider the impact of SGAs in the treatment of primary negative symptoms.
We evaluated in 12-month-study efficacy of SGA in 42 inpatients with schizophrenia(DSM-5). Inclusion criteria: persistent negative symptoms with adequate antipsychotic treatment, clinically stable, minimal psychotic symptoms, depression/anxiety, EPS. Patients were treated with SGAs (clozapine; risperidone; quetiapine, olanzapine) and evaluated at baseline and after 1, 3, 6, 12 mouths with: PANSS; BPRS; Brief Negative Symptoms Scale (BNSS); CDSS. Data were collected and evaluated by EZanalize /Excel.
Data obtained with BNSS and PANSS scales show no significant differences in olanzapine and risperidone groups. Clozapine-treated patients had a significant reduction in BNSS score (p < .03) and particularly in asociality and avolition subscales. Although no significant difference was found in the PANSS and BNSS total scores in all groups; quetiapine group showed significant symptoms reduction in the PANSS and BNSS, alogia subscale (p <=.06).
There are not studies that show a superiority of a drug over another in negative symptoms therapy. However, emergine results show that some antipsychotics act preferentially on some specific items of group of symptoms.
The use of atypical antipsychotics (SGAs) is hindered by the frequent occurrence of metabolic side effects, resulting in worsened quality of life and greater mortality as a result of increased risk factors for metabolic syndrome   in schizophrenic patients compared with general population .
To establish the relationship between antipsychotic efficacy and side effects, especially the impact of various antipsychotics on metabolic parameters after 20-year treatment with atypical (SGAs) and typical antipsychotics (FGAs)
To identify advantages and disvantages of SGAs in terms of quality of life, costs and benefits.
Forty-five psychiatric inpatients diagnosed with schizophrenia or schizoaffective disorder (DSM-IV-TR diagnosis), treated with typical (haloperidol) and atypical (clozapine, risperidone, olanzapine, quetiapine, aripiprazole) antipyschotics, were studied retrospectively during 20 years. We use data at baseline, follow-up: 1, 5, 10, 20 years. Rating scales administered: CGI-I, SAPS, SANS, PANSS.
The results have underlined a statistically significant variations(p value <.05) of the lipidic and glicidic profile. We have also found a reduction of the recorded values at endpoint vs baseline in aripiprazole and haloperidol groups. The glicemic values, were not statistically different in quetiapine, aripiprazole, risperidone and haloperidol groups. No significant statistical variations were observed in complete blood count, electrocardiogram, liver enzymes blood pressure and body weight.
The results confirm studies on efficacy and effectiveness of both SGAs and FGAs, and their influence on metabolic profile and other biological parameters. These data can represent a’real world’ study in patients observed during our daily out-patient practice.
In recent years, there has been an increase in migration in Europe. Particularly, Italy has been one of the most important landing place. Currently, migrants in the province of Avellino, South Italy city, amount to about 1400, housed in 40 facilities in 23 municipalities. Psychological interest on migration and its impact on lifestyle patterns has increased in recent years.
There are few studies that evaluated the frequent psychosomatic symptoms in these populations. Despite the trauma experienced, they are not able to give a name to the suffered and somatized pain.
Assessment of somatic symptoms reported by the immigrant cohort after a three-month observation period.
We included 50 migrants (21.3 mean years) hosted in emergency centre in Avellino, Italy. All guests have conducted psychological clinical interviews. At baseline, were administered following scales: the patient health questionnaire (PHQ-9); Illness Behaviour Inventory (IBI); Symptoms checklist-90-Revised (SCL-90-R) scale. Same data was collected after three months.
The migrant group was a heterogeneous group. Overall data on IBI and PHQ-9 scale indicate a statistically significant variation baseline vs deadline Data of IBI scale is statistically significant [T-Score: 3,921; P: 003]; also with PHQ-9 [T0 vs. T1: T-Score: 3,986; P: .003]. Similar results have been found with SCL-90-R.
In their vocabulary, terms such as anxiety, sadness, fear exist hardly. They tend to minimize the psychological pain, not because I do not feel, but because move it on the body. They have difficulty to talk about emotions, not just a matter of culture and language, but also because they are ashamed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Patients with serious psychiatric illness (SMI) have a reduced quality of life and life expectancy than the general population. Metabolic syndrome (MS) is a clinical aspect determining who should be considered to reduce the risk of serious and chronic organic factors, even more significant in the elderly.
To evaluate metabolic screening of elderly patients with severe mental illness (SMI).
To evaluate the importance of routine screening of metabolic parameters in elderly guests of residential facilities with or without SMI; metabolic screening at baseline and after two of hospitalization.
Elderly inpatients (44 Tot) with Severe Mental Illness (SMI: bipolar disorder: 34%; schizophrenia: 46%; other: 20%) vs elderly inpatients (78 Tot). Data collected at baseline: psychiatric diagnosis; any previous diagnosis of hypertension, diabetes, dyslipidemia; ECG. At baseline and for two years were administered following scale: BPRS; PANSS; Qli; MMSE, ADL.
After two years metabolic screening has recorded at least one of the new interactions between the five factors of MS (ATP III) in 50% of patients with: one (34%); two (21%); three (11%); four (3%) new altered parameters. In MS inpatients, 53% of new metabolic alterations were recorded in 53% (MS inpatients) vs 23% without MS after two years.
Our results showed a higher frequency of MS in patients with SMI than comparison subjects. Haloperidol was the antipsychotic medication that caused minor impact on the development of metabolic disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Guidelines recommend Botulinum toxin-A (BoNT-A) after deep brain stimulation (DBS), although the effectiveness of their combined use is uncertain. A chart review of Parkinson’s disease (17) and dystonia (7) patients undergoing 302 injections with IncobotulinumtoxinA before or after DBS was performed. Patients with cervical dystonia received less IncobotulinumtoxinA after DBS (290.7 ± 124.0 vs. 192.4 ± 131.4, p = 0.005) and experienced an increased benefit (4.0 ± 3.4 vs. 8.4 ± 3.6 weeks, p = 0.003). No significant differences were found when comparing the treatment outcomes of 14 patients who received both IncobotulinumtoxinA and OnabotulinumtoxinA after DBS. The use of BoNT-A after DBS is a useful strategy although prospective studies are needed.
Background: Stimulation frequency has been considered a crucial determinant of efficacy in deep brain stimulation (DBS). DBS at frequencies over 250Hz is not currently employed and consensus in the field suggests that higher frequencies are not clinically effective. With the recent demonstration of clinically effective ultra-high frequency (UHF) spinal cord stimulation at 10kHz we tested whether UHF stimulation could also be clinically useful in movement disorder patients with DBS. Methods: We studied the effects of conventional (130Hz) and UHF stimulation in five patients with Parkinson’s disease (PD) with STN DBS and in one patient with essential tremor (ET) with VIM DBS. We compared the clinical benefit and adverse effects of stimulation at various amplitudes either intraoperatively or postoperatively with the electrodes externalized. Results: Motor performance improved in all six patients with UHF DBS. 10kHz stimulation at amplitudes ≥3.0mA appeared to be as effective as 130Hz in improving motor symptoms (46.2% vs 53.5% motor score reduction, p=0.110, N=90 trials). Interestingly, 10kHz stimulation resulted in fewer stimulation-induced paresthesiae and speech adverse effects than 130Hz stimulation. Conclusions: Our results indicate that DBS at 10kHz produces clinical benefits while possibly reducing stimulation-induced adverse effects in patients with movement disorders.
During the “DBS Canada Day” symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to share their knowledge regarding deep brain stimulation (DBS) management of movement disorders in three domains: (1) the programming algorithms, (2) the necessary team to run a neurosurgery program, and (3) the appropriate scales to better define in a more comprehensive fashion the effect of the brain surgery. Each presentation was followed by an open discussion, and this article reports on the conclusions of this meeting on these three questions. Concerning programming, the role of the pulse width and the switching off of the stimulation at night for thalamic stimulation for the control of tremor have been discussed. The algorithms proposed in the literature for programming in Parkinson’s disease (PD) need validation. In dystonia, the use of monopolar vs bipolar parameters, the use of low vs high frequencies and the use of smaller versus larger pulse widths all need to be examined properly. Concerning the necessary team to run a neurosurgical program, recommendations will follow the suggestions for standardized outcome measures. Regarding the outcome measures for DBS in PD, investigations need to focus on the non-motor aspects of PD. Identifying which nonmotor symptoms respond to DBS would allow a better screening before and satisfaction postoperatively. There is an important need for more data to determine the optimal programming protocol and the standard measures that should be performed routinely by all centers.
In this review, we have gathered all the available evidence to guide medication management after deep brain stimulation (DBS) in Parkinson’s disease (PD). Surprisingly, we found that almost no study addressed drug-based management in the postoperative period. Dopaminergic medications are usually reduced, but whether the levodopa or dopamine agonist is to be reduced is left to the personal preference of the treating physician. We have summarized the pros and cons of both approaches. No study on the management of cognitive problems after DBS has been done, and only a few studies have explored the pharmacological management of such DBS-resistant symptoms as voice (amantadine), balance (donepezil) or gait disorders (amantadine, methylphenidate). As for the psychiatric problems so frequently reported in PD patients, researchers have directed their attention to the complex interplay between stimulation and reduction of dopaminergic drugs only recently. In conclusion, studies addressing medical management following DBS are still needed and will certainly contribute to the ultimate success of DBS procedures.
Considerable debate exists regarding the potential antineoplastic effect of dietary long-chain n-3 PUFA contained in fatty fishes. Since the majority of published data has proven that their intake does not induce toxic or carcinogenic effects in humans, their possible preventive use against cancer has been suggested. On the other hand, it is unlikely that they could be effective in cancer patients as a single therapy. Nevertheless, a considerable effort has been put forth in recent years to evaluate the hypothesis that n-3 PUFA might improve the antineoplastic efficiency of currently used anticancer agents. The rationale for this therapeutic combinatory strategy is trying to increase cancer sensitivity to conventional therapies. This could allow the use of lower drug/radiation doses and, thereby, a reduction in the detrimental health effects associated with these treatments. We will here critically examine the studies that have investigated this possibility, by focusing particularly on the biological and molecular mechanisms underlying the antineoplastic effect of these combined treatments. A possible use of n-3 PUFA in combination with the innovative single-targeted anti-cancer therapies, that often are not completely devoid of dangerous side-effects, is also suggested.
In this review, the available evidence to guide clinicians regarding
eligibility for deep brain stimulation (DBS) in the main conditions in which
these forms of therapy are generally indicated—Parkinson’s disease (PD),
tremor, and dystonia—is presented. In general, the literature shows that DBS
is effective for PD, essential tremor, and idiopathic dystonia. In these
cases, key points in patient selection must include the level of disability
and inability to manage symptoms using the best available medical therapy.
Results are, however, still not optimal when dealing with other aetiologies,
such as secondary tremors and symptomatic dystonia. Also, in PD, issues such
as age and neuropsychiatric profile are still debatable parameters. Overall,
currently available literature is able to guide physicians on basic aspects
of patient selection and indications for DBS; however, a few points are
still debatable and controversial. These issues should be refined and
clarified in future studies.
During the “DBS Canada Day” symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to discuss three main questions on target selection for deep brain stimulation (DBS) of patients with Parkinson’s disease (PD). First, is the subthalamic nucleus (STN) or the globus pallidus internus (GPi) the ideal target? In summary, both targets are equally effective in improving the motor symptoms of PD. STN allows a greater medications reduction, while GPi exerts a direct antidyskinetic effect. Second, are there further potential targets? Ventral intermediate nucleus DBS has significant long-term benefit for tremor control but insufficiently addresses other motor features of PD. DBS in the posterior subthalamic area also reduces tremor. The pedunculopontine nucleus remains an investigational target. Third, should DBS for PD be performed unilaterally, bilaterally or staged? Unilateral STN DBS can be proposed to asymmetric patients. There is no evidence that a staged bilateral approach reduces the incidence of DBS-related adverse events.
We present the first results obtained by analyzing the detailed kinematics of a subsample of 9 massive and compact galaxies found in the WINGS survey. The observed galaxies are very old (both luminosity and mass- weighted age are on average ≥ 10 Gyr), while they resemble more typical galaxies in the other characteristics. The total M/L ratio is determined using as free parameters the anisotropy β and the galaxy inclination i.
Neonatal transfusion therapy requires an understanding of the dynamic interactions of the fetomaternal unit, the physiologic changes that accompany the transition from fetus to neonate to infant, and the underlying pathophysiology of different hematologic disorders. Guidelines for neonatal transfusions remain controversial, since most have been extrapolated from evidence in adults or based on small studies in neonates with marginal statistical validity. Compared with older children and adult’s, neonates have small total blood volumes but a high blood volume per body weight. Because of the limited capacity to expand their blood volume to compensate for their rapid growth, many sick and/or premature infants require significant blood component support, especially within the first weeks of life. Immaturity of many organ systems predisposes them to metabolic derangements from blood products and their additive solutions, and to the infectious and immunomodulatory hazards of transfusion such as transfusion-acquired cytomegalovirus (TA-CMV) infection and transfusion-associated graft vs. host disease (TA-GVHD). Therefore, component modifications are often required to compensate for the infant’s small blood volume, immunologic immaturity, and/or compromised organ function, and constitute the uniqueness of neonatal transfusion therapy.
A sample of cord blood is often collected in newborn infants at the time of delivery, but routine testing of cord blood for ABO group and Rh type is not necessary for healthy newborn infants unless the mother is Rh-negative and/or has a positive antibody screen (4). ABO and Rh type should be determined on samples obtained from both mother and baby for sick infants. Cord blood may be used for initial testing, but should be confirmed with an infant’s sample. The infant’s blood group is determined from the red cells alone, since the corresponding isoagglutinins anti-A and anti-B in the serum/plasma are usually weak or absent. Screening for atypical antibodies may be performed on maternal blood if available, or in the neonatal serum/plasma. A conventional cross-match is unnecessary if atypical antibodies are not demonstrable.
We present a study of galaxy sizes in the local Universe as a function of galaxy environment, comparing clusters and the general field. Galaxies with radii and masses comparable to high-z massive and compact galaxies represent 4.4% of all galaxies more massive than 3 × 1010M⊙ in the field. Such galaxies are 3 times more frequent in clusters than in the field. Most of them are early-type galaxies with intermediate to old stellar populations. There is a trend of smaller radii for older luminosity-weighted ages at fixed galaxy mass. We show the relation between size and luminosity-weighted age for galaxies of different stellar masses and in different environments. We compare with high-z data to quantify the evolution of galaxy sizes. We find that, once the progenitor bias due to the relation between galaxy size and stellar age is removed, the average amount of size evolution of individual galaxies between high- and low-z is mild, of the order of a factor 1.6.
Waxy Crude Oils (WCO’s) are characterized by the presence of heavy paraffins in
sufficiently large concentrations. They exhibit quite complex thermodynamical and
rheological behaviour and present the peculiar property of giving rise to the formation of
segregated wax deposits, when temperature falls down the so called WAT, or Wax Appearance
Temperature. In extreme cases, segregated waxes may lead to pipeline occlusion due to
deposition on cold walls. In this paper we review the mathematical models formulated to
describe: (i) wax cystallization or thawing in cooling/heating cycles; (ii) the mechanisms
of mass transport in saturated non-isothermal solutions; (iii) the experimental device
used to measure wax solubility and wax diffusivity; (iv) wax deposition in pipelines
carrying a warm, wax-saturated WCO through cold regions; (v) wax deposition accompanied by
gelification during the cooling of a WCO under a thermal gradient.
We consider a solution of a mono-component oil and wax. The latter is dissolved in the oil if the temperature is above the so-called cloud point (which depends on the concentration) and it segregates in the form of solid crystals if temperature is below the cloud point. As the solid fraction of wax increases, the diffusivity of liquid wax in the oil decreases (gelification), eventually vanishing. We study a one-dimensional model where temperature is initially above the cloud point and then it is lowered to induce diffusion and gelification. We formulate the relevant mathematical problem (a free boundary problem), studying its well-posedness and showing some qualitative results.
Mathematical models of tumour spheroids, proposed since the early seventies, have been
generally formulated in terms of a single diffusive nutrient which is critical for cell replication
and cell viability. Only recently, attempts have been made to incorporate in the models the cell
energy metabolism, by considering the interplay between glucose, oxygen and lactate (or pH).
By assuming glucose and lactate as the only fuel substrates, we propose a simple model for the
cell ATP production which takes into account the main reactions that occur in the glycolytic and
the oxidative pathway. Under the assumption that cell death occurs when ATP production falls
below a critical level, we have studied the free boundary problem for the concentration of glucose,
lactate and oxygen inside the spheroid viable rim. We show that the existence of a necrotic core is
guaranteed for a sufficiently large size of the spheroid.