Search

Background: In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients., Methods: We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life., Results: Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications., Conclusions: The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background/Objectives : Essential oils (EOs) have been exploited by humans for centuries, but many sources remain poorly investigated, mainly due to the low yields associated with conventional extraction. Recently, new techniques have been developed, like solvent-free microwave extraction (SFME), able to enhance efficiency and sustainability. The use of Papaver rhoeas L. in traditional medicine has led researchers to investigate non-volatile fractions, but there are little data available on EOs. Methods : In the present work, we prepared EOs from the petals and leaves of P. rhoeas by SFME. GC/MS analysis of EOs revealed the presence of 106 compounds belonging to 13 different classes. Isomers of the different alkenes were identified thanks to an alkylthiolation reaction. Results : The results highlighted a predominance of saturated and unsaturated hydrocarbons, alcohols, and esters that might suggest a specific relationship with pollinators. Each population has been compared using PCA, heatmap, and barplot tools, highlighting differences in terms of composition by both comparing leaves and flowers and hill and lowland samples. Furthermore, cantharidin, a metabolite usually produced by insects, was detected in the flowers, possible present for attractiveness purposes. Conclusions : These results could contribute to ensuring a better understanding of the pollination process and of the biological activities of EOs from P. rhoeas .

Riverine wetlands are stepping-stone environments for the protection of local biodiversity, but they are particularly vulnerable to biological invasions. In order to take action against biological invasions, it is crucial to assess the impacts of alien species. However, it is also important to assess the potential benefits on ecosystem services that alien species could have. Once it has been verified that negative impacts are higher than potential benefits, it is important to propose feasible actions to contrast them. In this study, we assessed eight freshwater alien species recorded in an integral protected wetland using the Invasive Species Effects Assessment Tool (INSEAT) to quantify their negative impacts and potential benefits on ecosystem services. Moreover, for each species, we evaluated the feasibility of the main eradication techniques currently proposed in the literature using the Non-Native Risk Management scheme (NNRM), with the final aim of suggesting effective actions for their management. The INSEAT results indicated that all the assessed species had more impacts than benefits while NNRM provided useful indications on the best practical conservation actions to use for reducing the density, and therefore, the negative impacts on ecosystem services and the local biodiversity of the assessed alien species.

The history of safety science has seen the flourishing of several models and metaphors aimed at describing organizational accidents' dynamics. Metaphors and their graphical representations are powerful tools to frame risks and adverse events in socio-technical systems; they help in coping with systemic complexity but can also become a constraint and even bias the understanding of our environment. This paper aims to investigate how metaphors and their graphical representations influence the comprehension of organizational accidents, how they could be misinterpreted, and, as a result, generate misunderstandings of events. To address these questions, we analyze three paradigmatic accident causation models, typical of three phases in the evolution of models in the last century, describing how the related metaphors and depictions could influence the perception and understanding of risk factors. In addition, we present some possible misunderstandings that could be produced by the metaphor and graphical features of representations, with a particular focus on safety outcomes. Eventually, we provide a framework with the basic characteristics of an effective model and metaphor for the description and analysis of organizational accidents in modern complex socio-technical systems. This framework could be used as a guide for proposing new and more effective models in safety science.

The amount of pectin in the cell wall is considered a critical element regulating cell wall porosity. Thus, it is likely to influence the diffusional processes particularly that from the substomatal cavities to the carboxylation sites in the chloroplast stroma (i.e. mesophyll conductance, g m ). We analyzed in four deciduous species (Acer campestre , Crateaugus monogyna , Corylus avellana, Quercus robur ) the correlation between pectin and g m in two phase of leaves development (i.e. mature green leaves and senescent leaves). Results showed that in A. campestre , C. monogyna and Q. robur to higher value of pectin in mature green leaves corresponded the higher g m value. Taking into account this result, we can assume that a higher amount of pectins is associated to an increased cell wall hydrophilicity and elasticity, thus increasing g m because CO 2 molecules cross the wall dissolved in water. An opposite behavior was observed in C. avellana .

The Trentino-South Tyrol region is a special statute region of northeastern Italy. This territory is of particular interest for its morphology, flourishing vegetation, and history, having been a meeting area among different civilizations. Hence, Trentino is characterized by an ethnic plurality and a rich ethnobotanical knowledge, even if the available information is fragmentary, widely dispersed, and often guarded in oral popular culture. To fill this gap, in the present work 200 subjects were interviewed using an ethnobotanical survey. The resulting 817 citations referred to 64 native species, used either for human or animal health or for domestic purposes. As a second step, for each plant exploited for medicinal purposes, local importance was evaluated by calculating their relative frequency of citation. Moreover, the main traditional preparations were discussed. Among them, the most cited and exploited ones are Achillea millefolium , Arnica montana , Hypericum perforatum , Malva sylvestris , Pinus mugo, and Satureja montana , for which a deeper analysis has been performed. Lastly, the ethnobotanical knowledge of the plants growing in this territory will add a piece to the mosaic of traditional medicine in Italy and may lay the foundation for a nature-aided drug discovery process.

Across three experiments (N = 302), we explored whether people cognitively elaborate humanoid robots as human- or object-like. In doing so, we relied on the inversion paradigm, which is an experimental procedure extensively used by cognitive research to investigate the elaboration of social (vs. non-social) stimuli. Overall, mixed-model analyses revealed that full-bodies of humanoid robots were subjected to the inversion effect (body-inversion effect) and, thus, followed a configural processing similar to that activated for human beings. Such a pattern of finding emerged regardless of the similarity of the considered humanoid robots to human beings. That is, it occurred when considering bodies of humanoid robots with medium (Experiment 1), high and low (Experiment 2) levels of human likeness. Instead, Experiment 3 revealed that only faces of humanoid robots with high (vs. low) levels of human likeness were subjected to the inversion effects and, thus, cognitively anthropomorphized. Theoretical and practical implications of these findings for robotic and psychological research are discussed., Competing Interests: The authors have declared that no competing interests exist.

Background: Robotic sacrocolpopexy (RSCP) is an established option for the treatment of apical, anterior, and proximal posterior compartment pelvic organ prolapses (POP). However, there is lack of evidence investigating how lower bowel tract symptoms (LBTS) may change after RSCP., Methods: Data from consecutive patients treated with RSCP for stage 3 or higher POP from 2012 to 2019 at a single tertiary referral center with at least 1 year of follow-up were prospectively collected and retrospectively analyzed. RSCP was performed following a standardized technique which always employed both anterior and posterior hand-shaped meshes. Outcomes were collected at follow-up and analyzed. LBTS were evaluated through the Wexner questionnaire., Results: Overall, 114 women underwent RSCP. Eleven were excluded for missing data, whereas 12 had insufficient follow-up. Thus, 91 (79.8%) patients were included in this cohort. Median follow-up was 42 [interquartile range (IQR), 19-62] months. Mean age was 65 ± 10 years. In our series, RSCP was mainly performed for anterior and apical/medium stage 3 POP (in 95.6% of patients). Anatomic success rate of RSCP was 97.8%, with 89 patients with POP stage 0-1 at 12-month follow-up. Two patients (2.2%) experienced POP recurrence and were treated with redo-SCP. No patient experienced clinically significant posterior vaginal wall prolapse after RSCP. When analyzing LBTS, there was no significant change in postoperative total Wexner's score as compared to the preoperative value ( p  > 0.05). However, the manual assistance subscore was statistically significantly lower within the first-year follow-up ( p  = 0.04), but it spontaneously improved during the follow-up ( p  = 0.12)., Conclusion: RSCP with simultaneous placement of both anterior and posterior mesh is safe and successful to treat high-stage POP in carefully selected patients. Of note, LBTS appear unaffected by posterior mesh placement, supporting its routine use to prevent posterior POP recurrence. Larger prospective studies are needed to confirm our results., Competing Interests: Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2022.)

Background: With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic., Methods: Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system.  Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored., Discussion: This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021)., (© 2022. The Author(s).)

Recognition of identity and of emotional facial expressions of individuals are both based on processing of the human face. While most studies show these abilities to be dissociated, some others find evidence of a connection. One possible explanation for these contradictory results comes from neurological evidence, which points to identity recognition being mostly based on holistic processing, while emotion recognition seems to be based on both an explicit, fine-grained process, and an implicit, mostly-holistic one. Our main hypothesis, that would explain the contradictory findings, is that holistic implicit emotion recognition, specifically, would be related to identity recognition, while explicit emotion recognition would be a process separate to identity recognition. To test this hypothesis, we employed an experimental paradigm in which spatial frequencies of visual stimuli are manipulated so that automatic, holistic-based, implicit emotion recognition influences perceived friendliness of unfamiliar faces. We predicted the effect to be related to identity recognition ability, since they both require holistic face processing. After a successful replication study, we employed the paradigm with 140 participants, measuring also identity recognition ability and explicit emotion recognition ability. Results showed that the effect is not moderated by these two variables (p = .807 and .373, respectively), suggesting that the independence of identity and emotion recognition holds even when considering, specifically, implicit emotion recognition., (© 2021. Marta Olivetti Belardinelli and Springer-Verlag GmbH Germany, part of Springer Nature.)

Leaf secondary metabolites production and physiological leaf traits were analyzed in Corylus avellana wild type (WT) and cultivar ( cv. 'Tonda Gentile Trilobata', TGT) under different nutrient supplies. Three treatments were applied: control treatment with no fertilizer supply (WT C and TGT C ), low nutrient treatment (WT LN and TGT LN ) and high nutrient treatment (WT HN and TGT HN ). The analysis of leaf extracts showed a higher concentration of Quercitrin and Myricitrin, with the highest concentrations of both the compounds in WT than TGT. This result can be related to the ecological role of flavonoids, including also antimicrobial properties, which resulted more useful in the understory forest form which hazelnut wild type originates. Therefore, their lower concentration in TGT can be relate to the genetic background of TGT cultivar with a lesser intrinsic need to produce such compounds and justified by a usual growth under more controlled environmental conditions, including also pest and disease control.

The natural and seminatural components of agricultural landscapes play a key role in maintaining a high level of biodiversity. Being the Po Valley one of the most human-dominated and intensively cultivated landscapes in Europe, we investigated the effect of no-crop habitats on carabid richness and composition and evaluated the role of tree row as corridor for forest carabid dispersion. Carabids were sampled with 70 pitfall traps arranged in 35 sampling plots along three parallel transects (80, 100, and 140 m long) and encompassing five different habitats: tree row, tree row edge, grassland, forest edge, and forest. We found 5,615 individuals belonging to 55 species. Despite the similarity in species richness, all the habitats investigated showed a peculiar and distinct species assemblage. The main distinction was between the "open habitat" cluster composed of grassland and tree row edge and the "forest" cluster composed of forest, tree row, and forest edge. We found that forest species are able to penetrate the grassland matrix up to 30 m from the forest edge and that a distance of no more than 60 m between tree row and forest can allow the passage of up to 50% of the forest species. Beyond this distance, the grassland matrix becomes a barrier, preventing them from reaching other suitable habitats. Our findings confirm the importance of maintaining different types of natural habitats to significantly increase biodiversity in an intensively cultivated agroecosystem and demonstrated the role of linear elements as a corridor and "stepping stones" for many forest species., Competing Interests: None declared., (© 2021 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Simulation is a useful method to improve learning and increase the safety of work operations, both for technical and non-technical skills. However, the observation, assessment, and feedback about these skills is particularly complex, because the process needs expert observers, and the feedback could be judgmental and ineffective. Therefore, a structured process to develop effective simulation scenarios and tools for the observation and feedback about performance is crucial. To this aim, in the present research, we developed a training model for electricity distribution workers, based on high fidelity simulation., Methods: We designed simulation scenarios based on real cases, developed, and tested a set of observation and rating forms for the non-technical skills behavioral markers, and we tracked behaviors based on non-verbal cues (physiological and head orientation parameters)., Results: The training methodology proved to be highly appreciated by the participants and effective in fostering reflexivity. An in-depth analysis of physiological indexes and behaviors compliant to safety procedures revealed that breath rate and heart rate patterns commonly related with mindful and relaxed states were correlated with compliant behaviors, and patterns typical of stress and anxiety were correlated with non-compliant behaviors., Conclusions: a new training method based on high fidelity simulation, addressing both technical and non-technical skills is now available for fostering self-reflection and safety for electricity distribution workers. Future research should assess the long-term effectiveness of high-fidelity simulation for electricity workers, and should investigate non-invasive and real-time methods for tracking physiological parameters.

Background: Flooded semi-natural grasslands are endangered ecosystems throughout Europe. In Italy, amongst flooded meadows, one special type called " marcita " is strongly threatened. It is a stable flooded grassland used to produce green forage even during winter months due to the thermal properties of water coming from springs and fountains that prevent the soil from freezing. To date, some research has been carried out to investigate the role of the marcita for ornithological and herpetological communities. However, no comprehensive data on invertebrates inhabiting this particular biotope available. The aim of this study was to characterise the terrestrial entomological community of these typical winter-flooded meadows in northern Italy and, in particular, in six marcita fields located in the Ticino Valley Regional Park. We collected data on species richness and diversity of Carabidae, Staphylinidae, Araneae, Lepidoptera and Orthoptera inhabiting marcita during the summers of 2014 and 2015 and data on overwintering Coleoptera during the winter of 2014-2015. Amongst the collected species, we identified those highly linked to this habitat., New Information: We found a total of 47 ground beetle species, 35 rove beetle species, 29 spider species, one Lucanidae, 16 butterfly species and 24 grasshopper and cricket species. Most of the species were collected during the summers of 2014 and 2015, while some others were also, or exclusively, overwintering (17 ground beetles, four rove beetles and one Lucanidae) and were collected during the winter of 2014-2015. Marcita fields hosted specialised species and species typical of hygrophilous habitats, amongst which are included the butterfly Lycaena dispar , the ground beetle Dolichus halensis and the grasshopper Chrysochraon dispar . This study represents the first contribution to the knowledge of terrestrial arthropod communities associated with this particular type of winter-irrigated meadow in Europe and confirms the importance of this biotope for invertebrate conservation in agricultural landscapes., (Francesca Della Rocca, Silvia Stefanelli, Elisa Cardarelli, Giuseppe Bogliani, Francesco Bracco.)

Invasive alien plants are a major threat to biodiversity and they contribute to the unfavourable conservation status of habitats of interest to the European Community. In order to favour implementation of European Union Regulation no. 1143/2014 on invasive alien species, the Italian Society of Vegetation Science carried out a large survey led by a task force of 49 contributors with expertise in vegetation across all the Italian administrative regions. The survey summed up the knowledge on impact mechanisms of invasive alien plants in Italy and their outcomes on plant communities and the EU habitats of Community Interest, in accordance with Directive no. 92/43/EEC. The survey covered 241 alien plant species reported as having deleterious ecological impacts. The data collected illustrate the current state of the art, highlight the main gaps in knowledge, and suggest topics to be further investigated. In particular, the survey underlined competition as being the main mechanism of ecological impact on plant communities and Natura 2000 habitats. Of the 241 species, only Ailanthus altissima was found to exert an ecological impact on plant communities and Natura 2000 habitats in all Italian regions; while a further 20 species impact up to ten out of the 20 Italian administrative regions. Our data indicate that 84 out of 132 Natura 2000 Habitats (64%) are subjected to some degree of impact by invasive alien plants. Freshwater habitats and natural and semi-natural grassland formations were impacted by the highest number of alien species, followed by coastal sand dunes and inland dunes, and forests. Although not exhaustive, this research is the first example of nationwide evaluation of the ecological impacts of invasive alien plants on plant communities and Natura 2000 Habitats., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Mesophyll conductance ( g m ) has received over time much less attention than stomatal conductance ( g s ), although it affects leaf photosynthesis to about the same extent as stomatal conductance does. The objective of this study was to analyze the g m trend in five understory herbaceous species growing in a close-canopy forest in the north-west of Italy. In particular, three of analyzed species were monocots: Carex brizoides Lam., Carex pilosa Scop., and Oplismenus undulatifolius P. Beauv and the others dicots species: Circaea lutetiana L., and Pulmonaria officinalis Ced. The results showed, on one hand, the absence of correlation between g m and the considered environmental variables in the forest understory (i.e. air temperature, photosynthetic photon flux density and carbon dioxide concentration). Moreover, we carried out a principal component analysis considering all the analyzed morphological and physiological variables for the five species. The following correlation between the first component, related to the leaf mass per unit of leaf area and the leaf tissue density, and g m seem to suggest a key role of the leaf structural features in determining g m variations across the five species., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Prof. H.S. Srivastava Foundation for Science and Society 2020.)

Prunus lycioides (Spach) C.K. Schneid. (= Amygdalus lycioides Spach.), popularly recognized as "Badam Talkh kuhi", is an endemic species of Iran. It is widely distributed in Central and West Asia, where it plays a role in preventing and controlling soil erosion. Although domestic species of Prunus genus are well known and widely used in food, pharmaceutical, and cosmetic industries, inadequate information about wild species is available so far. As far as Prunus lycioides, it is commonly used by native people in traditional medicine for treating diabetes, inflammatory diseases, and microbial infections. The wild almonds are traditionally exploited for oil extraction due to their antioxidant properties. This review summarizes advances in the studies regarding Prunus lycioides and its pharmacological properties. The aim of the review is to renew the interest in this promising plant, thus stimulating researchers to go further with the study for discovering new bioactive compounds., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The goal of this work is to provide evidence for the cognitive objectification of sexualized targets via a change blindness paradigm. Since sexual objectification involves a fragmented perception of the target in which individuating features (i.e., the face) have less information potential than sexualized features (i.e., body parts), we hypothesized that changes in faces of sexualized targets would be detected with less accuracy than changes in faces of nonsexualized targets. Conversely, we expected that changes in body parts would be detected with higher accuracy for sexualized than nonsexualized targets. These hypotheses were supported by the results of two studies that employed a change blindness task in which stimuli with changes both to faces and bodies of sexualized and nonsexualized images were presented. Unexpectedly, the hypothesized effects emerged both for female and male targets.

Detecting the emotional state of others from facial expressions is a key ability in emotional competence and several instruments have been developed to assess it. Typical emotion recognition tests are assumed to be unidimensional, use pictures or videos of emotional portrayals as stimuli, and ask the participant which emotion is depicted in each stimulus. However, using actor portrayals adds a layer of difficulty in developing such a test: the portrayals may fail to be convincing and may convey a different emotion than intended. For this reason, evaluating and selecting stimuli is of crucial importance. Existing tests typically base item evaluation on consensus or expert judgment, but these methods could favor items with high agreement over items that better differentiate ability levels and they could not formally test the item pool for unidimensionality. To address these issues, the authors propose a new test, named Facial Expression Recognition Test (FERT), developed using an item response theory two-parameter logistic model. Data from 1,002 online participants were analyzed using both a unidimensional and a bifactor model, and showed that the item pool could be considered unidimensional. The selection was based on the items' discrimination parameters, retaining only the most informative items to investigate the latent ability. The resulting 36-item test was reliable and quick to administer. The authors found both a gender difference in the ability to recognize emotions and a decline of such ability with age. The PsychoPy implementation of the test and the scoring script are available on a Github repository. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Human factors are the most relevant issues contributing to adverse events in obstetrics. Specific training of Crisis Resource Management (CRM) skills (i.e., problem solving and team management, resource allocation, awareness of environment, and dynamic decision-making) is now widespread and is often based on High Fidelity Simulation. In order to be used as a guideline in simulated scenarios, CRM skills need to be mapped to specific and observable behavioral markers. For this purpose, we developed a set of observable behaviors related to the main elements of CRM in the delivery room. The observational tool was then adopted in a two-days seminar on obstetric hemorrhage where teams working in obstetric wards of six Italian hospitals took part in simulations. The tool was used as a guide for the debriefing and as a peer-to-peer feedback. It was then rated for its usefulness in facilitating the reflection upon one's own behavior, its ease of use, and its usefulness for the peer-to-peer feedback. The ratings were positive, with a median of 4 on a 5-point scale. The CRM observational tool has therefore been well-received and presents a promising level of inter-rater agreement. We believe the tool could have value in facilitating debriefing and in the peer-to-peer feedback., Competing Interests: The authors declare no conflict of interest.

Ischemic brain injury is one of the most important causes of death worldwide. The use of one-drug-multi-target agents based on natural compounds is a promising therapeutic option for cerebral ischemia due to their pleiotropic properties. This study assessed the neuroprotective properties of Castanea sativa Mill. bark extract (ENC) in human astrocytoma U-373 MG cells subjected to oxygen-glucose deprivation and reperfusion and rat cortical slices subjected to ischemia-like conditions or treated with glutamate or hydrogen peroxide. Neuroprotective effects were determined by assessing cells or slices viability (MTT assay), ROS formation (DCFH-DA assay), apoptosis (sub G0/G1 peak), nuclear fragmentation and chromatin condensation (DAPI staining) as well as changes in lysosomes and mitochondria morphology (Acridine Orange and Rhodamine123 staining, respectively). ENC treatment before injury on U-373 MG cells (5-50 μg/ml) and cortical slices (50-100 μg/ml) provided neuroprotection, while lower or higher concentrations (100 μg/ml U-373 MG cells, 200 μg/ml brain slices) were ineffective. ENC addition during reperfusion or after the injury was not found to be effective. The results suggest that ENC might hold potential as preventive neuroprotective agent, and indicate the importance of further studies exploring its mechanism of action. J. Cell. Biochem. 118: 839-850, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room)., Methods: The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected., Results: The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories., Conclusion: The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.

The kernel composition (moisture, ash, protein, carbohydrate, calories, fat, monounsaturated and polyunsaturated fatty acids) of two hazelnut (Corylus avellana L.) cultivars ('Tonda Gentile Trilobata' and 'Tonda Gentile Romana') and of two wild types growing in different climatic conditions (north-west and central Italy) was evaluated. The main kernel component was fatty acid (65.9 ± 1.8%, mean value), and the most abundant fatty acid in hazelnut was oleic acid (C 18:1 ) (83.5 ± 1.0%, mean value). The saturated fatty acids are the minor compounds in kernel hazelnut, resulting in a unsatured fatty acid to saturated (U/S) fatty acid ratio of 9.0 ± 1.6. Compared to other tree nuts and vegetable oils, hazelnut oil is among the ones with the highest contents of monounsaturated and the lowest content of saturated fatty acid. Thus, hazelnut may be beneficial for the human diet preventing cholesterol-based atherosclerosis and ischemic cardiovascular diseases.

Ethnobotanical and Ethnomedicinal Relevance: This study concerns seven Huperzia species (Lycopodiaceae), namely H. brevifolia, H. columnaris, H. compacta, H. crassa, H. espinosana, H. tetragona, H. weberbaueri, which are considered sacred plants by the Saraguro community, living in the Southern Andes of Ecuador; these plants are widely used in traditional medicine and ritual ceremonies., Material and Methods: The plants were selected on the basis of written interviews with 10 visionary healers (yachak) (2 women, 8 men), indicated as the most credible by the Saraguro Healers Council. The Informant Consensus Factor (F ic ) was determined. The first phytochemical study of the plants was performed by standard procedures, while the AChE and MAO-A inhibition by fractions enriched in high MW alkaloids, was measured in vitro., Aims of the Study: i) to investigate the uses of some Huperzia plants in healing and magical-religious practices of Saraguros; ii) to identify the main components of plant hydromethanolic extracts; iiì) to test the effects of alkaloidal fractions on the activity of two enzymes linked to mental health., Results: All the interviewed Saraguro yachak showed a high consensus about the uses of the seven Huperzia plants as purgatives and against supernatural diseases, such as the "espanto" (startle). In admixtures with other plants, some species also induce a state of trance or hallucinations in participants in magical-religious rituals. GC-MS of the volatile alkaloid fractions allowed the identification of some lycodine-type and lycopodine-type alkaloids (1-5) in H. compacta, H. columnaris, and H. tetragona. The flavones selgin) (6) and tricin (7) were isolated from H. brevifolia and H. espinosana. Tricin (7) was also detected in the other five species. The rare serratene triterpenes serratenediol (8) serratenediol-3-O-acetate (9), 21-episerratenediol (10), and 21-episerratenediol-3-O-acetate (11) were isolated from H. crassa. In addition, the presence of an unprecedented group of high molecular weight alkaloids has been determined. Alkaloid fractions of H. brevifolia, H. compacta, H. espinosana, and H. tetragona significantly inhibited AChE and MAO-A activities in vitro., Conclusions: The first phytochemical and ethnopharmacological study of seven Huperzia plants, widely used by Saraguro healers, led to the identification of several alkaloids and triterpenoids with different remarkable biological activities. In addition, alkaloid fractions exhibited a significant AChE and MAO-A inhibitory activity. These results may support the use of these plants in brews prepared for inducing psychoactive effects in participants in magical-religious ceremonies. This study confirms the rich traditional medical knowledge of Saraguro healers which must be documented and preserved for future generations., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The present contribution provides readers from diverse fields of psychology with a new and comprehensive model for the understanding of the characteristics of music ensembles. The model is based on a novel heuristic approach whose key construct is resilience, intended here as the ability of a system to adapt to external perturbations and anticipate future events. The paper clarifies the specificity of music ensemble as an original social and creative activity, and how some mechanisms, at an individual (cognitive) and group (coordination) level, are enacted in a particular way that endows these groups with exceptional capacity for resilience. There is now a wealth of evidence isolating the psychological mechanisms involved in these processes. However, there is much less focus on conditions in which the group has to face unexpected and potentially performance-disruptive events. The resilience approach offers a more thorough explanation of the regulatory strategies that musicians may resort to in order to maintain their performance at an optimal level. Music ensembles of different size are presented as case studies of how such systems (and their individual members) resist error and maintain joint performance. Three hypothetical scenarios are further proposed that epitomize resilient or non-resilient musical teams. The present contribution further proposes hypotheses and formulates predictions on which combinations of individual and group factors foster team resilience. This model further accommodates the most recent findings in neuroscience and experimental psychology. Besides highlighting the potential of music ensemble for psychological research, it offers hints about how resilience could be trained.

Practitioners' well-being and clinical risk management are two interrelated concepts in healthcare. Patient safety, workers' safety and practitioners well-being have often been managed and measured with different methods, even though they are tightly linked. In this paper we propose a method that is suitable to increase organizational health. The action-research project aims to increase the commitment of healthcare managers and practitioners toward the development of an organizational culture which is oriented to patient and practitioner safety and well-being. These are crucial organizational resource for an effective process management. The project lasted 18 months and involved 60 nurses and physicians working in the operating room of six hospitals in the North of Italy. The project aimed to develop an inter-organizational methodology for noticing and monitoring critical threats to safety and well-being. The tool consisted of a report form in which practitioners could describe possible threats, solutions and personal contributions to the solutions. The participants designed it according to their practice and it was considered suitable and usable in their current work activities. Its added value is to overcome the habitual bottleneck between anomalies investigation and action planning, by identifying a specific role in the learning process to take care of the transition from data gathering to data use. The tool aims to enable individuals and teams to monitor and share ideas about critical aspects that affect their safety and well-being, collect contributions to solve them, sustain dissemination of good practices and frame health promotion as a crucial organizational resource.

Myrcianthes hallii (O. Berg) McVaugh (Myrtaceae) is a plant native to Ecuador, traditionally used for its antiseptic properties. The composition of the hydro-methanolic extract of this plant was determined by submitting it to ultra-high performance liquid chromatography (UHPLC) hyphenated to heated-electrospray ionization mass spectrometry and UV detection. The presence of antimicrobial components prompted us to test the extract against methicillin-resistant and methicillin-susceptible Staphylococcus aureus , multidrug-resistant and susceptible Escherichia coli , Pseudomonas aeruginosa , Enterococcus spp. and Streptococcus pyogenes strains. The chromatographic analysis led to the identification of 38 compounds, including polyphenols and organic acids, and represents the first chemical characterization of this plant. The extract showed modest antibacterial activity against all tested bacteria, with the exception of E. coli which was found to be less sensitive. Whilst methicillin-resistant strains usually display resistance to several drugs, no relevant differences were observed between methicillin-susceptible and resistant strains. Considering its long-standing use in folk medicine, which suggests the relative safety of the plant, and the presence of many known antibacterial polyphenolic compounds responsible for its antibacterial activity, the results show that M. hallii extract could be used as a potential new antiseptic agent. Moreover, new anti-infective biomaterials and nanomaterials could be designed through the incorporation of M. hallii polyphenols. This prospective biomedical application is also discussed.

This work features the results of an ethnobotanical study on the uses of medicinal plants by the inhabitants of the region near to the Kutukú Scientific Station of Universidad Politécnica Salesiana, located in the Morona-Santiago province, southeast of Ecuador. In the surroundings of the station, one ethnic group, the Shuar, has been identified. The survey hereafter reports a total of 131 plant species, with 73 different therapeutic uses., Competing Interests: The authors declare that there is no conflict of interests.

Previous research has suggested that personality traits of the Five Factor Model play a role in worker's response to workload. The aim of this study was to investigate the association of personality traits of first responders with their perceived workload in real-life tasks. A flying column of 269 police officers completed a measure of subjective workload (NASA-Task Load Index) after intervention tasks in a major public event. Officers' scores on a measure of Five Factor Model personality traits were obtained from archival data. Linear Mixed Modeling was used to test the direct and interaction effects of personality traits on workload scores once controlling for background variables, task type and workload source (mental, temporal and physical demand of the task, perceived effort, dissatisfaction for the performance and frustration due to the task). All personality traits except extraversion significantly interacted at least with one workload source. Perceived workload in flying column police officers appears to be the result of their personality characteristics interacting with the workload source. The implications of these results for the development of support measures aimed at reducing the impact of workload in this category of workers are discussed.

Background: Set-up errors represent a source of uncertainty in head and neck (H&N) cancer radiotherapy. The present study evaluated set-up accuracy with the use of cone-beam computed tomography (CBCT) in order to establish the proper clinical target volume (CTV) to planning target volume (PTV) margins to be adopted., Methods: Local set-up accuracy was analysed for 44 H&N cancer patients since the implementation of CBCT. An on-line correction protocol was adopted, with the first 3 scans used to correct systematic errors with a 3-mm action level. The overall mean displacement (M), the population systematic (Σ) and random (σ) errors and the 3D vector length were calculated. PTV margins were calculated according to the van Herk formula (2.5Σ + 0.7σ)., Results: A total of 420 CBCT scans were analysed. A systematic correction was needed in 43% of patients. The value of M was <1 mm in all directions; the values of Σ and σ ranged over 1-1.2 and 1.4-1.9 mm, respectively. Pre-correction PTV margins were 3.48, 4.08 and 4.33 mm along the 3 axes. The PTV margins calculated after online correction were <2.5 mm in all directions., Conclusions: Kilovoltage CBCT is effective in evaluating set-up accuracy in H&N patients. CTV-PTV margins of 5 mm are safe and are currently adopted at our centre; however, some special situations, such as re-irradiation or the close proximity of organs at risk and high-dose regions, could benefit from daily image registration and lower (i.e., 3 mm) margins.

We compare three models of representation of item order in a verbal STM task: item-item associations, item-position associations, and primacy gradient. A speeded probed recall task is used, in which a list of words is presented, immediately followed by a probe; participants must report as fast as possible the word that was in the probed position. In the number probe condition, a digit is presented and one must say the word in that position. In the word probe condition, the probe is an item of the list and participants must say the immediately following item. Response times (RTs) are analyzed according to probe type and position. The three models imply different predictions about RTs as a function of serial order in the two conditions. Our results suggest a serial, self-terminating search from the beginning of the list to the target position, except for the final position, which is directly accessible. The item-item and item-position association models are ruled out; the primacy gradient model accounts satisfactorily for our results, except for the finding of a larger recency effect with a number probe. Alternative interpretations are also discussed.

Change detection performance is influenced by a number of factors, among which is the informativeness of targets. It has not been clarified, yet, whether the highly informative regions have a processing priority as a result of resource deployment from other tasks or whether it results from a better resource management. In this paper, we adopted a change detection paradigm in which thirty participants were randomly assigned to two groups: single (change detection task) and dual task [change detection and a simplified version of the Paced Auditory Serial Oppository Task (PASOT, Gow and Deary in J Clin Exp Neuropsychol 26:723-736, 2004), which implies a verbal effort]. Stimulus informativeness was defined as social relevance, that is, changing targets were people (high relevance) versus objects (low relevance), all other aspects (i.e., salience and position in the scene) kept constant. As hypothesized, data analyses showed a significant main effect of social relevance and task condition, i.e., better change detection performance and lower change detection times for people versus objects and for single than for dual task condition. Interestingly, the PASOT accuracy remained stable across the person versus object trials, thus implying that the better performance with socially relevant targets could not be explained by a resources withdrawal from the secondary task.

Introduction: The extract of Crataegus monogyna shows sedative, hypotensive, vasodilator and cardio-tonic actions. Although several papers dealing with the extraction of metabolites from Crataegus have been published, the plant productivity in terms of bioactive compounds is not easily understandable as yet., Objective: To investigate the influence of the extraction mode on the yield of bioactive compounds from Crataegus monogyna Jacq. in order to evaluate plant productivity., Methodology: Samples were prepared by extraction of powdered material obtained from top branches, flowers and leaves. Soxhlet extraction, maceration and ultrasound- and microwave-assisted extraction at different experimental conditions were investigated for the exhaustive extraction of hyperoside, vitexin and vitexin-2''-O-rhamnoside. The phytocomponents were identified and quantified by HPLC-UV/PAD, comparing HPLC retention times and UV spectra of individual peaks with those of the standards analysed under the same conditions., Results: An easy-to-use HPLC isocratic method suitable for the quantification of hyperoside, vitexin and vitexin-2''-O-rhamnoside in raw plant extracts was developed. The optimised HPLC methodology was applied to evaluate different extraction procedures. The ultrasound and microwave-assisted extraction protocols showed higher extraction efficiency than the others. In particular, the optimised microwave protocol gave rise to the highest extraction efficiency with high reproducibility., Conclusions: A microwave protocol combined with isocratic HPLC analysis is proposed for the rapid screening of plant materials collected in different environmental conditions in order to evaluate the productivity of Crataegus monogyna Jacq. and to find out the best ecological conditions to cultivate hawthorn in Northern Italy.

Objective: Multiple system atrophy (MSA) may be difficult to distinguish from idiopathic Parkinson's disease (PD). Our aim was to evaluate the accuracy of the arginine growth hormone (GH) stimulation test in distinguishing between MSA and PD in large populations of patients., Methods: We measured the GH response to arginine in 69 MSA (43 MSAp [parkinsonism as the main motor feature] and 26 MSAc [cerebellar features predominated]) patients, 35 PD patients, and 90 healthy control subjects. We used receiver-operating curve analysis to establish the arginine cutoff value that best differentiated between MSA and PD., Results: The GH response to arginine was significantly lower (p < 0.01) in MSA than in either PD patients or control subjects. At a cutoff level of 4 microg/L, arginine distinguished MSAp from PD with a sensitivity and specificity of 91% and MSAc from PD with a sensitivity of 96% and specificity of 91%. The arginine test had a positive predictive value for MSA of 95%. The GH response to arginine was not affected by disease duration or severity, MSA motor subtype, pyramidal signs, response to dopaminergic therapy, or magnetic resonance imaging findings., Interpretation: The GH response to arginine differentiates MSA from PD with a high diagnostic accuracy. The results suggest an impairment of cholinergic central systems modulating GH release in MSA.

Soxhlet extraction, ultrasound-assisted extraction (USAE) and microwaves-assisted extraction (MAE) in closed system have been investigated to determine the content of coumarin, o-coumaric and melilotic acids in flowering tops of Melilotus officinalis. The extracts were analyzed with an appropriate HPLC procedure. The reproducibility of extraction and of chromatographic analysis was proved. Taking into account the extraction yield, the cost and the time, we studied the effects of extraction variables on the yield of the above-mentioned compounds. Better results were obtained with MAE (50% v/v aqueous ethanol, two heating cycles of 5 min, 50 degrees C). On the basis of the ratio extraction yield/extraction time, we therefore propose MAE as the most efficient method.

In addition to treating the motor symptoms of Parkinson's disease, the dopamine agonist pramipexole has shown an antidepressant effect. The trials, however, included patients with motor complications, raising the question of whether the antidepressant benefit represented only a treatment-related motor improvement. To address this issue, we have conducted a 14-week randomized trial comparing pramipexole with an established antidepressant in patients without motor complications. At seven Italian centers, 67 Parkinsonian outpatients with major depression but no history of motor fluctuations and/or dyskinesia received open-label pramipexole (at 1.5 to 4.5 mg/day) or sertraline (at 50 mg/day). In both groups, the Hamilton Depression Rating Scale (HAM-D) score decreased throughout 12 weeks of treatment, but in the pramipexole group the proportion of patients who recovered, as defined by a final HAM-D score

Objectives: Cabergoline is an ergoline derivative with a very long half-life that allows once-daily administration and the potential for more continuous stimulation of dopaminergic receptors than is possible with other dopamine receptor agonists (DAs). The aim of this study was to evaluate whether the possible advantage resulting from a more sustained dopaminergic effect of cabergoline would translate into delayed onset of motor complications, compared with levodopa, in patients with newly diagnosed Parkinson's disease., Study Design and Methods: This study was a double-blind, multicentre trial that compared cabergoline and levodopa as initial therapy for Parkinson's disease. A total of 419 levodopa-, DA- and selegiline-naive patients with newly diagnosed Parkinson's disease were randomised to receive either cabergoline (n = 211) or levodopa (n = 209). Treatment was titrated to an optimal dose over a period of up to 24 weeks and then continued at this dose until the study endpoint (confirmed motor complications) or up to a maximum of 5 years. At years 1-5, the cabergoline group was receiving cabergoline at average daily doses ranging from 2.8-2.9 mg, with added levodopa at mean daily doses ranging from 322 mg at year 1 to 431 mg at year 5; over the same period, the levodopa group was receiving daily levodopa doses of 784 mg. Thus, patients in the cabergoline group received <50% levodopa than patients in the levodopa group., Results: Motor complications were significantly delayed (p = 0.0175) and occurred less frequently in cabergoline-treated patients than in levodopa-treated patients (22.3% vs 33.7%). Cox model proportional hazards regression analysis showed that the relative risk of developing such complications was >50% lower (0.46; p < 0.001) in the cabergoline group compared with the levodopa group. In particular, development of dyskinesias was markedly delayed in the cabergoline group and occurred in 9.5% of patients compared with 21.2% in the levodopa group (p < 0.001). Among patients not requiring supplemental levodopa, the frequency of motor complications was three times higher with levodopa (15.5% of 110 patients) than with cabergoline (5.3% of 76 patients). Among patients who did need supplemental levodopa, motor complications were more frequent in the levodopa arm (54.1% of 98 patients) than in the cabergoline arm (31.9% of 135 patients). Consistent improvements relative to baseline in average Unified Parkinson's Disease Rating Scale (UPDRS) daily living activities and motor function sections, and in Clinical Global Impression severity of illness and physician- and patient- rated global improvement scores, were seen in both treatment groups, with maximal effects occurring within 2 years. However, levodopa treatment was associated with a significantly (p < 0.001) greater improvement in motor disability (as measured by the UPDRS motor score) over time, with mean values of 13.8 versus 12.9 in the cabergoline versus levodopa arm recorded at 1 year, 18.6 versus 17.2 at 3 years and 19.2 versus 16.3 at 5 years, respectively. While the overall frequency of adverse events was similar in the two groups, the cabergoline-treated group experienced marginally, but not significantly, higher frequencies of nausea, vomiting, dyspepsia and gastritis (37.4% vs 32.2% in the levodopa group) and of dizziness and postural hypotension (31.3% vs 24% in the levodopa group). Cabergoline-treated patients also experienced a significantly higher frequency of peripheral oedema (16.1% vs 3.4%, respectively; p < 0.0001). The cabergoline and levodopa groups had similar rates of sleepiness (17.5% vs 18.3%, respectively) and hallucinations (4.8% vs 4.4%, respectively); in an elderly population subset, hallucinations were reported in 7.1% and 6.5% of patients taking cabergoline and levodopa, respectively. Adverse events generally occurred more frequently in female patients (with the exception of dyskinesias, hyperkinesias and hallucinations, which occurred more frequently in men) and in the elderly., Conclusion: This study showed that, compared with levodopa, initial therapy with cabergoline in patients with Parkinson's disease is associated with a lower risk of response fluctuations at the cost of a marginally reduced symptomatic improvement and some tolerability disadvantages that are mostly limited to a significantly higher frequency of peripheral oedema.

Parkinson's disease (PD) is a chronic, progressive, disabling movement disorder with a clear impact on Health-Related Quality of Life (HRQoL). We investigated the correlations between HRQoL and sleep disorders measured with the Parkinson's disease Sleep Scale (PDSS) and the motor and non-motor aspects of the disease. A correlation was found between HRQoL and the scores from PDSS, motor and depression scales. We conclude that more attention should be paid to the non-motor aspects of PD to attempt to improve HRQoL.

Parkinson's disease is characterized by heterogeneity of clinical presentations, association of signs and symptoms, rate of progression, and response to therapy. The aim of this prospective 5-year study was to evaluate whether clinical features at onset were predictive of the subsequent progression. Two courses were identified which differed in the characteristics at onset. Slow course was characterized by earlier age at onset, lateralization of motor signs, rest tremor, and absence of gait disturbance. Rapid course presented older age, less evident lateralization of signs, predominance of bradykinesia-rigidity and gait disturbance. Our results confirmed that PD is clinically heterogeneous and specific patterns of onset seem to be associated with different rates of disease progression. Predictive models based on these clinical characteristics have a good sensitivity in indicating a slow disease progression but are not reliable in indicating a rapid evolution.

A model of analysis and environmental evaluation was applied to 11 stretches of the Adige River, where an innovative procedure was carried out to interpret ecological results. Within each stretch, the most suitable methods were used to assess the quality and processes of flood plains, banks, water column, bed, and interstitial environment. Indices were applied to evaluate the wild state and ecological quality of the banks (wild state index, buffer strip index) and the landscape quality of wide areas of the fluvial corridor (environmental landscape index). The biotic components (i.e., macrozoobenthos, phytoplankton and zooplankton, interstitial hyporheic fauna, vegetation in the riparian areas) were analysed by both quantitative and functional methods (as productivity, litter--processing and colonisation). The results achieved were then translated into five classes of functional evaluation. These qualitative assessments have thus preserved a high level of precision and sensitivity in quantifying both the quality of the environmental conditions and the integrity of the ecosystem processes. Read together with urban planning data, they indicate what actions are needed to restore and rehabilitate the Adige River corridor.

We have achieved quantitative two-dimensional Raman measurements of the concentration of methane in a laminar methane jet into nitrogen without multipassing the incident laser sheet with a coaxial flash-lamp-pumped dye laser. The measurements are compared with the results of direct numerical simulation for the particular flow field. We conclude that the accuracy of the technique is determined by limitations in the dynamic range and in the spatial resolution of the data acquired with an intensified camera.

Magnetic resonance spectroscopy (MRS) has attracted much attention in recent years and has become an important tool to study in vivo particular biochemical aspects of brain disorders. Since the proton is the most sensitive stable nucleus for MRS, and since almost all metabolites contain hydrogen atoms, investigation by in vivo 1H MRS provides chemical information on tissue metabolites, thus enabling a non-invasive assessment of changes in brain metabolism underlying several brain diseases. In this review a brief description of the basic principles of MRS is given. Moreover, we provide some explanations on the techniques and technical problems related to the use of 1H MRS in vivo including water suppression, localization, editing, quantitation and interpretation of 1H spectra. Finally, we discuss the more recent advancement in three major areas of neurological diseases: brain tumors, multiple sclerosis, and inborn errors of metabolism.

This multicentre randomised double-blind 3- to 5-year trial was designed to assess whether initial therapy with cabergoline alone or in combination with levodopa prevents or delays the occurrence of long term motor complications in patients with early Parkinson's disease. Patients eligible for study inclusion (n = 412) had early idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 3) and had received no previous treatment with levodopa, selegiline or dopamine agonists. Patients were randomised to receive either cabergoline (0.25 to 4 mg once daily) or levodopa (100 to 600 mg/day) titrated over a maximum period of 24 weeks. Once the optimum or maximum tolerated dose was achieved, it was maintained up to the end-point (development of motor complications confirmed at 2 consecutive 3-month visits) or up to a minimum of 3 years' treatment. Open labelled levodopa was added in both treatment arms when the improvement in motor disability [Unified Parkinson's Disease Rating Scale (UPDRS) factor III] decreased below 30% vs baseline. Both treatments improved motor disability, decreasing UPDRS factor III scores and factor II scores for activities of daily living. The development of motor complications (end-point) was significantly less frequent in patients treated with cabergoline than in levodopa recipients (22% vs 34%; p < 0.02). The relative risk of developing motor complications during treatment with cabergoline was more than 50% lower than with levodopa. Serious adverse events, either drug related or not, were slightly more frequent in cabergoline-treated patients (31%) than in those treated with levodopa (25%). The withdrawal rate in the cabergoline vs levodopa group was 16 vs 13%. In conclusion, the study shows that, in patients with early Parkinson's disease, cabergoline is effective either as monotherapy or combined with levodopa. Moreover, starting treatment with cabergoline significantly delays the development of motor complications.

Cabergoline is a potent D2 receptor agonist with a half-life of 65 hours that may provide continuous dopaminergic stimulation administered once daily. In this study, we randomized de novo Parkinson's disease (PD) patients to treatment with increasing doses of cabergoline (0.25 to 4 mg/d) or levodopa (100 to 600 mg/d) up to the optimal or maximum tolerated dose. Decreases of > 30% in motor disability (Unified Parkinson's Disease Rating Scale Factor III) versus baseline were considered indicative of clinical improvement. If 30% improvement was not achieved, levodopa/ carbidopa could be added on an open basis. Of the 208 patients entered in the cabergoline group, 175 remained in the study for 1 year at a mean dose of 2.8 mg/d; in the levodopa group, 176 of the 205 patients entered were still on study after 1 year at a mean dose of 468 mg/d. The proportion of patients requiring additional levodopa/carbidopa increased in the cabergoline group from 18% at 6 months to 38% at 1 year versus 10% (p = 0.05) at 6 months and 18% (p < 0.01) at 1 year in the levodopa group. The proportion of patients showing clinical improvement did not differ significantly between the two groups, or between the subgroups on monotherapy, at any endpoint. Irrespective of levodopa/carbidopa addition, 81% of patients in the cabergoline group and 87% of patients in the levodopa group were clinically improved at 1 year (p = 0.189); the corresponding figures for the subgroup on monotherapy were 79% in the cabergoline-treated patients and 86% in the levodopa-treated patients (p = 0.199). The mean difference versus baseline in Unified Parkinson's Disease Rating Scale Factor III scores in patients who remained on monotherapy up to 1 year was 12.6 (95% confidence interval [CI]: 10.8, 14.3) in the cabergoline group and 16.4 (95% CI: 14.8, 18.0) in the levodopa group. Adverse events occurred in 76% of patients on cabergoline and in 66% of patients on levodopa. The severity profile for reported events was similar for the two agents. The results of this study indicate that cabergoline treatment for up to 1 year is only marginally less effective than levodopa in the proportion of patients who can be treated in monotherapy. More than 60% of de novo PD patients could be managed on cabergoline alone up to 1 year. In the patients in whom levodopa/carbidopa was needed, the combination therapy provided efficacy similar to that obtained with levodopa alone, with a relevant sparing of levodopa.

19F nuclear magnetic resonance (NMR) was utilized to obtain information on the uptake and half-life time of fluoride ion in rats. Changes in tissue fluoride level after acute loading were monitored over time in blood and tissue homogenates obtained from liver and brain. The rate of fluoride elimination from various tissues was roughly similar, following in all cases a first-order kinetic rate law. The F- concentration in brain was about 20% of that found in liver, indicating a reduced fluoride diffusion across the blood-brain barrier. In vivo F- spectra were obtained in rat brain in few minutes with a good signal-to-noise ratio; this confirms the possibility of extending the use of F- as a probe of biomolecules to in vivo applications.