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Abstract: The nocebo effect is a phenomenon that is opposite to the placebo effect, whereby expectation of a negative outcome may lead to the worsening of a symptom. Thus far, its study has been limited by ethical constraints, particularly in patients, as a nocebo procedure is per se stressful and anxiogenic. It basically consists in delivering verbal suggestions of negative outcomes so that the subject expects clinical worsening. Although some natural nocebo situations do exist, such as the impact of negative diagnoses upon the patient and the patient’s distrust in a therapy, the neurobiological mechanisms have been understood in the experimental setting under strictly controlled conditions. As for the placebo counterpart, the study of pain has been fruitful in recent years to understand both the neuroanatomical and the neurochemical bases of the nocebo effect. Recent experimental evidence indicates that negative verbal suggestions induce anticipatory anxiety about the impending pain increase, and this verbally-induced anxiety triggers the activation of cholecystokinin (CCK) which, in turn, facilitates pain transmission. CCK-antagonists have been found to block this anxiety-induced hyperalgesia, thus opening up the possibility of new therapeutic strategies whenever pain has an important anxiety component. Other conditions, such as Parkinson’s disease, although less studied, have been found to be affected by nocebo suggestions as well. All these findings underscore the important role of cognition in the therapeutic outcome, and suggest that nocebo and nocebo-related effects might represent a point of vulnerability both in the course of a disease and in the response to a therapy. [Copyright &y& Elsevier]

Crumb rubber (CR) derived from grinding of end-of-life tyres (ELTs) may be successfully used as a bitumen modifier or as a supplementary component in the production of bituminous mixtures employed for the construction and maintenance of road pavements. However, CRs deriving from different sources and production processes yield effects on performance of corresponding paving mixtures under traffic loading and on gaseous emissions produced during laying on site which may change considerably depending upon their physical and chemical properties. In order to quantitatively assess the possible variability of CR characteristics, 16 samples were taken from 9 Italian and 2 foreign ELT processing plants. Investigation activities included field surveys, during which plants were examined in detail, and laboratory tests, which focused on physical and chemical characterization of CR. Based on the analysis of available technical information and experimental data, it was possible to find relationships between the peculiar characteristics of treatment cycles and corresponding CR properties. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess whether the presence of probable REM sleep behaviour disorder (pRBD) influences the long-term outcome of Parkinson''s Disease (PD) patients undergoing Subthalamic Nucleus Deep Brain Stimulation (STN-DBS). Background: RBD is a parasomnia characterized by loss of muscular atonia and complex motor behaviours during REM sleep, frequently reported in PD patients. Recent evidence suggests that RBD is associated with akinetic rigid disease type and increased frequency of falls. We wondered whether the presence of RBD would also influence the long-term outcome of STN-DBS. Methods: Forty-one consecutive PD patients treated with bilateral STN-DBS were assessed. The diagnosis of pRBD was based on a clinical interview investigating the occurrence of diagnostic criteria for RBD. The Unified Parkinson''s Disease Rating Scale was used to compare the on- and off-medication conditions preoperatively and the on-stimulation/on- and off-medication conditions 1 and 3 years postoperatively. The general linear model for multivariate measures was used to analyse the interaction of pRBD with STN-DBS outcome measures. Results: pRBD was present in 12 out of 41 patients (29%) undergoing STN-DBS. Patients with pRBD had a significantly poorer outcome three years after STN-DBS compared to patients without pRBD, in particular for axial symptoms. Conclusions: Our findings suggest that the presence of pRBD in PD patients undergoing STN-DBS may be associated with a less favourable outcome and a more prominent development of axial symptoms over time. [Copyright &y& Elsevier]

Abstract: Background: Neuro-psychiatric (NP) disturbances are highly prevalent in patients with Parkinson''s disease (PD) and contribute to worsen quality of life. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is commonly utilized as surgical treatment for advanced PD with motor complications. The effectiveness of the procedure on motor symptoms is well established whereas the effects of STN-DBS on NP symptoms are less clear. The aim of our study was to analyze the postoperative pharmacological therapy for NP symptoms in a group of STN-DBS treated PD patients. Such therapy provides indirect information about the evolution of underlying NP disturbances during the follow-up in this group of PD patients. Methods: NP therapy (benzodiazepines, antidepressants, antipsychotics) was assessed in 48 consecutive PD patients treated by STN-DBS, preoperatively and postoperatively after 4months, 1year and 3years. Motor symptoms were evaluated by the Unified PD Rating Scale (UPDRS) and levodopa equivalence daily dose (LEDD) was calculated. Cognitive, mood and anxiety assessments were performed with appropriate rating scales. Results: The number of patients treated with antidepressant drugs gradually increased during the follow-up. The use of antipsychotic drugs was stable until 1year, with a subsequent increase at 3years. Benzodiazepines were given to fewer patients immediately after surgery. Conclusions: Pharmacological treatment supplies further information about NP symptoms in the follow-up of PD patients undergoing STN stimulation. [Copyright &y& Elsevier]

Abstract: Objective: This study reports a retrospective analysis of 67 consecutive parkinsonian patients to assess changes in antiparkinsonian medications after Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN). Methods: All antiparkinsonian drugs, including levodopa, dopamine agonists, associated drugs such as COMT and MAO inhibitors, amantadine and anticholinergics, were evaluated pre- and post-operatively at 1 and 3 years follow-up. Results: The levodopa mean daily dose was reduced approximately 60% after 1 year and remained stable after 3 years. Apomorphine, bromocriptine, tolcapone, entacapone and selegiline were withdrawn after STN DBS. Three years post-operatively, 9 patients (13.4%) no longer required levodopa and 6 patients (8.9%) completely stopped all dopaminergic medications. More patients were on monotherapy of either levodopa or dopamine agonist and fewer patients required a combined treatment of dopamine agonist and levodopa, compared to the pre-surgical condition. Conclusions: STN DBS treated PD patients experience a significant long-term reduction and simplification of the pharmacological treatment. [Copyright &y& Elsevier]

Four patients with Parkinson''s disease who had a Subthalamic Nucleus (STN) stimulator implanted and four age-matched controls underwent gait analysis using a three-dimensional system. STN stimulation substantially improved most of the key variables in the patients, without producing inefficient compensatory movements of the trunk. A reduction of ankle power production during push off was the most persistent abnormality seen when the patients were stimulated. We also found a reduction of trunk lateral bending and torsion when the patients were not stimulated when compared with controls. [Copyright &y& Elsevier]

Abstract: Objective: This article reports the detailed analysis of antiparkinsonian drug therapy in 78 consecutive Parkinson''s disease (PD) patients undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN). Methods: The amount and type of antiparkinsonian drugs – including l-dopa, dopamine receptor agonists, associated drugs such as catechol-O-methyl transferase and monoamine oxidase inhibitors, amantadine and anticholinergics – were quantified before surgery and at two control visits 1 and 3 years following chronic STN stimulation. Results: The l-dopa mean daily dose was reduced by approximately 60% after 1 year and remained stable after 3 years. Apomorphine, bromocriptine, tolcapone and selegiline were withdrawn after STN-DBS. Three years postoperatively, 9 patients (11.5%) no longer required l-dopa and 6 patients (7.7%) completely stopped all dopaminergic medications. More patients were on monotherapy with either l-dopa or dopamine receptor agonist, and fewer patients required combined treatment of dopamine receptor agonist and l-dopa compared with the pre-surgical condition. Conclusions: Dopaminergic drug treatment is persistently reduced and simplified following chronic STN-DBS for up to 3 years. [Copyright &y& Elsevier]