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Objectives To explore the impact of sex and age on relationship between prodromal constipation and disease phenotype in Parkinson’s disease at early stages. Methods A total of 385 Parkinson’s disease patients from the PRIAMO study were classified according to the presence of prodromal constipation and followed for 24 months. Multivariable mixed-effect models were applied. All analyses were performed separately for sex (64.1% men) and median age (different by sex: 67 years-old in men and 68 years-old in women). Results As for sex, prodromal constipation was associated with greater odds of attention/memory complaints and apathy symptoms in women only. As for age, prodromal constipation was associated with lower cognitive and higher apathy scores in older patients only. Conclusions Prodromal constipation anticipates lower cognitive performances and more severe apathy since the earliest stages in women and older patients. Sex- and age-related heterogeneity of prodromal markers of Parkinson’s disease may impact disease phenotype.

The flow upstream a wind turbine is studied in order to investigate blockage effects. We use rotating wind turbine models in a wind tunnel, where velocity measurements have been made both with hot- ...

The frequency of wind turbine wake meandering was studied using wind turbine models with one, two and three blades. The one-bladed turbine did not give rise to any meandering motion, whereas meande ...

The velocity held in the wake of a two-bladed wind turbine model (diameter 180 mm) has been studied under different conditions using a two-component hot wire. All three velocity components were m ...

We describe two cases of hemifacial spasm (HFS) with unusual synkinetic movements between facial muscles and respiratory activity. Patient 1 developed an idiopathic HFS. She underwent microvascular decompression surgery, followed by transitory facial nerve palsy; she recovered but later developed a facial synkinesia characterized by involuntary and forced eyelid closure on spontaneous and deep breathing; the orbicularis oculi muscle was active also when her mouth was open (the so-called Marin-Amat syndrome). Patient 2, 1 year after a peripheral facial nerve palsy (Bell's palsy), developed an HFS together with synkinetic movements between the orbicularis oculi muscle and respiration. In both cases electrophy siological studies showed pathological synkinetic electromyographic activity. An enhanced hyperexcitability of brain stem interneurons and facial motoneurons could be suggested to explain the phenomenon.

Novel methods for inducing chondrogenesis are critical for cartilage tissue engineering and regeneration. Here we show that the synthetic oleanane triterpenoids, CDDO-Imidazolide (CDDO-Im) and CDDO-Ethyl amide (CDDO-EA), at concentrations as low as 200 nM, induce chondrogenesis in organ cultures of newborn mouse calvaria. The cartilage phenotype was measured histologically with metachromatic toluidine blue staining for proteoglycans and by immunohistochemical staining for type II collagen. Furthermore, real-time polymerase chain reaction (PCR) analysis using mRNA from calvaria after 7-day treatment with CDDO-Im and CDDO-EA showed up-regulation of the chondrocyte markers SOX9 and type II collagen (alpha1). In addition, TGF-β; BMPs 2 and 4; Smads 3, 4, 6, and 7; and TIMPs-1 and -2 were increased. In contrast, MMP-9 was strongly down-regulated. Treatment of human bone marrow-derived mesenchymal stem cells with CDDO-Im and CDDO-EA (100 nM) induced expression of SOX9, collagen IIα1, and aggrecan, as well as BMP-2 and phospho-Smad5, confirming that the above triterpenoids induce chondrogenic differentiation. This is the first report of the use of these drugs for induction of chondrogenesis.

This report describes a 26 year old woman with a Coxsackie B virus infection complicated by an acute pandysautonomic and sensory neuropathy. Electrophysiological studies suggested an axonal neuropathy. A sural nerve biopsy performed early in the disease showed axonal degeneration with a virtual absence of unmyelinated fibres and moderate loss of myelinated fibres, mainly affecting the small fibres; this differs from previous reports. An immune-mediated or direct virus action might explain the pathogenesis of this unusual evolution of a viral infection.

The aim of our study was to evaluate the efficacy of myocardial protection during coronary artery bypass grafting (CABG) in cold blood intermittent (CBIC) and warm continuous blood cardioplegia (WCBC). To assess myocardial necrosis, Troponin T, a structural protein belonging to the troponin complex, was measured. Troponin T is released in the blood stream 4 hours after myocardial damage, and it does not cross-react with the isomeric form of the skeletal muscle.Our study involved 20 consecutive patients, scheduled for isolated CABG. They were divided into two groups: the first group (10 patients; 8 m, 2 f) underwent surgery with the use of CBIC, the second group (10 patients; 9 m, 1 f) with WCBC. The serum levels of cardiac Troponin T (cTn-T) were all0.2 microg/l before operation.In the CBIC the mean cTn-T peaked on the 1st day after CABG, in the WCBC group the first peak occurred in the 2nd hour after arrival in the intensive care unit, and the second peak occurred on the 4th day postoperatively. The mean serum cTn-T was lower in the WCBC vs CBIC group from the 1st to the 5th day postoperatively, with a statistical difference on the 1st day (p0.05). In the CBIC group either the cTn-T peak values (r=0.77; p0.02) or area under the concentration curve of cTn-T release (r=0.85; p0.004), were directly correlated with the aortic cross-clamping time. This was not demonstrated in the WCBC. CPK and CK-MB peaked in both groups 6 hours after arrival in the intensive care unit and on the 1st day postoperatively, with higher values at 6 hours in the WCBC group (p0.05). The CK-MB/CPK ratio was significantly lower in the WCBC group at the six hours (p0.05).The results of this preliminary study suggest that fewer necrosis markers are released during CABG in the WCBC group; in the CBIC group the release of cTn-T whether measured by peak serum level or by area under the curve, shows a statistically significant correlation with cross-clamping time. Warm blood cardioplegia is safe and supplies adequate myocardial protection during CABG; the more prolonged cross-clamping is, the more myocardial protection is afforded by WCBC.

Chylopericardium as an isolated complication after open heart surgery is a rare event. We present here a case of late postoperative chylopericardium and comment on the clinical course, the aetiopathology and treatment.

In this paper we present two algorithms for color image segmentation based on Huang's idea of describing the segmentation problem as the one of minimizing a suitable energy function for a Hopfield network. The first algorithm builds three different networks (one for each color feature) and then combine the results. The second builds a unique network according to the number of clusters obtained by histogram analysis. Experimental results, heuristically and quantitatively evaluated, are encouraging.

We studied an AIDS patient who suffered from numbness, paresthesias and pain in the territories of different non-contiguous cutaneous nerves at different times. A transitory partial loss of touch and pinprick sensibility was also present in the same cutaneous areas. Sensory conduction velocities and SAP amplitudes were normal. The clinical picture was consistent with the Migrant Sensory Neuritis of Wartenberg. This rare neuropathy has never previously been described in patients affected by AIDS.

A case of Holmes-Adie syndrome was studied clinically and electrophysiologically. A total loss of tendon reflexes was observed in upper and lower limbs. The main electrophysiological finding was a marked increase of the central conduction time after stimulation of peroneal and tibial nerves. Motor evoked potentials in soleus muscle after transcranial magnetic stimulation showed normal threshold and latencies. We suggest that tendon areflexia could be a consequence of a dysfunction of somatosensory large diameter afferent fibres at the spinal level.

The clinical involvement of the facial nerve is a rare finding among the initial symptoms of acoustic neurinomas. However, compression of the facial nerve is a common intraoperative finding. Blink reflex was recorded in 20 patients affected by cerebellar-pontine angle tumor confirmed at surgery. Recordings were also made of the M-response of the facial nerve from the naso-labial folds. In 6 cases jaw reflex was also recorded. In summary, these electrophysiological studies revealed a facial nerve damage in 13 and a trigeminal nerve dysfunction in 2 out of 18 clinically unaffected patients. The combined study of the 3 tests proved to be useful when the blink reflex showed an isolated R1 delay, that is, in cases in which the level of damage along the trigemino-facial reflex arc cannot be defined by the recording of the blink reflex alone.

Electromyographic responses of the masseter muscles and orbicularis oris muscles following transcranial magnetic stimulations were recorded with surface and needle electrodes. MEPs in masseter muscles (latency 6.9 +/- 0.71 ms, mean +/- SD) due to activation of controlateral cortico-nuclear connections were evoked by magnetic stimulations at 4 cm laterally to the vertex on the biauricular line. These MEPs were followed bilaterally by a silent period lasting about 20 ms and, less constantly, by a later silent period lasting up to 80 ms. The ipsilateral responses to the same stimuli presented shorter latencies and higher amplitudes and they were ascribed to direct stimulation of the trigeminal nerve, probably its intracisternal portion. Ipsilateral masseter "cortical" MEPs could be elicited only by a lower output setting (70% of the maximum output) of the stimulator. Orbicularis oris MEPs were polyphasic and dispersed with latencies ranging from 7 to 11 ms. In patients with hemispheric or capsular ischemic lesions "cortical" MEPs were absent when stimulating the affected hemisphere and present when stimulating the unaffected one. We suggest that the direct corticomotoneuronal projections for the masseter are mainly crossed.

After a brief description of the intraoperative angioplasty technique carried out together with direct revascularization through bypass with venous segments or with internal mammary (IMA) we hereby report the immediate and mid-term results obtained in 18 patients with this treatment. The simplicity of execution, having the possibility to operate on still heart and under the direct vision of the lesion the rareness of any complication, the fact that the coronary segment is open also during all checks done after 3 years from the treatment, and finally the considerable improvement in clinical symptomatology, lead the authors to consider this therapeutical succession possible in some selected cases, for which surgical operation is necessary.

We studied the efficacy and safety of botulinum toxin A (BTX-A) injections in patients affected by upper limb spasticity secondary to traumatic brain injury, in an open labelled trial. Increased stretch reflexes, hypertonia, flexor spasms, and abnormal cocontraction are often associated with muscular contractures, causing many clinical manifestations in patients with traumatic brain injuries. Botulinum toxin A (BTX-A) produces a dose related weakness of skeletal muscles by impairing the release of acetylcholine at the neuromuscular junction. Therapeutic intramuscular injections of BTX-A are a major advance in the treatment of focal dystonia, and show promise in spasticity of varying aetiology.1 The aim of this study was to evaluate the efficacy and safety of BTX-A treatment on disorders of muscular tone after traumatic brain injuries, in an early phase of rehabilitation, when retractions are still avoidable. We examined six patients affected by severe traumatic brain injury (Glasgow coma scale

The main parameters of muscle acid-base, water and energy metabolism were studied in ten patients undergoing low-flux (1.5 l/min/m2), low-pressure (40 to 60 mmHg) hypothermic (26 degrees C) cardiopulmonary bypass (CPB) for aortocoronary grafting; absolute gas exchange and haemodynamic data were also measured throughout the entire CPB period. At the end of CPB a substantial preservation of water and energy metabolic indexes was found; a condition of extracellular metabolic acidosis was apparently sustained by muscle cell anaerobic glycolysis enhancement with a consequent increase of both muscle and plasma lactate content. Subnormal cell phosphocreatine levels as well as reduced bicarbonate buffer stores and decreased intracellular pH, were detected. Direct limiting effects of hypothermia on tissue O2 delivery and muscle oxidative metabolism as well as vasoconstriction and arteriovenous shunting associated with CPB procedures are likely to be involved in the above mentioned alterations of cell metabolism.

Eleven children with coarctation of the aorta were investigated before and after surgical treatment, using simultaneous indirect carotid and femoral pulse wave tracing. The timing of the onset of the femoral pulse in the children with coarctation, both before and after operation, did not differ significantly from normal. However, the time interval between the peak of the femoral pulse and the dicrotic notch of the carotid pulse was significantly shorter than normal in the children with coarctation before operation. After operation, the peak femoral to carotid dicrotic notch time interval was restored to normal. It is suggested that this simple non-invasive test might be of value in the long-term follow-up of patients after operation for coarctation of the aorta, particularly in those undergoing operation early in childhood, to detect residual or recurrent coarctation.

Resumen basado en el de la publicación Resumen en inglés El léxico geométrico se relaciona con un criterio de equivalencia entre figuras -normalmente dado por un grupo de transformación (Klein)-. Puede haber un conflicto entre el lenguaje ordinario, el léxico geométrico tradicional y el criterio equivalente que una determinada situación específica puede sugerir. Se analizan los resultados de un conjunto de preguntas con el objetivo de descubrir los criterios de equivalencia elegidos por los alumnos entre 9 y 11, y la influencia de su léxico. Se ha notado una influencia considerable de los criterios basados ​​en el grupo de traducciones y en el grupo de homotecias y traducciones. También se ha observado la influencia de "modelos estándar" (i.e., figuras que aparecen normalmente en sus libros), y algunas dificultades de conceptualización. ESP

A new technique of anatomical study of cardiac nerves in man is described, and the results of the investigation are reported and discussed. Sections of the heart, 10 micron in thickness, stained with a modification of Masson's trichrome technique, and surrounded by at least 3 nerves fibres as a marker were projected by an ordinary photographic enlarger, and drawn on a polythene foam termoplastic material. The scale drawings were cut and put together to form a scale model of the heart studied in the peripulmonary tissue and between the aorta and the pulmonary artery. The advantages and the limits of this technique are then discussed.

Sonography is a safe and suitable diagnostic tool; to date it appears to be the most valuable method for detecting renal cystic lesions. In particular ultrasound examination, if a wider district is screened, can demonstrate the coexistence of the cystic disease in different organs. The Authors report a case of renal polycyctic disease in which the sonographic examination was extended to the entire abdomen disclosing simultaneous involvement of the kidneys and the liver.

The Authors report an experience of 165 patients who underwent to implantation of artificial pacemaker from January 1973 to December 1974 and report 16 cases of infection. They consider many surgical and biologic factors that can have caused uprinsing of infection. The Authors report the therapeutic treatment the patients underwent and conclude that the best treatment is the implantation, to another seat, of new pacemaker.

Nine patients with acute myocardial infarction underwent intracoronary urokinase infusion within 3 hours after the onset of AMI, and subsequent coronary artery by pass grafting. After thrombolytic therapy 3 patients showed single-vessel disease, 2 double-vessel disease and 4 triple-vessel disease. The ventricular function was normal in 2 patients, moderately depressed in 5 and severely depressed in 2. The coronary artery by-pass grafting was performed from 6 to days after the onset of the acute myocardial infarction (average 37 days) and the average number of grafts performed per patient was 3.2. There was no operative death. The follow up period ranged from 24 to 38 months: 7 patients are in NYHA Class I and 2, symptomatic for dispnea, are in NYHA Class II. These preliminary data suggest than the coronary artery by-pass grafting after intracoronary urokinase therapy for acute myocardial infarction can be performed safely and the surgical results do not differ from those obtained with standard coronary artery by pass grafting.

Our experience is based on 323 surgical operations on the mitral valve. Prosthetic valves were substituted in 308 patients and in 15 an anulo-valvulo-plastic operation. Mitral valve operation was associated with the correction of other heart lesions in 132 patients and in 197 patients, (objects of this study) surgery was carried out on the left atrio-ventricular valve. A detail report of the types of lesions found is made: 78 patients had massive calcification and 15 had a process of acute and subacute endocarditis. Mechanical prosthesis (Starr-Edwards 51; Björk-Shiley 77) were used 128 times and biologic prosthesis (Hancock 44; Carpentier-Edwards 7; Angell-Shiley) 54 times. Preference was given to the use of porcine prosthesis in patients presenting generic or specific controindications to anticoagulant therapy. Total mortality rate was 9,9% and in the last two years this fell to 5%. In our opinion, the sharp fall in mortality could be attributed to refined technic, better selection of cases, better myocardial protection consequent to the clinical use of cardioplegia and hypothermia.

Mechanical trauma to saphenous vein harvested and prepared for coronary artery bypass grafting may results in early and late graft occlusion due to subendothelial proliferation and to accelerated atherosclerosis. The distention of the vein a high pressure to overcome spasm and to identify leaks causes most of these pathological changes. On the basis of these considerations we developed a careful technique of vein removal and a convenient system to irrigate veins at controlled and limited pressures.

A psychological research on 80 patients with implanted pace-makers was carried out in order to explore their psychological adjustments following surgery. A questionnaire of 29 questions has been used. We explore the presence of anxiety due to the heart disease, to the operation or to the following period. Moreover the modification of social and family life, the relationship with the surgeon and the family doctor and, finally, the body image have been considered. The results show that the patients with implanted pace-makers, usually are able to subdue their anxiety and to recompose a good psychological equilibrium, mainly because of their favorable familiar and/or social environment.

In eight patients undergoing open heart surgery for elective myocardial revascularization, extra-intracellular acid-base and water metabolism parameters were studied before and after cardiopulmonary bypass procedures. All patients presented a different degree of metabolic acidosis related to plasma lactate increase. Intracellular acid-base indexes did not change significantly, though all but one patient showed an intracellular buffers consumption. Both total muscle and extracellular water increased, while intracellular water did not change. It was concluded that low flux-low pressure perfusion CPB was related to a substantial preservation of cell integrity.

The clinical and surgical features of eight patients with extensive calcifications of the left atrial wall and mitral valvular disease, has been reported. Seven patients underwent to prosthetic replacement of the mitral valve and one to prosthetic replacement of the mitral and aortic valve. Beside the valvular replacement, the authors stress the importance of the surgical removal of the atrium wall calcifications, in order to avoid the postoperative haemorrhagic and embolic complications.

The authors report the clinical haemodynamic and angiographic data and early and late postoperative results of 179 patients consecutively operated on for left main coronary artery stenosis. Operative mortality was 3.9%; incremental risk factors were identified by univariate analysis and included female sex, unstable angina pectoris and congestive heart failure. Late postoperative mortality was 4.9%. After a mean follow-up of 31 months overall survival is 91.6%; the great majority of survivors are doing well, free from anginal pain, while 16.4% of patients experience recurrent angina pectoris of lesser severity than before operation (I-II C.C.S. class) and well controlled by medical treatment alone.

In spite of continued improvement in the production of artificial tissues, there are still many instances where replacement of the damaged part by a natural tissue grafts would be preferable. It is to satisfy this requirement that tissue banding has been developed. In this paper a brief description of the preparation of tissue grafts currently being carried out in the Yorkshire Regional Tissue Bank is given and the philosophy of tissue banking from a financial and scientifical point of view is explained.

Ten patients between 8 months and 9 years of age (average 4.3 years) underwent surgical relief of coarctation of the aorta by the technique of left subclavian flap aortoplasty. Before operation, nine patients had systolic hypertension in the upper extremity (average 145 mm Hg) and all had a significant pressure gradient across the coarctated aortic segment (average 45 mm Hg). The hospital and late mortality were zero. The follow-up over 7 years has shown complete relief of the coarctation and no ischemic impairment or functional limitation of the left upper extremity. The blood pressure returned to normal in all patients. Hemodynamic and angiographic studies, performed in one case, demonstrated adequate growth of the repaired segment and absence of a pressure gradient across the previously narrowed area. The time interval between the peak of the femoral pulse and the dicrotic notch of the carotid pulse, recorded postoperatively, was normal. We consider the left subclavian flap technique to be the operation of choice in infancy and also in older children, whenever the anatomic configuration of the coarctation suggests that subsequent growth would be severely restricted if other techniques were used.