Acute effects of high-frequency microfocal vibratory stimulation on the H reflex of the soleus muscle. A double-blind study in healthy subjects

This study in healthy subjects examined the effects of a system delivering focal microvibrations at high frequency (Equistasi®) on tonic vibration stimulus (TVS)-induced inhibition of the soleus muscle H reflex. Highfrequency microvibrations significantly increased the inhibitory effect of TVS on the H reflex for up to three minutes. Moreover, Equistasi® also significantly reduced alpha-motoneuron excitability, as indicated by the changes in the ratio between the maximumamplitude H reflex (Hmax reflex) and the maximumamplitude muscle response (Mmax response); this effect was due to reduction of the amplitude of the H reflex because the amplitude of muscle response remained unchanged. The present findings indicate that Equistasi® has a modulatory effect on proprioceptive reflex circuits. Therefore, Equistasi® might interfere with some mechanisms involved in both physiological and pathophysiological control of movement and of posture

The central region of the msp gene of Treponema denticola has sequence heterogeneity among clinical samples, obtained from patients with periodontitis

<p>Abstract</p> <p>Background</p> <p><it>Treponema denticola </it>is an oral spirochete involved in the pathogenesis and progression of periodontal disease. Of its virulence factors, the major surface protein (MSP) plays a role in the interaction between the treponeme and host. To understand the possible evolution of this protein, we analyzed the sequence of the <it>msp </it>gene in 17 <it>T. denticola </it>positive clinical samples.</p> <p>Methods</p> <p>Nucleotide and amino acid sequence of MSP have been determined by PCR amplification and sequencing in seventeen <it>T. denticola </it>clinical specimens to evaluate the genetic variability and the philogenetic relationship of the <it>T. denticola msp </it>gene among the different amplified sequence of positive samples. In silico antigenic analysis was performed on each MSP sequences to determined possible antigenic variation.</p> <p>Results</p> <p>The <it>msp </it>sequences showed two highly conserved 5' and 3' ends and a central region that varies substantially. Phylogenetic analysis categorized the 17 specimens into 2 principal groups, suggesting a low rate of evolutionary variability and an elevated degree of conservation of <it>msp </it>in clinically derived genetic material. Analysis of the predicted antigenic variability between isolates, demonstrated that the major differences lay between amino acids 200 and 300.</p> <p>Conclusion</p> <p>These findings showed for the first time, the nucleotide and amino acids variation of the <it>msp </it>gene in infecting <it>T. denticola</it>, <it>in vivo</it>. This data suggested that the antigenic variability found in to the MSP molecule, may be an important factor involved in immune evasion by <it>T. denticola</it>.</p

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Irritable bowel syndrome.

No abstract available

Helicobacter pylori-related duodenitis.

none3---noneCaselli M.; Ruina M.; Alvisi V.Caselli, Michele; Ruina, Marco; Alvisi, Vittori

Non-cirrhotic extrahepatic portal vein thrombosis: a 6-year long case history.

We reviewed a case of a 47 years-old man with splenoportal vein thrombosis (SVT), not associated with liver cirrhosis. Additional risk factors as neoplasia, abdominal inflammatory disease, inherited and acquired thrombophilia were considered in the differential diagnosis. PCR assay identified the V617F mutation of JAK2 gene, a molecular marker of chronic myeloproliferative disorders (CMPD). JAK2 mutation and CMPD were diagnosed six years later than the onset of SVT. We discuss which clinical and laboratory features might be considered in advance, avoiding a delay of correct diagnosis. We confirm the importance to search JAK2 mutation whenever splanchnic vein thrombosis takes place, without underlying liver cirrhosi

An improvement in digoxin bioavailability. Studies with soft gelatin capsules containing a solution of digoxin

none6A study of relative bioavailability of two digoxin formulations was carried out on 28 healthy volunteer human subjects of both sexes. A commercial digoxin in tablet form was compared with a new commercial formulation which contains a solution of digoxin in soft gelatin capsules. The parameters investigated were: plasma levels, area under the plasma level-time curve, daily urinary excretion of digoxin and a series of polycardiographic measurements, all the parameters being evaluated in a steady-state condition (14 days of treatment). All the parameters investigated demonstrated better bioavailability in the capsules than in the tablets, the average improvement being 26.1%. The better bioavailability of digoxin capsules also resulted in more rapid and wider variations in the polycardiographic parameters.openV. Alvisi; C. Longhini; B. Bagni; F. Portaluppi; M. Ruina; C. FersiniAlvisi, Vittorio; Longhini, Carlo; B., Bagni; Portaluppi, Francesco; M., Ruina; Fersini, Carmel

Liver Enzymes (ALT, GGT), Insulin Resistance and Hepatic Steatosis at Ultrasonography in Obese And Severely Obese Patients

reserved6noBackground and aim: In obesity, a cluster of metabolic alterations is often associated with Fatty Liver (FL). The bright liver at abdominal ultrasonography (US) and, in most cases, increased levels of hepatic enzymes, alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT), are considered the hallmarks of Nonalcoholic Fatty Liver Disease (NAFLD). Moreover in obesity, insulin resistance (IR) is reported to be closely related to FL. Metabolic and liver enzymes alterations were investigated in a population of obese and severely obese patients (BMI&gt;40); patients with FL or without FL at US were compared. Material and methods: From March 2003 through October 2007, 146 patients (F 102; age 20-63 yrs) with obesity and severe obesity (BMI 32-62) were consecutively admitted to our digestive endoscopy service (Malatesta Novello Hospital, Cesena, Italy) for the intragastric balloon insertion. US, clinical and routine laboratory investigations were determined. IR was calculated by the Homeostasis Model Assessment (HOMA-IR), as fasting serum insulin (mU/ml) x fasting plasma glucose (mmol/l)/22.5; values &gt;2.5 indicate a state of IR. Patients with HBV(+), HCV(+), alcohol consumption &gt;20g/day, and steatogenic drugs in the history, were excluded. Statistical analysis was performed using SPSS 15.0 software. Results: In all patients BMI median value was 40 kg/m2. US showed FL in 60% pts. FL (88) group was compared with noFL (58) group, the values of HOMA-IR (4.8±3.1 vs 3.8±2.2, p&lt;.05), ALT (41.8±43.9 vs 23.3±14.2, p&lt;.01), GGT (35.3±27.2 vs 20.5±13.6 p&lt;.001), Triglycerides (202.8±145.3 vs 135.6±60.9, p&lt;.01) were significantly different. Glucose and HDL-cholesterol did not differ. HOMA-IR correlated significantly with ALT, in noFL and FL (R2=0.12 and R2=0.05; p&lt;.05) or with GGT, only in noFL (R2=0.175; p&lt;.001). Conclusions: In all obese patients with FL at US, liver enzymes (ALT, GGT) and HOMA-IR values were higher than in noFL, confirming the pivotal role of IR in liver damage due to visceral adiposity. As previously reported by Marchesini et al (2005), we confirm ALT could be considered a marker of hepatic dysfunction in obesity, more sensitive than GGT.mixedRicci G.; Rossi A.; Bersani G.; Pigò F.; De Fabritiis G.; Alvisi V.Ricci, Giorgio; Rossi, A.; Bersani, G.; Pigò, F.; De Fabritiis, G.; Alvisi, Vittori