Cardiac troponin I levels in patients with refractory temporal lobe epilepsy after cortico-amygdalo-hippocampectomy

PURPOSE: Sudden unexpected death in epilepsy (SUDEP) is the main cause of death in patients with epilepsy. Morphologic and functional changes in the heart are related to SUDEP. The aim of our study was to verify the concentration of troponin I, an important marker of myocardium damage, in patients with temporal lobe epilepsy who were submitted to surgical resection and were not seizure-free after the procedure. METHODS: Eleven non-consecutive patients participated in the study and all of them presented poor seizure control after surgical procedure. Troponin I levels higher then 1 ng/ml indicate myocardium damage. The detection level of the kit used in our study was 0,15 ng/ml. RESULTS: Only three patients showed detectable troponin I levels. The troponin I levels found in our study is not related with sex, age or side of the lesion. CONCLUSIONS: In spite of we did not find positive results in our study, an active role of the heart in SUDEP cannot be discarded, since some injuries, even so not being capable to modify troponin I levels, can be enough to generate arrhythmogenic foci.OBJETIVOS: A morte súbita em epilepsia (SUDEP) é a principal causa de morte entre os pacientes com epilepsia. Alterações morfológicas e funcionais do coração estão relacionadas com a SUDEP. Nesse sentido, o objetivo deste estudo foi avaliar a concentração de troponina I, um importante marcador de lesão do miocárdio, em pacientes com epilepsia do lobo temporal de difícil controle e que foram submetidos à ressecção cirúrgica e que não obtiveram sucesso com esta abordagem terapêutica. METODOLOGIA: Onze pacientes participaram do estudo e todos continuaram a apresentar crises após o tratamento cirúrgico. Os valores de troponina I indicativos de lesão seriam aqueles maiores de 1 ng/ml e o valor mínimo detectável pelo kit utilizado em nosso estudo foi de 0,15 ng/ml. RESULTADOS: Apenas três pacientes apresentaram níveis de troponina I detectáveis. Em relação aos níveis detectáveis de troponina I, não encontramos nenhuma relação com sexo, idade e lateralidade da lesão. CONCLUSÕES: APESAr de não termos encontrado resultados positivos em nosso estudo, o papel do coração na SUDEP não pode ser descartado, já que algumas lesões, embora não sendo capazes de alterar os níveis séricos de troponina I, podem ser suficientes na gênese de focos arritmogênicos.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade de Mogi das Cruzes Núcleo de Pesquisas TecnológicasHospital Brigadeiro Departamento de Neurologia e NeurocirurgiaCentro Universitário São CamiloHospital Israelita Albert EinsteinUniversidade Federal de São João del-Rei Departamento de Engenharia BiomédicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de FisiologiaUNIFESP, EPM, Depto. de FisiologiaSciEL

Influenza dell’aplotipo caseinico sulla qualità tecnologica del latte di capra Cilentana

Il latte di capra presenta un’elevata variabilità genetica a causa del polimorfismo qualiquantitativo ai loci caseinici, correlato positivamente o negativamente alla trasformazione casearia per le differenti caratteristiche chimico-fisiche. Nel latte caprino, la quantità di caseina dipende dalle classi quantitative, forti, intermedie e deboli, degli alleli ai loci delle tre principali frazioni caseiniche as1, as2 e b e dalla relativa frequenza nel latte da caseificare. Dal momento che la resa casearia dipende dai contenuti di caseina e grasso, nel presente lavoro è stata studiata l’influenza dell’aplotipo caseinico (as1, b e k-CN) sul contenuto dei macronutrienti e sull’attitudine alla trasformazione casearia del latte di capra Cilentana utilizzato nella produzione del Cacioricotta. Questo è uno dei prodotti simbolo della produzione casearia meridionale, che associa le caseine del formaggio alle sieroproteine della ricotta e viene prodotto solo in alcune zone del Cilento (SA). Questo studio si inserisce nell’ambito del PRIN 2005075887_005 finalizzato alla definizione della qualità tecnologica e nutrizionale del latte ovi-caprino. Sono stati analizzati 166 campioni individuali di latte di capra Cilentana mediante la determinazione del contenuto di grasso, proteina e dei parametri tromboelastografici. Dopo la fenotipizzazione ai loci as1, b e k-CN, effettuata mediante tecniche immuno-elettroforetiche, sono stati assemblati due latti massali (Forte e Debole) impiegati nella produzione di Cacioricotta. I fenotipi caseinici dei campioni individuali sono stati raggruppati in 17 aplotipi classificati in due classi: forti, F e deboli D, in base al contenuto di alleli forti e deboli dell’as1-CN. Nel latte della capra Cilentana gli aplotipi F sono più diffusi rispetto a quelli D; ad essi sono associati maggiori contenuti di grasso (4,12% vs 3,82%) e proteina (3,26% vs 2,86%) che lasciano presupporre una buona resa casearia. In base ai dati tromboelastografici il latte di capra Cilentana presenta buone attitudini casearie, in quanto agli aplotipi D è correlata una migliore attitudine alla coagulazione rispetto alle razze straniere (in cui prevalgono gli alleli deboli). I dati relativi alla resa in formaggio confermano questo risultato, perché la resa degli aplotipi D (14.50%) è inferiore solo di un punto percentuale a quella degli F (15.50%). Infine è interessante notare che nel latte massale D (cui è associata una minore quantità di caseine, particolarmente antigeniche), agli aplotidi D è associato il 73% (vs 77% dei forti) di contenuto di caseina e l’8% (vs 6% dei forti) di azoto non proteico. L’utilizzo di latte caprino con aplotipi D può anche rappresentare un’utile alternativa ai latti per l’infanzia che sono prodotti da latte bovino mediante processi di produzione che abbassano la biodisponibilità di aminoacidi, essenziali per la crescita del neonato

Inspiratory-Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial

End-stage kidney disease (ESKD) exposes patients to progressive physical deconditioning involving the respiratory muscles. The aim of this pilot randomized controlled trial was to determine the feasibility and effectiveness of low-intensity respiratory muscle training (RMT) learned at the hospital and performed at home. A group of ESKD patients (n = 22) were randomized into RMT or usual care (control group, CON) in a 1:1 ratio. The respiratory training was performed at home with an inspiratory-expiratory system for a total of 5 min of breathing exercises in a precise rhythm (8 breaths per minute) interspersed with 1 min of rest, two times per day on nondialysis days for a total of 4 weeks, with the air resistance progressively increasing. Outcome measures were carried out every 4 weeks for 3 consecutive months, with the training executed from the 5th to the 8th week. Primary outcomes were maximal inspiratory and expiratory pressure (MIP, MEP), while secondary outcomes were lung capacity (FEV1, FVC, MVV). Nineteen patients without baseline between-group differences completed the trial (T: n = 10; Age: 63 +/- 10; Males: n = 12). Both MIP and MEP significantly improved at the end of training in the T group only, with a significant difference of MEP of 23 cmH(2)O in favor of the RMT group (p = 0.008). No significant variations were obtained for FVC, FEV1 or MVV in either group, but there was a greater decreasing trend over time for the CON group, particularly for FVC (t = -2.00; p = 0.046). Low-fatiguing home-based RMT, with a simple device involving both inspiratory and expiratory muscles, may significantly increase respiratory muscle strength

Inspiratory–Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial

End-stage kidney disease (ESKD) exposes patients to progressive physical deconditioning involving the respiratory muscles. The aim of this pilot randomized controlled trial was to determine the feasibility and effectiveness of low-intensity respiratory muscle training (RMT) learned at the hospital and performed at home. A group of ESKD patients (n = 22) were randomized into RMT or usual care (control group, CON) in a 1:1 ratio. The respiratory training was performed at home with an inspiratory–expiratory system for a total of 5 min of breathing exercises in a precise rhythm (8 breaths per minute) interspersed with 1 min of rest, two times per day on nondialysis days for a total of 4 weeks, with the air resistance progressively increasing. Outcome measures were carried out every 4 weeks for 3 consecutive months, with the training executed from the 5th to the 8th week. Primary outcomes were maximal inspiratory and expiratory pressure (MIP, MEP), while secondary outcomes were lung capacity (FEV1, FVC, MVV). Nineteen patients without baseline between-group differences completed the trial (T: n = 10; Age: 63 ± 10; Males: n = 12). Both MIP and MEP significantly improved at the end of training in the T group only, with a significant difference of MEP of 23 cmH2O in favor of the RMT group (p = 0.008). No significant variations were obtained for FVC, FEV1 or MVV in either group, but there was a greater decreasing trend over time for the CON group, particularly for FVC (t = −2.00; p = 0.046). Low-fatiguing home-based RMT, with a simple device involving both inspiratory and expiratory muscles, may significantly increase respiratory muscle strength

Assessing the Relationship between Body Image Satisfaction and Physical Activity in Italian Adolescents: A Cross-Sectional Investigation

Purpose: The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V ̇ O2peak) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program. Methods: Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V ̇ O2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V ̇ O2peakEST). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V ̇ O2peak determination (V ̇ O2peakMEAS). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT. Results: Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V ̇ O2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V ̇ O2peakMEAS and V ̇ O2peakEST. Compared with CPX results, the 1km-TWT underestimated the V ̇ O2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05). Conclusions: The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V ̇ O2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs