Comparison of laboratory and daily-life gait speed assessment during on and off states in parkinson’s disease

Accurate assessment of Parkinson’s disease (PD) ON and OFF states in the usual environment is essential for tailoring optimal treatments. Wearables facilitate measurements of gait in novel and unsupervised environments; however, differences between unsupervised and in-laboratory measures have been reported in PD. We aimed to investigate whether unsupervised gait speed discriminates medication states and which supervised tests most accurately represent home perfor-mance. In-lab gait speeds from different gait tasks were compared to home speeds of 27 PD patients at ON and OFF states using inertial sensors. Daily gait speed distribution was expressed in percentiles and walking bout (WB) length. Gait speeds differentiated ON and OFF states in the lab and the home. When comparing lab with home performance, ON assessments in the lab showed moderate-to-high correlations with faster gait speeds in unsupervised environment (r = 0.69; p < 0.001), associated with long WB. OFF gait assessments in the lab showed moderate correlation values with slow gait speeds during OFF state at home (r = 0.56; p = 0.004), associated with short WB. In-lab and daily assessments of gait speed with wearables capture additional integrative aspects of PD, reflecting different aspects of mobility. Unsupervised assessment using wearables adds complementary information to the clinical assessment of motor fluctuations in PD.This research was funded by Keep Control from the EU’s Horizon 2020 (H2020) research and innovation program under the Marie Sklodowska-Curie (MSCA-ITN-ETN), grant number 721577. No other financial support and funding for the preceding twelve months are applied

Prognostic Value of Indeterminable Anaerobic Threshold in Heart Failure.

Background In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning. Methods and Results We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction <40%) HF in stable clinical conditions, New York Heart Association class I to III, who underwent clinical, laboratory, echocardiographic, and cardiopulmonary exercise test investigations at study enrollment. We excluded 921 patients who did not perform a maximal exercise, based on lack of achievement of anaerobic metabolism (peak respiratory quotient 1.05). Primary study end point was a composite of cardiovascular death and urgent cardiac transplant, and secondary end point was all-cause death. Median follow-up was 3.01 (1.39-4.98) years. AT was identified in 1935 out of 2137 patients (90.54%). At multivariable logistic analysis, failure in detecting AT resulted significantly in reduced peak oxygen uptake and higher metabolic exercise and cardiac and kidney index score value, a powerful prognostic composite HF index (P<0.001). At multivariable analysis, the following variables were significantly associated with primary study end point: peak oxygen uptake (% pred; P<0.001; hazard ratio [HR]=0.977; confidence interval [CI]=0.97-0.98), ventilatory efficiency slope (P=0.01; HR=1.02; CI=1.01-1.03), hemoglobin (P<0.05; HR=0.931; CI=0.87-1.00), left ventricular ejection fraction (P<0.001; HR=0.948; CI=0.94-0.96), renal function (modification of diet in renal disease; P<0.001; HR=0.990; CI=0.98-0.99), sodium (P<0.05; HR=0.967; CI=0.94-0.99), and AT nonidentification (P<0.05; HR=1.41; CI=1.06-1.89). Nonidentification of AT remained associated to prognosis also when compared with metabolic exercise and cardiac and kidney index score (P<0.01; HR=1.459; CI=1.09-1.10). Similar results were obtained for the secondary study end point. Conclusions The inability to identify AT most often occurs in patients with severe HF, and it has an independent prognostic role in HF

European guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part I

This guideline on mucous membrane pemphigoid (MMP) has been elaborated by the Task Force for Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology (EADV) with a contribution of physicians from all relevant disciplines and patient organizations. It is a S3 consensus-based guideline encompassing a systematic review of the literature until June 2019 in the MEDLINE and EMBASE databases. This first part covers methodology, the clinical definition of MMP, epidemiology, MMP subtypes, immunopathological characteristics, disease assessment and outcome scores. MMP describes a group of autoimmune skin and mucous membrane blistering diseases, characterized by a chronic course and by predominant involvement of the mucous membranes, such as the oral, ocular, nasal, nasopharyngeal, anogenital, laryngeal and oesophageal mucosa. MMP patients may present with mono- or multisite involvement. Patients’ autoantibodies have been shown to be predominantly directed against BP180 (also called BPAG2, type XVII collagen), BP230, laminin 332 and type VII collagen, components of junctional adhesion complexes promoting epithelial stromal attachment in stratified epithelia. Various disease assessment scores are available, including the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), the Autoimmune Bullous Skin disorder Intensity Score (ABSIS), the ‘Cicatrising Conjunctivitis Assessment Tool’ and the Oral Disease Severity Score (ODSS). Patient-reported outcome measurements (PROMs), including DLQI, ABQOL and TABQOL, can be used for assessment of quality of life to evaluate the effectiveness of therapeutic interventions and monitor disease course

UC.183, UC.110, and UC.84 Ultra-Conserved RNAs Are Mutually Exclusive with miR-221 and Are Engaged in the Cell Cycle Circuitry in Breast Cancer Cell Lines.

In the human genome, there are about 600 ultra-conserved regions (UCRs), long DNA sequences extremely conserved in vertebrates. We performed a large-scale study to quantify transcribed UCR (T-UCR) and miRNA levels in over 6000 cancer and normal tissue samples to find possible correlation between these kinds of regulatory molecules. Our analysis evidenced several non-coding RNAs showing negative co-regulation with miRNAs; among them, we focused on miR-221 to investigate any relationship with its pivotal role in the cell cycle. We have chosen breast cancer as model, using two cell lines with different phenotypes to carry out in vitro treatments with siRNAs against T-UCRs. Our results demonstrate that the expression of uc.183, uc.110, and uc.84 T-UCRs is mutually exclusive with miR-221 and is engaged in the regulation of CDKN1B expression. In addition, tests with a set of anticancer drugs, including BYL719, AZD5363, AZD8055, AZD7762, and XL765, revealed the modulation of specific T-UCRs without alteration of miR-221 levels

Motor, cognitive and mobility deficits in 1000 geriatric patients : protocol of a quantitative observational study before and after routine clinical geriatric treatment – the ComOn-study

© The Author(s). 2020 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany). Methods: This is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week's inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters. Discussion: This study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.info:eu-repo/semantics/publishedVersio

Different activations of the soleus and gastrocnemii muscles in response to various types of stance perturbation in man

The soleus (Sol) and medial and lateral gastrocnemii (GM and GL) behave differently during various movements, but no attempt has been made to disclose any distinct activation of these muscles during perturbations of upright stance. Therefore the pattern of activation of the three triceps surae (TS) muscles and of the tibialis anterior (TA) was studied in normal subjects following rotational and linear displacements of a movable platform. The effect of "postural set" on the responses was also studied while holding onto a frame. In free-standing subjects, TS stretches (upward tilt, UT and backward translation, BT) evoked a large short latency response (SLR) in Sol; smaller SLRs were sometimes induced in GM or GL. A medium latency response (MLR) was consistently present in both or only one gastrocnemii. On the average, the amplitude and the frequency of occurrence of the responses were distributed as follows: SLR, Sol greater than GL greater than GM; MLR, GM greater than GL greater than Sol. The type of perturbation did not affect the latency of all TS muscle responses, but the duration, amplitude and frequency of MLRs were larger during BT than UT. MLRs were followed by an antagonistic reaction (AR) in the TA, larger and more frequent during UT than BT. TA stretches (downward tilt, DT and forward translation, FT) induced a TA MLR, with duration and area larger in FT than DT. ARs occurred in one or more muscles of TS, being larger and more frequent in Sol. Under the conditions of stabilized stance, SLRs were not affected, but all the MLRs and ARs were much reduced in amplitude. The analogies between TS and TA MLRs (frequency of occurrence, latency and suppression under stabilized condition) suggest a common underlying mechanism and a similar postural role. On the other hand, all the TS responses are unequally distributed in the individual muscles and in the various subjects. This recommends caution in drawing conclusions in their absence or from their susceptibility to postural set in patients, when only one muscle of TS is being recorded

Changes of balance control in alcoholic patients after a short-term treatment: preliminary results of a trial

none4noAim: The purpose of the present study was to study changes of balance control after a short-term multidimensional treatment in a sample of chronic alcoholics. Alcohol ingestion negatively impacts physical performance, causing worsening of psychomotor skills and reduced postural control [1], exercise is associated with positive outcomes in the treatment of alcohol dependence [2]. Method: Participants were 30 alcoholic patients (20 men, 10 women; mean age = 46.9 ±6.6 years; mean BMI = 25.7 ±4.4) consecutively admitted to a 4-week residential treatment. They completed the Falls Efficacy Scale International (FES-I) and the Dizziness Handicap Inventory (DHI). Pre- post-measures of standing balance were collected with open and closed eyes on a firm surface and on a foam, by using a low cost set up based on Nintendo Wii Balance Board and a custom-made software [3,4]. Dynamic balance was tested by means of the Dynamic Gait Index (DGI) test. Twelve patients attended a specific balance exercises program (group 1, mean session = 10.8 ±0.8), 10 participated in standardized group-based physical activities (group 2, mean sessions attended = 11.2 ±1.3), 8 served as control and did not take part to organized physical activities during their hospitalization (group 3). Results: No significant difference by group were observed at the baseline on all the variables. Significant correlations (p < .01) of FES-I with DHI and DGI and between DHI and DGI were found. Significant correlation between all the sway-path measures (mm/s) with open/closed eyes and with/without foam were recorded. The mean value of the FES-I at baseline was 10.2 ±4.5. Patients in group 1 reported significant improvements in the DHI (p = .019) and in the DGI (p = .021). Patients in group 2 and in group 3 did not reported significant changes in both self-reported measures and in static and dynamic balance test. Conclusion: Findings support the notion that balance control represents a serious problem for chronic alcoholics and that most patients are not aware of their problematic. A specific exercise program oriented to improve balance control seems to be an effective strategy to ameliorate in the short time the selfperceived handicapping effects imposed by balance-related problems and the dynamic balance. References [1] Wober C. et al. (1999) Postural control and lifetime alcohol consumption in alcohol-dependent patients. Acta Neurol. Scand., 99, 48-53. [2] Carraro A. (2013) The role of exercise in alcohol dependence recovery. In M. Probst & A. Carraro (Eds.), Mental health and physical activity: a practice oriented approach, 61-69. Milano: Edi Ermes. [3] Carraro A. et al. (2013) Non-conventional methods for assessing standing balance: reliability evaluation of the Nintendo Wii balance board. European College of Sport Science book of abstract, 593-594.noneCarraro A.; Corrà A.; Gobbi E.; Pavan P.Carraro, Attilio; Corrà, A.; Gobbi, Erica; Pavan, Pier