Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis

Upper limb impairments can occur in patients with multiple sclerosis, affecting daily living activities; however there is at present no definite agreement on the best rehabilitation treatment strategy to pursue. Moreover, motor training has been shown to induce changes in white matter architecture in healthy subjects.This study aimed at evaluating the motor behavioral and white matter microstructural changes following a 2-month upper limb motor rehabilitation treatment based on task-oriented exercises in patients with multiple sclerosis.Thirty patients (18 females and 12 males; age. = 43.3. ±. 8.7. years) in a stable phase of the disease presenting with mild or moderate upper limb sensorimotor deficits were randomized into two groups of 15 patients each. Both groups underwent twenty 1-hour treatment sessions, three times a week. The "treatment group" received an active motor rehabilitation treatment, based on voluntary exercises including task-oriented exercises, while the "control group" underwent passive mobilization of the shoulder, elbow, wrist and fingers.Before and after the rehabilitation protocols, motor performance was evaluated in all patients with standard tests. Additionally, finger motor performance accuracy was assessed by an engineered glove.In the same sessions, every patient underwent diffusion tensor imaging to obtain parametric maps of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. The mean value of each parameter was separately calculated within regions of interest including the fiber bundles connecting brain areas involved in voluntary movement control: the corpus callosum, the corticospinal tracts and the superior longitudinal fasciculi.The two rehabilitation protocols induced similar effects on unimanual motor performance, but the bimanual coordination task revealed that the residual coordination abilities were maintained in the treated patients while they significantly worsened in the control group (p. = 0.002). Further, in the treatment group white matter integrity in the corpus callosum and corticospinal tracts was preserved while a microstructural integrity worsening was found in the control group (fractional anisotropy of the corpus callosum and corticospinal tracts: p. = 0.033 and p. = 0.022; radial diffusivity of the corpus callosum and corticospinal tracts: p. = 0.004 and p. = 0.008). Conversely, a significant increase of radial diffusivity was observed in the superior longitudinal fasciculi in both groups (p. = 0.02), indicating lack of treatment effects on this structure, showing damage progression likely due to a demyelination process.All these findings indicate the importance of administering, when possible, a rehabilitation treatment consisting of voluntary movements. We also demonstrated that the beneficial effects of a rehabilitation treatment are task-dependent and selective in their target; this becomes crucial towards the implementation of tailored rehabilitative approaches. © 2013 The Authors

Acquired pure red cell aplasia: updated review of treatment

Pure red cell aplasia (PRCA) is a syndrome characterized by a severe normocytic anaemia, reticulocytopenia, and absence of erythroblasts from an otherwise normal bone marrow. Primary PRCA, or secondary PRCA which has not responded to treatment of the underlying disease, is treated as an immunologically-mediated disease. Although vigorous immunosuppressive treatments induce and maintain remissions in a majority of patients, they carry an increased risk of serious complications. Corticosteroids were used in the treatment of PRCA and this has been considered the treatment of first choice although relapse is not uncommon. Cyclosporine A (CsA) has become established as one of the leading drugs for treatment of PRCA. However, common concerns have been the number of patients treated with CsA who achieve sustained remissions and the number that relapse. This article reviews the current status of CsA therapy and compares it to other treatments for diverse PRCAs

Adiponectin in relation to childhood myeloblastic leukaemia

Adiponectin, an adipocyte-specific secretory protein known to induce apoptosis, has been reported to be inversely related to breast and endometrial cancers and recently found to inhibit proliferation of myeloid but not lymphoid cell lines. We hypothesised that adiponectin may be inversely associated with acute myeloblastic leukaemia (AML), but not with acute lymphoblastic leukaemia of B (ALL-B) or T (ALL-T) cell origin in children. Blood samples and clinical information were collected over the period 1996–2000 from 201 children (0–14 years old) with leukaemia (22 AML, 161 ALL-B and 18 ALL-T cases) through a national network of childhood Hematology-Oncology units in Greece and from 201 controls hospitalised for minor pediatric ailments. Serum adiponectin levels were measured under code, at the Beth Israel Deaconess Medical Center, Boston, MA, USA using a radioimmunoassay procedure. Each of the three leukaemia groups was compared with the control group through multiple logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) for an increase of adiponectin equal to 1 s.d. among controls were estimated controlling for gender, age, as well as for height and weight, expressed in age–gender-specific centiles of Greek growth curves. Adiponectin was inversely associated with AML (OR=0.56; 95% CI, 0.34–0.94), whereas it was not significantly associated with either ALL-B (OR=0.88; 95% CI, 0.71–1.10) or ALL-T (OR=1.08; 95% CI, 0.67–1.72). Biological plausibility and empirical evidence point to the importance of this hormone in the pathogenesis of childhood AML

Isoniazid-triggered pure red cell aplasia in systemic lupus erythematosus complicated with myasthenia gravis.

A 47-year-old woman who had been treated for systemic lupus erythematosus (SLE) with myasthenia gravis (MG) was admitted to our hospital with acute onset of severe anemia after administration of isoniazid. Pure red cell aplasia (PRCA) was confirmed by elevated serum iron levels, reticulocytopenia and bone marrow aspiration showing a remarkable reduction of erythroblasts. Finally, cyclosporine A successfully improved PRCA. Although both SLE and MG have the potential complication of PRCA, we report here a case of isoniazid-triggered PRCA

Diagnosing and treating Diamond Blackfan anaemia: results of an international clinical consensus conference

Diamond Blackfan anaemia (DBA) is a rare, genetically and clinically heterogeneous, inherited red cell aplasia. Classical DBA affects about seven per million live births and presents during the first year of life. However, as mutated genes have been discovered in DBA, non-classical cases with less distinct phenotypes are being described in adults as well as children. In caring for these patients it is often difficult to have a clear understanding of the treatment options and their outcomes because of the lack of complete information on the natural history of the disease. The purpose of this document is to review the criteria for diagnosis, evaluate the available treatment options, including corticosteroid and transfusion therapies and stem cell transplantation, and propose a plan for optimizing patient care. Congenital anomalies, mode of inheritance, cancer predisposition, and pregnancy in DBA are also reviewed. Evidence-based conclusions will be made when possible; however, as in many rare diseases, the data are often anecdotal and the recommendations are based upon the best judgment of experienced clinicians. The recommendations regarding the diagnosis and management described in this report are the result of deliberations and discussions at an international consensus conference

Serum folate and B12 levels in association with cognitive impairment among seniors: results from the VELESTINO study in Greece and meta-analysis.

OBJECTIVE: To summarize existing evidence on the effect of serum folate and vitamin B12 levels on cognitive impairment among elders via a meta-analysis, also including unpublished data from a cross-sectional study of seniors ( > 65 years) residing in Velestino, Greece. METHOD: Serum measurements and Mini-Mental State Examination (MMSE) assessments were available for 593 Velestinians. In addition, 12 studies availing data on folate blood levels (N = 9,747) and 9 on B12 (N = 8,122) were identified following a search algorithm; pooled effect estimates were derived. RESULTS: Cognitive impairment (MMSE < 24) among Velestenians was associated with lower education level in both genders; decreased social activity, depressive symptoms and low folate levels in males; older age in females. Meta-analyses showed an adverse effect of low-folate levels on cognition (OR: 1.66, 95% CI: 1.40-1.96); B12 was nonsignificantly associated (OR: 1.11, 95% CI: 0.88-1.40). DISCUSSION: Low folate levels are associated with cognitive impairment of seniors; underlying pathophysiological mechanisms should be further explored

Statistical methods in the investigation of the etiology and risk factors of accidents

This doctoral thesis was part of the research needs of the Centre for Research and Prevention of Injuries (CEREPRI) in order to seek the most appropriate sources of mortality and morbidity data from physical injuries, to perform comparisons between countries and to examine the time trends of indicators of morbidity and to calculate at the national level the incidence indicators and the parameters of the medical cost of health services from physical injuries. Parallel objective was to implement a wide range of statistical methods in different types of studies and designs of explanatory epidemiology in order to investigate factors associated with the occurrence of the injuries in Greece, taking into account the specificities of epidemiology in this area and to highlight the necessity of a detailed database for recording the causes and the circumstances of the injury occurrence and so to identify dangerous consumer products.Analyses were based on data derived from WHO, on the 500000 cases recorded at the CEREPRI Emergency Department Injury Surveillance System (EDISS) database, on household survey of MRB and ad hoc collections. It was also used a simple method for calculating the preventable fraction of the injuries to illustrate the possibilities of using existing data to emerge the burden of the injuries and the need for policy decisions planning prevention interventions tailored to their respective populations.In particular, a nested case control study was performed for highlighting the burden and the causes of the childhood injuries in the town of Velestino. Traditional case control studies as well as the cluster analysis were used to investigate the potential role and to identify risk factors for injuries to specific groups of children. Also, for the first time in our country, a case crossover study was performed with injured children, to study the exposure of the victim in a series of risk factors at different time intervals before the event. Finally, we investigated the role of specific consumer products for infant injuries.From the analysis of available mortality data since 1980 appears that Greece is in a better position than the EU average. The last period it seems that the degree of reduction in mortality in Greece is lower than this of EU average resulting a decline in the advantageous position of Greece in relation to the average of EU countries. Based on EDISS data, it was estimated that in Greece each year are treated in the outpatient hospitals 1.5 million injuries, 18% of which involved children under the age of 15. In an alternative, less objective, approach in which data were collected from a household survey the corresponding estimated size was 0.52 million.Regarding the calculation of the preventable fraction of injuries, it was estimated that up to one in four deaths due to injury could have been avoided if it had been developed appropriate prevention strategies in each region of the U.S. The preventable fraction is particularly high in childhood, where it reaches 42% and similar to that (47%) who had previously calculated by the CEREPRI for the European Union countries.With the studies of this thesis it was presented the magnitude of the problem, indicated a series of risk factors such as intra-familial environment, demographic characteristics of parents, such as age and education or inherent biological parameters such as anthropometric and left-handedness or, designated and described homogeneous groups of individuals who are at increased risk for the same injury type. Confirmation of these findings as well as those of the case crossover study showed that emotional stress or strenuous physical and mental exercise may be associated with a subsequent accident, can provide an incentive to develop new prevention strategies that are aimed at informing and the training of teachers and parents with a view to reducing the injuries in children. Similarly, the example of the study for the injuries caused by the baby bouncers could be a springboard for industry to modify the characteristics of the product resulting an injury and until then, to recommendations for increased vigilance of parents and of the relevant authorities for the risk for injuries from consumer products.In conclusion, in order to assess the effectiveness of prevention efforts and to design targeted programs for the injuries it is necessary an additional database covering detailed description of the external cause of the incident, which is not reflected in the routine collectively data of mortality and morbidity. EDISS was established and operated in line with other databases that were co-funded in the beginning by the European Union and still continue to work with national resources in other countries of the Union. The analysis of the data as presented in this thesis contributed to capture the magnitude of the problem of the injuries in Greece, to identify series of risk factors, to formulate prevention policies, but also to international prominence in the relevant scientific knowledge base, with substantial participation in the scientific developments