Teaching anatomy in a modern medical course: an integrated approach at Vialba Medical School in Milan

Introduction The course of Anatomy in Vialba Medical School \u2013 University of Milan, integrates systemic, topographic and development anatomy, dissection laboratory, peer-teaching, flipped classroom, clinical correlation to radiology and surgery. Methods An anonymous questionnaire based on a five-point Likert scale was submitted to 162 students who had passed the exam of Anatomy. Students evaluated the importance given during study to morphology, relations and variations of organs, the usefulness of different tools in preparing the exam of anatomy. Finally, the impact of the new design course of Anatomy on students\u2019 progress was assessed. Results The results showed that most of the students found very useful dissections, multimedia sources and 3D virtual models. 3D virtual models, dissections and physical models were indicated as the most important tools that should be available for learning Anatomy; instead, medical imaging received a low score. Students focused the study on morphology and relations between organs much more than anatomical variations. Lastly, students who followed the new design course of anatomy showed a significant better performance when compared to students of the previous academic years, in particular on the anatomy of neck, thoracic and abdominopelvic cavity, and neuroanatomy. Conclusions Our study underlines the positive impact of the integration of traditional methods and innovative solutions in learning anatomy, but also the critical approach to radiologic imaging and anatomical variability

One Year Clinical Outcomes of Renal Artery Stenting: The Results of ODORI Registry

The safety, efficacy and long term clinical benefits of renal artery revascularization by stenting are still a matter of debate. The aim of our study was to define the safety and efficacy of renal artery stenting with the Tsunami peripheral stent (Terumo Corporation, Tokyo, Japan). The ODORI was a prospective, multicentre registry which enrolled 251 consecutive patients, (276 renal arteries) in 36 centres across Europe. The primary endpoint was acute procedural success defined as <30% residual stenosis after stent placement. Secondary endpoints included major adverse events, blood pressure control, serum creatinine level, and target lesion revascularization (TLR) at 6 and 12 months. Patients were 70 ± 10 years old, 59% were male, 33% had diabetes, and 96% hypertension. The main indications for renal stent implantation were hypertension in 83% and renal salvage in 39%. Direct stent implantation was performed in 76% of the cases. Acute success rate was 100% with residual stenosis of 2.5 ± 5.4%. Systolic/diastolic blood pressure decreased from a mean of 171/89 at baseline to 142/78 mmHg at 6 months (p < 0.0001 vs. baseline), and 141/80 mmHg at 12 months (p < 0.0001 vs. baseline). Mean serum creatinine concentration did not change significantly in the total population. However, there was significant improvement in the highest tercile (from 283 μmol/l at baseline to 205 and 209 μmol/l at 6 and 12 months respectively). At 12-months, rates of restenosis and TLR were 6.6 and 0.8% respectively. The 12 month cumulative rate of all major clinical adverse events was 6.4% while the rate of device or procedure related events was 2.4%. In hypertensive patients with atherosclerotic renal artery stenosis Tsunami peripheral balloon-expandable stent provides a safe revascularization strategy, with a potential beneficial impact on hypertension control and renal function in the highest risk patients

Beta-Thalassaemia Intermedia: Evaluation of Endocrine and Bone Complications

Objective. Data about endocrine and bone disease in nontransfusion-dependent thalassaemia (NTDT) is scanty. The aim of our study was to evaluate these complications in -TI adult patients. Methods. We studied retrospectively 70 -TI patients with mean followup of 20 years. Data recorded included age, gender, haemoglobin and ferritin levels, biochemical and endocrine tests, liver iron concentration (LIC) from 2 * , transfusion regimen, iron chelation, hydroxyurea, splenectomy, and bone mineralization by dual X-ray absorptiometry. Results. Thirty-seven (53%) males and 33 (47%) females were studied, with mean age 41±12 years, mean haemoglobin 9.2 ± 1.5 g/dL, median ferritin 537 (range 14-4893), and mean LIC 7.6 ± 6.4 mg Fe/g dw. Thirty-three patients (47%) had been transfused, occasionally (24/33; 73%) or regularly (9/33; 27%); 37/70 (53%) had never been transfused; 34/70 patients had been splenectomized (49%); 39 (56%) were on chelation therapy; and 11 (16%) were on hydroxyurea. Endocrinopathies were found in 15 patients (21%): 10 hypothyroidism, 3 hypogonadism, 2 impaired glucose tolerance (IGT), and one diabetes. Bone disease was observed in 53/70 (76%) patients, osteoporosis in 26/53 (49%), and osteopenia in 27/5

Response of the photosynthetic apparatus to a flowering-inductive period by water stress in Citrus

The photosynthetic responses to a flowering-inductive water-stress period and recovery were studied and compared in two Citrus species. Under greenhouse conditions, Fino lemon and Owari satsuma trees were subjected to moderate (-2 MPa at predawn) and severe (-3 MPa) water stress levels and were re-watered after 60 days. Vegetative growth was inhibited during the stress assays, and strong defoliation levels were reported, especially in Fino lemon. In both species, bud sprouting was induced after re-watering. Flowers and vegetative shoots developed in Owari satsuma after a drought period, and the development was independent of the stress level. In Fino lemon, vegetative shoots and flowers were primarily formed after moderate and severe stress, respectively. The photosynthetic rate and stomatal conductance were reduced by water stress, and a marked increase in water-use efficiency at the moderate water deficit level was observed. Nevertheless, the photosynthetic apparatus was not damaged, since the maximum quantum yield, photosynthetic pigment concentrations and Rubisco level and activity did not change. Furthermore, the measured malonyldialdehyde (MDA) and peroxidase activity indicated that oxidative stress was not specifically triggered by water stress in our study. Therefore, the gas exchange, fluorescence and biochemical parameters suggested that diffusional limitations to photosynthesis predominated in both of the studied Citrus species, and explained the rapid recovery of the photosynthetic parameters after rehydration. The net CO 2 fixation rate and stomatal conductance were recovered within 24 h in Fino lemon, whereas 3 days were required in Owari satsuma. This suggests the presence of some metabolic limitations in the latter species. Furthermore, the sensibility of the defoliation rates, the accumulation of proline and the stomatal behaviour in response to water stress indicated a higher drought tolerance of Fino lemon, according to its better acclimation to hot climates. © 2011 Springer-Verlag.The authors thank Dr. J. Moreno and co-workers from the Departamento de Bioquimica of the Universidad de Valencia for his help and support in the Rubisco assays, and Dr. F. Fornes, Dr. A. Calatayud and Dr. E. Primo-Millo for the critical review of the manuscript. This work was funded by the Universitat Politecnica de Valencia, Spain (Ayudas para primeros proyectos de investigacion PAID06-06).Ávila Reséndiz, C.; Guardiola Barcena, JL.; González Nebauer, S. (2012). Response of the photosynthetic apparatus to a flowering-inductive period by water stress in Citrus. Trees - Structure and Function. 26(3):833-840. https://doi.org/10.1007/s00468-011-0657-4S833840263Addicott FT (1982) Abscission. University of California Press, BerkeleyBajji M, Kinet JM, Lutts S (1998) Salt stress effects on roots and leaves of Atriplex halimus L. and their corresponding callus. Plant Sci 137:131–142Barbera G, Fatta-del-Bosco G, Lo-Cascio B (1985) Effect of water stress on lemon summer bloom: the Forzatura technique in the Sicilian citrus industry. Acta Hortic 171:391–397Bates LS, Waldren RP, Teare ID (1973) Rapid determination of free proline for water stress studies. Plant Soil 39:205–207Bota J, Medrano H, Flexas J (2004) Is photosynthesis limited by decreased Rubisco activity and RuBP content under progressive water stress? New Phytol 162:671–681Bradford MM (1976) A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding. Anal Biochem 72:248–254Cassin J, Bourdeaut A, Fougue V, Furon V, Gaillard JP, LeBourdelles J, Montagut G, Moreuil C (1969) The influence of climate upon blooming of Citrus in tropical areas. Proc Int Soc Citrus 1:315–323Castel JR, Buj A (1990) Response of Salustiana oranges to high frequency deficit irrigation. Irrig Sci 11:121–127Chaikiatitiyos S, Menzel CM, Rasmussen TS (1994) Floral induction in tropical fruit trees: effects of temperature and water supply. J Hortic Sci 69:397–415Chaves MM, Flexas J, Pinheiro C (2009) Photosynthesis under drought and salt stress: regulation mechanisms from whole plant to cell. Ann Bot 103:551–560Costa JM, Ortuño MF, Chaves M (2007) Deficit irrigation as a strategy to save water: physiology and potential application to horticulture. J Integr Plant Biol 49:1421–1434Davenport TL (1990) Citrus flowering. Hortic Rev 12:249–408Davies FS, Albrigo LG (1994) Citrus. CAB International, Wallingford, pp 126–134Domingo R, Ruiz-Sánchez MC, Sánchez-Blanco MJ, Torrecillas A (1996) Water relations, growth and yield of Fino lemon trees under regulated deficit irrigation. Irrig Sci 16:115–123Erismann ND, Machado EC, Tucci MLS (2008) Photosynthetic limitation by CO2 diffusion in drought stressed orange leaves on three rootstocks. Photosynth Res 96:163–172Flexas J, Bota J, Galmés J, Medrano H, Ribas-Carbó M (2006) Keeping a positive carbon balance under adverse conditions: responses of photosynthesis and respiration to water stress. Physiol Plant 127:343–352Gallé A, Florez-Sarasa I, Tomas M, Pou A, Medrano H, Ribas-Carbó M, Flexas J (2009) The role of mesophyll conductance during water stress and recovery in tobacco (Nicotiana sylvestris): acclimation or limitation? J Exp Bot 60:2379–2390Galmés J, Medrano H, Flexas J (2007) Photosynthetic limitations in response to water stress and recovery in Mediterrenean plants with different growth forms. New Phytol 175:81–93García-Luis A, Kanduser M, Santamarina P, Guardiola JL (1992) Low temperature influence on flowering in Citrus. The separation of inductive and bud dormancy releasing effects. Physiol Plant 86:648–652García-Sánchez F, Syvertsen JP, Gimeno V, Botía P, Pérez-Pérez JG (2007) Responses to flooding and drought stress by two citrus rootstock seedlings with different water-use efficiency. Physiol Plant 130:532–542Genty B, Briantais JM, Baker NR (1989) The relationship between quantum yield of photosynthetic electron transport and quenching of chlorophyll fluorescence. Biochim Biophys Acta 990:87–92Gómez-Cadenas A, Tadeo FR, Talon M, Primo-Millo E (1996) Leaf abscission induced by ethylene in water-stressed intact seedlings of Cleopatra mandarin requires previous abscisic acid accumulation in roots. Plant Physiol 112:401–408Gordo O, Sanz JJ (2010) Impact of climate change on plant phenology in Mediterranean ecosystems. Glob Chang Biol 16:1082–1106Heath RL, Packer L (1968) Photoperoxidation in isolated chloroplasts. I. Kinetics and stoichiometry of fatty acid peroxidation. Arch Biochem Biophys 125:189–190Hoagland DR, Arnon DI (1950) The water culture method for growing plants without soil. California Agricultural Experiment Station Circular no. 347, p 32IPCC (2001) Climate change 2001. In: Houghton JT (ed) The scientific basis. Cambridge University Press, CambridgeLawlor DW (1995) The effects of water deficit on photosynthesis. In: Smirnoff N (ed) Environment and plant metabolism. Bios Scientific Publishers, Oxford, pp 129–160Lichtenthaler HK, Buschmann C (2001) Current protocols in food analytical chemistry, F4.2.1 and F4.3.1. John Wiley and Sons, Inc, NJLorimer GH, Badger MR, Andrews TJ (1977) D-Ribulose-1, 5-bisphosphate carboxilase-oxigenase. Improved methods for activation and assay of catalytic activities. Anal Biochem 78:66–75Miyashita K, Tanakamaru S, Maitani T, Kimura K (2005) Recovery responses of photosynthesis, transpiration, and stomatal conductance in kidney bean following drought stress. Environ Exp Bot 53:205–214Nir I, Leshem B, Goren R (1972) Effects of water stress, gibberellic acid and 2-chloroethylammoniumchloride (CCC) ob flower differentiation in Eureka lemon trees. J Am Soc Hortic Sci 97:774–778Peñarrubia L, Moreno J (1988) Ribulose 1, 5-bisphosphate carboxylase oxygenase from citrus leaves. Phytochemistry 27:1999–2004Pérez-Pérez JG, Syvertsen JP, Botía P, García-Sánchez F (2007) Leaf water relations and net gas exchange responses of salinized carrizo citrange seedlings during drought stress and recovery. Ann Bot 100:335–345Pérez-Pérez JG, Robles JM, Tovar JC, Botía P (2009) Response to drought and salt stress of lemon ‘Fino 49’ under field conditions: water relations, osmotic adjustment and gas Exchange. Sci Hortic 122:83–90Reynolds M, Tuberosa R (2008) Translational research impacting on crop productivity in drought-prone environments. Curr Opin Plant Biol 11:171–179Ruiz-Sánchez MC, Domingo R, Savé R, Biel C, Torrecillas A (1997) Effects of water stress and rewatering on leaf water relations of lemon plants. Biol Plant 39:623–631Sarris D, Christodoulakis D, Körner C (2007) Recent decline in precipitation and tree growth in the eastern Mediterranean. Glob Chang Biol 13:1187–1200Sharkey TD (1990) Water-stress effects on photosynthesis. Photosynthetica 24:651Southwick SM, Davenport TL (1986) Characterization of water stress and low temperature effects on flower induction in Citrus. Plant Physiol 81:26–29Spiegel-Roy P, Goldschmidt EE (1996) Biology of Citrus. Cambridge University Press, Cambridge, pp 131–136Syvertsen JP, Lloyd J (1994) Citrus. In: Schaffer BA, Andersen PC (eds) Handbook of environmental physiology of fruit crops. Vol II Subtropical and tropical crops. CRC Press, Boca Raton, pp 65–99Syvertsen JP (1996) Water stress and carbon budgets. Proc Int Soc Citrus 1:46–50Valladares F, Arrieta S, Aranda I, Lorenzo D, Sánchez-Gómez D, Tena D, Suarez F, Pardos JA (2005) Shade tolerance, photoinhibition sensitivity and phenotypic plasticity of Illex aquifolium in continental Mediterranean sites. Tree Physiol 25:1041–1052Vu JCV, Yelenosky G (1988) Solar irradiance and drought stress effects on the activity and concentration of ribulose bisphosphate carboxylase in ‘Valencia’ orange leaves. Isr J Bot 37:245–25

A new MRI rating scale for progressive supranuclear palsy and multiple system atrophy: validity and reliability

AIM To evaluate a standardised MRI acquisition protocol and a new image rating scale for disease severity in patients with progressive supranuclear palsy (PSP) and multiple systems atrophy (MSA) in a large multicentre study. METHODS The MRI protocol consisted of two-dimensional sagittal and axial T1, axial PD, and axial and coronal T2 weighted acquisitions. The 32 item ordinal scale evaluated abnormalities within the basal ganglia and posterior fossa, blind to diagnosis. Among 760 patients in the study population (PSP = 362, MSA = 398), 627 had per protocol images (PSP = 297, MSA = 330). Intra-rater (n = 60) and inter-rater (n = 555) reliability were assessed through Cohen's statistic, and scale structure through principal component analysis (PCA) (n = 441). Internal consistency and reliability were checked. Discriminant and predictive validity of extracted factors and total scores were tested for disease severity as per clinical diagnosis. RESULTS Intra-rater and inter-rater reliability were acceptable for 25 (78%) of the items scored (≥ 0.41). PCA revealed four meaningful clusters of covarying parameters (factor (F) F1: brainstem and cerebellum; F2: midbrain; F3: putamen; F4: other basal ganglia) with good to excellent internal consistency (Cronbach α 0.75-0.93) and moderate to excellent reliability (intraclass coefficient: F1: 0.92; F2: 0.79; F3: 0.71; F4: 0.49). The total score significantly discriminated for disease severity or diagnosis; factorial scores differentially discriminated for disease severity according to diagnosis (PSP: F1-F2; MSA: F2-F3). The total score was significantly related to survival in PSP (p<0.0007) or MSA (p<0.0005), indicating good predictive validity. CONCLUSIONS The scale is suitable for use in the context of multicentre studies and can reliably and consistently measure MRI abnormalities in PSP and MSA. Clinical Trial Registration Number The study protocol was filed in the open clinical trial registry (http://www.clinicaltrials.gov) with ID No NCT00211224