Brain-derived neurotrophic factor and epilepsy: a systematic review

Several in vitro, ex vivo and in vivo studies imply brain-derived neurotrophic factor (BDNF) in the pathophysiology of epilepsy. Aim of our work is to report the most important findings regarding BDNF and its potential role in epilepsy. We targeted those publications addressing both in vitro and in vivo evidences of relationship between BDNF and epilepsy. Basic researches, randomized trials, cohort studies, and reviews were contemplated to give a breadth of clinical data. Medline, CENTRAL, and Science Direct were searched till August 2017 using keywords agreed by the authors. Together with a defined role in developmental and mature brain, BDNF has excitatory effects in neuronal cultures and animal brain slices. Furthermore, both BDNF and its conjugated receptor (i.e. Tropomyosin receptor kinase B or TrkB) are increased in animal models and humans with epilepsy, particularly in the temporal and hippocampal areas. Acute injection of BDNF in brain of mice induces seizures, which are almost or totally abolished blocking its transcription and pathway. Chronic infusion of BDNF is conversely associated with a decreased neuronal excitability, probably via several mechanism including an increase in central levels of neuropeptide Y (NPY), altered conductance of chloride, and downregulation of TrkB. While genetic studies are inconclusive, serum BDNF is more frequently higher in patients with epilepsy and appears to be correlated to severity of disease. Current evidences suggest that inhibiting BDNF-TrkB signaling and reinforcing the NPY system could represent a potential therapeutic strategy for epilepsy, especially for temporal lobe epilepsy

Epidemiology, diagnosis and treatment of chronic venous disease. A systematic review

iNTrODuCTiON: The spectrum of Chronic venous disease (CVD) ranges from varicose veins to leg edema, and serious dermal clinical manifestations consisting of hyperpigmentation, eczema, lipodermatosclerosis, and venous skin ulceration. CVD management has undergone a revolution based on technological advances: duplex ultrasound has impacted almost every facet of phlebology, including preoperative diagnosis, periprocedural monitoring, postoperative surveillance, and even our understanding of the disease process itself. Furthermore, numerous success- ful treatment options, based on surgical, compression and medical therapy, are available for patients with CVD. This study performs a systematic and comprehensive analysis of the most recent scientific literature on the epidemiology of CVD, diagnostic procedures and conventional and innovative treatments

Endothelin-1, nitric oxide, serotonin and high blood pressure in male adolescents

Gulfiia Nagimovna Aflyatumova,1 Razina Ramazanovna Nigmatullina,2 Dinara Ilgizarovna Sadykova,3 Mariia Dmitrievna Chibireva,4 Francesco Fugetto,5 Raffaele Serra6,7 1Department of Pediatrics, Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Republic of Tatarstan, Russian Federation; 2Department of Normal Physiology, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation; 3Department of Hospital Pediatrics, Kazan State Medical Academy, Kazan, Republic of Tatarstan, Russian Federation; 4Koltsov Institute of Developmental Biology, Russian Academy of Sciences, Moscow, Russian Federation; 5Department of Vascular Surgery, Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy; 6Department of Vascular Surgery, Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters: University Magna Graecia of Catanzaro, Catanzaro, Italy; 7Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy Background: Essential arterial hypertension (EAH) in adolescents represents a social burden. The endothelium is involved in the pathogenesis of EAH. Imbalance of key vasoactive factors – namely nitric oxide (NO) and endothelin-1 (ET-1) – is observed, and serotonin (5-HT) release is also impaired. The relationship between the factors and high blood pressure (BP) has been established mainly in preclinical studies and in the adult age. The aim of the present manuscript is to establish the association between plasma ET-1, serum NO and 5-HT, platelet 5-HT levels and BP in male adolescents, analyzing their concentrations in controls, prehypertensive and hypertensive children. Consequently, we want to evaluate ET-1, NO and 5-HT levels as preclinical biomarkers of EAH. Methods: Outpatient adolescents, examined at Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, were recruited between 26th of May and 25th of September 2016. Predictor variables identified were plasma ET-1, serum NO and 5-HT levels and were evaluated in serum and platelets of case and control groups. Results: Plasma ET-1 and serum 5-HT concentrations in prehypertensive and hypertensive children were higher than in controls, with hypertensive adolescents showing higher levels of both factors compared with prehypertensive adolescents. Platelet 5-HT levels were lower in prehypertensive and hypertensive children compared with controls, while serum NO levels were higher in prehypertensive children than in hypertensive children. Conclusion: Measurable ET-1, NO and 5-HT are related to BP in adolescents and may serve as diagnostic biomarkers of EAH. Furthermore, they could help to better define prehypertensive and hypertensive children. Keywords: endothelin-1, serotonin, nitric oxide, pediatric arterial hypertension, biomarkers, pre-hypertension, monoamines, endothelial dysfunctio

Absorbable suture material in carotid surgery

Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials

Resection of carotid body tumors reduces arterial blood pressure. An understimated neuroendocrine syndrome

ntroduction: Carotid Body Tumors (CBTs) are Paragangliomas (PGLs) located in the head and neck region which usually do not cause overt neuroendocrine symptoms and hypertension. Matrix Metal- loproteinases (MMPs) have shown a strong correlation between CBTs and their clinical behavior. Aim of this study is to analyze the relationship between changes in arterial blood pressure and metal- loproteinases levels after surgical resection of CBTs. Methods: We performed a multicenter clinical study on 17 patients with benign and malignant CBTs (5 males; 12 females). Tumors were completely resected and biopsies, obtained at the time of surgery, were lysed for Western blot analysis to determine MMPs levels in tissues. An enzyme-linked immune sorbent assay (ELISA) kit was used to determine the concentration of MMPs in plasma fluid. Blood pressure values were measured at admission and at 10 days after surgery. Results: At the time of the admission, blood pressure values were higher in patients with CBTs respect to control patients; moreover in patients with malignant CBTs blood pressure values were higher (P < 0.01) respect to patients with benign CBTs. 10 days after the surgery, we documented a significant decrease (P < 0.01) in blood pressure values and in MMPs levels in all patients with CBTs. Conclusion: These results suggest that, despite the CTBs are considered non-functional tumors, an “underestimated” neuroendocrine activity on arterial blood pressure may be detecte

Matrix metalloproteinases and risk stratification in patients undergoing surgical revascularisation for critical limb ischaemia

Critical limb ischaemia (CLI) is the most advanced form of peripheral artery disease (PAD) and it is often associated with foot gangrene, which may lead to major amputation of lower limbs, and also with a higher risk of death due to fatal cardiovascular events. Matrix metalloproteinases (MMPs) seem to be involved in atherosclerosis, PAD and CLI. Aim of this study was to evaluate variations in MMP serum levels in patients affected by CLI, before and after lower limb surgical revascularisation through prosthetic or venous bypass. A total of 29 patients (7 females and 22 males, mean age 73·4 years, range 65–83 years) suffering from CLI and submitted to lower extremity bypass (LEB) in our Institution were recruited. Seven patients (group I) underwent LEB using synthetic polytetrafluoroethylene (PTFE) graft material and 22 patients (group II) underwent LEB using autogenous veins. Moreover, 30 healthy age-sex-matched subjects were also enrolled as controls (group III). We documented significantly higher serum MMPs levels (P < 0·01) in patients with CLI (groups I and II) with respect to control group (group III). Finally, five patients with CLI (17·2%) showed poor outcomes (major amputations or death), and enzyme-linked immunosorbent assay (ELISA) test showed very high levels of MMP-1 and MMP-8. MMP serum levels seem to be able to predict the clinical outcomes of patients with CLI

Endovascular repair versus open repair in the treatment of ruptured aortic aneurysms. A systematic review

Rupture of abdominal aortic aneurysm remains a fatal event in up to 65% of cases and emergency open surgery (ruptured open aneurysm repair or rOAR) has a great intraoperative mortality of about 30-50%. The introduction of endovascular repair of abdominal aortic aneurysm (ruptured endovascular aneurysm repair or rEVAR) has rapidly challenged the conventional approach to this catastrophic event. The purpose of this systematic review is to compare the outcomes of open surgical repair and endovascular interventions

Skin Grafting and Topical Application of Platelet Gel in the Treatment of Vascular Lower Extremity Ulcers.

Aim. Chronic wounds of lower limbs are a significant issue for physicians and specialists across a wide variety of dis- ciplines. These chronic wounds are result primarily from chronic venous insufficiency, arterial disease, diabetes. When a chronic wounds fail to heal within six weeks after appro- priate treatment skin grafting procedure may be considered. Aim of this study was to provide evidence of the use of local platelet gel (PG) in order to enhance healing time after skin grafting procedure. Methods. A total of 162 patients (69 males, 93 females) with lower limbs ulcers (venous, arterial, diabetic) with a duration of more than six weeks were recruited in order to undergo autologous skin grafting procedure. Results. Patients were randomized in two groups: Group A (87 patients) which received also local PG as adjuvant treat- ment and Group B (75 patients) which did not receive PG ad- juvant treatment. In our study the use of local PG, in Group A patients, enhanced the engraftment of autologous skin grafts respect to patients of Group B. Conclusion. The use of PG in skin grafting seems to be an effective and safe tool in order to speed up the healing rate of difficult-to-treat ulcers