Efficacy and safety of extracranial vein angioplasty in multiple sclerosis: A randomized clinical trial

Importance: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. Objective: To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. Design, Setting, and Participants: We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. Interventions: Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). Main Outcomes and Measures: Two primary end pointswere assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. Results: Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7%vs 48.7%; odds ratio, 0.75; 95%CI, 0.34-1.68; P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95%CI, 0.15-0.91; P = .03: adjusted P = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95%CI, 0.32-1.63; P = .45; adjusted P = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95%CI, 1.11-6.28; P = .03; adjusted P = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95%CI, 0.81-4.01; P = .15; adjusted P = .30). Conclusion and Relevance: Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS

Giornata di studio e aggiornamento su effetti biologici e dosimetria degli ultrasuoni

Proceedings of the one-day conference organized by the Italian Association of Protection against Radiations (AIRP). Non-Ionizing Radiation SectionSIGLEITItal

Postural Rehabilitation and Kinesio Taping for Axial Postural Disorders in Parkinson's Disease.

OBJECTIVE: To assess the effects of postural rehabilitation (PR) on trunk asymmetry and balance, with and without Kinesio taping (KT) of the back muscles as additional treatment, in patients with Parkinson's disease (PD) who have postural disorders. DESIGN: Single-blind, randomized controlled trial with 1-month follow-up. SETTING: Ambulatory care in referral center. PARTICIPANTS: Patients (N=20) with PD showing postural abnormalities of the trunk, in the sagittal and/or coronal plane. INTERVENTIONS: Four weeks of patient-tailored proprioceptive and tactile stimulation, combined with stretching and postural reeducation, was provided to 13 subjects (PR group), while 7 received no treatment (control group). Six of the 13 subjects receiving PR also had KT strips applied to their trunk muscles, according to the features of their postural abnormalities. MAIN OUTCOME MEASURES: Berg Balance Scale, Timed Up and Go, and degrees of trunk bending in the sagittal and coronal planes were assessed at the enrollment (t0), 1 month later (t1), and 2 months later (t2). RESULTS: At t1, all treated patients showed a significant improvement in trunk posture in both the sagittal (P=.002) and coronal planes (P=.01), compared with baseline. Moreover, they showed an improvement in measures of gait and balance (P<.01). Benefits persisted at t2 for all measures, except lateral trunk bend. No differences were found when comparing the PR and KT groups. CONCLUSIONS: The combination of active posture correction and trunk movements, muscle stretching, and proprioceptive stimulation may usefully impact PD axial symptoms. Repeated training is advocated to avoid waning of the effect

Aspekte der angloamerikanischen pädagogischen Differenzdebatte: Überlegungen zur Kontextualisierung

Der Beitrag bindet markante Linien der angloamerikanischen pädagogischen Auseinandersetzung um kulturelle/ethnische „Differenz“ an zwei weltsystemtheoretische Zugänge und zeigt Implikationen für die weitere erziehungswissenschaftliche Diskussion auf. Der eine weltsystemtheoretische Zugang ist mit den Namen Immanuel Wallerstein und Etienne Balibar verbunden und befasst sich mit dem Konnex von Nationalstaatlichkeit, Ethnizität und Klassenverhältnissen. Dabei kommt den Institutionen Familie und Schule (als öffentliches Bildungssystem) eine besondere Rolle zu. Es geht u. a. darum, wie gesellschaftliche Kohärenz trotz sozialer Ungleichheit gewährleistet wird. Die US-amerikanische Multikulturalismusdebatte ist hier ein Beispiel für Einsprüche, die den Konnex von Macht, Ethnizität und Kultur in nationalstaatlichen Gesellschaftsorganisationen thematisieren. Anders formuliert: Es geht um Einsprüche, die über die Mobilisierung von Gruppeninteressen auf gesellschaftliche Widersprüche und Ungerechtigkeiten aufmerksam machen, welche gesellschaftlich gelöst werden sollen. Daneben gibt es in der Multikulturalismusdebatte die Tendenz, den Streit auf Kultur, Differenz, Identität und Repräsentation zu fokussieren und auf Forderungen zur Beseitigung von Ungerechtigkeiten zu verzichten. Dann kann es zur unbeabsichtigten Stützung des „Gegendiskurses“ kommen, der Gegenstand des zweiten Teils ist. Hier werden weltsystemtheoretische Untersuchungen zunehmender Standardisierung und Universalisierung der Diskussion über staatlich kontrollierte Erziehung referiert – eine Sichtweise, die modernen Individualismus statt Gruppenzugehörigkeiten zentriert. (DIPF/ Orig.

Angptl3 Deficiency Is Associated With Increased Insulin Sensitivity, Lipoprotein Lipase Activity, and Decreased Serum Free Fatty Acids

OBJECTIVE: Angiopoietin-like 3 (Angptl3) is a regulator of lipoprotein metabolism at least by inhibiting lipoprotein lipase activity. Loss-of-function mutations in ANGPTL3 cause familial combined hypolipidemia through an unknown mechanism. APPROACH AND RESULTS: We compared lipolytic activities, lipoprotein composition, and other lipid-related enzyme/lipid transfer proteins in carriers of the S17X loss-of-function mutation in ANGPTL3 and in age- and sex-matched noncarrier controls. Gel filtration analysis revealed a severely disturbed lipoprotein profile and a reduction in size and triglyceride content of very low density lipoprotein in homozygotes as compared with heterozygotes and noncarriers. S17X homozygotes had significantly higher lipoprotein lipase activity and mass in postheparin plasma, whereas heterozygotes showed no difference in these parameters when compared with noncarriers. No changes in hepatic lipase, endothelial lipase, paraoxonase 1, phospholipid transfer protein, and cholesterol ester transfer protein activities were associated with the S17X mutation. Plasma free fatty acid, insulin, glucose, and homeostatic model assessment of insulin resistance were significantly lower in homozygous subjects compared with heterozygotes and noncarriers subjects. CONCLUSIONS: These results indicate that, although partial Angptl3 deficiency did not affect the activities of lipolytic enzymes, the complete absence of Angptl3 results in an increased lipoprotein lipase activity and mass and low circulating free fatty acid levels. This latter effect is probably because of decreased mobilization of free fatty acid from fat stores in human adipose tissue and may result in reduced hepatic very low density lipoprotein synthesis and secretion via attenuated hepatic free fatty acid supply. Altogether, Angptl3 may affect insulin sensitivity and play a role in modulating both lipid and glucose metabolism