Role of permanent atrial fibrillation (AF) on long-term mortality in community-dwelling elderly people with and without chronic heart failure (CHF)

Permanent AF is characterized by an increased mortality in elderly subjects with CHF. Moreover, AF increased the risk of mortality also in elderly subjects without CHF. Thus, we examined long-term mortality in community-dwelling elderly people with and without CHF. A total of 1332 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. The relationship between AF and mortality during a 12-year follow-up in 125 subjects with CHF and in 1.143 subjects without CHF were studied. Elderly subjects showed a higher mortality in those with respect to those without AF (72.1% vs. 51.8%; p < 0.01). Similarly, elderly subjects without CHF showed a higher mortality in those with respect to those without AF (61.8% vs. 49.8%; p < 0.05). In contrast, elderly subjects with CHF showed a similar mortality in those with respect to those without AF (74.7% vs. 82.4%; p = 0.234). Multivariate analysis shows that AF was predictive of mortality in all elderly subjects (Hazard Risk = HR = 1.39, 95% confidence interval (CI) = 1.25-2.82; p < 0.001). When the analysis was conducted considering the presence and the absence of CHF, AF was strongly predictive of mortality in elderly subjects without CHF (HR = 1.95, 95% CI = 1.25-4.51; p < 0.001) but not in those with CHF (HR = 1.12, 95% CI = 0.97-3.69; p = 0.321). We concluded that AF is able to predict long-term mortality in elderly subjects. Moreover, AF is strongly predictive of long-term mortality in the absence but not in the presence of CHF. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Mortality and heart rate in the elderly: role of cognitive impairment

Mortality related to heart rate ( HR) increase in the elderly has not yet been well established. To ascertain the relationships among cognitive impairment ( CI), mortality, and HR increase, the authors prospectively studied a random sample of elderly subjects stratified according to presence or absence of CI. Elderly subjects randomly selected in 1991 ( n = 1332) were followed up for 12 years. Mortality was established in 98.1% of the subjects. When HR was stratified in quartiles (< 69,70-75,76-80, and > 80 bpm), mortality was linearly associated with increased HR in all ( from 47.7 to 57.0; r(2) = .43, p = .019) and in subjects without ( from 41.7 to 51.1%; r(2) = .50, p = .043) but not in those with CI ( from 57.5 to 66.1; r(2) = .20, p = .363). Cox regression analysis, adjusted for several variables, shows that HR doesn't predict mortality in all subjects ( RR 0.69; 95% CI = 0.27-1.73) or in those with CI ( RR 0.91; 95% CI = 0.81-1.02). In contrast, HR predicts mortality in subjects without CI ( RR 1.10; 95% CI = 1.00-1.22). Hence, HR increase is a predictor of mortality in elderly subjects without CI. However, when considering all elderly subjects and those with CI, HR increase seems to have no effect on mortality. Thus, CI should be considered when focusing on HR increase as risk factor for mortality in the elderly

Proteomic Analysis of Sera from Common Variable Immunodeficiency Patients Undergoing Replacement Intravenous Immunoglobulin Therapy

Common variable immunodeficiency is the most common form of symptomatic primary antibody failure in adults and children. Replacement immunoglobulin is the standard treatment of these patients. By using a differential proteomic approach based on 2D-DIGE, we examined serum samples from normal donors and from matched, naive, and immunoglobulin-treated patients. The results highlighted regulated expression of serum proteins in naive patients. Among the identified proteins, clusterin/ApoJ serum levels were lower in naive patients, compared to normal subjects. This finding was validated in a wider collection of samples from newly enrolled patients. The establishment of a cellular system, based on a human hepatocyte cell line HuH7, allowed to ascertain a potential role in the regulation of CLU gene expression by immunoglobulins

Prediction of the information processing speed performance in multiple sclerosis using a machine learning approach in a large multicenter magnetic resonance imaging data set

Many patients with multiple sclerosis (MS) experience information processing speed (IPS) deficits, and the Symbol Digit Modalities Test (SDMT) has been recommended as a valid screening test. Magnetic resonance imaging (MRI) has markedly improved the understanding of the mechanisms associated with cognitive deficits in MS. However, which structural MRI markers are the most closely related to cognitive performance is still unclear. We used the multicenter 3T-MRI data set of the Italian Neuroimaging Network Initiative to extract multimodal data (i.e., demographic, clinical, neuropsychological, and structural MRIs) of 540 MS patients. We aimed to assess, through machine learning techniques, the contribution of brain MRI structural volumes in the prediction of IPS deficits when combined with demographic and clinical features. We trained and tested the eXtreme Gradient Boosting (XGBoost) model following a rigorous validation scheme to obtain reliable generalization performance. We carried out a classification and a regression task based on SDMT scores feeding each model with different combinations of features. For the classification task, the model trained with thalamus, cortical gray matter, hippocampus, and lesions volumes achieved an area under the receiver operating characteristic curve of 0.74. For the regression task, the model trained with cortical gray matter and thalamus volumes, EDSS, nucleus accumbens, lesions, and putamen volumes, and age reached a mean absolute error of 0.95. In conclusion, our results confirmed that damage to cortical gray matter and relevant deep and archaic gray matter structures, such as the thalamus and hippocampus, is among the most relevant predictors of cognitive performance in MS

Timed rise from floor as a predictor of disease progression in Duchenne muscular dystrophy: An observational study

The role of timed items, and more specifically, of the time to rise from the floor, has been reported as an early prognostic factor for disease progression and loss of ambulation. The aim of our study was to investigate the possible effect of the time to rise from the floor test on the changes observed on the 6MWT over 12 months in a cohort of ambulant Duchenne boys.A total of 487 12-month data points were collected from 215 ambulant Duchenne boys. The age ranged between 5.0 and 20.0 years (mean 8.48 ±2.48 DS).The results of the time to rise from the floor at baseline ranged from 1.2 to 29.4 seconds in the boys who could perform the test. 49 patients were unable to perform the test at baseline and 87 at 12 month The 6MWT values ranged from 82 to 567 meters at baseline. 3 patients lost the ability to perform the 6mwt at 12 months. The correlation between time to rise from the floor and 6MWT at baseline was high (r = 0.6, p<0.01).Both time to rise from the floor and baseline 6MWT were relevant for predicting 6MWT changes in the group above the age of 7 years, with no interaction between the two measures, as the impact of time to rise from the floor on 6MWT change was similar in the patients below and above 350 m. Our results suggest that, time to rise from the floor can be considered an additional important prognostic factor of 12 month changes on the 6MWT and, more generally, of disease progression

Relation of sensorimotor and cognitive cerebellum functional connectivity with brain structural damage in patients with multiple sclerosis and no disability

Background and purpose To investigate the relationship between the functional connectivity (FC) of the sensorimotor and cognitive cerebellum and measures of structural damage in patients with multiple sclerosis (MS) and no physical disability. Methods We selected 144 relapsing-remitting MS patients with an Expanded Disability Status Scale score of &lt;= 1.5 and 98 healthy controls from the Italian Neuroimaging Network Initiative database. From multimodal 3T magnetic resonance imaging (MRI), including functional MRI at rest, we calculated lesion load, cortical thickness, and white matter, cortical gray matter, and caudate, putamen, thalamic, and cerebellar volumes. Voxel-wise FC of the sensorimotor and cognitive cerebellum was assessed with seed-based analysis, and multiple regression analysis was used to evaluate the relationship between FC and structural damage. Results Whole brain, white matter, caudate, putamen, and thalamic volumes were reduced in patients compared to controls, whereas cortical gray matter was not significantly different in patients versus controls. Both the sensorimotor and cognitive cerebellum showed a widespread pattern of increased and decreased FC that were negatively associated with structural measures, indicating that the lower the FC, the greater the tissue loss. Lastly, among multiple structural measures, cortical gray matter and white matter volumes were the best predictors of cerebellar FC alterations. Conclusions Increased and decreased cerebellar FC with several brain areas coexist in MS patients with no disability. Our data suggest that white matter loss hampers FC, whereas, in the absence of atrophy, cortical volume represents the framework for FC to increase

RING and ReCal GPS networks: two Italian geodetic infrastructures and their data management, sharing and dissemination

Geographic data sharing and collection are becoming key activities among geological and geophysical studies worldwide, and the recent increase of infrastructures is demanding to scientific and civil community an effort to manage and disseminate their products as efficiently as possible. With this effort in mind, INGV began some years ago to collaborate with civilian and commercial subjects in order to promote the integration and sharing of data from GNSS (Global Navigation Satellite System) networks existing in Italy. Since 2004, INGV deployed a permanent, integrated and real-time monitoring CGPS network (RING, Rete Integrata Nazionale GPS, http://ring.gm.ingv.it), which is now constituted by about 170 stations all over Italy (Selvaggi et al., 2006; Avallone et al, 2010). All stations have high quality GPS monuments (D’Ambrosio, 2007; Minichiello et al., 2010) and most of them are co-located with broadband or very broadband seismometers and strong motion sensors. This scientific network is aimed to monitor crustal deformation in Italy in order to study earthquake deformation processes, from interseismic strain accumulation to rupture processes, and is giving an effective contribute to Italian Civil Protection for seismic hazard monitoring. Moreover, in the last years, local Authorities, nation-wide industries and other scientific institutions started to establish GPS/GNSS networks all over the Italian territory mainly for cartographic and positioning purposes. More than 500 CGPS stations are actually operating in Italy. The INGV acquire and analyze most of these networks, promoting at the same time actions to integrate the RING with the ones managed by regional and national data providers (D’Anastasio et al., 2010). The Regione Calabria in 2009 planned and established a network of 17 CGPS stations for cartographic and civil protection purposes covering the Calabria region (hereafter ReCal network). The CGPS stations are good quality monument connected in real time and, in the next future, will start to furnish to the civil community a positioning service. In order to share the RING and ReCal data and relative products, a synergy between the CNT-INGV (Centro Nazionale Terremoti) and the Regione Calabria started in 2011. An official agreement between the two institutions state the sharing of CGPS data, the collaboration between CNT-INGV and Regione Calabria to test the efficiency and the positioning service of ReCal network, and the contribution of ReCal network to scientific monitoring of Calabria, one of the most seismically active region in Italy. Moreover, this agreement included also the commissioning of the ReCal network and of its positioning services performed by CNT-INGV. Figure 1 shows the GPS and GNSS stations currently operating in Italy. In the inset it could be noticed how the RING and ReCal networks are integrated in order to have the best spatial coverage of the Calabrian territory. We will present the first results of the agreement between INGV-CNT and Regione Calabria, and of the commissioning of ReCal network. Moreover, we will focus on the infrastructure already existing and developed by CNT-INGV to manage data acquisition, storage, distribution and access (Cecere, 2007; Cardinale et al., 2010; Falco, 2006; 2008; Memmolo et al., 2010; Pignone et al., 2009). INGV developed dedicated facilities including new softwares for data acquisition and a web-based collaborative environment for management of data and metadata. These facilities are used to manage data coming from the RING as well as from agreements with ReCal and other CGPS networks in Italy. We believe that this infrastructure represents an important reality in the framework of GNSS data sharing development in Italy