Exercise training improves vascular function in patients with Alzheimer’s disease

Purpose: Vascular dysfunction has been demonstrated in patients with Alzheimer’s disease (AD). Exercise is known to positively affect vascular function. Thus, the aim of our study was to investigate exercise-induced effects on vascular function in AD. Methods: Thirty-nine patients with AD (79 ± 8 years) were recruited and randomly assigned to exercise training (EX, n = 20) or control group (CTRL, n = 19). All subjects performed 72 treatment sessions (90 min, 3 t/w). EX included moderate–high-intensity aerobic and strength training. CTRL included cognitive stimuli (visual, verbal, auditive). Before and after the 6-month treatment, the vascular function was measured by passive-leg movement test (PLM, calculating the variation in blood flow: ∆peak; and area under the curve: AUC) tests, and flow-mediated dilation (FMD, %). A blood sample was analyzed for vascular endothelial growth factor (VEGF). Arterial blood flow (BF) and shear rate (SR) were measured during EX and CTRL during a typical treatment session. Results: EX group has increased FMD% (+ 3.725%, p ' 0.001), PLM ∆peak (+ 99.056 ml/min, p = 0.004), AUC (+ 37.359AU, p = 0.037) and VEGF (+ 8.825 pg/ml, p = 0.004). In the CTRL group, no difference between pre- and post-treatment was found for any variable. Increase in BF and SR was demonstrated during EX (BF + 123%, p ' 0.05; SR + 134%, p ' 0.05), but not during CTRL treatment. Conclusion: Exercise training improves peripheral vascular function in AD. These ameliorations may be due to the repetitive increase in SR during exercise which triggers NO and VEGF upregulation. This approach might be included in standard AD clinical practice as an effective strategy to treat vascular dysfunction in this population

A comparison of lysosomal enzymes expression levels in peripheral blood of mild- and severe-Alzheimer’s disease and MCI patients: implications for regenerative medicine approaches

The association of lysosomal dysfunction and neurodegeneration has been documented in several neurodegenerative diseases, including Alzheimer’s Disease (AD). Herein, we investigate the association of lysosomal enzymes with AD at different stages of progression of the disease (mild and severe) or with mild cognitive impairment (MCI). We conducted a screening of two classes of lysosomal enzymes: glycohydrolases (β-Hexosaminidase, β-Galctosidase, β-Galactosylcerebrosidase, β-Glucuronidase) and proteases (Cathepsins S, D, B, L) in peripheral blood samples (blood plasma and PBMCs) from mild AD, severe AD, MCI and healthy control subjects. We confirmed the lysosomal dysfunction in severe AD patients and added new findings enhancing the association of abnormal levels of specific lysosomal enzymes with the mild AD or severe AD, and highlighting the difference of AD from MCI. Herein, we showed for the first time the specific alteration of β-Galctosidase (Gal), β-Galactosylcerebrosidase (GALC) in MCI patients. It is notable that in above peripheral biological samples the lysosomes are more sensitive to AD cellular metabolic alteration when compared to levels of Aβ-peptide or Tau proteins, similar in both AD groups analyzed. Collectively, our findings support the role of lysosomal enzymes as potential peripheral molecules that vary with the progression of AD, and make them useful for monitoring regenerative medicine approaches for AD

Physiological effects of aerobic training in chronic stroke patients: mechanisms for changes in oxygen consumption: a pilot study

The first aim of the study was to investigate the physiological effect of a high intensity aerobic training in chronic stroke patients. The second aim was to understand the mechanism of adaptation in oxygen consumption (VO2peak) that occurs with a three-month aerobic training in this population

Home-based and extreme exercise in pancreatic cancer: a case study

In the recent literature, it has been shown that exercise is well tolerated by pancreatic cancer patients undergoing chemotherapy

Cardiac and non cardiac collateral findings assessment in multislice CT coronary angiography

Purpose: While scanning the heart and the coronary arteries, non-cardiac collateral findings may be revealed but are usually not assessed. The aim of the study is to describe the prevalence of non-cardiac collateral findings during MSCT-CA in a multicenter study. Methods and Materials: 540 patients undergoing MSCT-CA with 64-slice MDCT-CA acquired between 05/2008 and 09/2010 due to suspected coronary artery disease were retrospectively reviewed. All datasets obtained with a large Field of view (FOV) were in blind analysed by 2 radiologists, using standard mediastinal and lung window settings. Collateral findings were divided according to clinical importance into: non significant, remarkable and compulsory to be investigated. Among significant diseased patients, medical records were reviewed to check the clinical follow-up, subsequent examinations, or surgical procedures of non-cardiac abnormalities in the 6 months after MSCT-CA. Results: 72 % of the patients revealed coronary artery disease. Only 106/540 (19.6%) patients were without any additional finding. 637 additional findings were recorded, divided into non significant findings: 266 (41.75%), mild: 339 (53.21%), 32 (5.02%) compulsory to be studied. 63 (9.89) of these were recorded as cardiac collateral finding. A total of 27 patients (5.30%) had significant non-cardiac pathology requiring clinical or radiological follow-up. Among these new discovered pathologies were revealed in 3/540 patients (0.55%). Conclusion: A significant number of non-cardiac findings might have been missed in MSCT-CA scans if the evaluation is limited to the heart

Santorinicele: secretin-enhanced magnetic resonance cholangiopancreatography findings before and after minor papilla sphincterotomy.

OBJECTIVES: To evaluate secretin-enhanced MRCP (S-MRCP) findings of patients with pancreas divisum and Santorinicele, before and after minor papilla sphincterotomy. METHODS: S-MRCP examinations of 519 patients with suspected pancreatic disease were included. Size of the main pancreatic duct, presence and calibre of Santorinicele were evaluated. Duodenal filling was assessed on dynamic images. After sphincterotomy the same parameters and the clinical findings were re-evaluated. RESULTS: Pancreas divisum was depicted in 55/519 patients (11 %) by MRCP and an additional 26/519 by S-MRCP (total 81/519, 16 %). Santorinicele was detected in 7/81 patients (8.6 %) with pancreas divisum by MRCP and an additional 20/81 by S-MRCP (total 27/81, 33 %). Dorsal duct in patients with Santorinicele was significantly larger in the head compared with patients with only pancreas divisum (p\u2009<\u20090.01), in basal conditions (average 2.4 versus 1.9 mm) and after secretin administration (average 3.0 versus 2.4 mm). Duodenal filling was impaired in 11/27 patients (41 %) with Santorinicele. After sphincterotomy significant reduction in size of Santorinicele (-33 %) and dorsal duct (-17 %), increase of pancreatic juice and symptoms improvement were observed. CONCLUSION: Secretin administration increases the accuracy of MRCP in detecting Santorinicele and demonstrates the impaired duodenal filling. S-MRCP is useful to assess results of sphincterotomy. KEY POINTS: \u2022 Secretin-enhanced MRCP gives anatomical and functional information on pancreatic outflow dynamics. \u2022 Santorinicele is a cystic dilatation of the termination of the Santorini duct. \u2022 S-MRCP images are the most useful to recognize the presence of Santorinicele. \u2022 Minor papilla sphincterotomy during ERCP is indicated in patients with Santorinicele

MRI features of solid pseudopapillary neoplasm of the pancreas

PURPOSE: To evaluate the magnetic resonance imaging (MRI) findings of solid pseudopapillary neoplasm (SPN) of the pancreas. METHODS AND MATERIALS: From January 2006 to December 2013, 41 patients with SPN of the pancreas were retrospectively evaluated. Inclusion criteria were the execution of an MR examination and tumor resection with an histopathological evaluation at our Institute. Exclusion criteria were the execution of an MR examination at other centers (14/41) and the execution of CT or ultrasonography (10/41) at our Institute. The qualitative analysis evaluated: location (head/body-tail), shape (round/oval/lobulated), margins (regular/irregular), and signal intensity on T1- and T2-weighted images compared to the surrounding pancreas (hypo-, iso-, or hyperintense and homogeneous or heterogeneous), appearance of MPD and the secondary ducts, and the presence of metastases and/or vascular involvement. The quantitative analysis included: maximum size of the lesion, wall thickness, and maximum diameter of the main pancreatic duct (MPD). RESULTS: The population comprised 17 women (median age: 31 year) with a median tumor size of 50.6 mm, a median wall thickness of 2 mm and median diameter of the MPD of 1.8 mm. 9/17 were at the head; 8/17 on the body/tail: respectively, 8/17 round, 6/17 oval, and 3/17 lobulated. All showed regular margins. On T1-weighted images 8/17 appeared homogeneously hypointense, 7/17 heterogeneously hypointense, and 2/17 heterogeneously hyperintense. On T2-weighted images 1/17 appeared homogeneously hyperintense and 16/17 heterogeneously hyperintense. No secondary ducts dilatations were detected. During the follow-up, one patient presented disease recurrence 48 months after surgery. CONCLUSIONS: MR imaging features can be highly suggestive for the diagnosis of SPN

Secretin-enhanced MRCP features of Santorinicele before and after minor papilla sphincterotomy

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Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings.

AIM:To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis.METHODS:MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement.RESULTS:Signal intensity abnormalities were localized in the head in 10/26 (38.5 %) and in the body-tail in 16/26 (61.5 %) patients. MRCP showed a single MPD stenosis in 12/26 (46.1 %) and multiple MPD stenosis in 14/26 (53.8 %) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6 %) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2 %) patients with contrast retention.CONCLUSIONS:MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma

Funzionalit&#224; endoteliali e progressione della malattia di Alzheimer

INTRODUZIONE L\u2019invecchiamento \ue8 associato ad un progressivo deterioramento della performance fisica che si accompagna ad una riduzione del massimo consumo d\u2019ossigeno (VO2max). Inoltre con l\u2019avanzare dell\u2019et\ue0 si osservano anche severi peggioramenti delle funzionalit\ue0 vascolari con una conseguente elevata incidenza delle malattie cardiocircolatorie. Oltre a queste patologie la popolazione anziana presenta un\u2019elevata incidenza di malattie caratterizzate da deficit cognitivi, la pi\uf9 frequente \ue8 la malattia di Alzheimer (AD). L\u2019eziologia e la progressione dell\u2019AD sono legate ad alterazioni della proteina b-amiloide, ma recenti pubblicazioni suggeriscono un ruolo del metabolismo e delle funzionalit\ue0 vascolari. Attualmente esistono scarse evidenze indicanti se metabolismo e funzionalit\ue0 vascolari siano colpite in modo pi\uf9 severo in pazienti con AD rispetto ad individui sani di pari et\ue0. L\u2019 obiettivo \ue8 quindi quello di verificare se il VO2max e le funzionalit\ue0 vascolari siano significativamente ridotte nei pazienti con AD, rispetto ad anziani sani e di considerare l\u2019effetto dell\u2019invecchiamento confrontandoli con giovani sani (GS) di controllo. MATERIALI E METODI 17 anziani con diagnosi accertata di AD, 10 anziani senza patologie neurologiche o cardiovascolari (AS), e 18 GS, sono stati sottoposti ad un protocollo di valutazione comprendente test per stimare il VO2max, misurazioni delle capacit\ue0 vasodilatative (flow mediated dilation, FMD) e la rigidit\ue0 delle principali arterie (pulse wave velocity, PWV). RISULTATI Il VO2max nel gruppo GS era 46.4\ub110.2 ml/kg/min, 39.2\ub13.4 ml/kg/min, nel gruppo AS e 27.5\ub17.1 ml/kg/min, nel gruppo AD. L\u2019FMD nel gruppo GS era 15.4\ub11.3 %, nel gruppo AS 10.9\ub11.4% e nel gruppo AD 4.3\ub10.9 %. La PWV nel gruppo GS era: 5.5\ub10.3 m/s, nel gruppo AS 6.5\ub10.4 m/s e nel gruppo AD 15.3\ub12.8 m/s. CONCLUSIONI I dati del nostro studio indicano che il VO2max \ue8 progressivamente ridotto all\u2019avanzare dell\u2019et\ue0 (-29.9% tra GS e AS), ma i pazienti con AD hanno dimostrato un ulteriore peggioramento (-15.5% rispetto a AS). La capacit\ue0 vasodilatativa mostra un\u2019analoga riduzione et\ue0 dipendente (-29.2% tra GS e AS), ma una pi\uf9 marcata compromissione nei pazienti con AD (-60.6% AD vs AS). Inoltre anche la rigidit\ue0 delle arterie ha evidenziato lo stesso andamento (+15.4% tra GS e AS, e +57.5% in AD rispetto ad AS). Questi dati suggeriscono che le persone colpite dalla malattia di AD, in confronto di pari et\ue0 sani, presentano un marcato peggioramento delle massime capacit\ue0 metaboliche e della funzionalit\ue0 vascolare. BIBLIOGRAFIA Burns J.M. et al. Cardiorespiratory fitness and brain atrophy in early Alzheimer disease. Neurology 2008; 71;21