Effect of insulin glargine on cardiovascular risk analysed by mean HRV

Type 2 diabetes mellitus is an insidious disease that is increasingly present in geriatric population [1]. The greatest difficulty is represented by glycaemic control in geriatric patients often not very compliant with diet therapy and drug therapy. A new insulin glargine 300 units/ml formulation seems im- prove patient compliance due to the lower volume of insulin to be injected and improved glycaemic control over 24 hours. The HRV signal, derived from digital electrocardiographic recording, is the simplest and most imme- diate analysis that consists in calculating some temporal parameters [2]. HRV is a simple statistics derived from beat-beat intervals of sinus origin expressed as units of time in milliseconds. Data in the literature indicate that a decrease in HRV, measured with time domain analysis, denotes a worse prognosis and/or an increased risk of mortality in patients with heart disease, especially in the elderly ones

Effect of Ferric Sodium EDTA administration, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine, on cardiovascular risk evaluation: exploration of the HRV frequency domain

diseases. Using the Heart Rate Variability (HRV) analysis is possible to provide an evaluation of the safety and the effectiveness of intervention. Objective: To evaluate the efficacy and safety of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) 2 tabs/day for 24 days in elderly patients with secondary anaemia, by exploring the HRV frequency domain. Methods: In 45 elderly patients with secondary anaemia and/or low-moderate kidney failure, laboratory values after administration of Ferric Sodium EDTA, 2 tabs a day, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) for 24 days (N=16 patients) or ferrous gluconate 63 mg/day added to saline solution, administered using intravenous access during the hospitalization period of 15 ± 5 days (N=29 patients) were evaluated. Also, ECG signals and bioelectrical impedance (BIA) were measured. Results: Oral iron supplementation with Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) confirmed to be effective and safe about the cardiovascular risk in old patients. This study showed the real superiority of the oral administration about the cardiovascular risk in elderly patients in comparison with intravenous administration of ferrous gluconate. Conclusion: This study confirms that Ferric Sodium EDTA combination (Ferachel forte®) can be a valid alternative to ferrous gluconate intravenous therapy (gold standard) in the treatment of secondary anaemia in elderly patients. In fact, during the treatment, efficacy results have been maintained without statistically significant variations about cardiovascular risk, evaluated by exploring the HRV frequency domain

Evaluation of gait kinematics and kinetics using a powered ankle-foot orthosis for gait assistance in people with multiple sclerosis

Gait impairment is one of the many motor symptoms of multiple sclerosis (MS) but has the largest perceived impact on overall quality of life for people with the disease. Currently, there is no cure for MS and no treatments or therapies can reverse the progression of symptoms. Typically, gait speed becomes slower with disease progression requiring the prescription of assistive devices to maintain or improve movement ability and promote independence. For people with MS who suffer from drop foot (i.e., the diminished or lack of ability to dorsiflex the foot), prescription of a passive ankle-foot orthosis is common. The purpose of these devices is to hold the foot in neutral position and prevent the foot from dropping during forward swing. Although these devices can be beneficial, ankle-foot orthoses generally prevent the ability to plantarflex the ankle, and successful implementation of these devices has been limited. Recently, powered orthotics and exoskeletons have been developed for people with neurological impairments or injuries that impact gait function. These devices can provide active motion control and assistance in both plantarflexion and dorsiflexion of the ankle. The purpose of this thesis was to investigate the utility of a powered ankle-foot orthosis for gait assistance in people with MS. Specifically, the analyses performed in this thesis focused on the kinematic and kinetic changes in gait associated with a powered ankle-foot orthosis compared to a passive ankle-foot orthosis and walking without an assistive device. Results indicate that the vertical ground reaction force during the propulsive phase of gait (i.e., terminal stance) was increased with the powered ankle-foot orthosis, counteracting the diminished behavior typically observed in people with MS. However, peak plantarflexor torque during this same phase of gait was diminished compared to walking without an assistive device, which may have been due to a slower gait speed. The only difference between a powered ankle-foot orthosis or prescribed passive ankle-foot orthosis was an increased mid-stance minima in the vertical ground reaction force, which could also be an indicator of slower gait speed. The findings of this study provide an initial baseline for future studies of powered orthoses in people with MS. Further investigation and tuning of the powered orthosis used in this study is needed

Modulation and modeling of anticipatory postural adjustments for gait initiation in persons with Parkinson's disease

Parkinson’s disease (PD) is a movement disorder traditionally thought to be caused by the degeneration of striatal dopaminergic neurons in the substantia nigra. One of the most devastating symptoms of PD that can decrease mobility and substantially impair quality of life is freezing of gait (FOG). Currently, the treatments for the motor symptoms of PD (e.g., levodopa, deep brain stimulation) are ineffective at managing FOG as the disease progresses. These treatments only target the cortical-striatal pathways of volitional movement that are dependent on dopamine, whereas FOG may be caused by the degeneration of other non-dopaminergic subcortical nuclei that are involved with posture and gait control (e.g., the pedunculopontine nucleus). A well-characterized behavior observed in PD that could contribute to FOG is a diminished ability to properly coordinate anticipatory postural adjustments (APAs) prior to the first step. In particular, diminished muscle activation leads to impaired limb mechanics and slower, less-coordinated gait initiation. Sensory cues have been demonstrated to improve gait initiation behaviors, possibly because they provide relevant information for movement to the motor cortex through cerebellar-thalamo-parietal pathways that remain intact during the disease process. However, sensory cues are not always reliable or effective in all contexts and are unable to directly modulate the force production of the user. Forms of mechanical stimuli can amplify force production during APAs by directly modulating force production and providing relevant timing and magnitude information through afferent sensory pathways. To date, no mechanical assistance that mimics the desired motion during an APA provided at the ankle joint in the form of modest ankle torques has been tested. The overall research objective of this dissertation work was to test the hypothesis that mechanical assistance provided at the ankle joint can be an effective paradigm for facilitating the diminished gait initiation behaviors in persons with PD and FOG symptoms. Biomechanical measurements and mechanical modeling techniques were used to explore the neuromechanical factors (e.g., cognitive, sensorimotor, biomechanical) that could enable this type of intervention or therapy. (1) The first research objective was to provide proof of concept that mechanical assistance provided at the ankle through a powered ankle-foot orthosis can shorten and amplify APAs compared to self-initiated stepping in healthy young adults. (2) The second research objective was to test the hypothesis that mechanical assistance provided at the ankle by a wearable powered ankle-foot orthosis can directly shorten and amplify gait initiation APAs compared to self-initiated and acoustic cued stepping in persons with PD and FOG. (3) The third research objective was to evaluate how cue-induced modulation of APAs in persons with PD and FOG vary based on whether the external cue is initiated exogenously or is self-triggered. (4) The fourth research objective of this dissertation was to simulate the behaviors observed during the early phase of an APA for gait initiation in persons with PD and FOG using mechanical modeling techniques. Results from these studies may inform future interventions or therapies that can provide mechanical assistance at the ankle during gait initiation for persons with PD and FOG. Such interventions could increase mobility and promote independence, thereby improving quality of life and decreasing morbidity for these patients

Compton reflection in AGN with Simbol-X

AGN exhibit complex hard X-ray spectra. Our current understanding is that the emission is dominated by inverse Compton processes which take place in the corona above the accretion disk, and that absorption and reflection in a distant absorber play a major role. These processes can be directly observed through the shape of the continuum, the Compton reflection hump around 30 keV, and the iron fluorescence line at 6.4 keV. We demonstrate the capabilities of Simbol-X to constrain complex models for cases like MCG-05-23-016, NGC 4151, NGC 2110, and NGC 4051 in short (10 ksec) observations. We compare the simulations with recent observations on these sources by INTEGRAL, Swift and Suzaku. Constraining reflection models for AGN with Simbol-X will help us to get a clear view of the processes and geometry near to the central engine in AGN, and will give insight to which sources are responsible for the Cosmic X-ray background at energies above 20 keV.Comment: 4 pages, 1 figure, to appear in the proceedings of the second Simbol-X Symposium "Simbol-X - Focusing on the Hard X-ray Universe", AIP Conf. Proc. Series, P. Ferrando and J. Rodriguez ed

Thermographic and reflectographic imaging investigations on Baroque paintings preserved at the Chigi Palace in Ariccia

In this work, two different mid-infrared imaging techniques operating in the 3-5 μm spectral range are applied to the study of three paintings on canvas, dating back to the XVII century, preserved at the Chigi Palace in Ariccia (Italy). A combined approach based on the use of pulsed thermography and mid-infrared reflectography is proposed for the analysis of the 'Primavera' by Filippo Lauri and Mario Nuzzi, the 'Ritratto di Mario Nuzzi che dipinge un vaso di fiori' by Giovanni Maria Morandi and Mario Nuzzi and the 'Ebbrezza di Noee' by Andrea Sacchi. The aim is to show how the integrated use of these techniques enables a depth-resolved investigation of the entire layered structure of the paintings, from the surface up to the canvas support. The complementarity of the presented results allows an evaluation of the conservative status of the support and the detection of graphical and pictorial features hidden beneath the surface layer, such as pentimenti, as these features are important for the historical and artistic characterisation of the artefact

INTEGRAL and XMM-Newton Spectral Studies of NGC 4388

We present first INTEGRAL and XMM-Newton observations of a Seyfert galaxy, the type 2 AGN NGC 4388. Several INTEGRAL observations performed in 2003 allow us to study the spectrum in the 20 - 300 keV range. In addition two XMM-Newton observations give detailed insight into the 0.2 - 10 keV emission. The measurements presented here and comparison with previous observations by BeppoSAX, SIGMA and CGRO/OSSE show that the overall spectrum from soft X-rays up to the gamma-rays can be described by a highly absorbed (N_H = 2.7e23 1/cm^2) and variable non-thermal component in addition to constant non-absorbed thermal emission (T = 0.8 keV) of low abundance (7% solar), plus a constant Fe K-alpha and K-beta line. The hard X-ray component is well described by a simple power law with a mean photon index of 1.7. During the INTEGRAL observations the 20 - 100 keV flux increased by a factor of 1.4. The analysis of XMM-Newton data implies that the emission below 3 keV is decoupled from the AGN and probably due to extended emission as seen in Chandra observations. The constant iron line emission is apparently also decoupled from the direct emission of the central engine and likely to be generated in the obscuring material, e.g. in the molecular torus.Comment: 11 pages, 5 figures, accepted for publication in Ap

Discovery of a new INTEGRAL source: IGR J19140+0951

IGR J19140+0951 (formerly known as IGR J19140+098) was discovered with the INTEGRAL satellite in March 2003. We report the details of the discovery, using an improved position for the analysis. We have performed a simultaneous study of the 5-100 keV JEM-X and ISGRI spectra from which we can distinguish two different states. From the results of our analysis we propose that IGR J19140+0951 is a persistent Galactic X-ray binary, probably hosting a neutron star although a black hole cannot be completely ruled out.Comment: 4 pages, 4 figures. Accepted for publication in A&A