Is the natural feed the better nutritional therapy in patients with severe acquired brain injury? A retrospective study

SUMMARY: Background: This retrospective study aimed to assess whether the use of natural foods, also in combination with enteral nutrition, improves rehabilitative recovery in patients severe acquired brain injuries. Methods: 40 severe acquired brain injuries patients (75% males, aged 50.2 ± 16.6) were selected. The study population was divided into three groups based on the type of nutrition administered (enteral, oral, and mixed). Mini Nutritional Assessment and Level of Cognitive Functioning scales were used to assess changes from admission to discharge in each group. Multiple logistic regression model was performed to assess the association between the feeding typology and nutritional recovery. Results: At admission, about 97.5% of patients were malnourished. We found significant score changes from baseline to follow-up for both test used and in each subgroup, except for the subgroup that includes patients fed with enteral nutrition. There were significant differences in biochemical indicators, including levels of albumin (p < 0.01) and protein (p < 0.001), compared to baseline and follow-up. Oral nutrition resulted to be a significant predictor for nutritional improvement. Conclusions: Nutrition therapy within a multi-disciplinary team may improve both the hospital care and the recovery in severe acquired brain injuries population. Notably, our findings suggest that natural nutrition is superior to enteral nutrition in improving nutritional outcomes, which should be confirmed by further studies

Effect of Different Environmental Conditions on Some Haematological Parameters in Cow

Abstract The aim of this study was to establish physiological responses of Piemontese cows to different environmental conditions (ambient temperature, relative humidity and temperature-humidity index). To this end, 43 clinically healthy Piemontese cows aged 2-12 years were used to evaluate the effect of environmental conditions on haematological parameters. For each period, ambient temperature and relative humidity were recorded by means of a data logger and the temperature-humidity index (THI) was calculated as indicator of thermal comfort for cattle. Blood samples were collected at 4 time points under different environmental conditions (T1, T2, T3 and T4) and analysed for haematological parameters. One way repeated measure analysis of variance showed a statistically significant effect of time (P<0.0001) on RBC, Hb, Hct, MCV, MCH, MCHC, Plt, WBC, neutrophils, lymphocytes, monocytes and eosinophils. The majority of haematological values obtained in the present study, even though within the physiological range for cattle, showed that variations in haematological parameters are related to changes in ambient temperature, relative humidity and temperature-humidity index. These results provide insight into the physiological responses of Piemontese cows to different environmental conditions, allowing to better evaluate its ability to adapt and cope with environmental stress

Post-traumatic olfactory dysfunction: a scoping review of assessment and rehabilitation approaches

Post-traumatic Olfactory Dysfunction (PTOD) consists of a complete or partial loss of olfactory function that may occur after a traumatic brain injury (TBI). PTOD may be linked to some neuropsychiatric features, such as social, cognitive and executive dysfunction, as well as behavioral symptoms, especially when TBI involves the orbito-frontal cortex. The diagnosis of PTOD is based on medical history and clinical data and it is supported by psychometric tests (i.e., subjective tools) as well as electrophysiological and neuroimaging measures (i.e., objective methods). The assessment methods allow monitoring the changes in olfactory function over time and help to establish the right therapeutic and rehabilitative approach. In this context, the use of the olfactory training (OT), which is a non-pharmacological and non-invasive treatment option, could promote olfactory function through top-down (central) and bottom-up (peripheral) processes. To better manage patients with TBI, PTOD should be detected early and properly treated using the various therapeutic rehabilitative possibilities, both conventional and advanced, also taking into consideration the emerging neuromodulation approach

Clinical and Neurocognitive Outcome EvaluationIn locked-in Syndrome

We reported a case of Locked-in syndrome, who underwent a specific clinical and neuropsychological battery, assessing verbal memory, linguistic comprehension, perception, executive functioning..

Functional evaluation of awareness in vegetative and minimally conscious state

Objective: The aim of this study was to assess differences in brain activation in a large sample of Vegetative State (VS) and Minimally Conscious State (MCS) patients, using functional magnetic resonance imaging (fMRI). Methods: We studied 50 patients four to seven months after brain injury. By using international clinical criteria and validated behavioural scales such as the Glasgow Coma Scale and the Clinical Unawareness Assessment Scale, the patients were grouped into VS (n=23) and MCS (n=27). All patients underwent to fMRI examination. After 6 months, the patients were reassessed using Glasgow Outcome Scale and Revised Coma Recovery Scale. Results: fMRI showed significant (p<0.01, cluster-corrected) brain activation in the primary auditory cortex bilaterally during the acoustic stimuli in patients with both VS and MCS. However, ten patients clinically classified as VS, showed a pattern of brain activation very similar to that of MCS patients. Six months later, these ten VS patients had significant clinical improvement, evolving into MCS, whereas the other VS patients and patients with MCS remained clinically stable. Conclusion: Brain activity could help in discerning whether the status of wakefulness in VS is also accompanied by partial awareness, as occurs in MCS. This may have very important prognostic implications

Clinical Study Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation

Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and H max /M max ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability

Red wine consumption increases antioxidant status and decreases oxidative stress in the circulation of both young and old humans

Background: Red wine contains a naturally rich source of antioxidants, which may protect the body from oxidative stress, a determinant of age-related disease. The current study set out to determine the in vivo effects of moderate red wine consumption on antioxidant status and oxidative stress in the circulation.Methods: 20 young (18&ndash;30 yrs) and 20 older (&ge; 50 yrs) volunteers were recruited. Each age group was randomly divided into treatment subjects who consumed 400 mL/day of red wine for two weeks, or control subjects who abstained from alcohol for two weeks, after which they crossed over into the other group. Blood samples were collected before and after red wine consumption and were used for analysis of whole blood glutathione (GSH), plasma malondialdehyde (MDA) and serum total antioxidant status.Results: Results from this study show consumption of red wine induced significant increases in plasma total antioxidant status (P &lt; 0.03), and significant decreases in plasma MDA (P &lt; 0.001) and GSH (P &lt; 0.004) in young and old subjects. The results show that the consumption of 400 mL/day of red wine for two weeks, significantly increases antioxidant status and decreases oxidative stress in the circulation.Conclusion: It may be implied from this data that red wine provides general oxidative protection and to lipid systems in circulation via the increase in antioxidant status.<br /

17β-Estradiol Prevents Early-Stage Atherosclerosis in Estrogen Receptor-Alpha Deficient Female Mice

Estrogen is atheroprotective and a high-affinity ligand for both known estrogen receptors, ERα and ERβ. However, the role of the ERα in early-stage atherosclerosis has not been directly investigated and is incompletely understood. ERα-deficient (ERα−/−) and wild-type (ERα+/+) female mice consuming an atherogenic diet were studied concurrent with estrogen replacement to distinguish the actions of 17β-estradiol (E2) from those of ERα on the development of early atherosclerotic lesions. Mice were ovariectomized and implanted with subcutaneous slow-release pellets designed to deliver 6 or 8 μg/day of exogenous 17β-estradiol (E2) for a period of up to 4 months. Ovariectomized mice (OVX) with placebo pellets (E2-deficient controls) were compared to mice with endogenous E2 (intact ovaries) and exogenous E2. Aortas were analyzed for lesion area, number, and distribution. Lipid and hormone levels were also determined. Compared to OVX, early lesion development was significantly (p < 0.001) attenuated by E2 with 55–64% reduction in lesion area by endogenous E2 and >90% reduction by exogenous E2. Compared to OVX, a decline in lesion number (2- to 4-fold) and lesser predilection (~4-fold) of lesion formation in the proximal aorta also occurred with E2. Lesion size, development, number, and distribution inversely correlated with circulating plasma E2 levels. However, atheroprotection was independent of ERα status, and E2 athero-protection in both genotypes was not explained by changes in plasma lipid levels (total cholesterol, triglyceride, and high-density lipoprotein cholesterol). The ERα is not essential for endogenous/exogenous E2-mediated protection against early-stage atherosclerosis. These observations have potentially significant implications for understanding the molecular and cellular mechanisms and timing of estrogen action in different estrogen receptor (ER) deletion murine models of atherosclerosis, as well as implications to human studies of ER polymorphisms and lipid metabolism. Our findings may contribute to future improved clinical decision-making concerning the use of hormone therapy