Dietary factors and progression of diabetic nephropathy

The role of dietary factors in patients with type 1 (insulin-dependent) diabetes is reviewed by examining three different aspects: the effect of an acute protein load, the effect of dietary protein restriction on the progression of nephropathy and the metabolic effects of low-protein diets. After an acute protein load some impairment of the renal functional reserve may be observed only in patients with type 1 diabetes and overt nephropathy. However, the renal functional reserve is not able to give useful indications of the extent of renal damage and the prognosis of the disease. Both short-term and long-term dietary protein restriction are followed by a significant decrease in glomerular filtration rate (GFR) and albuminuria in type 1 diabetics with incipient nephropathy. In patients with overt nephropathy the long-term administration of a low-protein diet is followed by significant reductions in the rate of decline of GFR and in urinary protein excretion only when started at GFR values higher than 45 ml/min. The rate of functional deterioration when dietary treatment is prescribed seems critical in modulating the effects of a low-protein diet. In addition, low-protein diets may exert important metabolic and clinical effects beyond their supposed effect on progression. Clearly, an adequate dietary regimen is only part of the medical treatment in patients with diabetic nephropathy.     

Environmental enrichment prevents effects of dark-rearing in the rat visual cortex

Environmental enrichment potentiates neural plasticity, enhancing acquisition and consolidation of memory traces. In the sensory cortices, after cortical circuit maturation and sensory function acquisition are completed, neural plasticity declines and the critical period 'closes'. In the visual cortex, this process can be prevented by dark-rearing, and here we show that environmental enrichment can promote physiological maturation and consolidation of visual cortical connections in dark-reared rats, leading to critical period closure.     

Observations on the arterial baroreflex in neurally mediated vasodepressor syncope

The arterial baroreflex was studied in subjects who had recently had an episode of vasodepressor syncope. This was determined using 2–3 mcg/kg intravenous boluses of phenylephrine and assessing the bradycardic response. The values were measured in ms/mmHg and expressed as the angular coefficient of the regression line between the increase in R—R interval on the electrocardiograph and the systolic arterial pressure. In subjects examined immediately after the vasodepressor syncope episode the bradycardic response was much more marked than in controls (p < 0.01) and in the subjects themselves 6 months after the episode, provided that they were symptom-free (p < 0.01). It is concluded that in vasodepressor syncope there is a phase in which the baroreflex is highly sensitive and that this is due not to a lowering of the stimulation threshold but to a gain in the efferent arc, which explains a vagotonic response.     

A prospective controlled trial on effect of percutaneous transluminal angioplasty on functioning arteriovenous fistulae survival

Balloon angioplasty (PTA) is an established treatment modality for stenosis in dysfunctional arteriovenous fistulae (AVF), although most studies showing efficacy have been retrospective, uncontrolled, and nonrandomized. In addition, it is unknown whether correction of stenosis not associated with significant hemodynamic, functional, and clinical abnormality may improve survival in AVF. This study was a prospective controlled open trial to evaluate whether prophylactic PTA of stenosis not associated with access dysfunction improves survival in native, virgin, radiocephalic forearm AVF. Sixty-two stenotic, functioning AVF, i.e., able to provide adequate dialysis, were enrolled in the study: 30 were allocated to control and 32 to PTA. End points of the study were either AVF thrombosis or surgical revision due to reduction in delivered dialysis dose. Kaplan-Meier analysis showed that PTA improved AVF functional failure-free survival rates (P = 0.012) with a fourfold increase in median survival and a 2.87-fold decrease in risk of failure. Cox proportional hazard model identified PTA as the only variable associated with outcome (P = 0.012). PTA induced an increase in access blood flow rate (Qa) by 323 (236 to 445) ml/min (P < 0.001), suggesting that improved AVF survival is the result of increased Qa. PTA was also associated with a significant decrease in access-related morbidity by approximately halving the risk of hospitalization, central venous catheterization, and thrombectomy (P < 0.05). This study shows that prophylactic PTA of stenosis in functioning forearm AVF improves access survival and decreases access-related morbidity, supporting the usefulness of preventive correction of stenosis before the development of access dysfunction. It also strongly supports surveillance program for early detection of stenosis.     

Comparison between magnetic resonance angiography and duplex ultrasound for preoperative planning of lower limb revascularisation

The purpose of this study was to compare magnetic resonance angiography with duplex ultrasound for defining anatomical features relevant to performing lower limb revascularisation. From June 2003 to June 2004, 30 consecutive patients with chronic lower limb ischaemia underwent magnetic resonance angiography and duplex ultrasound investigations before undergoing lower limb revascularisation procedures. The mean age was 72 years (range: 45-93). Indications for the procedure included resting pain (6 cases), ischaemic ulcer (8 cases), and gangrene (16 cases). We compared magnetic resonance angiography and duplex ultrasonography findings and the differences in the aorto-iliac, femoro-popliteal and infrapoliteal segments were noted. Magnetic resonance angiography and duplex ultrasound findings agreed in 13/15 cases (86%) in the aorto-iliac segment, in 14/17 (82%) in the femoro-popliteal segment, and in 8/11 (74%) in the infrapopliteal segment. In all, duplex ultrasound agreed with intraoperative findings in 97% of cases while magnetic resonance angiography agreed in 81%. These data show that magnetic resonance angiography is less accurate than duplex ultrasound in the infrapopliteal segment. Adeguate training is necessary before duplex ultrasound can be used as the only preoperative imaging procedure.     

Permanent Spacers Are a Reliable Solution for Peri-prosthetic Shoulder Infection: A Systematic Review

HSS Journal ® - Peri-prosthetic shoulder infection (PSI), a highly disabling complication of shoulder arthroplasty, often requires additional surgery and prolonged antibiotic therapy. Of...     

Clinical correlation between motor evoked potentials and gait recovery in poststroke patients

OBJECTIVE: To evaluate, in patients with a stroke in the area of the middle cerebral artery, whether transcranial magnetic stimulation values from the affected lower limb correlated with the degree of gait recovery. DESIGN: The prognostic evaluation in subjects with complete lower-limb palsy, inability to walk, and dependence in the activities of daily living, 1 month after vascular injury. SETTING: University-affiliated rehabilitation hospital. PARTICIPANTS: Twenty consecutive patients (12 women, 8 men) were enrolled 1 month poststroke (30+/-5 d); all patients concluded the rehabilitation program, which lasted 6 months. INTERVENTION: Barthel Index score, Hemiplegic Stroke Scale (HSS) score, and motor evoked potentials (MEPs) from the tibialis anterior muscle were performed 1, 4, and 7 months poststroke. The Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman rank-order correlation coefficient were employed. MAIN OUTCOME MEASURES: The independence of gait defined as an HSS gait score of 3 or less (ability to walk without assistance apart from a stick or cane). RESULTS: Patients with no recordable MEPs 1 month poststroke never regained walking ability; patients with MEPs of 8% or more (13.11+/-5.95) regained independent gait at discharge. It was not possible to predict walking capacity in patients with MEPs less than 8% (4.0+/-1.41). Four months postinjury, walking capacity was achieved only by the patients with MEPs of 18% or more (23.1+/-6.2). CONCLUSIONS: In the postacute phase of stroke, the lower-limb MEP amplitudes could be a supportive tool for prognosis of lower-limb motor outcome.     

Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study

BACKGROUND: Infertile women positive for thyroid antibodies suffer from a poor pregnancy/delivery outcome, although conflicting data have been published. Our objective was to investigate if levothyroxine (LT4) exerts any effect on pregnancy and/or delivery rates in thyroid peroxidase antibody (TPOAb)-positive (+) women undergoing assisted reproductive technologies. METHODS: Patients undergoing treatment were screened for TPOAb, thyroid-stimulating hormone (TSH) and free thyroxine (FT4). A total of 72 (15%) out of the 484 euthyroid women selected were TPOAb (+). These 72 patients were randomly divided into two groups: group A (n = 36) underwent LT4 treatment, group B (n = 36) placebo. Group C consisted of 412 women (85%) who were TPOAb negative (-). All patients received controlled ovarian stimulation. The endpoints of treatment were pregnancy rate, miscarriage rate and delivery rate. RESULTS: No differences in pregnancy rate were observed between the three groups. Miscarriage rate was higher in TPOAb (+) in comparison to TPOAb (-) [relative risk: 2.01 (95% CI = 1.13-3.56), P = 0.028]. CONCLUSIONS: The pregnancy rate is not affected either by presence of TPOAb or treatment with LT4. However, TPOAb (+) women show a poorer delivery rate compared to TPOAb (-). LT4 treatment in TPOAb (+) does not affect the delivery rate.     

Preliminary Evaluation of the Safety and Efficacy of Standard Intravenous Immunoglobulins in Pregnant Women with Primary Cytomegalovirus Infection

Hyperimmune globulins were reported to prevent and treat fetal cytomegalovirus (CMV) infection during pregnancy. Here, we report that infusions of standard human intravenous immunoglobulin significantly increase CMV IgG titers and avidity indexes in pregnant women, paving the way to their use for passive transfer of maternal CMV humoral immunity to fetuses. Preliminary data on perinatal outcomes of the first 67 newborns are encouraging.     

Determinants of maximal oxygen uptake in moderate acute hypoxia in endurance athletes

The factors determining maximal oxygen consumption were explored in eight endurance trained subjects (TS) and eight untrained subjects (US) exposed to moderate acute normobaric hypoxia. Subjects performed maximal incremental tests at sea level and simulated altitudes (1,000, 2,500, 4,500 m). Heart rate (HR), stroke volume (SV), cardiac output arterialized oxygen saturation oxygen uptake ventilation ( expressed in normobaric conditions) were measured. At maximal exercise, ventilatory equivalent transport and O₂ extraction (O₂ER_max) were calculated. In TS, remained unchanged despite a significant reduction in at 4,500 m. SV_max remained unchanged. decreased in TS at 4,500 m, was lower in TS and greater at 4,500 m vs. sea level in both groups. Sa′O_2max decreased at and above 1,000 m in TS and 2,500 m in US, O₂ER_max increased at 4,500 m in both groups. decreased with altitude and was greater in TS than US up to 2,500 m but not at 4,500 m. decreased with altitude but the decrement was larger in TS at 4,500 m. In both groups in moderate hypoxia was correlated with Several differences between the two groups are probably responsible for the greater in TS at 4,500 m : (1) the relative hypoventilation in TS as shown by the decrement in at 4,500 m (2) the greater decrement in TS due to a lower Sa′O_2max and unchanged 3) the smaller increase in O₂ER_max in TS, insufficient to compensate the decrease in