Brain perfusion effects of cholinesterase inhibitors in Parkinson’s disease with dementia

Summary. Several evidences suggest that cholinergic deficits may significantly contribute to dementia in Parkinson’s disease (PDD) and acetylcholinesterase inhibitors (ChEIs) have been reported to improve cognitive symptoms in PDD, without worsening parkinsonism. Nineteen PDD patients underwent brain perfusion SPECT with ^99mTc-ethyl cysteinate dimer after 6 months ChEIs treatment in order to evaluate the functional correlates of clinical improvement. A clear-cut cognitive improvement was reported in PDD patients with a significant improvement of ADAS-cog total score as well as of subscores exploring executive functions (p < 0.01). MMSE total score did not significantly change after ChEIs but the subscore of attention significantly improved after therapy (p < 0.01). No difference in motor performance as evaluated by UPDRS was reported. SPM analysis showed a significant increase of perfusion (p < 0.0001) in bilateral cingulate, and frontal regions after ChEIs. Our data confirm the efficacy of ChEIs in the treatment of dementia associated with PD mainly on attention and executive functions, and the functional findings indicate that this cognitive improvement could be associated with a sort of pharmacological frontal “re-afferentation”.     

Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure

Background

The best format of exercise training in patients with chronic heart failure (CHF) is controversial. We tested the hypothesis that aerobic continuous training (ACT) and aerobic interval training (AIT) induce similar effects on functional capacity, central hemodynamics and metabolic profile in patients with postinfarction CHF provided that the training load is equated by an individually-tailored volume/intensity dose of exercise.

Methods

Twenty patients with postinfarction CHF under optimal medical treatment were randomized to ACT or AIT for 12 weeks. Exercise training consisted in individualized loads prescribed according to the Training Impulses (TRIMP_i) method, which was determined using the individual HR and lactate profiling obtained during a treadmill test at baseline.

Results

Peak VO₂ increased significantly by 22% with both ACT and AIT, without differences between the two training programs. Changes in anaerobic threshold and VE/VCO₂ slope were not significantly different between ACT and AIT. Resting HR significantly decreased with both exercise modes. Resting cardiac output and stroke volume, left ventricular diastolic dimension and ejection fraction did not change from baseline with both exercise modes. Lipid profile and glucose metabolism were not substantially altered by ACT and AIT.

Conclusions

ACT and AIT both induce significant improvement in aerobic capacity in patients with postinfarction CHF, without significant differences between the two training modes, provided that patients are trained at the same, individually tailored, dose of exercise. The TRIMPi method might represent a step forward in the individualization of an aerobic training tailored to the patient's clinical and functional status within cardiac rehabilitation programs.     

Crosses between Saccharomyces cerevisiae and Saccharomyces bayanus generate fertile hybrids

Crossings between strains of Saccharomyces cerevisiae and Saccharomyces bayanus were carried out. Genetic, molecular and electrophoretic karyotyping data indicated that interspecific hybrids were obtained. The hybrid cells segregated "grande" and "petite" colonies, and the latter ranged between 20 and 50%; unlike "grande" colonies, "petite" colonies did not sporulate and did not ferment maltose. In the hybrids, the extent of sporulation varied between 10 and 20%; only very rare asci (around 10(-4)) held viable ascospores. Clones from the viable ascospores sporulated and produced asci with viable ascospores able to give mating with spores from both hybrid derivatives and parental species. Fertile asci could derive from allotetraploid cells generated by endomitotic events in allodiploid cells, a mechanism that enables overcoming the species barrier between S. cerevisiae and S. bayanus.     

Comparison of Microlife BP A200 Plus and Omron M6 Blood Pressure Monitors to Detect Atrial Fibrillation in Hypertensive Patients

Introduction

Self-monitoring home blood pressure (BP) devices are currently recommended for long-term follow-up of hypertension and its management. Some of these devices are integrated with algorithms aimed at detecting atrial fibrillation (AF), which is common essential hypertension. This study was designed to compare the diagnostic accuracy of two widely diffused home BP monitoring devices in detecting AF in an unselected population of outpatients referred to a hypertension clinic because of high BP.

Methods

In 503 consecutive patients the authors simultaneously compared the accuracy of the Microlife? BP A200 Plus (Microlife) and the OMRON? M6 (OMRON) home BP devices, in detecting AF.

Results

Systolic and diastolic BP as well as heart rate (HR) values detected by the two devices were not significantly different. Pulse irregularity was detected in 124 and 112 patients with the OMRON M6 and Microlife BP A200 Plus devices, respectively. Simultaneous electrocardiogram (ECG) recording revealed that pulse irregularity was due to AF in 101 patients. Pulse irregularity detected by the OMRON M6 device corresponded to AF in 101, to supraventricular premature beats in 18, and to frequent premature ventricular beat in five patients, respectively. Pulse irregularity detected by the Microlife BP A200 Plus device corresponded to AF in 93, to supraventricular premature beats in 14, and to ventricular premature beats in five patients. The sensitivity for detecting AF was 100%, the specificity was 92%, and diagnostic accuracy 95% for the OMRON M6 and 100%, 92%, and 95 for the Microlife BP A200 Plus, respectively. AF was newly diagnosed by ECG recordings in 47 patients, and was detected in all patients by the OMRON device, and in 42 patients by the Microlife device.

Conclusion

These results indicate that OMRON M6 is more accurate than Microlife BP A200 Plus in detecting AF in patients with essential hypertension. Widespread use of these devices in hypertensive patients could be of clinical benefit for the early diagnosis and treatment of this arrhythmia and related consequences.     

Fever as a seizure precipitant factor in Panayiotopoulos syndrome: a clinical and genetic study

PurposeTo examine fever as a precipitating factor for focal seizures in patients with Panayiotopoulos syndrome (PS) and evaluate the role of SCN1A in PS patients with seizures triggered by fever.MethodsFrom January 2000 to June 2008, we identified patients referred for seizures who fulfilled the criteria of PS. Patients were divided into two groups, according to the presence (group A) or the absence (group B) of seizures triggered by fever. Electroclinical features of the two groups were compared. In addition, an analysis of SCN1A in patients of group A was performed.ResultsThirty patients fulfilled the inclusion criteria. Eleven patients (36%) had at least one focal autonomic seizure triggered by fever (group A). In group A, 7/11 patients (63.5%) had the first focal autonomic seizure during a febrile illness. Two of these 7 patients were misdiagnosed at the onset of PS. The median age at the onset of PS was slightly lower in group A than in group B (p = .050). Moreover, patients in group A more frequently had a positive familial history of febrile seizures (FS) (p = .047). No mutations of SCN1A were found in any of the 10 patients screened.ConclusionFever is a common trigger for focal autonomic seizures in PS. Knowing that an autonomic manifestation during fever can be an epileptic seizure could facilitate diagnosis and prevent unnecessary investigations and erroneous treatments. Moreover, our data show that SCN1A gene does not contribute significantly to susceptibility to autonomic seizures during fever in patients with PS.