Right Ventricular Longitudinal Strain Measures Independently Predict Chronic Heart Failure Mortality

The assessment of right ventricular (RV) function still remains a challenge. Two‐dimensional (2D) speckle tracking has recently been proposed to evaluate right ventricular function by analyzing myocardial deformation. The aim of this study was to evaluate the role of 2D systolic strain measures of RV in predicting mortality in patients with chronic heart failure (HF). We enrolled 332 outpatients in a stable clinical condition and in conventional therapy. A right ventricular–focused four‐chamber view was analyzed by 2D speckle tracking to evaluate the global longitudinal strain of RV (RV‐GLS) and the strain of RV free wall (RV‐fwLS). During a mean follow‐up of 36 ± 26 months, 64 patients died. Both RV‐GLS and RV‐fwLS were associated with all‐cause mortality in univariate (HR: 1.16; 95% CI: 1.10–1.23; P < 0.001; C‐index: 0.72; and HR: 1.10; 95% CI: 1.06–1.15; P < 0.001; C‐index: 0.68, respectively) as well as multivariate analysis (HR: 1.13; 95% CI: 1.05–1.21; P:0.001; C‐index: 0.85; and HR: 1.07; 95% CI: 1.02–1.12; P:0.004; C‐index: 0.84, respectively). In conclusion, our findings demonstrate the role of RV 2D strain measures to independently predict mortality. These data highlight the clinical usefulness of this echocardiographic approach in the daily management of HF outpatients.     

Kidney disease and psoriasis: novel evidences beyond old concepts

Psoriasis is an immune-mediated inflammatory disease for a long time considered as a type of pathology characterized by an exclusive skin involvement. Recently it has been shown that patients affected by this disease have a higher risk of developing comorbidities such as cardiovascular diseases, arterial hypertension, diabetes mellitus, and metabolic syndrome. Even the kidneys can be affected by psoriasis through three different mechanisms: immune-mediated renal damage, drug-related renal damage and chronic renal damage. Renal function should be monitored periodically to minimize the risk of renal adverse events.     

Autosomal dominant thrombocytopenias with reduced expression of glycoprotein Ia

We have recently studied a case series of 46 unrelated patients with inherited thrombocytopenias and identified 18 cases that did not fit any known platelet disorder. In two unrelated families, a mild thrombocytopenia with normal platelet size was transmitted in an autosomal dominant fashion. Bleeding time was prolonged in 5 investigated patients. In all of them, flow cytometry and SDS-PAGE of platelet glycoproteins (GP) showed a reduced content of GPIa, a subunit of the GPIa-IIa complex (also known as integrin alpha 2 beta(1)) that is a major collagen receptor on platelets. All other membrane GPs were within the normal range. GPIa deficiency was associated with severely reduced in vitro platelet adhesion to molecules known to interact selectively with GPIa. In vitro platelet aggregation was normal in all subjects, except for a suboptimal platelet response to fibrillar collagen in two patients. A mild defect of alpha-granules was observed in all affected subjects. No mutation was identified in the genes encoding for GPIa or GPIIa. Since no other similar cases have been reported in the literature, we suggest that an autosomal dominant thrombocytopenia associated with GPIa deficiency and alpha-granule defect represents a new form of inherited thrombocytopenia.     

Independent component model of the default-mode brain function: Assessing the impact of active thinking

The “default-mode” network is an ensemble of cortical regions, which are typically deactivated during demanding cognitive tasks in functional magnetic resonance imaging (fMRI) studies. Using functional connectivity, this network can be conceptualized and studied as a “stand-alone” function or system. Regardless of the task, independent component analysis (ICA) produces a picture of the “default-mode” function even when the subject is performing a simple sensori-motor task or just resting in the scanner. This has boosted the use of default-mode fMRI for non-invasive research in brain disorders. Here, we studied the effect of cognitive load modulation of fMRI responses on the ICA-based pictures of the default-mode function. In a standard graded working memory study based on the n-back task, we used group-level ICA to explore the variability of the default-mode network related to the engagement in the task, in 10 healthy volunteers.

The analysis of the default-mode components highlighted similarities and differences in the layout under three different cognitive loads. We found a load-related general increase of deactivation in the cortical network. Nonetheless, a variable recruitment of the cingulate regions was evident, with greater extension of the anterior and lesser extension of the posterior clusters when switching from lower to higher working memory loads. A co-activation of the hippocampus was only found under no working memory load.

As a generalization of our results, the variability of the default-mode pattern may link the default-mode system as a whole to cognition and may more directly support use of the ICA model for evaluating cognitive decline in brain disorders.     

Use of complementary and alternative medicine in epilepsy

Complementary and alternative medicine (CAM) has become much in vogue, and CAM practitioners have increased in tandem with this. The trend of using CAM for treating epilepsy does not differ from that in other medical conditions, with nearly one half of patients using CAM. In this article we review the major complementary and alternative medicines used for treatment of epilepsy. They include mind-body medicines such as reiki and yoga; biologic-based medicine such as herbal remedies, dietary supplements, and homeopathy; and manipulative-based medicine such as chiropractic. In the available literature, there is a sense of the merit of these therapies in epilepsy, but there is a paucity of research in these areas. Individualized therapies such as homeopathy and reiki cannot be compared with medicines in a conventional pharmaceutical model. Hence, many studies are inconclusive. In a science of double-blind, randomized controlled trials, appropriate designs and outcome measurements need to be tailored to CAM. This article explains the principles of the major CAM therapies in epilepsy, and discusses peer-reviewed literature where available. More effort needs to be put into future trials, with the assistance of qualified CAM professionals to ensure conformation to their therapeutic principles.     

Observing a premature baby: the case of Eliecer

Abstract

This paper describes the process by which an infant acquires and assimilates his mother's culture through play and musicality within his first two years of life. Becoming a first-time mother away from her country of origin had an impact on the mother's cultural identity and therefore on her musicality when speaking and relating with her son within his first month of life. Gradually, the mother was able to come to terms with her identity conflict and thus she could relate to her son with the musicality of her culture. This paper analyses the quality of the mother's vocal and corporal musicality along with her use of play, and their vital role in the transmission of her culture to her infant.     

Reliability and validity of the Italian nose obstruction symptom evaluation (I-NOSE) scale

The NOSE scale is a questionnaire assessing QOL related with nasal obstruction. The aim of this study was to culturally adapt the NOSE scale into Italian (I-NOSE). Prospective instrument validation study. Cross-cultural adaptation and validation were accomplished. Cronbach α was used to test internal consistency in 116 patients complaining nasal obstruction and 232 asymptomatic subjects. Pearson and ICC tests were used for test–retest reliability analysis. Normative data were gathered from the 232 asymptomatic subjects. Mann–Whitney test was used to compare the I-NOSE scores in patients and asymptomatic subjects and in 40 patients before and after septoplasty. I-NOSE scores obtained in 60 patients were correlated with rhinomanometric results and with the score of a visual analog scale (VAS) measuring the subjective sensation of nasal obstruction. Good internal consistency and good test–retest reliability were found. I-NOSE mean score of the normal cohort was 12.1 ± 13.2. Asymptomatic subjects scored lower than patients with nasal obstruction (p = 0.001). Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found. The mean I-NOSE score improved from 64.4 ± 23.6 to 22.1 ± 13.5 after septoplasty (p < 0.001). The I-NOSE scale is a reliable, valid, self-administered, symptom-specific questionnaire; its application is recommended.     

Origanum Vulgare Induces Apoptosis in Human Colon Cancer Caco2 Cells

Oregano spice is widely used in the Mediterranean diet, which is associated with a low risk for colon cancer. Although the medicinal benefits of oregano, such as the anti-inflammatory and antimicrobial activities, are well known; nonetheless, only few data are available on its effect in cancer prevention, especially concerning the mechanism of action. Here, we investigated the effect of Origanum vulgare ethanolic extracts on redox balance, cell proliferation, and cell death in colon adenocarcinoma Caco2 cells. Oregano extract leads to growth arrest and cell death in a dose- and time-dependent manner. Changes in glutathione content, as well as the increase in its oxidized form, may be involved in oregano-triggered death. Both extrinsic and intrinsic apoptotic pathways appear to be activated by spice extract. Our findings suggest that oregano amounts found in the Mediterranean diet can exert proapoptotic effects, which are selective for cancer cells. Moreover, whole extract, instead of a specific component, can be responsible for the observed cytotoxic effects.