Regional cerebral blood flow study with 99mTc-hexamethyl-propyleneamine oxime single photon emission computed tomography in Alzheimer's and multi-infarct dementia

Thirty-four demented patients, 19 with Alzheimer's and 15 with multi-infarct dementia, were studied using single photon emission computed tomography, and 99mTc-hexamethyl-propylenemine oxime as a tracer of regional cerebral perfusion. Tracer activity ratios, determined in cortical and subcortical regions, were compared with those of 11 age-matched controls. In both groups of demented patients, most of the cortical regions showed significant declines in tracer uptake from control values, with the greatest reductions in the parietal cortex. Significantly lower parietal indexes were found in the Alzheimer's patient group as compared both to the control values and to the group of multi-infarct dementia patients. A positive correlation was found between the magnitude of the parietal deficits and the severity of dementia.     

Cost analysis of incisional hernia repair with synthetic mesh and biological mesh: an Italian study

Repair of an incisional hernia (IH) generates costs on several levels and domains of society. The aim of this study was to make a complete cost analysis of incisional hernia repair (IHR) with synthetic and biological mesh and to compare it with financial reimbursement. Patients were grouped into three levels to determine the complexity of their care, and hence, the costs involved. Group 1 included patients without comorbidities, who underwent a “standard” incisional hernia repair (SIHR), with synthetic mesh. Group 2 included patients with comorbidities, who underwent the same surgical procedure. Group 3 included all patients who underwent a “complex” IHR (CIHR) with biological mesh. Total costs were divided into direct (including preoperative and operative phases) and indirect costs (medications and working days loss). Reimbursement was calculated according to Diagnosis-Related Group (DRG). From 2012 to 2014, 76 patients underwent prosthetic IHR: group 1 (35 pts); group 2 (30 pts); and group 3 (11 pts). The direct costs of preoperative and operative phases for groups 1 and 2 were €5544.25 and €5020.65, respectively, and €16,397.17 in group 3. The total reimbursement in the three groups was €68,292.37 for group 1, €80,014.14 for group 2, and €72,173.79 for group 3, with a total loss of €124,658.43, €69,675.36, and €100,620.04, respectively. All DRGs underestimate the costs related to IHR and CIHR, thus resulting in an important economic loss for the hospital. The cost analysis shows that patient-related risk factors do not alter the overall costs. To provide a correct “cost-based” reimbursement, different DRGs should be created for different types of hernias and prostheses.     

Comparison of the lipid composition of porcine buccal and esophageal permeability barriers

Pig esophageal mucosa has been shown to be a useful and practical substitute for buccal mucosa in in vitro permeability studies in that it offers a larger surface area and it is much easier to prepare. Further, the tissues demonstrate similar histological characteristics.

The objectives of this work were to characterize the lipid composition of the esophageal mucosa, to compare it to that of the buccal tissue, and to correlate lipid composition with the membranes’ permeability to fentanyl. The major lipid classes of buccal and esophageal epithelia were separated and analysed by automated multiple development high-performance thin-layer chromatography (AMD-HPTLC). The two epithelia presented a very similar lipid pattern. In general, there were more polar lipids than non-polar; glycosylceramides were relatively abundant whereas the amount of ceramides present was very small. The flux of fentanyl applied as the citrate in aqueous solution was comparable across the buccal and esophageal barriers. Lipid extraction provoked a significant increase in permeability. In conclusion, this research confirms the suitability of the esophageal mucosa as a model for buccal permeability studies.     

Elastin VII: Aging effects on vascular elastica staining by oil soluble nigrosin dyes

Summary Neutral hydroalcoholic stains with spirit soluble nigrosin (C.I. 50415) and nigrosin base (C.I. 50415B) were applied to a series of human arteries from individuals ranging from newborn to 82 years of age for the demonstration of the selective staining by these dyes of the aging change in their elastica described by Lillie, Pizzolato and Donaldson (1974). The staining is absent in infants and children. It first appears in slight grade in some individuals at age 18. It increases in frequency and intensity with advancing age. It is often seen without obvious other histologic lesion and is regularly present when fibrous and fibroatheromatous plaques appear. In this series it was studied in the aorta of children and in grossly relatively normal areas of the superior mesenteric artery which was selected for the survey because of its usual rather slight involvement in arteriosclerosis. The intensity of the neutral nigrosin staining of the elastica of this artery appeared to be uninfluenced by the extent or severity of aortic lesions in the same individual. This nigrosinophilia appears to be an integral early phase in the development of the arteriosclerotic process and may precede appearance of fibrous or fibroatheromatous plaques by some years. The nigrosinophilia has been assigned (1974) to a lipoprotein alteration of arterial elastica. Prolonged storage in formol in plastic bags induced a strong neutral Solvent black 5 and 7 staining of aortic elastica in the normally negative 10–20 year age group. This reaction is presently considered artifactual, but is being studied further experimentally.Supported by U.S.P.H.S. Grants, NIH HL 08974 and HL 14496 from the National Heart and Lung Institute     

Aspergillus endocarditis and myocarditis in a patient with the acquired immunodeficiency syndrome (AIDS)

Summary We report the post-mortem findings of the case of a 31-year-old male who, through sexual contacts with a female drug addict, was found to be HIV-positive and developed the acquired immunodeficiency syndrome (AIDS) 2 years later. He was treated for various opportunistic infections over the next 7 years when he presented with cardiac abnormalities and multiple cerebral lesions which were responsible for his death. The results revealedAspergillus fumigatus endocarditis and myocarditis with mycotic thromboembolic extension to the brain, spleen, kidney and pancreas. We review the literature ofAspergillus infection in patients with AIDS and more specifically cardiac involvement with this pathogen.     

Grip-dependent cortico-spinal excitability during grasping imagination and execution

Studies converge in indicating a substantial similarity of the rules and mechanisms underlying execution, observation and imagery of actions, along with a large overlapping of their neural substrates. Recent transcranial magnetic stimulation (TMS) studies have demonstrated a muscle-specific facilitation of the observer's motor system for force requirement and type of grip during grasping observation. However, whether similar fine-tuned muscle-specificity occurs even during imagination, when subjects are free to select the most convenient grip configuration, is still unknown. Here we applied TMS over the primary motor cortex and measured the corticospinal excitability (MEP) in three muscles (FDI, ADM and FDS) while subjects imagined grasping spheres of different dimensions and materials. This range of object weights and sizes (diameters) allowed subjects to freely imagine the most suitable grip configuration among several possibilities. Activation measured during grasping imagination has been also compared to that obtained during real execution (EMG recorded from the same muscles).We found that during imagination of grasping small objects, the FDI muscle was more active than the ADM and the FDS, whereas the opposite pattern was found for big objects. Imagination of medium size objects, instead, required an equal involvement of the three muscles. The same pattern was observed when subjects were asked to perform the action. This suggests that during imagination, the cortico-spinal system is modulated in a muscle-specific/grip-specific way, as if the action would be really performed. However, when force was required (i.e., for the aluminum objects), the motor activation obtained during action execution was more fine-tuned to object dimensions than the facilitation recorded during imagination, suggesting a separate control of force production.     

Urinary excretion of low molecular weight proteins in patients with pure monoclonal light chain proteinuria

BACKGROUND: Because urinary low molecular weight protein (LMWP) measurement shows changes in renal integrity at an early stage, beta2-microglobulin (B2m), retinol-binding protein (RBP) and alpha1-microglobulin (A1m) were evaluated in 24-hour urine collection of 65 patients with pure monoclonal light chain (MLC) proteinuria and in 47 patients with different kidney diseases (DKDs) for comparison.METHODS AND RESULTS: Albumin, kappa, lambda, A1m and B2m were measured by immunonephelometry. RBP was determined by ELISA. The mean values of LMWP quantitation were significant for origin of the disease (MLC and DKD) (p<0.05) and renal failure (RF) (p<0.001) (MANOVA). Tukey HSD test only showed significant differences for LMWP between MLC patients with RF and DKD patients without RF. The mean value of A1m was different between patients with and without RF in each group (p<0.05 for MLC, and p<0.01 for DKD). In the group without RF, the frequency of A1m excretion above 12 mg/L differed between MLC patients and DKD patients (p<0.01). CONCLUSION: A tubular dysfunction occurred in a great number of patients excreting pure MLC even in those with well-preserved renal function, as it did in patients with DKDs. In patients with MLC without RF, A1m might be measured for the early recognition of tubular involvement.