Cross-cultural adaptation and validation of the “spinal cord injury-falls concern scale” in the Italian population

Study design: Psychometrics study. Objective: The objective of this study was to develop an Italian version of the Spinal Cord Injury-Falls Concern Scale (SCI-FCS) and examine its reliability and validity. Setting: Multicenter study in spinal units in Northern and Southern Italy. The scale also was administered to non-hospitalized outpatient clinic patients. Methods: The original scale was translated from English to Italian using the “Translation and Cultural Adaptation of Patient-Reported Outcomes Measures” guidelines. The reliability and validity of the culturally adapted scale were assessed following the “Consensus-Based Standards for the Selection of Health Status Measurement Instruments” checklist. The SCI-FCS-I internal consistency, inter-rater, and intra-rater reliability were examined using Cronbach’s alpha coefficient and the intraclass correlation coefficient, respectively. Concurrent validity was evaluated using Pearson’s correlation coefficient with the Italian version of the short form of the Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon-M-I-short form). Results: The Italian version of the SCI-FCS-I was administered to 124 participants from 1 June to 30 September 2017. The mean ± SD of the SCI-FCS-I score was 16.73 ± 5.88. All SCI-FCS items were either identical or similar in meaning to the original version’s items. Cronbach’s α was 0.827 (p < 0.01), the inter-rater reliability was 0.972 (p < 0.01), and the intra-rater reliability was 0.973 (p < 0.01). Pearson’s correlation coefficient of the SCI-FCS-I scores with the WheelCon-M-I-short form was 0.56 (p < 0.01). Conclusions: The SCI-FCS-I was found to be reliable and a valid outcome measure for assessing manual wheelchair concerns about falling in the Italian population

Coronary angiography and angioplasty in diabetic patients

Screening, diagnosis and revascularization of coronary artery disease (CAD) in type 2 diabetes mellitus are major challenges for current clinical practice. Diagnostic (angiography) and therapeutic (angioplasty) cardiac catheterization are important resources for the clinical assessment and management of coronary atherosclerosis. Anatomic peculiarities of CAD in diabetics can be well characterized by angiography, associated or not by intravascular ultrasound. The worse outcome following coronary revascularization procedures, either angioplasty or surgery, in diabetic is one of the main fields of clinical research. In spite of controversies, about one quarter of angioplasty and one third of surgical revascularization procedures are performed in diabetics. Two ongoing, large, randomized, multicentric trials are investigating the best management of CAD in diabetics. The BARI 2D trial is randomizing asymptomatic or mildly symptomatic patients with CAD for either medical therapy or revascularization (angioplasty or surgery, according to the best clinical judgment). The FREEDOM trial is randomizing stable patients with multivessel CAD for either angioplasty with drug eluting stents or surgery, with or without extracorporeal circulation. While the evidences are not available, in order to decide on the best revascularization procedure for individual patients, medical practice has been balanced according to a number of variables. Conditions that favor angioplasty: short lesions, lesions in large vessels, absence of left anterior descending artery disease, previous coronary bypass surgery and high surgical risk due to co-morbidities. Conditions that favor surgery: long lesions, lesions in small vessels, presence of left anterior descending artery disease and need for associated valve surgery.O rastreamento, o diagnóstico e a revascularização da doença arterial coronária (DAC) no diabetes tipo 2 representam enormes desafios para a prática médica. Neste contexto, o cateterismo cardíaco diagnóstico (angiografia) e terapêutico (angioplastia) são recursos fundamentais na avaliação clínica e manejo da aterosclerose coronária. Avaliações das particularidades anatômicas da DAC no diabetes são detalhadamente caracterizadas pela angiografia coronária, associada ou não ao ultra-som intracoronário. Por outro lado, a resposta pior aos procedimentos de revascularização (angioplastia e cirurgia) da DAC nos diabéticos representa umas das áreas de maior investigação clínica contemporânea. A despeito das controvérsias, cerca de um quarto dos pacientes submetidos a angioplastia e um terço dos pacientes submetidos a cirurgia são diabéticos. Dois grandes estudos multicêntricos randomizados, em andamento, investigam o melhor manejo da DAC nos diabéticos. O BARI 2D está randomizando pacientes com DAC assintomáticos ou com sintomas leves para tratamento clínico ou revascularização (angioplastia ou cirurgia, conforme melhor julgamento clínico). O FREEDOM está randomizando pacientes diabéticos estáveis com DAC multiarterial, para angioplastia com stent farmacológico ou cirurgia, com ou sem uso de circulação extra-corpórea. Enquanto as evidências não estão disponíveis, a prática médica atual é balanceada por um conjunto de variáveis na decisão sobre a melhor alternativa de revascularização. Condições que favorecem a angioplastia: estenoses curtas, vasos grandes, ausência de estenose na artéria descendente anterior (ADA), cirurgia de revascularização prévia e risco cirúrgico elevado. Condições que favorecem a indicação de cirurgia: estenoses longas, vasos pequenos, presença de estenose da ADA e cirurgia valvar associada.UNIFESP-EPMSPDM Hospital São Paulo Serviço de Hemodinâmica e Cardiologia IntervencionistaFOR Hospital do Rim e HipertensãoUNIFESP, EPMSPDM Hospital São Paulo Serviço de Hemodinâmica e Cardiologia IntervencionistaSciEL

Capillaria hepatica-induced septal fibrosis in rats: a contribution to the study of liver fibrogenesis

INTRODUCTION: Septal fibrosis of the liver regularly develops in rats infected with the nematode Capillaria hepatica. Curative treatment of the infection prevents the development of septal fibrosis when intervention occurs up to postinfection day (PID) 15, but not later. The present investigation aimed to demonstrate which parasitic factors are present when the process of septal fibrosis can no longer be prevented by curative treatment. METHODS: Wistar rats were infected with 600 embryonated eggs of C. hepatica administered by gavage and treated with ivermectin and mebendazole in separate groups at PIDs 10, 12, 15, 17 or 20. Rats from each group and their nontreated controls, were killed and examined 40 days after the end of treatment. RESULTS: Findings by PID 15 were compatible with the stage of complete maturation of infection, when worms and eggs were fully developed and a complex host-parasite multifocal necroinflammatory reaction showed greater intensity, but with no signs of septal fibrosis, which appeared from PID 17 onward. CONCLUSIONS: Since the worms spontaneously died by PID 15, not only septal fibrosis production, but also its maintenance and further development appeared dependent on the presence of eggs, which were the only parasitic factor remaining thereafter.INTRODUÇÃO: A fibrose septal do fígado se desenvolve regularmente em ratos infectados pelo nematódeo Capillaria hepatica. O tratamento curativo da infecção, feito antes do 15º dia da infecção, mas não mais tarde, impediu o aparecimento da fibrose septal. O presente trabalho procura verificar qual o estado do parasitismo aos 15 dias da infecção, crucial para patogenia da fibrose septal. MÉTODOS: Ratos foram infectados por via digestiva com 600 ovos embrionados de C. hepatica e tratados com Ivermectina e mebendazol, em grupos separados, aos 10, 12, 15, 17 ou 20 dias após a infecção. O animal de cada grupo e seus respectivos controles foram mortos e examinados aos 40 dias após o fim do tratamento. RESULTADOS: Os achados aos 15 dias da infecção mostraram a maturação completa da parasitose, com presença de ovos e vermes, circundados por reação necro-inflamatória, mas ainda sem fibrose septal. Daí por diante, a fibrose septal se fez presente. CONCLUSÕES: Como os vermes morrem espontaneamente após o 15º dia da infecção, não apenas a origem, mas o posterior crescimento e a manutenção da fibrose septal dependem da presença dos ovos acumulados no fígado, os quais são os únicos elementos parasitários presentes após o 15º dia da infecção por C. hepatica no rato

CNTF Mediates Neurotrophic Factor Secretion and Fluid Absorption in Human Retinal Pigment Epithelium

Ciliary neurotrophic factor (CNTF) protects photoreceptors and regulates their phototransduction machinery, but little is known about CNTF's effects on retinal pigment epithelial (RPE) physiology. Therefore, we determined the expression and localization of CNTF receptors and the physiological consequence of their activation in primary cultures of human fetal RPE (hfRPE). Cultured hfRPE express CNTF, CT1, and OsM and their receptors, including CNTFRα, LIFRβ, gp130, and OsMRβ, all localized mainly at the apical membrane. Exogenous CNTF, CT1, or OsM induces STAT3 phosphorylation, and OsM also induces the phosphorylation of ERK1/2 (p44/42 MAP kinase). CNTF increases RPE survivability, but not rates of phagocytosis. CNTF increases secretion of NT3 to the apical bath and decreases that of VEGF, IL8, and TGFβ2. It also significantly increases fluid absorption (JV) across intact monolayers of hfRPE by activating CFTR chloride channels at the basolateral membrane. CNTF induces profound changes in RPE cell biology, biochemistry, and physiology, including the increase in cell survival, polarized secretion of cytokines/neurotrophic factors, and the increase in steady-state fluid absorption mediated by JAK/STAT3 signaling. In vivo, these changes, taken together, could serve to regulate the microenvironment around the distal retinal/RPE/Bruch's membrane complex and provide protection against neurodegenerative disease

670-nm light treatment reduces complement propagation following retinal degeneration

AIM: Complement activation is associated with the pathogenesis of age-related macular degeneration (AMD). We aimed to investigate whether 670-nm light treatment reduces the propagation of complement in a light-induced model of atrophic AMD. METHODS: Sprague–Dawley (SD) rats were pretreated with 9 J/cm(2) 670-nm light for 3 minutes daily over 5 days; other animals were sham treated. Animals were exposed to white light (1,000 lux) for 24 h, after which animals were kept in dim light (5 lux) for 7 days. Expression of complement genes was assessed by quantitative polymerase chain reaction (qPCR), and immunohistochemistry. Counts were made of C3-expressing monocytes/microglia using in situ hybridization. Photoreceptor death was also assessed using outer nuclear layer (ONL) thickness measurements, and oxidative stress using immunohistochemistry for 4-hydroxynonenal (4-HNE). RESULTS: Following light damage, retinas pretreated with 670-nm light had reduced immunoreactivity for the oxidative damage maker 4-HNE in the ONL and outer segments, compared to controls. In conjunction, there was significant reduction in retinal expression of complement genes C1s, C2, C3, C4b, C3aR1, and C5r1 following 670 nm treatment. In situ hybridization, coupled with immunoreactivity for the marker ionized calcium binding adaptor molecule 1 (IBA1), revealed that C3 is expressed by infiltrating microglia/monocytes in subretinal space following light damage, which were significantly reduced in number after 670 nm treatment. Additionally, immunohistochemistry for C3 revealed a decrease in C3 deposition in the ONL following 670 nm treatment. CONCLUSIONS: Our data indicate that 670-nm light pretreatment reduces lipid peroxidation and complement propagation in the degenerating retina. These findings have relevance to the cellular events of complement activation underling the pathogenesis of AMD, and highlight the potential of 670-nm light as a non-invasive anti-inflammatory therapy