Biomedical subjects

M Motta

Publications and source records attributed to M Motta.

At least 253 records · Page 14Linked to original sources

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Study of the language functions controlled by the right hemisphere in patients affected by dementia.

An insertion test (Shift vs. non-Shift) was performed by eight subjects (mean age 69 years, mean schooling 5.87 years) with clinical diagnosis of suspected Alzheimer disease (AD) in order to reveal right hemisphere cerebral distress in concomitance with damage of the left hemisphere which controls language in AD. Their Shift and non-Shift test scores were significantly lower than those of 28 controls, even if they achieved normal or slightly modified classical language test scores. Shift involves insertion of a syntagma or word in a stimulus-sentence that changes the syntactical relationship of some components of the newly formed sentence, whereas in non-Shift the insertion determines only a change in meaning. Statistical analysis revealed that the difference was not caused by age and schooling. Furthermore, the AD patients achieved significantly lower scores in Shift compared with non-Shift. This indicates greater right hemisphere damage in these patients and confirms its physiological decline in the elderly. The results revealed that the insertion test is more sensitive than classical neurolinguistic tests. They also showed that both superficial (non-Shift) and deep (Shift) types of syntaxes are already compromised in early stages of AD and that they mirror the bilateral thinning which is more pronounced in the right hemisphere.

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Effects of reality orientation therapy on elderly patients in the community.

Twenty-three institutionalized subjects, confused and disoriented as to time, space and persons, were divided into two groups: the study group and the control group. The study group then participated in a 3-month period of formal Realithy Orientation Therapy (ROT). At the end of the 3 months of therapy significant differences emerged in the scores of MMSE, OSGP and GDS obtained by the two groups. Moreover, significant positive differences were observed only in the study group, comparing the tests' results before and after therapy. Even the comparison of the results obtained at the end of the sessions and 3 months after the interruption of the therapy revealed a difference in the trends that emerged for the two groups.

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Ipriflavone-treatment of senile osteoporosis: results of a multicenter, double-blind clinical trial of 2 years.

Eighty-four out of 100 enrolled female patients affected by osteoporosis completed a double-blind, randomized trial, using ipriflavone (IP) in a dose of 3 x 200 mg/day (41 patients) or placebo (P)(43 patients). All patients received 1 g/day oral calcium supplementation. Inclusion criteria were: age over 65 years; at least one vertebral fracture in the past; bone mineral density measured at the distal tenth of the radius lower than the normal average -2 x S.D. The trial period was between June 1990 and November 1993. Patients of the IP group showed a significant increase in bone mineral density (P < 0.05) compared with the starting values during the whole study period. Pain decreased rapidly, intake of analgesics dropped, and often significant decreases in calciuria, hydroxyprolinuria, alkaline phospatase, osteocalcin and parathormone values were observed. Only two new fractures occurred during the trial in the IP group. Patients of the P group at the end of the study displayed decreased bone mineral densities (P < 0.05), increased pain, greater consumption of analgesics, and often significant increases in the bone metabolism parameters listed for the IP group. In the

Clinical Trial↗

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Senile diabetes and bone mineral density.

Bone mineral density was determined in a series of 67 elderly diabetics (38 males and 29 females) and 40 non-diabetic elderly subjects (20 males and 20 females) at the third medial and tenth ultradistal of the non-dominating radius using an X-ray densitometer (DEXA). Bone metabolism markers (Ct, PTH, HOP, UCA, AP, Vit-25-OH-D, BGP) were also measured. Our results indicate that there is no significant difference in values of BMD and the bone metabolism markers studied between diabetic and non-diabetic elderly subjects. We believe that senile diabetes is not a risk factor of onset and maintenance of senile osteoporosis.

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Alterations of blood and plasma viscosity and erythrocyte filtration in senile osteoporosis.

Blood and plasma viscosity, as well as erythrocyte filtration rates were studied in 44 osteopenic (20 men and 24 women) and in 40 non-osteopenic (20 men and 20 women) patients, all over 65 years of age. Pathological hemorheological parameters were observed only in 12 subject of the osteopenic group, and 10 controls. The results indicate that although the hemorheological parameters do not show a direct correlation with the osteopenia, it is worthwhile following these parameters, among others, in order to optimize the treatment with anti-osteoporotic drugs which are able to regulate them.

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Erythropoietin in healthy elderly subjects.

The effects of aging on erythropoiesis and the factors regulating it are not well known. Erythropoietin (Epo) is a specific growth factor for the erythroid line and is mainly produced by the kidney. As data on the effects of aging on Epo are discordant we studied serum Epo concentrations in a group of apparently healthy subjects divided into age classes in order to evaluate age-related modifications and correlations with hemoglobin (Hb) and red blood cells (RBC). Our results revealed that Epo values were correlated with age. Epo was higher in the over 65 years age classes than observed in control subjects. We believe that the elevated Epo values in the latter age class may be required to maintain Hb and RBC within normal range.

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Altered laboratory thyroid parameters indicating hyperthyroidism in elderly subjects.

The most common laboratory alterations of thyroid function indicating hyperthyroidism were evaluated in a series of 3015 subjects over 65 years of age by determining total T3, total T4 and TSH. Ultrasound and scintigraphy of the thyroid were performed where necessary. Our results showed a high prevalence of laboratory alterations hyperthyroidism type of around 8.09%, whereas the real prevalence (both clinical and laboratory) is 2.00% with a female/male ratio of 2.00. The most frequent hyperfunctioning thyreopaty is thyroidal adenoma (50%), followed by toxic multinodular goiter (33%) and Basedow's disease (17%). The most common clinical signs of hyperthyroidism involve the neuromuscular system and are often present in the so called 'euthyroid' elderly subject. We conclude that it is very difficult to diagnose hyperthyroidism in the elderly on clinical and laboratory grounds. The most significative laboratory thyroid parameter indicating hyperthyroidism seems to be TSH values below 0.2 IU/ml determined using the ultrasensitive IRMA method.

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Altered laboratory thyroid parameters indicating hypothyroidism in elderly subjects.

The altered laboratory thyroid parameters indicating hypothyroidism were evaluated in a series of 3015 subjects over 65 years of age by determining total T3, total T4 and TSH. In addition, clinical signs of hypothyroidism were recorded in a subsample of 300 randomly selected elderly. Our results showed a high prevalence of altered laboratory thyroid parameters indicating hypothyroidism of 17.88%, whereas the real prevalence (both clinical and laboratory) is 1.00% with a female/male ratio of 2.00. The most frequent laboratory alterations was the so-called 'alerted pituitary' status'. The most common clinical signs of hypothyroidism involved the nervous system. We conclude that it is very difficult to diagnose hypothyroidism in the elderly and that the most indicative laboratory alterations seem to be TSH values above 3 IU/ml determined using the IRMA method.

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Successful aging in centenarians: myths and reality.

The term "successful aging" appeared in the first issue of "The Gerontologist" in 1961. During the successive years, this expression has changed its meaning. Nowadays, successful aging means "absence of diseases and disabilities, maintenance of high levels of physical and cognitive abilities, preservation of the social and productive activities". It has become a common opinion that the centenarians may represent the prototypes of the successful aging. This motivated our work to study the clinical, psychical, and functional aspects in a centenarian group, verifying the real autonomy, instrumental capacities, and working abilities. Our study pool consisted of 602 centenarians, who were also subjects of then epidemiological studies of the Italian Multicenter Studies on Centenarians (IMUSCE). All subjects underwent a clinical-anamnestic evaluation, cognitive-functional tests by means of the mini mental state examination (MMSE), the independence index in activities of daily living (ADL), the instrumental activities of daily living (IADL) scale. The centenarians were classified in three groups, according to the criteria elaborated previously by us, based on their psychophysical status and autonomy, as follows. Group A: centenarians in good health status; Group B: centenarians in an intermediate health status. Group C: centenarians in bad health status. Group A represented 20.0% of the total pool, Group B amounted to 33.4%, and the Group C was 46.6%. The centenarians of Group A presented normal ADL values, and 47.9% of them were autosufficient in all functions; 5.7% of them were independent in all IADL items. These data confirm that the centenarians of Group A are free of invalidating chronic diseases, are autonomous, maintain good physical and cognitive capacities, however, have not maintained any social or productive activities. Therefore, they cannot be considered as prototypes of successful aging.

Activities of Daily Living↗

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Correlation between the bone mass, psychometric performances, and the levels of autonomy and autosufficiency in an elderly Italian population above 80 years of age.

This study was aimed at evaluating the correlation between bone mineral density (BMD) and the psychophysical health status in an elderly study population (62 subjects, mean age 84+/-5 years, 21 males and 41 females), institutionalized (Group A) in various structures of Pozzallo, a marine locality of the Ragusa Province in Sicily. BMD was measured by using ultrasonography of the calcanear area (T-score, Z-score, stiffness). The alterations of the cognitive and affective spheres as well as the levels of autonomy and autosufficiency were estimated by means of psychometric scales like mini-mental state examination (MMSE), geriatric depression scale (GDS), activities of daily living (ADL) and instrumental activities of daily living (IADL). Other biological, social and health-related factors, such as age, sex, body weight and height, nutritional and drug-taking habits, physical activity and previous pathologies, were also considered. These variables were compared to those obtained in a similar, but non-institutionalized controls (Group B) of 63 subjects (mean age 85+/-2 years, 27 males and 36 females), being similar in number and age distribution, frequenting the Geriatric Day Center of the same locality. Statistical analysis revealed significant differences between Groups A and B: the BMD was considerably lower, but also the cognitive and affective performances were strongly reduced in Group A. These findings can be attributed to decreased psychosensorial stimuli and lost interest of the patients in Group A, resulting in a lower physical activity, accompanying the depressive state, and may represent the first signs of a decreased intellectual performance, which can later be transformed into dementia. The functional abilities and the levels of autonomy are also reduced, risking the loss of autosufficiency. Also, the drug usage was different in Group A: more sedative-hypnotics and anticoagulants were consumed. As regards the polymorbidities, arterial hypertension and consequent chronic renal failure, hepatopathies and thyreopathies were most frequent, these latter two being more frequent in the Group A.

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Alendronate reduces the daily consumption of insulin (DCI) in patients with senile type I diabetes and osteoporosis.

The use of Alendronate for the treatment of senile diabetes with osteopenia or osteoporosis is a common practice today, although the reasons for the success of this treatment are not completely understood. We investigated 40 elderly female patients, over 70 years of age, divided in two Groups (A and B) 20 cases of each, with insulin-dependent senile diabetes and fair metabolic balance, with an average disease duration of 30 +/- 4 years. They all had osteoporosis shown by the mean T-score of bone mineral densitometry. The Groups were treated as follows, Group A with 10 mg/day of Alendronate per os, with morning fasting plus a supplementation of calcium and vitamin D3, while the Group B received only calcium and vitamin D3 per os. Bone mineral density (BMD) expressed in mg/cm2, and in terms of T-score and Z-score at the spine (L1-L4) was monitored over time after 12 and 24 months, using dexa technique with a Lunar DPX densitometer. Moreover, the variation of daily consumption of insulin (DCI) of all the study population was calculated 12 and 24 months after the start of treatments. The data of Group A showed an improvement of osteoporosis, as evidenced by the increase of BMD at both times of measurement, accompanied by a significant reduction in the DCI (-21.6% by the 12th month, and -36.2% by the end of the observation period). In the Group B only small, statistically insignificant changes were observed in both the BMD and DCI. The most plausible explanation of reduction of DCI in Group A seems to be that Alendronate has improved the clinical symptoms of osteoporosis (pain, rigidity, and reduction of movements) through its action on the bone mass recovery and slowing down the bone turnover and under these conditions the diabetic patients improved their own physical performance. The better and more extensive movements certainly produced a reduction in the DCI, since a correct and adequate physical activity does contribute to an improved glucose metabolism.

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Alterations of the lymphocytic set-up in elderly patients with cancer.

It is assumed that the increased incidence of neoplastic pathologies with advancing age is correlated with the immunosenescence and with the altered immune-surveillance. The present study was aimed at evaluating the role of the immunocompetent system and immunosenescence in carcinogenesis. A pool of 99 subjects (38 females, 61 males) has been analyzed in three groups as follows. Group A: 51 elderly subjects with cancer (16 females and 35 males, average age 73.7 +/- 7.5 years). Group B: 24 young subjects with cancer (12 females, 12 males, average age 49.5 +/- 10.3 years). Group C: 24 elderly subjects without any clinical evidence of cancer (10 females, 14 males, average age 74.6 +/- 6.3 years). Hemo-chromocytometric analysis and cytofluorimetric typifying have been performed in all subjects. A decrease of T (CD3+)-lymphocytes has been observed in group A, if compared to group B (P < 0.007), and to group C (P < 0.01), The T (CD4+)-lymphocytes were fewer in group A, than in group C (P < 0.004), and also the NK cells showed the same trend (P < 0.002). The numbers of leukocytes and monocytes increased in group A compared to group C (P < 0.01 and P < 0.004, respectively). Red cell numbers, hemoglobin and hematocrit values were lower in group A than in group B (P < 0.03, P < 0.03, P < 0.01, respectively), and also than in group C (P < 0.007, P < 0.001, P < 0.01, respectively), The results demonstrate that the alterations of the immunocompetent cells, particularly of the T-cell pool, may play an important role in the carcinogenesis of the elderly.

Aged↗

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The NTX assay in the follow-up of the osteoporotic patients: 3 years of alendronate treatment.

These studies were conducted on 38 female patients treated with alendronate (10 mg/day, per os) for 3 years, because of osteoporosis. Of these patients, 29 were in the menopausal age longer than 10 years, and the remaining nine patients were in menopausa shorter than 10 years. Urine sample were taken at the start of the treatment and every 6 months afterward for 3 years, and crosslinked N-telopeptides of type I collagen (NTx) have been measured in them by means of an ELISA technique. Bone mineral density (BMD) has been recorded at the ultradistal (UDBMD) and mediodistal (MDBMD) region of radius of the non-dominant side. Body mass index (BMI) of the subjects has also been determined each time. The baseline values of NTx varied very much, scattered in a range of 11-215 nanomoles bone collagen equivalent/millimoles creatinine (nM BCE/mM Cr), in average 59+/-46; those of UDBMD and MDBMD amounted to 258+/-63 and 587+/-112 mg/cm(2), respectively. NTx, the BMD values and the menopausal age does not correlate with cach other. Both BMD values increased almost linearly in the total study pool during the 3-years-long treatment, being 3.0-9.2 and 0.8-2.5% higher in terms of UDBMD and MDBMD, respectively. Urine NTx concentrations decreased during the same time 30-35%. It is concluded that monitoring of urine NTx levels may be very useful during antiosteoporotic treatments, because a reduction of NTx is an indicator of the slowing down of bone turnover and the bone losses, as was observed during the alendronate therapy.

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Rotational laxity after anterior cruciate ligament injury by kinematic evaluation of clinical tests.

Despite the numerous studies on anterior cruciate ligament biomechanics and clinical tests, some disagreements still exist in the literature on the role of ACL in restraining rotations and which kinematic test after ACL injuries is the most suitable to evaluate this instability. This work analyses the capability of passive clinical and stress tests to detect an ACL state quantifying rotational instability. The study was conducted on animal knees with a new protocol. We found that an internal-external stress test can give a useful indication on the ACL state when used to estimate the side to side differences while varus-valgus laxity and secondary motions in standard kinematic tests did not seem to be affected by ACL injury. The kinematic protocol performed could be used intra-operatively to quantify rotations, allowing a more accurate evaluation of knee instability to guide surgical reconstruction and improve its final outcome.

Animals↗

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Effect of 5 alpha-reduced androgens on prolactin secretion.

The effects of a 6-day treatment with 2 mg/day of testosterone, dihydrotestosterone (DHT), 5 alpha-androstan-3 alpha, 17 beta-diol (3 alpha-diol) and 5 alpha-androstan-3 beta, 17 beta-diol (3 beta-diol) on serum prolactin levels have been evaluated in long-term castrated male and female rats. The steroids were administered either in the free alcohol or in the propionated form (mono and dipropionates for the 3 alpha- and 3 beta-diols). Practically no effect of any steroid was evident in the treated male animals. DHT and 3 alpha-diol inhibited prolactin secretion in the female animals, while testosterone and 3 beta-diol remained ineffective. The data suggest a possible role of 5 alpha-reduced compounds, DHT and 3 alpha-diol in the control of prolactin secretion in females.

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Intertubular capillary changes in the cortex and medulla of transplanted kidneys and their relationship with transplant glomerulopathy: an ultrastructural study of 12 transplantectomies.

Twelve kidney allografts removed 3 to 98 months (mean, 44.8 months) after transplantation were investigated. The presence and severity of intertubular capillary changes, which were characterized by splitting and multilayering of the basement membrane, were carefully noted. These changes were graded as mild, moderate, and severe according to the number of basement membrane layers. They were found in both cortical and medullary capillaries in all but one kidney and were always associated with transplant glomerulopathy. Ultrastructural changes observed in the glomeruli and capillaries were similar, suggesting that they share the same pathogenetic mechanisms, probably connected to immune-mediated endothelial cell damage. Although glomeruli can be absent in small biopsy specimens, intertubular capillaries are easily detectable. Because capillary changes can be considered a marker of transplant glomerulopathy, which is known to have ominous prognostic significance, the identification of such changes acquires clinical relevance. Electron microscopic investigation is therefore strongly advisable whenever a renal biopsy is performed to identify transplant glomerulopathy.

Adult↗

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High prognostic impact of growth fraction parameters in advanced stage laryngeal squamous cell carcinoma.

One hundred and two cases of laryngeal squamous cell carcinoma, all treated in the same center with total or supraglottic laryngectomy, bilateral neck dissection and postoperative radiotherapy, were investigated with both Ki67 and MIB-1 monoclonal antibodies. The aim was to determine the prognostic impact of growth fraction markers in a homogeneous series of patients. All samples were stained with Ki67 monoclonal antibody on frozen sections, and with MIB-1 monoclonal antibody on paraffin sections, using the ABC immunoperoxidase method. The percentage of positive cells was compared in each case with the overall and disease-free survival, pathologic stage and histologic grading. The values obtained from Ki67 and MIB-1 counts were similar and highly correlated (r=0.90). Two groups of cases with low and high proliferation rate (59 and 43 respectively) were obtained by splitting up the whole series, on the basis of the median value; 84. 6% of the patients with high proliferation relapsed and/or died due to the tumor within two years from diagnosis whereas, at time of writing, 94% of the patients with low proliferation are alive and well (p<0.00001). No relation was found between growth fraction and histologic grading, pathologic stage (pT and pN) and site of the tumor. Only lymph node involvement was correlated with disease-free survival. Our results indicate that Ki67/MIB-1 index represents an independent variable to determine long-term prognosis in laryngeal squamous cell carcinomas. We recommend its use in diagnostic protocols, to distinguish high risk subsets of patients who might benefit from more aggressive treatments.

Adult↗

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Treatment of nonresectable hepatocellular carcinoma: review of the literature and meta-analysis.

Many doubts surround the numerous forms of nonsurgical treatment of nonresectable hepatocellular carcinoma (HCC). Our study aimed to reach reliable conclusions on the actual efficacy of these treatments. We examined 85 studies involving a total of 6746 patients: 6113 were treated; the remaining 633 were not. We applied the Mantel-Haenszel-Peto method to the extrapolated data, based on the reported 1- and 3-year survival rates. The results confirm that percutaneous ethanol injection achieved survival exceeding 5 years in many cases of HCC characterized by small nodules (diameter < 3 cm). The most efficacious nonsurgical treatment options were transcatheter arterial embolization and transcatheter arterial chemoembolization. Systemic chemotherapy and hepatic intra-arterial chemotherapy were not very effective.

Adult↗