Neuropeptide Y, one of the most abundant polypeptides within the nervous system, is co-stored wit... more Neuropeptide Y, one of the most abundant polypeptides within the nervous system, is co-stored with catecholamines, especially norepinephrine (NE), thus suggesting its possible involvement in pathologies characterized by a noradrenergic impairment. In Parkinson's disease (PD), as well as in multiple system atrophy (MSA), a central noradrenergic deficit has been demonstrated, and in the dementia of Alzheimer type (DAT) an impaired noradrenergic transmission has been postulated. In this study we determined CSF NE and MHPG levels in 29 PD, 15 MSA, 22 DAT patients and in 36 controls, while CSF NPY-immunoreactivity (NPY-ir) levels were measured in 10 PD, 7 MSA, 10 DAT patients and 20 controls. PD, MSA, and DAT patients showed a significant reduction in CSF NPY-ir and NE levels compared with controls, while CSF MHPG levels resulted in a reduction in only the MSA group. Furthermore, an inverse correlation between either NE or MHPG levels and the duration of the orthostatic hypotension was found in MSA patients while for DAT patients the MHPG levels were directly correlated to the severity of cognitive impairment, and inversely to the duration of illness.
Background During the last 4 years, the keystone-design fasciocutaneous island flap has become th... more Background During the last 4 years, the keystone-design fasciocutaneous island flap has become the principal form of reconstruction in our unit for primary melanoma defects of the leg distal to the knee where primary closure is not possible. Methods Data describing the primary tumor, surgical management, and outcome were collected prospectively for consecutive keystone flap cases. The study’s primary end points were complication rates and length of hospital stay. Results A total of 176 patients with new primary melanomas of the lower limb were treated over 4 years. The average Breslow thickness was 1.33 mm (range, in situ to 9.0 mm), and the average width of the defect was 3 cm. The reconstructions comprised 106 standard, 65 modified, and 5 double-opposing keystone type flaps performed from the knee to the dorsum of the foot. Complications that required further therapeutic intervention were seen in eight patients (4.6%), with only one partial flap necrosis (.6%) and one total flap loss (.6%). In this series, modification of the flap design significantly decreased the complication rate (Fisher’s exact test, P = .033). There was no increase in complications in the distal third of the leg. The procedure was performed in day-only surgery setting in almost a quarter of patients. Conclusion We present the largest series of flap reconstructions for melanoma of the leg. The keystone flap is extremely reliable, affords excellent cosmesis, and is technically straightforward to perform. At the Sydney Melanoma Unit, reconstruction after primary melanoma excision on the leg has been transformed so that skin grafts are now rarely performed.
Background: As obesity prevalence and health-care costs increase, Health Care providers must pre... more Background: As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively.Methods: Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain.Results: Mean weight changes in Counterweight attenders was −3 kg and −2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was £59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was ‘dominant’ (cost-saving) under ‘base-case scenario’, where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was £2017 where background weight gain was limited to 0.5 kg/year, and £2651 at 0.3 kg/year. Under a ‘best-case scenario’, where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained ‘dominant’ with background weight gains 1 kg, 0.5 kg or 0.3 kg/year.Conclusion: Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.
The ELDCARE study aims to investigate, at the ecological level, the relationships between socio-e... more The ELDCARE study aims to investigate, at the ecological level, the relationships between socio-economic variables and cancer survival in patients aged 65 years and over. Survival data for patients diagnosed during the period 1985-1989 and followed up to 1994 were provided by 43 European Cancer Registries in 16 countries participating in the EUROCARE 2 project. Relative survival was computed by Hakulinen's methods. Data on socio-economic factors were collected by national statistics offices for the years around 1991. Pearson's correlation was used to study the relationships between cancer survival and socio-economic factors. We selected four groups of variables. The first group included macro-economic variables (such as Gross Domestic Product, GDP; Total Health Expenditure, THE); the second, the main characteristics of national health care systems; the third, demographic factors; and the fourth, variables on labour market organisation. The countries with the largest proportions of elderly populations, in Northern and Western Europe, spent more on health than the less affluent countries of Eastern Europe. GDP was strongly related to THE but a very high variability in Computed Tomography Scanners (CTS) among countries with similar THE was observed. Indeed, those countries with THE around US 1500 dollars per capita had survival rates for breast cancer ranging from 67 to 82%. Cancer survival in elderly patients in Europe was most strongly related to GDP and THE, especially for good prognosis cancers. Survival was strongly correlated with health care technologies, particularly CTS, but not with health employment. Survival was positively correlated with proportion of married elderly people (and negatively with widowed elderly), suggesting a role played by social support in influencing the prognosis of elderly patients. These results highlight how health outcomes in the elderly are a complex phenomenon, not determined only by GDP and THE, but affected by social organisation and life habits as well as economic development conditions.
The age at which passively acquired antibodies are lost is critical to determining the optimal ag... more The age at which passively acquired antibodies are lost is critical to determining the optimal age for measles vaccination. Little is known about the influence of human immunodeficiency virus type 1 (HIV-1) infection on levels of prevaccination antibodies to measles virus. Antibodies to measles virus were measured by plaque reduction neutralization assay in HIV-1-infected, HIV-seropositive but uninfected, and HIV-seronegative Zambian infants aged 6 weeks to 9 months. Regression models were used to estimate age-specific antibody concentrations. Neutralizing antibodies to measles virus were measured in 652 plasma samples collected from 448 infants, of whom 61 (13.6%) were HIV-1 infected, 239 (53.4%) were HIV seropositive but uninfected, and 148 (33%) were HIV seronegative. The best fitting model suggests that HIV-1-infected infants have lower levels of passively acquired antibodies to measles virus at birth than do HIV-seronegative infants, but their antibody levels decrease more slowly. By 6 months of age, 91% (95% confidence interval, 83%-99%) of HIV-1-infected infants, 83% (95% confidence interval, 77%-89%) of HIV-seropositive but uninfected infants, and 58% (95% confidence interval, 51%-64%) of HIV-seronegative infants were estimated to have antibody levels that were unlikely to affect immune responses to measles vaccine (cutoff value for immune response, <50 mIU/mL). By 9 months of age, 99% of all infants had antibody levels <50 mIU/mL. Infants born to HIV-1-infected women are less likely to have passively acquired antibodies that would neutralize measles vaccine virus and, thus, have an increased risk of measles prior to the age of routine vaccination. Protection could be achieved by administration of the first dose of measles vaccine prior to 9 months of age.
The lipid composition and degree of unsaturation of fatty acids has been measured for membranes i... more The lipid composition and degree of unsaturation of fatty acids has been measured for membranes isolated from leaves of Pisum sativum grown under either summer or winter conditions. Although the lipid-class composition was not significantly changed for the two growth conditions the degree of unsaturation of the fatty acids was greater for winter than summer plants. The difference in unsaturation was evident with all lipid classes of the non-thylakoid membranes including the galactolipids of the chloroplast envelope. In contrast, both the relative amounts of lipid classes and degree of saturation were not greatly changed for summer and winter thylakoids with the exception that phosphatidylglycerol had a greater linolenic acid (18:3) content for the thylakoids of winter grown leaves. However, a striking difference was found for the total acyl lipid to chlorophyll ratio for thylakoids isolated from summer or winter plants, with the former producing a lower ratio than the latter growth conditions. The above changes in lipid composition of chloroplast membranes are discussed in terms of optimizing their functional activities under the different growth conditions.
Neuropeptide Y, one of the most abundant polypeptides within the nervous system, is co-stored wit... more Neuropeptide Y, one of the most abundant polypeptides within the nervous system, is co-stored with catecholamines, especially norepinephrine (NE), thus suggesting its possible involvement in pathologies characterized by a noradrenergic impairment. In Parkinson's disease (PD), as well as in multiple system atrophy (MSA), a central noradrenergic deficit has been demonstrated, and in the dementia of Alzheimer type (DAT) an impaired noradrenergic transmission has been postulated. In this study we determined CSF NE and MHPG levels in 29 PD, 15 MSA, 22 DAT patients and in 36 controls, while CSF NPY-immunoreactivity (NPY-ir) levels were measured in 10 PD, 7 MSA, 10 DAT patients and 20 controls. PD, MSA, and DAT patients showed a significant reduction in CSF NPY-ir and NE levels compared with controls, while CSF MHPG levels resulted in a reduction in only the MSA group. Furthermore, an inverse correlation between either NE or MHPG levels and the duration of the orthostatic hypotension was found in MSA patients while for DAT patients the MHPG levels were directly correlated to the severity of cognitive impairment, and inversely to the duration of illness.
Background During the last 4 years, the keystone-design fasciocutaneous island flap has become th... more Background During the last 4 years, the keystone-design fasciocutaneous island flap has become the principal form of reconstruction in our unit for primary melanoma defects of the leg distal to the knee where primary closure is not possible. Methods Data describing the primary tumor, surgical management, and outcome were collected prospectively for consecutive keystone flap cases. The study’s primary end points were complication rates and length of hospital stay. Results A total of 176 patients with new primary melanomas of the lower limb were treated over 4 years. The average Breslow thickness was 1.33 mm (range, in situ to 9.0 mm), and the average width of the defect was 3 cm. The reconstructions comprised 106 standard, 65 modified, and 5 double-opposing keystone type flaps performed from the knee to the dorsum of the foot. Complications that required further therapeutic intervention were seen in eight patients (4.6%), with only one partial flap necrosis (.6%) and one total flap loss (.6%). In this series, modification of the flap design significantly decreased the complication rate (Fisher’s exact test, P = .033). There was no increase in complications in the distal third of the leg. The procedure was performed in day-only surgery setting in almost a quarter of patients. Conclusion We present the largest series of flap reconstructions for melanoma of the leg. The keystone flap is extremely reliable, affords excellent cosmesis, and is technically straightforward to perform. At the Sydney Melanoma Unit, reconstruction after primary melanoma excision on the leg has been transformed so that skin grafts are now rarely performed.
Background: As obesity prevalence and health-care costs increase, Health Care providers must pre... more Background: As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively.Methods: Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain.Results: Mean weight changes in Counterweight attenders was −3 kg and −2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was £59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was ‘dominant’ (cost-saving) under ‘base-case scenario’, where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was £2017 where background weight gain was limited to 0.5 kg/year, and £2651 at 0.3 kg/year. Under a ‘best-case scenario’, where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained ‘dominant’ with background weight gains 1 kg, 0.5 kg or 0.3 kg/year.Conclusion: Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.
The ELDCARE study aims to investigate, at the ecological level, the relationships between socio-e... more The ELDCARE study aims to investigate, at the ecological level, the relationships between socio-economic variables and cancer survival in patients aged 65 years and over. Survival data for patients diagnosed during the period 1985-1989 and followed up to 1994 were provided by 43 European Cancer Registries in 16 countries participating in the EUROCARE 2 project. Relative survival was computed by Hakulinen's methods. Data on socio-economic factors were collected by national statistics offices for the years around 1991. Pearson's correlation was used to study the relationships between cancer survival and socio-economic factors. We selected four groups of variables. The first group included macro-economic variables (such as Gross Domestic Product, GDP; Total Health Expenditure, THE); the second, the main characteristics of national health care systems; the third, demographic factors; and the fourth, variables on labour market organisation. The countries with the largest proportions of elderly populations, in Northern and Western Europe, spent more on health than the less affluent countries of Eastern Europe. GDP was strongly related to THE but a very high variability in Computed Tomography Scanners (CTS) among countries with similar THE was observed. Indeed, those countries with THE around US 1500 dollars per capita had survival rates for breast cancer ranging from 67 to 82%. Cancer survival in elderly patients in Europe was most strongly related to GDP and THE, especially for good prognosis cancers. Survival was strongly correlated with health care technologies, particularly CTS, but not with health employment. Survival was positively correlated with proportion of married elderly people (and negatively with widowed elderly), suggesting a role played by social support in influencing the prognosis of elderly patients. These results highlight how health outcomes in the elderly are a complex phenomenon, not determined only by GDP and THE, but affected by social organisation and life habits as well as economic development conditions.
The age at which passively acquired antibodies are lost is critical to determining the optimal ag... more The age at which passively acquired antibodies are lost is critical to determining the optimal age for measles vaccination. Little is known about the influence of human immunodeficiency virus type 1 (HIV-1) infection on levels of prevaccination antibodies to measles virus. Antibodies to measles virus were measured by plaque reduction neutralization assay in HIV-1-infected, HIV-seropositive but uninfected, and HIV-seronegative Zambian infants aged 6 weeks to 9 months. Regression models were used to estimate age-specific antibody concentrations. Neutralizing antibodies to measles virus were measured in 652 plasma samples collected from 448 infants, of whom 61 (13.6%) were HIV-1 infected, 239 (53.4%) were HIV seropositive but uninfected, and 148 (33%) were HIV seronegative. The best fitting model suggests that HIV-1-infected infants have lower levels of passively acquired antibodies to measles virus at birth than do HIV-seronegative infants, but their antibody levels decrease more slowly. By 6 months of age, 91% (95% confidence interval, 83%-99%) of HIV-1-infected infants, 83% (95% confidence interval, 77%-89%) of HIV-seropositive but uninfected infants, and 58% (95% confidence interval, 51%-64%) of HIV-seronegative infants were estimated to have antibody levels that were unlikely to affect immune responses to measles vaccine (cutoff value for immune response, <50 mIU/mL). By 9 months of age, 99% of all infants had antibody levels <50 mIU/mL. Infants born to HIV-1-infected women are less likely to have passively acquired antibodies that would neutralize measles vaccine virus and, thus, have an increased risk of measles prior to the age of routine vaccination. Protection could be achieved by administration of the first dose of measles vaccine prior to 9 months of age.
The lipid composition and degree of unsaturation of fatty acids has been measured for membranes i... more The lipid composition and degree of unsaturation of fatty acids has been measured for membranes isolated from leaves of Pisum sativum grown under either summer or winter conditions. Although the lipid-class composition was not significantly changed for the two growth conditions the degree of unsaturation of the fatty acids was greater for winter than summer plants. The difference in unsaturation was evident with all lipid classes of the non-thylakoid membranes including the galactolipids of the chloroplast envelope. In contrast, both the relative amounts of lipid classes and degree of saturation were not greatly changed for summer and winter thylakoids with the exception that phosphatidylglycerol had a greater linolenic acid (18:3) content for the thylakoids of winter grown leaves. However, a striking difference was found for the total acyl lipid to chlorophyll ratio for thylakoids isolated from summer or winter plants, with the former producing a lower ratio than the latter growth conditions. The above changes in lipid composition of chloroplast membranes are discussed in terms of optimizing their functional activities under the different growth conditions.
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