On the 'classification' of neurodegenerative disorders:discrete entities, overlap or continuum?

The traditional method of classifying neurodegenerative diseases is based on the original clinico-pathological concept supported by 'consensus' criteria and data from molecular pathological studies. This review discusses first, current problems in classification resulting from the coexistence of different classificatory schemes, the presence of disease heterogeneity and multiple pathologies, the use of 'signature' brain lesions in diagnosis, and the existence of pathological processes common to different diseases. Second, three models of neurodegenerative disease are proposed: (1) that distinct diseases exist ('discrete' model), (2) that relatively distinct diseases exist but exhibit overlapping features ('overlap' model), and (3) that distinct diseases do not exist and neurodegenerative disease is a 'continuum' in which there is continuous variation in clinical/pathological features from one case to another ('continuum' model). Third, to distinguish between models, the distribution of the most important molecular 'signature' lesions across the different diseases is reviewed. Such lesions often have poor 'fidelity', i.e., they are not unique to individual disorders but are distributed across many diseases consistent with the overlap or continuum models. Fourth, the question of whether the current classificatory system should be rejected is considered and three alternatives are proposed, viz., objective classification, classification for convenience (a 'dissection'), or analysis as a continuum.

Technology in Parkinson's disease:challenges and opportunities

The miniaturization, sophistication, proliferation, and accessibility of technologies are enabling the capture of more and previously inaccessible phenomena in Parkinson's disease (PD). However, more information has not translated into a greater understanding of disease complexity to satisfy diagnostic and therapeutic needs. Challenges include noncompatible technology platforms, the need for wide-scale and long-term deployment of sensor technology (among vulnerable elderly patients in particular), and the gap between the "big data" acquired with sensitive measurement technologies and their limited clinical application. Major opportunities could be realized if new technologies are developed as part of open-source and/or open-hardware platforms that enable multichannel data capture sensitive to the broad range of motor and nonmotor problems that characterize PD and are adaptable into self-adjusting, individualized treatment delivery systems. The International Parkinson and Movement Disorders Society Task Force on Technology is entrusted to convene engineers, clinicians, researchers, and patients to promote the development of integrated measurement and closed-loop therapeutic systems with high patient adherence that also serve to (1) encourage the adoption of clinico-pathophysiologic phenotyping and early detection of critical disease milestones, (2) enhance the tailoring of symptomatic therapy, (3) improve subgroup targeting of patients for future testing of disease-modifying treatments, and (4) identify objective biomarkers to improve the longitudinal tracking of impairments in clinical care and research. This article summarizes the work carried out by the task force toward identifying challenges and opportunities in the development of technologies with potential for improving the clinical management and the quality of life of individuals with PD. © 2016 International Parkinson and Movement Disorder Society.

Can neurodegenerative disease be defined by four 'primary determinants':anatomy, cells, molecules, and morphology?

Traditional methods of describing and classifying neurodegenerative disease are based on the clinico-pathological concept supported by molecular pathological studies and defined by 'consensus criteria'. Disease heterogeneity, overlap between disorders, and the presence of multiple co-pathologies, however, have questioned the validity and status of many traditional disorders. If cases of neurodegenerative disease are not easily classifiable into distinct entities, but more continuously distributed, then a new descriptive framework may be required. This review proposes that there are four key neuropathological features of neurodegenerative disease (the 'primary determinants') that could be used to provide such a framework, viz., the anatomical pathways affected by the disease ('anatomy'), the cell populations affected ('cells'), the molecular pathology of 'signature' pathological lesions ('molecules'), and the morphological types of neurodegeneration ('morphology'). This review first discusses the limitations of existing classificatory systems and second provides evidence that the four primary determinants could be used as axes to define all cases of neurodegenerative disease. To illustrate the methodology, the primary determinants were applied to the study of a group of closely related tauopathy cases and to heterogeneity within frontotemporal lobar degeneration with TDP-43 proteinopathy (FTLD-TDP).

Decision support based on genomics:integration of data-and knowledge-driven reasoning

The breadth and depth of available clinico-genomic information, present an enormous opportunity for improving our ability to study disease mechanisms and meet the individualised medicine needs. A difficulty occurs when the results are to be transferred 'from bench to bedside'. Diversity of methods is one of the causes, but the most critical one relates to our inability to share and jointly exploit data and tools. This paper presents a perspective on current state-of-the-art in the analysis of clinico-genomic data and its relevance to medical decision support. It is an attempt to investigate the issues related to data and knowledge integration. Copyright © 2010 Inderscience Enterprises Ltd.

Estudo da correlação das características clínico-patológicas do câncer colorretal com a expressão imunohistoquímica de proteínas da progressão tumoral

Except the non-melanoma skin tumors, colorectal cancer is the second most common in the Southeastern Region of Brazil, the third most common in the Southern and Central Regions. It is also the forth most common in the Northern Region and it is the fifth one in the Northeastern. To assess pathological and clinical variables of colorectal Cancer is crucial to know the possible conclusions for the survival of patients and point out the characteristics in the progress of tumor, such as the profile of tumor invasion and its angiogenesis. This work focuses on analyzing clinically and pathologically some settings in colorectal cancer patients (CRC) in the city of Natal and its countryside through those variables as parameters of prognosis and determine the level of protein expression, for instance: E-cadherin (E-cad), beta- -catenin (β-cat), galectin-3 (gal-3), matrix metalloproteinases (MMP) 2 and 9 and vascular-endothelial growth factor alpha (α VEGF) in the tumor tissues. A retrospective study was done in colorectal cancer cases in the regions of Rio Grande do Norte state from 1995 to 2005, specifically in Natal city/RN/Brazil. The pathological and clinical variables, such as: age, gender, ethnicity, lifestyle, family history, the location of the primary tumor, level of differentiation, TDM staging, modified Dukes’, treatment and survival were analyzed. The pathological and clinical data were collected from medical records through a specific form and were filed on Excel. A total of 534 patients were selected from the Pathology Department file in this institution, however, 176 patients were excluded. 358 patients were included for Epidemiological analysis and its clinical and pathological correlations were selected. 180 patients were also selected for histological and immunohistochemical studies. The tumor progression of these selected proteins mentioned before were analyzed. The Paraffin blocks of these samples were treated by Microarray Tissue technique and its blades subjected to immunohistochemistry to test the intensity of these proteins in tumor tissues. The results of this analysis were correlated with clinicopathologic variables of patients. Statistical analysis using the chi-frame Pearson test and analysis of midlife by Kaplan-Meier curve was also utilized. P values < 0.05 were considered statistically significant. The average age of our sample was 58.8 years and 51.7 % were female. Alcohol consumption has increased by 1.71 time the risk of death by CCR (p = 0.034) and tobacco consumption increased 2.7 times the chance of developing tumors of high TNM stage (p = 0.001). Cancer patients had a family history of 3,833 times the chance of developing the CCR (p = 0.002). The expression of MMP-2 showed a significant association with tumors of high TNM stage (p <0.046) and mortality (p = 0.041). The α VEGF expression had statistically significant correlation with high TNM stage (p <0.009), degree of cell indifferentiation (p <0.025) and mortality (p <0.035). Expressions of E-cadherin and beta-catetina demonstrated tumor linked to high TNM stage (p = 0.0001) and Dukes› modified (p = 0.05), lesions in the rectum (p = 0.03 and p = 0.007, respectively), smoking (p = 0.05) and indifferentiation (p = 0.001). The expression of Gal-3 showed statistical significance with high TNM stage of patients (p = 0.01), smokers (p = 0.01), alcohol drinking (p = 0.03), indifferentiation (p = 0.0001) and mortality (p = 0.0001). Based on the results, therefore, we could realize that lifestyle and family history had correlation in the CCR prognosis, as well as MMP-2 expression, MMP-9, VEGF alpha, E-cadherin, Beta-catenin and Galectin-3 were important prognostic markers in tumor progression in colorectal cancer.

Imunoexpressão das proteínas APE-1 e XRCC-1 em carcinoma epidermoide de língua oral

DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens present in the environment. Mutations in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. The objective of this study was to investigate the immunoexpression of APE-1 and XRCC-1, which are proteins involved in DNA base excision repair and its association with clinical and histopathological parameters in oral tongue squamous cell carcinoma (OTSCC), in order to investigate a possible prognostic value for those proteins. The expression of APE-1 and XRCC-1 was evaluated semi-quantitatively by immunohistochemistry in 50 OTSCC cases. Clinical data was collected from patients’ medical charts and histopathological grading was performed for each case. Statistical analysis (Chi-square and Fisher’s exact tests; significance of 5%) was performed to determine the association between protein expressions and clinico-pathological characteristics. APE-1 was highly expressed in nucleus and cytoplasm in 56% of cases. XRCC-1 showed overexpression only in nucleus in 60% of cases. High expression of XRCC-1 was significantly associated to clinical stages I and II (P=0.02). Both proteins were not associated to other clinical parameters or histopathological grading. Our findings demonstrate that DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in OTSCC, however, they are not related to clinical and histologic parameters, except for XRCC-1 association to better clinical staging. Our results indicate that the immunohistochemical expression of these proteins has no association with prognostic parameters in this tumor.

Imunoexpressão das proteínas APE-1 e XRCC-1 em carcinoma epidermoide de língua oral

DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens present in the environment. Mutations in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. The objective of this study was to investigate the immunoexpression of APE-1 and XRCC-1, which are proteins involved in DNA base excision repair and its association with clinical and histopathological parameters in oral tongue squamous cell carcinoma (OTSCC), in order to investigate a possible prognostic value for those proteins. The expression of APE-1 and XRCC-1 was evaluated semi-quantitatively by immunohistochemistry in 50 OTSCC cases. Clinical data was collected from patients’ medical charts and histopathological grading was performed for each case. Statistical analysis (Chi-square and Fisher’s exact tests; significance of 5%) was performed to determine the association between protein expressions and clinico-pathological characteristics. APE-1 was highly expressed in nucleus and cytoplasm in 56% of cases. XRCC-1 showed overexpression only in nucleus in 60% of cases. High expression of XRCC-1 was significantly associated to clinical stages I and II (P=0.02). Both proteins were not associated to other clinical parameters or histopathological grading. Our findings demonstrate that DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in OTSCC, however, they are not related to clinical and histologic parameters, except for XRCC-1 association to better clinical staging. Our results indicate that the immunohistochemical expression of these proteins has no association with prognostic parameters in this tumor.

Correlação da imunoexpressão do fator de choque térmico 1 (hsf1) com aspectos clinicopatológicos em carcinomas de células escamosas de língua oral

Squamous cell carcinoma of oral tongue shows high rates of morbidity and mortality in the population, therefore, great efforts are being made to classify morphological changes and identify biomarkers that have prognostic value and that are able to group patients in individualized therapeutic options. From this perspective, there is the heat shock factor 1 (HSF1), which is a heat shock factor transcription protein (HSPs) that allows the cancer to deal with stressors associated with malignancy, acting differently in tumor progression. This research aimed to perform a clinico-pathological analysis of 70 cases of oral tongue squamous cell carcinoma (OTSCC) and immunohistochemical study of the expression of HSF1 protein in OTSCC, comparing it with 30 specimens of normal oral mucosa (NOM), and correlating this immunostaining with clinico-pathological aspects of OTSCC. To analyze the association between immunoexpression of HSF1 and clinicophatoloical aspects, the cases were categorized in minor and major overexpression, based in the median immunostaining score. Regarding the cases of OTSCC, 57.1% showed clinical stage III or IV, 82.9% were graded as high grade according to Bryne (1998) and 47.1% as high risk of malignancy according to Brandwein-Gensler et al., (2005). A disease free survival rate of 47.84% and overall survival rate of 68.20% was observed in the analyzed cases, and the high degree of malignancy according to Bryne’s system (1998) (p=0.05), tumor size T3 or T4 (p=0.04), local recurrence (p=0.02), and perineural invasion (p=0.02) determined negative impacts in survival time. We observed also a statistically significant result (p<0.01) when comparing the immunoreactivity of HSF1 between NOM and OTSCC. This significantly increased expression of HSF1 in cases of OTSCC suggests that this protein acts, indeed, in the pathogenesis of this disease. However, there were no statistically significant associations between this overexpression and the clinico-pathological parameters analyzed. This finding may reflect the influence of epigenetic events on HSF1 gene or a possible stability of this protein expression throughout disease progression.

Correlação da imunoexpressão do fator de choque térmico 1 (hsf1) com aspectos clinicopatológicos em carcinomas de células escamosas de língua oral

Squamous cell carcinoma of oral tongue shows high rates of morbidity and mortality in the population, therefore, great efforts are being made to classify morphological changes and identify biomarkers that have prognostic value and that are able to group patients in individualized therapeutic options. From this perspective, there is the heat shock factor 1 (HSF1), which is a heat shock factor transcription protein (HSPs) that allows the cancer to deal with stressors associated with malignancy, acting differently in tumor progression. This research aimed to perform a clinico-pathological analysis of 70 cases of oral tongue squamous cell carcinoma (OTSCC) and immunohistochemical study of the expression of HSF1 protein in OTSCC, comparing it with 30 specimens of normal oral mucosa (NOM), and correlating this immunostaining with clinico-pathological aspects of OTSCC. To analyze the association between immunoexpression of HSF1 and clinicophatoloical aspects, the cases were categorized in minor and major overexpression, based in the median immunostaining score. Regarding the cases of OTSCC, 57.1% showed clinical stage III or IV, 82.9% were graded as high grade according to Bryne (1998) and 47.1% as high risk of malignancy according to Brandwein-Gensler et al., (2005). A disease free survival rate of 47.84% and overall survival rate of 68.20% was observed in the analyzed cases, and the high degree of malignancy according to Bryne’s system (1998) (p=0.05), tumor size T3 or T4 (p=0.04), local recurrence (p=0.02), and perineural invasion (p=0.02) determined negative impacts in survival time. We observed also a statistically significant result (p<0.01) when comparing the immunoreactivity of HSF1 between NOM and OTSCC. This significantly increased expression of HSF1 in cases of OTSCC suggests that this protein acts, indeed, in the pathogenesis of this disease. However, there were no statistically significant associations between this overexpression and the clinico-pathological parameters analyzed. This finding may reflect the influence of epigenetic events on HSF1 gene or a possible stability of this protein expression throughout disease progression.

Studio, analisi, progettazione e sviluppo di una cartella infermieristica informatizzata in un sistema informativo di reparto

La Cartella Clinica Elettronica è lo strumento d’eccellenza per la condivisione e il recupero dei dati clinici e per la gestione organica e strutturata dei dati riferiti alla storia clinica di un paziente. Garantisce il supporto dei processi clinici (diagnostico-terapeutici) e d’assistenza nei singoli episodi di cura e favorisce la continuità di cura. In questo nuovo scenario acquista rilevanza il contributo degli infermieri ai processi sanitari e al percorso diagnostico-terapeutico di competenza medica, nonché l’affermarsi del processo assistenziale di specifica competenza infermieristica. Nasce l’esigenza di progettare e sviluppare un valido sistema informativo, indispensabile per documentare sistematicamente ogni attività infermieristica, ottenere informazioni utili per la pianificazione, la gestione e la valutazione dei percorsi assistenziali e per migliorare l’assistenza. Il seguente progetto di tesi sperimentale ha come obiettivo la digitalizzazione delle documentazione infermieristica,in accordo con le esigenze del personale clinico in un ambito realmente operativo di reparto ospedaliero, al fine di realizzare uno strumento informativo semplice ma efficace, in grado di rendere agevole la registrazione dell’attività clinica quotidiana. Per iniziare la trattazione, sono forniti elementi introduttivi e propedeutici ad una comprensione più esaustiva del sistema che verrà integrato con le schede infermieristiche digitali. Si procede con la descrizione delle fasi di sviluppo che hanno portato all’informatizzazione delle schede infermieristiche, analizzando sia gli studi preliminari che gli strumenti utilizzati per la loro realizzazione. Il lavoro si conclude con la presentazione e discussione di un prototipo al personale infermieristico referente, così da mostrare al cliente l’effettiva funzionalità della cartella infermieristica e il flusso di utilizzo per avere un riscontro preliminare su leggibilità ed organicità dei documenti.

Le metodiche di Diffusion Weighted Imaging per la caratterizzazione della malattia policistica renale

La tecnica di Diffusion Weighted Imaging (DWI) si basa sullo studio del moto diffusivo delle molecole d’acqua nei tessuti biologici ed è in grado di fornire informazioni sulla struttura dei tessuti e sulla presenza di eventuali alterazioni patologiche. Il più recente sviluppo della DWI è rappresentato dal Diffusion Tensor Imaging (DTI), tecnica che permette di determinare non solo l’entità, ma anche le direzioni principali della diffusione. Negli ultimi anni, grazie ai progressi nella tecnica di risonanza magnetica, l’imaging di diffusione è stato anche applicato ad altri distretti anatomici tra cui quello renale, per sfruttarne le potenzialità diagnostiche. Tuttavia, pochi sono ancora gli studi relativi all’applicazione delle metodiche di diffusione per la valutazione della malattia policistica renale autosomica dominante (ADPKD). ADPKD è una delle malattie ereditarie più comuni ed è la principale causa genetica di insufficienza renale dell’adulto. La caratteristica principale consiste nella formazione di cisti in entrambi i reni, che progressivamente aumentano in numero e dimensioni fino a causare la perdita della funzionalità renale nella metà circa dei pazienti. Ad oggi non sono disponibili terapie capaci di arrestare o rallentare l’evoluzione di ADPKD; è possibile controllare le complicanze per evitare che costituiscano componenti peggiorative. Il lavoro di tesi nasce dalla volontà di indagare se la tecnica dell’imaging di diffusione possa essere utile per fornire informazioni sullo stato della malattia e sul suo grado di avanzamento. L’analisi di studio è concentrata sul calcolo del coefficiente di diffusione apparente (ADC), derivato dalle immagini DWI e valutato nella regione della midollare. L’obiettivo di questo lavoro è verificare se tale valore di ADC sia in grado di caratterizzare la malattia policistica renale e possa essere utilizzato in ambito clinico-diagnostico come indicatore prognostico nella progressione di questa patologia.

Analisi di 3 microdelezioni implicate nel disturbo autistico

Nella Tesi viene riportata l’analisi genetica di un campione di 128 famiglie con Disturbo dello Spettro Autistico, tramite il sistema di SNP array “PsychArray” (Illumina ), contenente oltre 500.000 sonde sull’intero genoma. Questi dati sono stati utilizzati per individuare Copy Number Variants (CNVs) rari e rilevanti da un punto di vista clinico. Sono stati quindi selezionati tre CNVs per un ulteriore approfondimento: due microdelezioni già descritte come patologiche (rispettivamente nella regione 1p36.32 e 22q13.33 comprendente il gene SHANK3) sono risultate essere “de novo”, mentre una terza microdelezione nel gene CTNNA3 è ereditata dalla madre. Tutti e tre i CNV sono stati validati tramite Real Time-PCR, definendone i confini. Per quanto riguarda la microdelezione in CTNNA3, poiché difetti di questo gene sono stati implicati nell’autismo con un meccanismo recessivo, è stata anche condotta un’analisi di sequenza di tutti gli esoni del gene negli individui della famiglia interessata, al fine di ricercare eventuali mutazioni puntiformi sull’allele non deleto. Questa analisi non ha individuato nessuna variante potenzialmente dannosa, pertanto il difetto in CTNNA3 non risulta essere la causa principale del fenotipo autistico in questa famiglia, anche se potrebbe avere un ruolo come fattore di suscettibilità.

El Otro y el yo, las porras vs. el café: soluciones de traducción para los elementos culturales en las versiones castellanas de "Las baladas del ajo", de Mo Yan

El objetivo de este trabajo es mostrar los fenómenos en las traducciones de Las baladas del ajo, de texto original chino traducido primero al inglés, y del inglés al español. Asimismo, tenemos dos objetivos específicos, por un lado estudiamos las fórmulas de traducción de los elementos culturales –muy frecuentes– detectados en Las baladas del ajo y por el otro, observamos la traducción indirecta del inglés al español a través de una comparación entre el texto original en chino, la versión en inglés y la española. Las conclusiones de este trabajo nos permiten estudiar tanto las soluciones adoptadas para los elementos culturales, así como hacer una evaluación general de la traducción de segunda mano.

In silico methods to evaluate Fracture Risk and Bone Mineral Density changes in patients undergoing Total Hip Replacement

La sostituzione totale d’anca è uno degli interventi chirurgici con le più alte percentuali di successo. Esistono due varianti di protesi d’anca che differiscono in base al metodo di ancoraggio all’osso: cementate (fissaggio tramite cemento osseo) e non cementate (fissaggio tramite forzamento). Ad oggi, i chirurghi non hanno indicazioni quantitative di supporto per la scelta fra le due tipologie di impianto, decidendo solo in base alla loro esperienza. Due delle problematiche che interessano le protesi non cementate sono la possibilità di frattura intra-operatoria durante l’inserimento forzato e il riassorbimento osseo nel periodo di tempo successivo all’intervento. A partire da rilevazioni densitometriche effettuate su immagini da TC di pazienti sottoposti a protesi d’anca non cementata, sono stati sviluppati due metodi: 1) per la valutazione del rischio di frattura intra-operatorio tramite analisi agli elementi finiti; 2) per la valutazione della variazione di densità minerale ossea (tridimensionalmente attorno alla protesi) dopo un anno dall’operazione. Un campione di 5 pazienti è stato selezionato per testare le procedure. Ciascuno dei pazienti è stato scansionato tramite TC in tre momenti differenti: una acquisita prima dell’operazione (pre-op), le altre due acquisite 24 ore (post 24h) e 1 anno dopo l’operazione (post 1y). I risultati ottenuti hanno confermato la fattibilità di entrambi i metodi, riuscendo inoltre a distinguere e a quantificare delle differenze fra i vari pazienti. La fattibilità di entrambe le metodologie suggerisce la loro possibilità di impiego in ambito clinico: 1) conoscere la stima del rischio di frattura intra-operatorio può servire come strumento di guida per il chirurgo nella scelta dell’impianto protesico ottimale; 2) conoscere la variazione di densità minerale ossea dopo un anno dall’operazione può essere utilizzato come strumento di monitoraggio post-operatorio del paziente.

Analisi del cammino di pazienti con lesione midollare

Nel trattamento e nella cura di pazienti con lesione spinale è fondamentale una corretta valutazione della lesione e delle disfunzionalità che questa produce. Il cammino è senza dubbio una delle funzionalità maggiormente ridotta a seguito di una lesione, che può portare sia ad una diminuzione di questa capacità sia ad una completa inabilità. Nella valutazione del cammino il clinico si avvale di diverse strumentazioni come sistemi stereofotogrammetrici, pedane di forza ed elettromiografi che gli permettono di svolgere un’analisi strumentale del passo ed indagare le cause muscolari e neurologiche che portano a delle anormalità nella deambulazione. Questo lavoro si propone di presentare questi sistemi e compiere una panoramica dei principali parametri cinematici (velocità del cammino, lunghezza del passo, fase di stance, angoli articolari, ciclogrammi intra-articolari) che influenzano il passo e le metodologie con più successo nel migliorarli. Inoltre verranno evidenziati i risultati ottenuti dall’analisi elettromiografica riguardo alla presenza di pattern muscolari comuni alla base del cammino riscontrabili anche in persone sane e come gli impulsi EMG siano modulabili in ampiezza e durata a seguito di training motori.