Lidia Ricci

Interleukin-18 modulation in autism spectrum disorders

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disease which affects 1 in 88 children. Its etiology remains basically unknown, but it is apparent that neuroinflammation is involved in disease development. Great attention has been focused on pro-inflammatory cytokines, and several studies have reported their dysfunction unbalance in serum as well as in the brain. The present work aimed at evaluating putative dysregulation of interleukin-18 (IL-18), a pro-inflammatory cytokine of the IL-1 family in the sera of patients with ASD of different grades, compared to healthy controls, as well as in postmortem brain samples obtained from patients with tuberous sclerosis as well as acute inflammatory diseases. Moreover, quantitative analysis of IL-18 was performed in the sera and brain obtained from Reeler mice, an experimental model of autism.MethodsSerum IL-18 levels were measured by ELISA. IL-18 was localized by immunohistochemical analysis in brain sections obtained from tuberous sclerosis and encephalitis patients, as well as from gender- and age-matched controls, and in the brain sections of both Reeler and wild-type mice. IL-18 was also quantified by Western blots in homogenates of Reeler and wild-type mice brains. IL-18 binding protein (IL-18BP) was evaluated in Reeler and wild-type mice plasma as well as in their brains (sections and homogenates).ResultsIL-18 content decreased in the sera of patients with autism compared to healthy subjects and in Reeler sera compared to wild-type controls. IL-18 was detected within glial cells and neurons in the brain of subjects affected by tuberous sclerosis and encephalitis whereas in healthy subjects, only a weak IL-18 positivity was detected at the level of glial cells. Western blot identified higher amounts of IL-18 in Reeler brain homogenates compared to wild-type littermates. IL-18BP was expressed in higher amounts in Reeler brain compared to the brain of wild-type mice, whereas no significant difference was detected comparing IL-18BP plasma levels.ConclusionsIL-18 is dysregulated in ASD patients. Further studies seemed necessary to clarify the molecular details behind IL-18 increase in the brain and IL-18 decrease in the sera of patients. An increase in the size of the patient cohort seems necessary to ascertain whether decreased IL-18 content in the sera can become a predictive biomarker of ASD and whether its measure, in combination with other markers (e.g., increased levels of brain-derived neurotrophic factor (BDNF)), may be included in a diagnostic panel.

Quality of life in dementia sufferers: diet and exercise in an evaluatory role.

BACKGROUND Among the myriad of factors modulating quality of life assessments estimated in patients presenting a variety of cognitive impairments, the distinctive and critical influence of diet and exercise cannot be overestimated. OBJECTIVE The objective of this study was to review the evidence to confirm the association between these health-endowering agents and cognitive performance in People With Dementia as well as providing a correlation between Mini Mental State Examination scores and available anthropometric data. METHODS The authors tested the hypothesized correlation on a sample of subjects with instrumentally confirmed cognitive impairment using parameters as Body Mass Index and calf circumference. RESULTS The results confirm the hypothesis and suggesting the possible use of anthropometric data in the process of objective evaluation of the patient with cognitive impairment that could also be used for forensic medicine.

The Portal Hypertensive Gastropathy: A Case and Review of Literature.

Upper gastrointestinal bleeding is a cause of high risk for morbidity and mortality. It has been debated in alcoholic cirrhosis, if alcohol exerts an exclusive and causal role upon gastropathy or whether it is linked to cirrhotic portal hypertension. The authors describe an autopsy report regarding mortality caused by gastric bleeding in a 53-year-old patient who suffered from cirrhosis. Literature has evidence of direct, marked damage of alcohol upon the gastric mucosa and there is noteworthy statistical data implying the revaluation of the pathogenesis of the bleeding.

Medico Legal Consideration in Postmortem Diagnostic of Intracranial Haemorrhage.

The forensic diagnosis of traumatic or non-traumatic death in intracranial haemorrhage is difficult in putrefactive status. It needs a careful analysis and accurate description of all the variables (intra and extracranial). Postmortem imaging with Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) is emerging as an effective technique to augment forensic autopsy, especially if combined [1], but expected findings on postmortem imaging of the brain may mimic pathologic processes in the living brain, leading to potential misdiagnosis [2]. The cerebral haemorrhage is an accumulation of blood in the intracranial side. It can be epidural if there is blood between the skull and the dura mater, subdural if between the dura mater and the arachnoid, subarachnoid if between arachnoid and the brain, or finally, intracerebral if intra parenchymal. Intraparenchymal cerebral haemorrhage can be further distinguished by the lobar location (frontal, temporal, parietal, occipital) or intraventricular (if there is a collection of blood in the cerebral ventricles) [3]. The location is very important for the diagnosis of establishing the nature of the haemorrhage. Subdural and epidural bleeding is most often traumatic, while a subarachnoid haemorrhage or intraparenchymal, when isolated and not associated with other signs such as bruises and lacerations of the brain can be non traumatic haemorrhage (aneurysmal and non-aneurysmal hypertensive) [4]. The autopsy diagnosis requires a careful study of the brain and intracranial structures, with a meticulous description of the individual components. But the diagnosis of the nature of a cerebral haemorrhage, which is important in order to distinguish whether it is a natural or traumatic death, is complicated in the putrefactive status due to the changes that makes the macroscopic study of the organ completely unusable. During the opening of the skull the tenacious adhesion of the dura mater to the inner surface of the cranial vault significantly affects the study of the membrane [Table/Fig-1]. [Table/Fig-1]: Aspect of the brain after opening the skull. The adhesions and the reduced consistency makes it difficult to distinguish the individual structures The parenchyma appears in an altered appearance and it is possible to hypothesize the haemorrhagic nature of the disease solely on the basis of red aspect of the content. In these cases, for recognizing the traumatic nature of death, beyond the study of other organs such as the heart for identifying disorders that may be associated with hypertension [5,6], it is fundamental to find signs of blunt skull injuries, as broken bones, and soft tissues blood infiltration. However, in absence of both these marks it is necessary to exclude the action of compressive forces in the formation of intracerebral haemorrhage. The absence of fractures may be particularly due to the elasticity of the bone and their ability to bend without fracturing, it is imperative to consider intracranial haemorrhage due to acceleration forces of traumatic origin and, therefore, of a forensic importance.

Quality of life in chemotherapy

The Quality of Life (QoL) is a complex concept and it depends on many variables. It can be defined as the judgment of a specific personal situation in reference to a determined period of time, and it depends on the mental or physical state, and by the system of values of the person. The QoL related to health is defined as “the value assigned to duration of life as modified by the impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy” [1]. In the past, many authors have studied QoL of chronic pathologies of the oncologic patients with particular attention to distress. In 1999, distress was defined by the National Comprehensive Cancer Network as “a

Head trauma with clinical and medical legal interest

In clinical and legal cases some injuries found in living patient or dead body can give rise to difficulties of interpretation regarding the nature of the legally relevant formation mechanism. A field of study that offers often this issue is the brain hemorrhage that it could be traumatic or no traumatic. The authors propose a narrative review of the literature that enables us to recognize in the analysis of the kind of bleeding or type of associated lesions, useful and updated support tools for settlement of the case in question.

Learning Disability and Medico-Legal Implications

Learning Disability is a pediatric disorder of reading, writing or arithmetic skills. When it’s no secondary to known diseases (called Not Otherwise Specified) as autism, epilepsy or genetic pathologies, it causes many diagnostic difficulties. Especially if as in Italy the diagnosis involves the provision of benefits, also economic benefits. The available diagnostic instruments should have a sensible and specific diagnostic to win the simulation risk of siymptomps and for this reason a greater interest of research in this field is desiderable.