Serena Micheletti

Neurofunctional dopaminergic impairment in elderly after lifetime exposure to manganese.

BACKGROUND Manganese (Mn) is an essential element that can become neurotoxic through various exposure windows over the lifespan. While there is clear evidence of Mn neurotoxicity in pediatric and adult occupational populations, little is known about effects in the elderly who may exhibit enhanced susceptibilities due to compromised physiology compared to younger adults. In the province of Brescia, Italy, the Valcamonica area has been the site of three ferroalloy plants operating from 1902 to 2001. Metal emissions of Mn and to a lesser extent lead (Pb) have impacted the surrounding environment, where a high prevalence of Parkinsonism was previously observed. This study aimed to assess neurocognitive and motor functions in healthy elderly subjects residing for most of their lifetime in Valcamonica or in a reference area unimpacted by ferroalloy plant activity. METHODS Subjects were enrolled for extensive neurobehavioral assessment of motor, cognitive and sensory functions. Exposure was assessed with 24h personal air sampling for PM10 airborne particles, surface soil and tap water measurement at individual households, Mn levels in blood and urine and Pb in blood. Dose-response relationships between exposure indicators and biomarkers and health outcomes were analyzed with generalized (linear and logistic) additive models (GAM). RESULTS A total of 255 subjects (55% women) were examined; most (52.9%) were within the 65-70 years age class. Average airborne Mn was 26.41 ng/m(3) (median 18.42) in Valcamonica and 20.96 ng/m(3) (median 17.62) in the reference area. Average Mn in surface soil was 1026 ppm (median 923) in Valcamonica and 421 ppm (median 410) in the reference area. Manganese in drinking water was below the LDL of 1 μg/L. The GAM analysis showed significant association between airborne Mn (p=0.0237) and the motor coordination tests of the Luria Nebraska Neuropsychological Battery. The calculation of the Benchmark Dose using this dose-response relationship yielded a lower level confidence interval of 22.7 ng/m(3) (median 26.4). For the odor identification score of the Sniffin Stick test, an association was observed with soil Mn (p=0.0006) and with a significant interaction with blood Pb (p=0.0856). Significant dose-responses resulted also for the Ravens Colored Progressive Matrices with the distance from exposure point source (p=0.0025) and Mn in soil (p=0.09), and for the Trail Making test, with urinary Mn (p=0.0074). Serum prolactin (PRL) levels were associated with air (p=0.061) and urinary (p=0.003) Mn, and with blood Pb (p=0.0303). In most of these associations age played a significant role as an effect modifier. CONCLUSION Lifelong exposure to Mn was significantly associated with changes in odor discrimination, motor coordination, cognitive abilities and serum PRL levels. These effects are consistent with the hypothesis of a specific mechanism of toxicity of Mn on the dopaminergic system. Lead co-exposure, even at very low levels, can further enhance Mn toxicity.

White matter changes associated with cognitive visual dysfunctions in children with cerebral palsy: A diffusion tensor imaging study

Children with cerebral palsy often present with cognitive‐visual dysfunctions characterized by visuo‐perceptual and/or visuo‐spatial deficits associated with a malfunctioning of visual‐associative areas.

Music reduces pain perception in healthy newborns: A comparison between different music tracks and recoded heartbeat

OBJECTIVES To assess the effect of 3 musical interventions, as compared to no music, on the physiological response of healthy newborns undergoing painful medical procedures (Guthrie test and/or intramuscular antibiotic injections). METHODS Prospective study of 80 full-term newborns, aged 1 to 3 days, randomly allocated to exposure to Mozarts Sonata for two pianos K.448, Beethovens Moonlight Sonata, heartbeat sound recordings (70 bpm) or no music. Pain perception (evaluated using the Neonatal Infant Pain Scale), heart rate and oxygen saturation were measured 10 min before (T0), during (T1), 10 (T2) and 20 (T3) minutes after the interventions. RESULTS Infants who were exposed to the three music interventions displayed a significant reduction in heart rate and in pain perception and an increase in oxygen saturation, as compared to the control group, which showed less modifications on stress measurements after painful medical procedures (F(3,76) = 6.40, p = .001, partial η2 = 0.20). CONCLUSIONS Exposure to music and heartbeat sound recordings changes short-term physiological parameters in healthy newborns undergoing potentially painful procedures. The similar effect shown by the 3 interventions might be explained by the common characteristics of the sound shared by the various tracks. Further research is needed to investigate the impact of different types of music used in intervention, in order to develop guidelines and include music as a part of evidence-based strategies to promote the outcome for neonates.

I disturbi delle funzioni oculomotorie in età evolutiva

La metodologia che vogliamo proporre, sia per quanto riguarda la valutazione che, quindi, la formulazione di un’ipotesi diagnostica, fondamentale momento per impostare un mirato progetto di intervento, non puo prescindere dal riconoscere l’importanza di un adeguato sviluppo delle funzioni oculomotorie. Iniziare a osservare come un bambino utilizza lo sguardo, se sa fissare l’interlocutore, se e presente la condivisione di sguardo e la condivisione dell’oggetto (triangolazione), cosa che implica la capacita di attenzione visiva, e un momento fondamentale per iniziare a comprendere il comportamento del bambino stesso. Nei casi di DSL e, in particolare, in quei casi in cui vi e una seria componente disprattica, spesso si rischia di giungere a delle ipotesi diagnostiche errate (ad esempio, definizioni di DGS e inclusione del caso nello spettro autistico) proprio per evidenti difficolta del bambino di sostenere lo sguardo sull’interlocutore e/o sugli oggetti che fanno parte del suo mondo. Riteniamo quindi che sviluppare questi concetti sia di prioritaria importanza ai fini di comprendere i disturbi in generale dello sviluppo e, in particolare, i DSL nelle diverse accezioni che verranno quindi definite.