Pain perception and migraine

Background: It is well-known that both inter-and intra-individual differences exist in the perception of pain; this is especially true in migraine, an elusive pain disorder of the head. Although electrophysiology and neuroimaging techniques have greatly contributed to a better understanding of the mechanisms involved in migraine during recent decades, the exact characteristics of pain threshold and pain intensity perception remain to be determined, and continue to be a matter of debate.Objective: The aim of this review is to provide a comprehensive overview of clinical, electrophysiological, and functional neuroimaging studies investigating changes during various phases of the so-called "migraine cycle" and in different migraine phenotypes, using pain threshold and pain intensity perception assessments.Methods: A systematic search for qualitative studies was conducted using search terms "migraine," "pain," "headache," "temporal summation," "quantitative sensory testing," and "threshold," alone and in combination (subject headings and keywords). The literature search was updated using the additional keywords "pain intensity," and "neuroimaging"to identify full-text papers written in English and published in peer-reviewed journals, using PubMed and Google Scholar databases. In addition, we manually searched the reference lists of all research articles and review articles.Conclusion: Consistent data indicate that pain threshold is lower during the ictal phase than during the interictal phase of migraine or healthy controls in response to pressure, cold and heat stimuli. There is evidence for preictal sub-allodynia, whereas interictal results are conflicting due to either reduced or no observed difference in pain threshold. On the other hand, despite methodological limitations, converging observations support the concept that migraine attacks may be characterized by an increased pain intensity perception, which normalizes between episodes. Nevertheless, future studies are required to longitudinally evaluate a large group of patients before and after pharmacological and non-pharmacological interventions to investigate phases of the migraine cycle, clinical parameters of disease severity and chronic medication usage

A soil non-aqueous phase liquid (NAPL) flushing laboratory experiment based on measuring the dielectric properties of soil–organic mixtures via time domain reflectometry (TDR)

Abstract. The term non-aqueous phase liquid (NAPL) refers to a group of organic compounds with scarce solubility in water. They are the products of various human activities and may be accidentally introduced into the soil system. Given their toxicity level and high mobility, NAPLs constitute a serious geo-environmental problem. Contaminant distribution in the soil and groundwater contains fundamental information for the remediation of polluted soil sites. The present research explored the possible employment of time domain reflectometry (TDR) to estimate pollutant removal in a silt-loam soil that was primarily contaminated with a corn oil as a light NAPL and then flushed with different washing solutions. Known mixtures of soil and NAPL were prepared in the laboratory to achieve soil specimens with varying pollution levels. The prepared soil samples were repacked into plastic cylinders and then placed in testing cells. Washing solutions were then injected upward into the contaminated sample, and both the quantity of remediated NAPL and the bulk dielectric permittivity of the soil sample were determined. The above data were also used to calibrate and validate a dielectric model (the α mixing model) which permits the volumetric NAPL content (θNAPL; m3 m−3) within the contaminated sample to be determined and quantified during the different decontamination stages. Our results demonstrate that during a decontamination process, the TDR device is NAPL-sensitive: the dielectric permittivity of the medium increases as the NAPL volume decreases. Moreover, decontamination progression can be monitored using a simple (one-parameter) mixing model

Spatial Economic Impacts of the TEN-T Network Extension in the Adriatic and Ionian Region

Investments in transportation infrastructure have been identified as one of the main factors to promote territorial economic growth. However, appraisal methods currently used in the planning practice do not consider spatial economic distributional effects, ignoring who within a given region would receive greater economic benefits from an investment than others (and eventually who might receive worse). In this paper, a modelling framework is proposed to assess the spatial economic impacts of transportation infrastructure investments; the method combines spatial regressions with transportation accessibility analysis, assuming Gross Domestic Product per Capita variation as a proxy of the economic growth. The application to the case study is related to the Adriatic and Ionian region, which includes both some EU (Italy, Slovenia, Croatia, and Greece) and non-EU countries (Bosnia-Herzegovina, Montenegro, Albania, North Macedonia, and Kosovo) and is characterized by huge disparities in terms of infrastructural assets. The models allow us to both statistically prove the importance of spatial modelling specifications and to forecast economic impacts that would be generated by ongoing infrastructure investment plans for the reconstruction of the road and railway networks in the region; this highlighted where current economic disparities tend to be bridged up, i.e., mainly along the foreseen extensions of the Trans-European Transport Network (TEN-T) corridors, and where not

CA19.9 Serum Level Predicts Lymph-Nodes Status in Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Single-Center Analysis

BackgroundThe choice between upfront surgery or neoadjuvant treatments (NAT) for resectable pancreatic ductal adenocarcinoma (R-PDAC) is controversial. R-PDAC with potential nodal involvement could benefit from NT. Ca (Carbohydrate antigen) 19.9 and serum albumin levels, alone or in combination, have proven their efficacy in assessing PDAC prognosis. The objective of this study was to evaluate the role of Ca 19.9 serum levels in predicting nodal status in R-PDAC.MethodsPreoperative Ca 19.9, as well as serum albumin levels, of 165 patients selected for upfront surgery have been retrospectively collected and correlated to pathological nodal status (N), resection margins status (R) and vascular resections (VR). We further performed ROC curve analysis to identify optimal Ca 19.9 cut-off for pN+, R+ and vascular resection prediction.ResultsIncreased Ca 19.9 levels in 114 PDAC patients were significantly associated with pN+ (p <0.001). This ability, confirmed in all the series by ROC curve analysis (Ca 19.9 >= 32 U/ml), was lost in the presence of hypoalbuminemia. Furthermore, Ca 19.9 at the cut off >418 U/ml was significantly associated with R+ (87% specificity, 36% sensitivity, p 0.014). Ca 19.9, at the cut-off >78 U/ml, indicated a significant trend to predict the need for VR (sensitivity 67%, specificity 53%; p = 0.059).ConclusionsIn R-PDAC with normal serum albumin levels, Ca 19.9 predicts pN+ and R+, thus suggesting a crucial role in deciding on NAT

Understanding the Evolving Nature of Novel Psychoactive Substances: Mapping 10 Years of Research

© 2023 Published by Elsevier Ltd on behalf of International Society for the Study of Emerging Drugs. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Novel psychoactive substances (NPS) is an umbrella term used to describe a heterogeneous group of compounds that mimic the effects of existing drugs and whose demand and use rapidly emerge, change, or even vanish in the drug market. The novelty of this global phenomenon and its dynamic nature represent major challenges for the scientific community that constantly requires timely evidence-based inputs. Our aim is to review the literature on NPS and compare its temporal evolution according to the topics presented at the International Conference series on NPS over the past decade. Our analysis shows that some new clusters of research recently emerged in comparison to a previous review and that the material presented at the NPS Conferences anticipates the scientific literature by approximately 2.5 years. Such findings not only provide new original insights on the latest NPS trends but also address existing knowledge gaps in the NPS field, while emphasizing the importance of face-to-face thematic events supported by faster publication processes to inform prompt interventions and policy making.Peer reviewe

Validations of new cut-offs for surgical drains management and use of computerized tomography scan after pancreatoduodenectomy: The DALCUT trial

BACKGROUND Postoperative pancreatic fistula (POPF) is the most fearful complication after pancreatic surgery and can lead to severe postoperative complications such as surgical site infections, sepsis and bleeding. A previous study which identified cut-offs of drains amylase levels (DALs) determined on postoperative day (POD) 1 and POD3, was able to significantly predict POPF, abdominal collections and biliary fistulas, when related to specific findings detected at the abdominal computerized tomography (CT) scan routinely performed on POD3. AIM To validate the cut-offs of DALs in POD1 and POD3, established during the previous study, to assess the risk of clinically relevant POPF and confirm the usefulness of abdominal CT scan on POD3 in patients at increased risk of abdominal collection. METHODS The DALCUT trial is an interventional prospective study. All patients who will undergo pancreatoduodenectomy (PD) for periampullary neoplasms will be considered eligible. All patients will receive clinical staging and, if eligible for surgery, will undergo routine preoperative evaluation. After the PD, daily DALs will be evaluated from POD1. Drains removal and possible requirement of abdominal CT scans in POD3 will be managed on the basis of the outcome of DALs in the first three postoperative days. RESULTS This prospective study could validate the role of DALs in the management of surgical drains and in assessing the risk or relevant complications after PD. Drains could be removed in POD3 in case of POD1 DALs < 666 U/L and POD3 DALs < 207 U/L. In case of POD3 DALs & GE; 252, abdominal CT scan will be performed in POD3 to identify abdominal collections & GE; 5 cm. In this latter category of patients, drains could be maintained beyond POD3. CONCLUSION The results of this trial will contribute to a better knowledge of POPF and management of surgical drains

Multi-Dimensional Cost-Effectiveness Analysis for Prioritizing Railway Station Investments: A General Framework with an Application to the Italian Case Study

In recent years, several authors have highlighted the merits of the Cost-Effectiveness Analysis (CEA), e.g., compared to Cost-Benefits Analysis (CBA), particularly for small projects appraisal (e.g., revamping or extraordinary maintenance interventions) and when the impacts of the project are difficult to value or quantify in monetary terms. CEA is a quite consolidated technique, typically applied in practice when one specific impact prevails over the others. This research extends the concept of CEA to a multi-dimensional decision-making context, outlining a methodological framework that includes several criteria to assess the impacts of railway station revamping in urban contexts. The proposed method has already been applied for the project appraisals of five railway stations in Italy; this paper presents the application to a case study representing the typical configuration of a medium-sized Italian railway station. Results have shown that the proposed approach is a valid tool for both designers and infrastructure managers for prioritizing railway station investments in the presence of multiple strategic objectives that also conflict with each other. A multi-dimensional CEA can provide, in a communicative, lean, and effective way, the information on investment costs and the impacts that different policies, layouts, and technological solutions would have, creating the basis for a more transparent debate on resource allocation priorities. Finally, results have shown that the CEA is not only a method for project assessment, but also a tool for improving and directing the design towards the identification of interventions that allow the achievement of the key objectives set ex ante

MEASUREMENT OF MACRO-SCALE INDENTATION MODULUS USING THE PRIMARY HARDNESS STANDARD MACHINES AT INRIM

In this paper it is described the experimental procedure and the statistical method for the measurement of indentation modulus by using the primary hardness standard machine at INRIM, in the macro-scale range. Indentation modulus is calculated on the basis of Doerner-Nix linear model and from accurate measurements of indentation load, displacement, contact stiffness and Vickers hardness impression imaging. Load is provided by dead-weight masses and displacement is measured by a laser-interferometric system, perpendicular with respect to the Vickers pyramid vertex. The geometrical dimension of the Diamond Pyramid Hardness (DPH) impression is measured by means of a micro-mechanical system and optical microscopy imaging technique. Applied force and indentation depth are measured simultaneously, 16 Hz of sampling rate, and the resulting indentation curve is obtained. Preliminary tests are performed on metals and alloys samples. Considerations and comments on the accuracy of the proposed method and analysis are discussed

Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy: Literature review and single center experience

BACKGROUNDThe role of preoperative inflammatory biomarkers (PIBs) in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery. However, data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy (PD) are less consistent.AIMTo assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy.METHODSA database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed. Data regarding preoperative neutrophil-to-lymphocyte ratio (NLR), derived NLR and C-reactive protein (CRP), and postoperative complications of 238 cases have been evaluated. Exclusion criteria were: age < 18-years-old, previous neoadjuvant treatment, absence of data about PIBs, concomitant hematological disorders, and presence of active infections at the moment of the surgery. PIBs were compared using Mann-Whitney's test and receiver operating characteristic (ROC) analysis was performed to define the cutoffs. The positive predictive value (PPV) was computed to evaluate the probability to develop complication. P-values < 0.05 were considered statistically significant.RESULTSAccording to the literature findings, only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity. A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula (POPF) have been reported. The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF. According to our results, CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections (P < 0.05). Notably, patients with preoperative CRP > 8.81 mg/dL were at higher risk of both overall complications and abdominal collections (respectively P = 0.0037, PPV = 0.95, negative predictive value [NPV] = 0.27 and P = 0.016, PPV = 0.59, NPV = 0.68). Preoperative derived neutrophil-to-lymphocyte ratio (dNLR) (cut off > 1.47) was also a predictor of abdominal collection (P = 0.021, PPV = 0.48, NPV = 0.71). Combining CRP and dNLR, PPV increased to 0.67. NLR (cut off > 1.65) was significantly associated with postoperative hemorrhage (P = 0.016, PPV = 0.17, NPV = 0.98).CONCLUSIONPIBs may predict complications after PD. During postoperative care, PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams