3T diffusion tensor imaging and electroneurography of peripheral nerve: A morphofunctional analysis in carpal tunnel syndrome

Objective: The aim of the study was to assess the diagnostic potential of diffusion tensor imaging (DTI) for pathologies of the peripheral nervous system (PNS) through clinical, electrophysiological and morphological evaluation of the median nerve. Methods: The present work was a multilevel prospective study involving 30 subjects, 15 of whom had carpal tunnel syndrome (CTS) and 15 healthy controls. All subjects underwent clinical evaluation through administration of the Boston Carpal Tunnel Questionnaire (BCTQ), electroneurography (ENG), 3-Tesla magnetic resonance imaging with DTI, and calculation of fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) at the flexor retinacu, lum. Tractography was also performed for three-dimensional reconstruction of the route of the median nerve through the carpal tunnel. The degree of functional impairment was compared with the anatomical damage to the median nerve according to ENG and DTI. Results: FA and ADC were significantly correlated with ENG parameters of CTS and BCTQ data. Mean FA and ADC values in the CTS patients were 0.359 +/- 0.06 and 1.866 +/- 0.050 x 10(-3) mm(2)/s, respectively, vs 0.59 +/- 0.014 and 1.395 +/- 0.035 x 10(-3) mm2/s, respectively, in the controls. FA was decreased and ADC increased in patients with CTS compared with healthy controls (P< 0.05). Conclusion: DTI parameters were clearly confirmed by both clinical and ENG data and, therefore, may be used for the diagnosis of CTS. (c) 2013 Elsevier Masson SAS. All rights reserved

Prevenzione dell’ipotermia intraoperatorianon provocata nell’adulto

OBIETTIVI: L’ipotermia intraoperatoria, definita come una temperatura centrale (Tc) 4 ore) su pazienti adulti effettuati in una delle sale dell’AOU Policlinico di Modena. La Tc è stata misurata prima dell’induzione e dopo il risveglio dall’anestesia mediante termometro digitale auricolare e nel periodo post-induzione–pre-risveglio tramite sonda esofagea monousoconnessa al monitor di anestesia. Per la prevenzione dell’ipotermia sono stati utilizzati i dispositivi scaldaliquidi e il sistema di riscaldamento ad aria forzata, con copertura del paziente limitata al torace, agli arti superiori e al capo od estesa anche agli arti inferiori. La temperatura dell’aria è stata rilevata con un multiacquisitore microclimatico e i dati sono stati confrontati con quelli riportati nel DPR 14.1.97.RISULTATI: Prima dell’induzione e dopo il risveglio dall’anestesia, la Tc era >36°C in tutti i pazienti finora studiati. Durante l’anestesia, invece, la Tc era scesa al di sotto dei 36°C in tutti i pazienti. Nei pazienti con riscaldamento limitato alla parte superiore del corpo, rispetto a quelli con riscaldamento esteso anche alla parte inferiore, la Tc rimaneva <36°C (valore minimo più basso 34,7°C vs 35,2°C) per un periodo di tempo più lungo. I valori medi della temperatura dell’aria (21,4-21,6°C) erano all’interno del range previsto (20-24°C).CONCLUSIONI: I pazienti sono in condizioni di normotermia primadell’induzione e dopo il risveglio dall’anestesia, in linea con le più recenti raccomandazioni della letteratura. L’aumento della superficie corporea esposta al riscaldamento, con la copertura anche degli arti inferiori, assicura un migliore controllo dell’ipotermia intraoperatoria e quindi del brivido postoperatorio. L’ipotermia si verifica anche quando la temperatura dell’ariaè nella norma. È opportuno monitorare la Tc negli interventi di lunga durata e diffondere le conoscenze sull’ipotermia fra gli operatori sanitari

The Dynamic Generation of Hypertext Presentations of Medical Guidelines

Abstract We describe a project aimed at developing a tool to generate user and context-adapted textual descriptions of clinical guidelines on the World Wide Web. ARIANNA employs two knowledge sources (a decision tree and a taxonomy of concepts in the clinical domain) and schema and ATN-based NLG techniques, to dynamically generate the hypermedia. This appears to the user as a frameset with three main components: the guideline itself, the explanation of related concepts and the justification of individual steps. Each component is adapted to the user: i) the guideline is adapted to the user goal in consulting the system (tutoring vs decision support); ii) explanations of concepts are adapted to the user knowledge and to the interaction history; iii) justifications are reserved to the tutoring consultation mode.We describe a project aimed at developing a tool to generate user and context-adapted textual descriptions of clinical guidelines on the World Wide Web. ARIANNA employs two knowle..

Impact of the new 2019 EULAR/ACR classification criteria for Systemic Lupus Erythematosus in a multicenter cohort study of 133 women with undifferentiated connective tissue disease

We aimed to investigate the impact of applying the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus (SLE) in a previously described cohort of women with undifferentiated connective tissue disease (UCTD)

A multicentre study of 244 pregnancies in undifferentiated connective tissue disease: maternal/fetal outcomes and disease evolution

Objectives: To investigate fetal/perinatal and maternal outcomes from a large multicentre cohort of women diagnosed with UCTD. Methods: This multicentre retrospective cohort study describes the outcomes of 224 pregnancies in 133 consecutive women with a diagnosis of UCTD, positive for ANA and aged <45 years old at study inclusion. Results: Of the 224 pregnancies analysed, 177 (79%) resulted in live births, 45 (20.1%) in miscarriages (defined as pregnancy loss before 12 weeks' gestation), 2 (0.9%) in stillbirths (pregnancy loss after 20 weeks' gestation) and 6 (2.7%) cases showed intrauterine growth restriction. Miscarriages and stillbirths were strongly associated with the presence of aPL and ENA antibodies (P < 0.05). Maternal pregnancy complications were as follows: 5 (2.2%) cases developed pre-eclampsia, 11 (4.9%) cases gestational hypertension and 12 (5.4%) cases gestational diabetes. Joint involvement represented the most frequent clinical manifestation of the cohort (57.9%), followed by RP (40.6%), photosensitivity (32.3%) and haematological manifestations (27.1%). The rate of disease evolution of our cohort from a diagnosis of UCTD to a diagnosis of definite CTD was 12% within a mean time of 5.3 ± 2.8 years. With a total follow-up after first pregnancy of 1417 patient-years, we observed the evolution to a defined CTD in one out of every 88 patient- years. Conclusion: In our multicentre cohort, women with UCTD had a live birth rate of 79%. Women with UCTD should be referred to specialist follow-up when planning a pregnancy. ENA profiling and aPL testing should be mandatory in this setting, and further therapeutic approaches and management should be planned accordingly

Giureconsulti e giudici. L'influsso dei professori sulle sentenze, II, La dottrina nella giurisprudenza oltre i confini di spazio, giurisdizione e materia

Il volume, pubblicato nella Collana "Studi di Diritto Comparato", intitolato "La dottrina nella giurisprudenza oltre i confini di spazio, giurisdizione e materia", unitamente all'altro volume "Le prassi delle Corti e le teorie degli studiosi" (edito da Giappichelli nella Collana "Diritto privato comparato"), entrambi riuniti sotto l'unico titolo "Giureconsulti e giudici. L'influsso dei professori sulle sentenze", rappresenta il frutto di una ricerca scientifica triennale sul tema del rapporto tra dottrina e giurisprudenza delle Corti di vertice che ha coinvolto quattordici Università italiane e vari gruppi di ricerca internazionali. I saggi in essi raccolti sono stati presentati nel corso di convegni organizzati nell'ambito della ricerca presso le sedi universitarie di Napoli Federico II, Verona, Rabat (Marocco) e Torino. Come si legge nella premessa comune "i due libri sull'influsso dei professori sulla giurisprudenza delle corti di vertice testimoniano l'importanza del diritto comparato, che continua a proporsi come disciplina autonoma, vocata al ruolo di guardiano dei giudici, e attraverso di essi di custode del legislatore e di osservatore critico delle dottrine interne, che manifestino pretese di universalità". In particolare, il volume pubblicato in questa Collana include studi relativi all'influenza della dottrina sulla giurisprudenza di Corti accomunate dall'appartenenza a comuni ambiti territoriali e saggi che analizzano l'influsso dottrinario in sentenze di tribunali italiani e stranieri selezionate per materia e per rilevanza del contributo

Lymphopenia as a risk factor for neurologic involvement and organ damage accrual in patients with systemic lupus erythematosus : A multi-center observational study

Objective: Detailed analysis of hematological manifestations (HM) in systemic lupus erythematosus (SLE) are limited and their clinical impact on disease remain obscure. Here, we aimed to decipher factors associated with different hematological abnormalities in SLE patients and to assess their impact on disease related outcomes. Methods: A dataset (GIPT) originating from SLE patients of six European tertiary centers was assessed. Six-monthly visits of each patient for at least 2 years were registered. The association between hematologic manifestations (HM; per ACR-1997criteria) and clinical/serologic variables, as well as the impact of HM on disease related outcomes (damage, infection and hemorrhage) were explored. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI2K), the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) and events for any infection and hemorrhage were recorded. Results were compared with a cross-sectional, well-characterized SLE dataset from Sweden. Descriptive statistics, the generalized estimating equations (GEE), general linear models (GLM), Cox regression models were applied. Results: We monitored 1425 longitudinal visits in 286 SLE patients with HM (GIPT dataset: 88% female, 95% Caucasian, 68% dsDNA positive). Thrombocytopenia (regression coefficient [95% confidence interval] 1.86[1.1–3.13]) and neurologic involvement (ACR-8) (2.1[1.10–3.89]) were associated with lymphopenia (<1000/mm3); the latter was an independent predictor of organ damage accrual (1.68[1.2–2.62]). These associations were confirmed in an independent dataset of 1348 SLE patients (86% female, 93% Caucasian, 61% dsDNA positive) in Sweden.Severe lymphopenia (<500/mm3) and severe thrombocytopenia (<20 K/mm3) were associated with increased risk for infection (hazard ratio [95% confidence interval] 2.56[1.23–5.31]) and hemorrhage (4.38[2.10–11.1]), respectively, independent of the effect of other predictors. Conclusion: : Lymphopenia in SLE is independently associated with neurologic involvement and organ damage accrual, and thus, may be considered as a marker of severe/progressive disease

Addiction. Aspetti biologici e di ricerca

Negli ultimi anni lo studio delle dipendenze patologiche si \ue8 arricchito di numerosi contributi scientifici ma anche di osservazioni cliniche che hanno ampliato l'area di indagine sulle condotte compulsive. Obiettivo degli autori \ue8 offrire le acquisizioni pi\uf9 recenti per affrontare la sfida che le dipendenze patologiche pongono oggi al clinico e al ricercatore, allo psicofarmacologo e allo psicoterapeut