a sonographic quantitative cutoff value of cerebral venous outflow in neurologic diseases a blinded study of 115 subjects

BACKGROUND AND PURPOSE: The autonomic nervous system maintains constant cerebral venous blood outflow in changing positions. Alterations in cerebral autoregulation can be revealed by postural changes at quantitative color Doppler sonography. The aim of this study was to reach an optimal cutoff value of the difference between the cerebral venous blood outflow in the supine and seated positions that can discriminate healthy controls from patients with multiple sclerosis and those with other neurologic diseases and to evaluate its specificity, sensitivity, and diagnostic accuracy. MATERIALS AND METHODS: One hundred fifteen subjects (54 with MS, 31 healthy controls, 30 with other neurologic diseases) underwent a blinded quantitative color Doppler sonography evaluation of cerebral venous blood outflow in the supine and sitting positions. An optimal difference value between the supine and sitting positions of the cerebral venous blood outflow cutoff value was sought. RESULTS: The difference value between supine and sitting positions of the cerebral venous blood outflow was ≤ 503.24 in 38/54 (70.37%) patients with MS, 9/31 (29.03%) healthy controls, and 13/30 (43.33%) subjects with other neurological diseases. A difference value between supine and sitting positions of the cerebral venous blood outflow at a 503.24 cutoff reached a sensitivity at 70.37%, a 70.96% specificity, a 80.85% positive predictive value, and a 57.89% negative predictive value; the quantitative color Doppler sonography parameters yielded significant differences. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 assessed the significant difference between MS versus other neurological diseases. CONCLUSIONS: Alteration of cerebral venous blood outflow discriminated MS versus other neurologic diseases and MS versus healthy controls. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 was statistically associated with MS

NEUROCISTICERCOSI, UNA SFIDA TERAPEUTICA

Introduzione La neurocisticercosi (NCC) è la più comune infezione elmintica del sistema nervoso centrale ed una delle principali cause di epilessia acquisita in paesi a risorse limitate. In Europa sono in aumento i casi d’importazione. Descriviamo un caso di NCC con localizzazione parenchimale ed intraventricolare in un paziente immigrato, trattato efficacemente con terapia medica. Caso Clinico. Il paziente di 64 anni, peruviano, in Italia da 6 anni, è giunto in pronto soccorso per crisi comiziale parziale. Non si rilevavano precedenti di nota nell’anamnesi. All’ingresso il paziente si presentava in discrete condizioni generali, l’esame obiettivo mostrava deficit del VII nervo cranico di sinistra. Le indagini neuroradiologiche (TC ed RMN encefalo) hanno documentato la presenza di numerose (>5) lesioni cerebrali (cistiche, nodulari e calcifiche) compatibili con NCC in diverse fasi evolutive (da segnalare anche la presenza di una cisti intraventricolare laterale sinistra). Esami ematochimici, EEG, fondo oculare, ECG, eco-addome erano nei limiti. Risultava positiva la sierologia per cisticercosi (IgG ,Western Blot), mentre erano negative quelle per per Toxoplasmosi, Tripanosoma cruzi, Strongyloides, Echinococco, HIV, HBV, HCV. L’esame coproparassitologico non mostrava la presenza di T. solium. Il neurochirugo non poneva indicazioni chirurgiche, consigliando terapia antiepilettica (Levetiracetam). Il paziente è stato sottoposto a trattamento antiparassitario (albendazolo per 30 giorni), inizialmente associato a steroide, con buona tolleranza e regressione del deficit neurologico focale. Il controllo RMN, dopo 2 mesi, mostrava riduzione volumetrica di gran parte delle lesioni cistiche, persistendo tuttavia edema perilesionale. Dopo ulteriore ciclo di trattamento antiparassitario (albendazolo 15 giorni + steroide), a distanza di 5 mesi dalla prima RMN, era evidente ulteriore riduzione dimensionale delle lesioni. Il paziente, asintomatico, è in follow-up ambulatoriale e prosegue terapia antiepilettica. Conclusione. La gestione clinica della NCC richiede un approccio multidisciplinare che include farmaci per il controllo della sintomatologia, antiinfiammatori, trattamento antiparassitario e talvolta chirurgia. Sebbene recenti tendenze indichino come trattamento di prima scelta delle cisti intraventricolari la rimozione per via neuroendoscopica, il caso descritto mostra comunque il miglioramento clinico e strumentale con terapia medica

Spinal reflex pattern to foot nociceptive stimulation in standing humans.

Ipsi- and contralateral patterns of lower limb nociceptive reflex responses were studied in 6 normal subjects in free standing position. Once the position was stabilized, only ankle extensor muscles showed consistent tonic activity while ankle flexors and knee extensors and flexors were virtually silent. Reflex responses, elicited by painful electrical stimuli to the skin of the plantar and dorsal aspect of the foot, were recorded from ipsi- and contralateral quadriceps (Q), biceps femoris (Bic), tibialis anterior (TA) and soleus (Sol) muscles. Plantar foot stimulation evoked a large excitatory response in the ipsilateral TA at about 80 ms and a smaller responses in Bic and Q at 70 ms and 110 ms, respectively. Ipsilateral excitatory effects after dorsal foot stimulation consisted of a Bic response at about 75 ms. In addition to excitatory effects, both plantar and dorsal foot stimulation evoked long-lasting suppression of ipsilateral Sol background activity starting at about 60 ms. Contralaterally, the only nociceptive effects after plantar or dorsal foot stimulation were a small excitatory response of Sol at about 85 ms. Evidence is provided that only excitatory responses were contingent upon nociceptive volley. The main mechanical effects seen after plantar stimulation were dorsiflexion of the foot without loss of heel contact with the floor; no withdrawal response of the foot followed nociceptive dorsal stimulation. Our main conclusion is that only reflex nociceptive responses serving to avoid the stimulus without conflicting with limb support function are expressed. The mechanisms reconciling nociceptive action and postural function of the lower limbs are discussed

A Sonographic Quantitative Cutoff Value of Cerebral Venous Outflow in Neurologic Diseases: A Blinded Study of 115 Subjects

BACKGROUND AND PURPOSE: The autonomic nervous system maintains constant cerebral venous blood outflow in changing positions. Alterations in cerebral autoregulation can be revealed by postural changes at quantitative color Doppler sonography. The aim of this study was to reach an optimal cutoff value of the difference between the cerebral venous blood outflow in the supine and seated positions that can discriminate healthy controls from patients with multiple sclerosis and those with other neurologic diseases and to evaluate its specificity, sensitivity, and diagnostic accuracy. MATERIALS AND METHODS: One hundred fifteen subjects (54 with MS, 31 healthy controls, 30 with other neurologic diseases) underwent a blinded quantitative color Doppler sonography evaluation of cerebral venous blood outflow in the supine and sitting positions. An optimal difference value between the supine and sitting positions of the cerebral venous blood outflow cutoff value was sought. RESULTS: The difference value between supine and sitting positions of the cerebral venous blood outflow was ≤ 503.24 in 38/54 (70.37%) patients with MS, 9/31 (29.03%) healthy controls, and 13/30 (43.33%) subjects with other neurological diseases. A difference value between supine and sitting positions of the cerebral venous blood outflow at a 503.24 cutoff reached a sensitivity at 70.37%, a 70.96% specificity, a 80.85% positive predictive value, and a 57.89% negative predictive value; the quantitative color Doppler sonography parameters yielded significant differences. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 assessed the significant difference between MS versus other neurological diseases. CONCLUSIONS: Alteration of cerebral venous blood outflow discriminated MS versus other neurologic diseases and MS versus healthy controls. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 was statistically associated with MS

Calorimeter calibration of the ComPol CubeSat gamma-ray polarimeter

ComPol is a proposed CubeSat mission dedicated to long-term study of gamma-ray polarisation of astrophysical objects. Besides spectral and timing measurements, polarisation analysis can be a powerful tool in constraining current models of the geometry, magnetic field structure and acceleration mechanisms of different astrophysical sources. The ComPol payload is a Compton telescope optimised for polarimetry and consists of a 2 layer stacked detector configuration. The top layer, the scatterer, is a Silicon Drift Detector matrix developed by the Max Planck Institute for Physics and Politecnico di Milano. The second layer is a calorimeter consisting of a CeBr scintillator read-out by silicon photo-multipliers developed at CEA Saclay. This paper presents the results of the prototype calorimeter calibration campaign, executed in March 2022 at IJCLab Orsay and simulations of the expected performance of the polarimeter using updated performance figures of the detectors

Multimodally profiling memory T cells from a tuberculosis cohort identifies cell state associations with demographics, environment and disease

Multimodal T cell profiling can enable more precise characterization of elusive cell states underlying disease. Here, we integrated single-cell RNA and surface protein data from 500,089 memory T cells to define 31 cell states from 259 individuals in a Peruvian tuberculosis (TB) progression cohort. At immune steady state >4 years after infection and disease resolution, we found that, after accounting for significant effects of age, sex, season and genetic ancestry on T cell composition, a polyfunctional type 17 helper T (TH17) cell-like effector state was reduced in abundance and function in individuals who previously progressed from Mycobacterium tuberculosis (M.tb) infection to active TB disease. These cells are capable of responding to M.tb peptides. Deconvoluting this state-uniquely identifiable with multimodal analysis-from public data demonstrated that its depletion may precede and persist beyond active disease. Our study demonstrates the power of integrative multimodal single-cell profiling to define cell states relevant to disease and other traits