Nightmare disorder and REM sleep behavior disorder in inflammatory arthritis: Possibility beyond neurodegeneration.

OBJECTIVES:To investigate the prevalence of REM sleep behavior disorder (RBD) in patients with inflammatory arthritis (IA) to ascertain if RBD could be an internal red flag signaling a fluctuating state of inflammation based on the theory of "protoconsciousness". MATERIALS & METHODS:One hundred and three patients with a confirmed diagnosis of IA were consecutively recruited. The patients underwent general (IA activity, functional status, laboratory tests) and neurological evaluations. A neurologist investigated RBD and REM sleep parasomnias in a semi-structured interview. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while the risk of obstructive sleep apnea syndrome (OSAS) was evaluated with the Berlin questionnaire. Beck Depression Inventory II and State-Trait Anxiety Inventory investigated depression and anxiety. RESULTS:Patients had a mean age of 53.7 ± 14.6 years, 65% were women; 57.3% were in a clinically active phase of IA. Two women fulfilled ICSD-3 criteria for RBD appearing 11 years after and 20 years before IA onset respectively. 31 patients scored positive for nightmare disorder (ND), 8 for recurrent isolated sleep paralysis. 65 (63.1%) patients reported poor sleep quality and 25 (24.3%) resulted at high risk for OSAS. 32 (31.0%) patients scored positively for depression or anxiety. CONCLUSIONS:The prevalence of RBD in patients with IA did not differ from that in the general population, whereas ND presented a 2-fold increased prevalence. Whether RBD can be considered a red flag signaling an internal danger remains an open question, while ND may be a new player in this intriguing relation

Occupational Exposure to Solar UV Radiation of a Group of Fishermen Working in the Italian North Adriatic Sea

Occupational solar radiation exposure is a relevant heath risk in the fishing sector. Our aim was to provide a detailed evaluation of individual UV exposure in three different fishing activities in Italy, with personal UV dosimeters and a simple formula to calculate the fraction of ambient erythemal UV dose received by the workers. The potential individual UV exposure of the fishermen was between 65 and 542 Joules/m2. The percentages of the ambient exposure were estimated between 2.5% and 65.3%. Workers\u2019 UV exposure was mainly influenced by the characteristics of the work activity, the postures adopted, and the type of boats. Overall, our data showed that 43% of the daily measurements could result largely above the occupational limits of 1\u20131.3 standard erythemal dose (i.e., 100 Joules/m2) per day, in case of exposure of uncovered skin areas. Measurements of individual UV exposure are important not only to assess the risk but also to increase workers\u2019 perception and stimulate the adoption of preventive measures to reduce solar UV risk. Furthermore, the simple method proposed, linking ambient erythemal UV dose to the workers\u2019 exposure, can be a promising tool for a reliable assessment of the UV risk, as time series of environmental UV dose are widely availabl

Intravenous methylprednisolone pulses in hospitalised patients with severe COVID-19 pneumonia, A double-blind, randomised, placebo-controlled trial

Rationale: Pulse glucocorticoid therapy is used in hyperinflammation related to coronavirus 2019 (COVID-19). We evaluated the efficacy and safety of pulse intravenous methylprednisolone in addition to standard treatment in COVID-19 pneumonia. Methods: In this multicenter, randomised, double-blind, placebo-controlled trial, 304 hospitalised patients with Covid-19 pneumonia were randomised to receive 1 g of methylprednisolone intravenously for 3 consecutive days or placebo in addition to standard dexamethasone. The primary outcome was the duration of the patient hospitalisation, calculated as the time interval between randomisation and hospital discharge without the need of supplementary oxygen. The key secondary outcomes were survival free from invasive ventilation with orotracheal intubation and overall survival. Results: Overall, 112 of 151 (75.4%) patients in the pulse methylprednisolone arm and 111 of 150 (75.2%) in the placebo arm were discharged from hospital without oxygen within 30 days from randomisation. Median time to discharge was similar in both groups [15 days (95% confidence interval (CI), 13.0 to 17.0) and 16 days (95%CI, 13.8 to 18.2); hazard ratio (HR), 0.92; 95% CI 0.71-1.20; p=0.528]. No significant differences between pulse methylprednisolone and placebo arms were observed in terms of admission to Intensive Care Unit with orotracheal intubation or death (20.0% versus 16.1%; HR, 1.26; 95%CI, 0.74-2.16; p=0.176), or overall mortality (10.0% versus 12.2%; HR, 0.83; 95%CI, 0.42-1.64; p=0.584). Serious adverse events occurred with similar frequency in the two groups. Conclusions: Methylprenisolone pulse therapy added to dexamethasone was not of benefit in patients with COVID-19 pneumonia. Message of the study: Pulse glucocorticoid therapy is used for severe and/or life threatening immuno-inflammatory diseases. The addition of pulse glucocorticoid therapy to the standard low dose of dexamethasone scheme was not of benefit in patients with COVID-19 pneumonia

Dependence of gait parameters on height in typically developing children

In clinical gait analysis is fundamental to have access to normative data, to be used as a reference in the interpretation of pathological walking. In a paediatric population this may be complicated by the dependence of gait parameters on child growth. The aim of this work is to provide the correlations of spatial-temporal gait parameters with children’s height. We obtained the regression lines of cadence, double support, and gait phases, with respect to height, from a sample of 85 normally typically developing children aged 6 to 11. Our analysis of gait phases was not limited to the traditional analysis of stance and swing, but rather focused on the subphases of stance - heel contact, flat foot contact, push off - which proved to be an innovative approach to gait analysis. Heel contact decreased, flat foot contact increased and push off remained essentially unchanged with respect to children’s height. These results may be useful in the interpretation of gait data in developing children, and the regression lines obtained may be used to normalize their gait parameters

Gait asymmetry in Winters' group I hemiplegic children

Hemiplegia is a neurological disorder that in children is a common consequence of cerebral palsy. Hemiplegia involves one-half of the body, while the other half is typically not affected. Aim of the study was to evaluate gait asymmetry in Winters' group I hemiplegic children (W1), by identifying possible differences between hemiplegic and non-hemiplegic side in foot-floor contact and activation patterns of gastrocnemius lateralis (GL). To this aim, basographic and EMG data from 12 hemiplegic cerebral palsy children (Winters' group I) were analyzed. Gait data from 100 normal developing children were used as reference. Mean decrease (p<0.05) of normal cycles (i.e. normal sequence of gait phases HFPS) and a concomitant increase (p<0.05) of atypical cycles (PFPS) were detected in hemiplegic side of W1, with respect to both non-hemiplegic side and control group. No relevant variations of GL recruitment were observed between hemiplegic and non-hemiplegic side of W1, in terms of muscle activation patterns and occurrence frequency. In conclusion, the study suggested that gait asymmetries detected in W1 lie in foot-floor contact patterns, but not in GL recruitment

A new parameter for quantifying the variability of surface electromyographic signals during gait: The occurrence frequency

Natural variability of myoelectric activity during walking was recently analyzed considering hundreds of strides. This allowed assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides when a muscle is recruited with that specific activation modality. Aim of present study was to propose the occurrence frequency as a new parameter for assessing sEMG-signal variability during walking. Aim was addressed by processing sEMG signals acquired from Gastrocnemius Lateralis, Tibialis Anterior, Rectus Femoris and Biceps femoris in 40 healthy subjects in order to: 1) show that occurrence frequency is not correlated with ON/OFF instants (Rmean=0.11±0.07; P>0.05) and total time of activation (Rmean=0.15±0.08; P>0.05); 2) confirm the above results by two handy examples of application (analysis of gender and age) which highlighted that significant (P<0.05) gender-related and age-related differences within population were detected in occurrence frequency, but not in temporal sEMG parameters. In conclusion, present study demonstrated that occurrence frequency is able to provide further information, besides those supplied by classical temporal sEMG parameters and thus it is suitable to complement them in the evaluation of variability of myoelectric activity during walking

Dynamic knee muscle co-contraction quantified during walking

The purpose of the present study was the quantification of the co-activation patterns of the knee extensor and flexor muscles during walking at self-selected speed and cadence. To this aim, the Statistical Gait Analysis, a recent methodology providing a statistical characterization of gait, was performed on surface EMG signals from Vastus Lateralis (VL) and Medial Hamstrings (MH) in 14 healthy young adult subjects. Muscular co-contraction was assessed as the overlapping period between activation intervals of agonist and antagonist muscles. Superimpositions between VL and MH activity were detected from terminal swing to the following loading response in 100% of the considered strides. This superimposition could be intended as an actual co-contraction of VL and MH, working across the same joint, the knee. It occurs in this gait phase likely in order to assist knee extension, developing muscle tension for weight acceptance during loading response, and to control knee flexion. A further less frequent (28.9±13.6% of the strides, P<0.001) superimposition was detected in terminal stance; this superimposition, however, should not be considered a real co-contraction , because VL and MH work on different joints. These findings have the merit to provide a novel data on the variability of the reciprocal role of VL and MH during walking, allowing a deeper insight in the physiological mechanisms that regulate the knee flexion/extension

The occurrence frequency: A suitable parameter for the evaluation of the myoelectric activity during walking

Many studies have recently addressed the quantification of the natural variability of myoelectric activity during walking, considering hundreds of strides. The availability of so many strides allows assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides in which a muscle is recruited with that specific activation modality. Aim of this study is to point out the occurrence frequency as a suitable parameter for the evaluation of the variability of the myoelectric activity during walking. This goal was pursued by means of the statistical gait analysis of sEMG signal acquired from Gastrocnemius Lateralis (GL) in six healthy subjects, with different characteristics. Results show that among these six subjects relevant differences were not detected in the temporal parameters, i.e., activation onset/offset instant and activation duration. In the same subjects, the values of the occurrence frequency ranged from 3% to 74% in the different activation modalities, indicating a large variability of this parameter. These findings show that occurrence frequency is able to provide further and different information with respect to classical temporal parameters. Thus, the occurrence frequency is proposed as a suitable parameter to support the classic temporal parameters in the evaluation of variability of myoelectric activity during walking

Ankle muscles co-activation during walking: A gender comparison in adults and children

The present study aimed to evaluate possible gender-related differences in adults and children co-activation and antagonistic behavior of ankle muscles (Tibialis Anterior and Gastrocnemius) during walking. The statistical gait analysis technique, applied to a total of 40 subjects (20 children and 20 young adults), allowed the statistical description of gait, considering spatial-temporal and electromyography parameters over a large number (hundreds) of consecutive strides per subject. Co-activations were computed as the overlapping periods of muscles bursts, while antagonism occurred when no simultaneous muscular activity was detected. Outcomes showed no significant differences in temporal characteristics of coactivations in children and adults. Evaluating antagonistic and co-contraction activity in terms of number of strides where each pattern happened, i.e. their occurrence frequency, no significant differences were observed between males and females in children, while in adults group co-contraction pattern resulted significantly more recurrent in females with respect to males. Furthermore, the direct comparison between adults and children showed significant differences in the recurrence of both coactivation and antagonist pattern only for males. Results suggested a possible age-related change in males muscular recruitment during walking, which could lead to the gender differences in co-contraction activity observed in adults but not in children