Trigeminal sensory pathway function in patients with SUNCT

[IF 2.64] Objective: Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a rare primary headache whose origins are unclear. To seek information on its pathophysiology, we studied the trigeminal Ab and Ad pathways by recording trigeminal reflexes and laser evoked potentials (LEPs) in patients with SUNCT. Methods: Trigeminal reflexes and LEPs were recorded in 11 consecutive patients. Ten patients had neuroimaging evidence documenting idiopathic SUNCT and one had a posterior fossa tumour that compressed the trigeminal nerve thus causing symptomatic SUNCT. Results: Whereas the patients with idiopathic SUNCT had normal trigeminal reflex and LEP responses, the patient with symptomatic SUNCT had abnormal responses. Conclusions: Our neurophysiological findings show that idiopathic SUNCT spares the trigeminal sensory pathways whereas symptomatic SUNCT does not. Significance: Neurophysiological testing can easily differentiate the idiopathic and symptomatic forms of SUNCT. It also suggests that the two forms are pathophysiologically distinct entities

Noninvasive vagus nerve stimulation as acute therapy for migraine. The randomized PRESTO study

Objective: To evaluate the efficacy, safety, and tolerability of noninvasive vagus nerve stimulation (nVNS; gammaCore; electroCore, LLC, Basking Ridge, NJ) for the acute treatment of migraine in a multicenter, double-blind, randomized, sham-controlled trial. Methods: A total of 248 participants with episodic migraine with/without aura were randomized to receive nVNS or sham within 20 minutes from pain onset. Participants were to repeat treatment if pain had not improved in 15 minutes. Results: nVNS (n = 120) was superior to sham (n = 123) for pain freedom at 30 minutes (12.7% vs 4.2%; p = 0.012) and 60 minutes (21.0% vs 10.0%; p = 0.023) but not at 120 minutes (30.4% vs 19.7%; p = 0.067; primary endpoint; logistic regression) after the first treated attack. A post hoc repeatedmeasures test provided further insight into the therapeutic benefit of nVNS through 30, 60, and 120 minutes (odds ratio 2.3; 95% confidence interval 1.2, 4.4; p = 0.012). nVNS demonstrated benefits across other endpoints including pain relief at 120minutes and was safe and well-tolerated. Conclusion: This randomized sham-controlled trial supports the abortive efficacy of nVNS as early as 30 minutes and up to 60 minutes after an attack. Findings also suggest effective pain relief, tolerability, and practicality of nVNS for the acute treatment of episodic migraine

Development of multi-use platforms at sea:Barriers to realising Blue Growth

The recent H2020 Blue Growth projects MARIBE and MUSES investigated the potential of a variety of different combinations of economic activities in co-location or integrated in multi-use platforms. Both projects identified barriers - including regulatory, financing, liability and insurance issues; environmental concerns; stakeholder perceptions; and lack of appropriate skills – that hamper the development of multi-use platforms. The H2020 MARIBE project concluded that further funding for multi-use demonstrations should be provided to increase investor confidence and bring multi-use through the so-called Valley of Death. The H2020 MUSES project concluded that multi-use needs to be proactively facilitated and incentivised through public regulatory bodies and respective support programmes. This paper combines and analyses results from both projects in order to identify key research gaps and actions required for the continued development of multi-use platforms, based on a structured critical review of available peer-reviewed literature on the topic as well as reports of both the MUSES and MARIBE projects. Research gaps and actions are analysed based on a multi-use platform typology to inform developers, policy makers, academia and investors for future development of multi-use at sea

Integrated Zoning for Aquaculture and Biodiversity using a Spatial Decision-Support Tool

Spatial decision-support tools can guide decision-makers towards knowledge-based spatial planning. Their application for multiple-objective zoning is beneficial for supporting the on-going Maritime Spatial Planning (MSP) process, in particular in areas of high density of uses like the Adriatic-Ionian region (AIR). In this work, we give contribution to the sustainable development of the aquaculture, as one of the main maritime activities for sustainable Blue Growth in the AIR. Aquaculture expansion should occur alongside the protection of biodiversity and the conservation of sites where aquaculture and its synergic uses can coexist. Planning for these objectives independently from one another has been shown to produce inefficiencies in costs, area, and conflicts across sectors. The objective of this research is to operationalize multi-objective zoning for aquaculture expansion and biodiversity protection (seabed habitats, marine mammals, seabirds and turtles species distribution, nursery and spawning areas of commercially important fish species). The area of analyses is the coastal area of the Emilia Romagna Region (Italian Northern Adriatic Sea). This area is the main producer of mussels in Italy and it is currently intensively crowded by several maritime uses, which are expected to grow over next years resulting in increase of conflicts and pressures on sensitive environments (Natura 2000 sites; Biological Protection zone). The decision support tool Marxan and its advanced version Marxan with Zones were applied to develop planning scenarios. Firstly, we prioritise biodiversity conservation, through Marxan, while minimizing conflicts with other anthropic uses. Secondly, we carry out an aquaculture suitability analysis using a multicriteria evaluation approach based on environmental, biological and socio-economic conditions. Next, we simultaneously prioritize both aquaculture and biodiversity, through Marxan with Zones, while minimizing impacts on seven other industries operating in the Emilia Romagna Region. We discuss an integrated zoning plan that meets targets for multiple objectives, and which adheres to several constraints regarding the location of aquaculture farms offshore in order to both allow the use of bigger technologies for mussel catch and minimize the impacts on coastal environments (pollution impact, visual impact). Our analysis can guide multiple stakeholders and decision-makers towards cost-efficient solutions that are scientifically based, thus contributing to the marine spatial planning process and sustainable growth in the Adriatic-Ionian region

Prevalence and time course of post-stroke pain: A multicenter prospective hospital-based study

OBJECTIVE: Pain prevalence data for patients at various stages after stroke. DESIGN: Repeated cross-sectional, observational epidemiological study. SETTING: Hospital-based multicenter study. SUBJECTS: Four hundred forty-three prospectively enrolled stroke survivors. METHODS: All patients underwent bedside clinical examination. The different types of post-stroke pain (central post-stroke pain, musculoskeletal pains, shoulder pain, spasticity-related pain, and headache) were diagnosed with widely accepted criteria during the acute, subacute, and chronic stroke stages. Differences among the three stages were analyzed with χ(2)-tests. RESULTS: The mean overall prevalence of pain was 29.56% (14.06% in the acute, 42.73% in the subacute, and 31.90% in the chronic post-stroke stage). Time course differed significantly according to the various pain types (P < 0.001). The prevalence of musculoskeletal and shoulder pain was higher in the subacute and chronic than in the acute stages after stroke; the prevalence of spasticity-related pain peaked in the chronic stage. Conversely, headache manifested in the acute post-stroke stage. The prevalence of central post-stroke pain was higher in the subacute and chronic than in the acute post-stroke stage. Fewer than 25% of the patients with central post-stroke pain received drug treatment. CONCLUSIONS: Pain after stroke is more frequent in the subacute and chronic phase than in the acute phase, but it is still largely undertreated

Tools4MSP: an open source software package to support Maritime Spatial Planning

This paper presents the Tools4MSP software package, a Python-based Free and Open Source Software (FOSS) for geospatial analysis in support of Maritime Spatial Planning (MSP) and marine environmental management. The suite was initially developed within the ADRIPLAN data portal, that has been recently upgraded into the Tools4MSP Geoplatform (data.tools4msp.eu), an integrated web platform that supports MSP through the application of different tools, e.g., collaborative geospatial modelling of cumulative effects assessment (CEA) and marine use conflict (MUC) analysis. The package can be used as stand-alone library or as collaborative webtool, providing user-friendly interfaces appropriate to decision-makers, regional authorities, academics and MSP stakeholders. An effective MSP-oriented integrated system of web-based software, users and services is proposed. It includes four components: the "jats:italic"Tools4MSP Geoplatform"/jats:italic" for interoperable and collaborative sharing of geospatial datasets and for MSP-oriented analysis, the "jats:italic"Tools4MSP package as stand-alone library"/jats:italic" for advanced geospatial and statistical analysis, the "jats:italic"desktop applications"/jats:italic" to simplify data curation and the "jats:italic"third party data repositories"/jats:italic" for multidisciplinary and multilevel geospatial datasets integration. The paper presents an application example of the Tools4MSP GeoNode plugin and an example of Tools4MSP stand-alone library for CEA in the Adriatic Sea. The Tools4MSP and the developed software have been released as FOSS under the GPL 3 license and are currently under further development. Document type: Articl

Ecosystem-Based MSP for Enhanced Fisheries Sustainability: An Example from the Northern Adriatic (Chioggia\u2014Venice and Rovigo, Italy)

Human pressures on marine ecosystems significantly increased during last decades. Among the intense anthropic activities, industrial fisheries have caused the alteration of habitats, the reduction of biodiversity and the main fish stocks. The aim of this research, carried out in the Adriatic Sea, was to test a repeatable Marine Spatial Planning framework aimed at enhancing fisheries sustainability through the application of Decision Support Tools and the composition of a catalog of possible measures. The use of these tools proved very useful to identify possible criticalities and facilitate an effective exchange with fisheries stakeholders, local authorities, and fishermen, whose involvement was an indispensable step in the process. Tool-based analyses allowed to assess the spatial footprint of a range of anthropogenic pressures from human activities (e.g., fisheries, maritime traffic, and aquaculture). Within this multi-pressure scenario, special attention was paid to fishing-related disturbances and potential conflicts across different fishing m\ue9tier and with other sectors. Specifically, results highlighted the spatial features of the major fishing pressures (e.g., abrasion from trawling) affecting essential fish habitats, marine mammals and turtles in the study area. A portfolio of possible management measures is identified for the study area. It provides clear evidence that, in order to mitigate emerging conflicts and cumulative impacts, it is necessary to combine and integrate different types of measures: spatial measures modulated over time, monitoring and control, actions to fill knowledge gaps, concertation\u2014involvement\u2014co-management actions, improvement of governance systems, actions to support innovation in the sector, etc. Given the complex set of measures discussed, this work can provide a useful contribution to the management of fisheries both at local and regional level, fostering the transition to sustainable fisheries

Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting

This study sought to evaluate the feasibility and early outcomes of a percutaneous edge-to-edge repair approach for mitral valve regurgitation with the MitraClip((R)) system (Evalve, Inc., Menlo Park, CA, USA).Patients were selected for the procedure based on the consensus of a multidisciplinary team. The primary efficacy endpoint was acute device success defined as clip placement with reduction of mitral regurgitation to &lt; 2+. The primary acute safety endpoint was 30-day freedom from major adverse events, defined as the composite of death, myocardial infarction, non-elective cardiac surgery for adverse events, renal failure, transfusion of &gt; 2 units of blood, ventilation for &gt; 48 h, deep wound infection, septicaemia, and new onset of atrial fibrillation. Thirty-one patients (median age 71, male 81%) were treated between August 2008 and July 2009. Eighteen patients (58%) presented with functional disease and 13 patients (42%) presented with organic degenerative disease. A clip was successfully implanted in 19 patients (61%) and two clips in 12 patients (39%). The median device implantation time was 80 min. At 30 days, there was an intra-procedural cardiac tamponade and a non-cardiac death, resulting in a primary safety endpoint of 93.6% [95% confidence interval (CI) 77.2-98.9]. Acute device success was observed in 96.8% of patients (95% CI 81.5-99.8). Compared with baseline, left ventricular diameters, diastolic left ventricular volume, diastolic annular septal-lateral dimension, and mitral valve area significantly diminished at 30 days.Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favourable short-term safety and efficacy results

Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO)

Abstract One hundred nine patients with hematologic malignancies, undergoing bone marrow transplants (BMT) from unrelated donors, were randomized in 2 consecutive trials to receive or not to receive antithymocyte globulin (ATG) in the conditioning regimen, as follows: (A) 54 patients (median age, 28 years; 39% with advanced disease) were randomized to no ATG (n = 25) versus 7.5 mg/kg rabbit ATG (Thymoglobulin; Sangstat, Lyon, France) (n = 29) ; (B) 55 patients (median age, 31 years, 71% with advanced disease) were randomized to no ATG (n = 28) versus 15 mg/kg rabbit ATG (n = 27). Grade III-IV graft-versus-host disease (GVHD) was diagnosed in 36% versus 41% (P = .8) in the first and in 50% versus 11% (P = .001) in the second trial. Transplant-related mortality (TRM), relapse, and actuarial 3-year survival rates were comparable in both trials. In fact, despite the reduction of GVHD in the second trial, a higher risk for lethal infections (30% vs 7%; P = .02) was seen in the arm given 15 mg/kg ATG. Extensive chronic GVHD developed overall more frequently in patients given no ATG (62% vs 39%;P = .04), as confirmed by multivariate analysis (P = .03). Time to 50 × 109/L platelets was comparable in the first trial (21 vs 24 days; P = .3) and delayed in the ATG arm in the second trial (23 vs 38 days;P = .02). These trials suggest that (1) 15 mg/kg ATG before BMT significantly reduces the risk for grade III-IV acute GVHD, (2) this does not translate to a reduction in TRM because of the increased risk for infections, and (3) though survival is unchanged, extensive chronic GVHD is significantly reduced in patients receiving ATG