On being a neurologist in Italy at the time of the COVID-19 outbreak

Italy is facing its fifth week of crisis due to the Coronavirus disease (COVID-19) outbreak, with affected patients and deaths near to 70,000 and 6,000, respectively,(1)numbers that are increasing every day. Whether government imposition of quarantines, travel bans, and lockdown throughout the country will have effect in the next weeks in limiting the spreading of this disease has still to be seen. Meanwhile, a great spirit of sacrifice is required to health care personnel, and authorities have to manage resource allocation to rapidly increase the number of intensive care beds to assist patients with COVID-19.(2)Although operating rooms and a number of wards have been turned into dedicated intensive units, beds and resources are hardly sufficient to satisfy the needs of so many simultaneously critically ill patients.(3,4)Notably, among infected people, about 10% are health workers, and their number is increasing, also due to the scarcity of efficacious protective measures

Ingress of Coolant Event simulation with TRACE code with accuracy evaluation and coupled DAKOTA Uncertainty Analysis

Among the Postulated Initiating Events in nuclear fusion plants, the Ingress of Coolant Event (ICE) in the Plasma Chamber is one of the main safety issues. In the present paper, the best estimate thermal-hydraulic system code TRACE, developed by USNRC, has been adopted to study the ICE, and it has been qualified based on experimental results obtained in the Integrated ICE facility at JAERI. A nodalization has been developed in the SNAP environment/architecture, using also the TRACE 3D Vessel component where multidimensional phenomena could occur. The accuracy of the code calculation has been assessed both from a qualitative and quantitative point of view. In addition, an Uncertainty Analysis (UA), with the probabilistic method to propagate the input uncertainties, has been performed to characterize the dispersion of the results. The analysis has been carried out with the DAKOTA toolkit coupled with TRACE code in the SNAP environment/architecture. Results show the adequacy of the 3D nodalization and the capability of the code to follow the transient evolution also at a very low pressure. Response correlations have been computed to characterize the correlation between the selected uncertain input parameters and the Plasma Chamber pressure

Stem cell transplantation for ischemic stroke

Background Stroke is a leading cause of morbidity and mortality worldwide, with very large healthcare and social costs, and a strong demand for alternative therapeutic approaches. Preclinical studies have shown that stem cells transplanted into the brain can lead to functional improvement. However, to date, evidence for the benefits of stem cell transplantation in people with ischemic stroke is lacking. This is the first update of the Cochrane review published in 2010. Objectives To assess the efficacy and safety of stem cell transplantation compared with control in people with ischemic stroke. Search methods We searched the Cochrane Stroke Group Trials Register (last searched August 2018), CENTRAL (last searched August 2018), MED-LINE (1966 to August 2018), Embase (1980 to August 2018), and BIOSIS (1926 to August 2018). We handsearched potentially relevant conference proceedings, screened reference lists, and searched ongoing trials and research registers (last searched August 2018). We also contacted individuals active in the field and stem cell manufacturers (last contacted August 2018). Selection criteria We included randomized controlled trials (RCTs) that recruited people with ischemic stroke, in any phase of the disease (acute, subacute or chronic), and an ischemic lesion confirmed by computerized tomography or magnetic resonance imaging scan. We included all types of stem cell transplantation, regardless of cell source (autograft, allograft, or xenograft; embryonic, fetal, or adult; from brain or other tissues), route of cell administration (systemic or local), and dosage. The primary outcome was efficacy (assessed as neurologic impairment or functional outcome) at longer term follow-up (minimum six months). Secondary outcomes included post-procedure safety outcomes (death, worsening of neurological deficit, infections, and neoplastic transformation). Data collection and analysis Two review authors independently applied the inclusion criteria, assessed trial quality and risk of bias, and extracted data. If needed, we contacted study authors for additional information. We performed random effects meta-analyses when two or more RCTs were available for any outcome. We assessed the certainty of the evidence by using the GRADE approach. Main results In this updated review, we included seven completed RCTs with 401 participants. All tested adult human non-neural stem cells; cells were transplanted during the acute, subacute, or chronic phase of ischemic stroke; administered intravenously, intra-arterially, intracerebrally, or into the lumbar subarachnoid space. Follow-up ranged from six months to seven years. Efficacy outcomes were measured with the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), or Barthel Index (BI). Safety outcomes included case fatality, and were measured at the end of the trial. Overall, stem cell transplantation was associated with a better clinical outcome when measured with the NIHSS (mean difference [MD]-1.49, 95% confidence interval [CI]-2.65 to-0.33; five studies, 319 participants; low-certainty evidence), but not with the mRS (MD-0.42, 95% CI-0.86 to 0.02; six studies, 371 participants; very low-certainty evidence), or the BI (MD 14.09, 95% CI-1.94 to 30.13; three studies, 170 participants; very low-certainty evidence). The studies in favor of stem cell transplantation had, on average, a higher risk of bias, and a sample size of 32 or fewer participants. No significant safety concerns associated with stem cell transplantation were raised with respect to death (risk ratio [RR] 0.66, 95% CI 0.39 to 1.14; six studies, participants; low-certainty evidence). We were not able to perform the sensitivity analysis according to the quality of studies, because all of them were at high risk of bias. Authors’ conclusions Overall, in participants with ischemic stroke, stem cell transplantation was associated with a reduced neurological impairment, but not with a better functional outcome. No obvious safety concerns were raised. However, these conclusions came mostly from small RCTs with high risk of bias, and the certainty of the evidence ranged from low to very low. More well-designed trials are needed

The Genetic Basis of Moyamoya Disease

Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive spontaneous bilateral occlusion of the intracranial internal cerebral arteries (ICA) and their major branches with compensatory capillary collaterals resembling a "puff of smoke" (Japanese: Moyamoya) on cerebral angiography. These pathological alterations of the vessels are called Moyamoya arteriopathy or vasculopathy and a further distinction is made between primary and secondary MMD. Clinical presentation depends on age and population, with hemorrhage and ischemic infarcts in particular leading to severe neurological dysfunction or even death. Although the diagnostic suspicion can be posed by MRA or CTA, cerebral angiography is mandatory for diagnostic confirmation. Since no therapy to limit the stenotic lesions or the development of a collateral network is available, the only treatment established so far is surgical revascularization. The pathophysiology still remains unknown. Due to the early age of onset, familial cases and the variable incidence rate between different ethnic groups, the focus was put on genetic aspects early on. Several genetic risk loci as well as individual risk genes have been reported; however, few of them could be replicated in independent series. Linkage studies revealed linkage to the 17q25 locus. Multiple studies on the association of SNPs and MMD have been conducted, mainly focussing on the endothelium, smooth muscle cells, cytokines and growth factors. A variant of the RNF213 gene was shown to be strongly associated with MMD with a founder effect in the East Asian population. Although it is unknown how mutations in the RNF213 gene, encoding for a ubiquitously expressed 591 kDa cytosolic protein, lead to clinical features of MMD, RNF213 has been confirmed as a susceptibility gene in several studies with a gene dosage-dependent clinical phenotype, allowing preventive screening and possibly the development of new therapeutic approaches. This review focuses on the genetic basis of primary MMD only

Association of phenylthiocarbamide perception with anthropometric variables and intake and liking for bitter vegetables

Phenylthiocarbamide (PTC) sensitivity, a sensory trait mediated by the bitter taste receptor 38 (TAS2R38), has been described as a promising biomarker of health status or disease risk. The aim of this cross-sectional study was to evaluate the influence of PTC phenotypes on (1) individual anthropometric and clinical history variables; (2) other basic taste recognition thresholds (RTs), and (3) the hedonic perception and habitual intake of Brassicaceae vegetables in a young adult population (18.9 ± 1.7 years old). The PTC phenotype was determined by the quantitative measure of the PTC recognition threshold (non-tasters, 24.1%; tasters, 52.3%; and super tasters, 23.6%). No significant differences in smoking habits, oral and nasal disorders, family antecedents of diseases related to metabolic syndrome, and Brassicaceae vegetable hedonic perception and consumption were found between the PTC phenotype groups. The average BMI of super-taster females and males was significantly lower compared to non-tasters. In addition, the PTC taster status was a predictor of lower scores for other basic taste RTs. Overall, the defined PTC super-taster cohort could be differentiated from the non-tasters by variables related to weight control such as BMI and sucrose RT

Juvenile moyamoya and craniosynostosis in a child with deletion 1p32p31: Expanding the clinical spectrum of 1p32p31 deletion syndrome and a review of the literature

Moyamoya angiopathy (MA) is a rare cerebrovascular disorder characterised by the progressive occlusion of the internal carotid artery. Its aetiology is uncertain, but a genetic background seems likely, given the high MA familial rate. To investigate the aetiology of craniosynostosis and juvenile moyamoya in a 14-year-old male patient, we performed an array-comparative genomic hybridisation revealing a de novo interstitial deletion of 8.5 Mb in chromosome region 1p32p31. The deletion involved 34 protein coding genes, including NF1A, whose haploinsufficiency is indicated as being mainly responsible for the 1p32-p31 chromosome deletion syndrome phenotype (OMIM 613735). Our patient also has a deleted FOXD3 of the FOX gene family of transcription factors, which plays an important role in neural crest cell growth and differentiation. As the murine FOXD3-/- model shows craniofacial anomalies and abnormal common carotid artery morphology, it can be hypothesised that FOXD3 is involved in the pathogenesis of the craniofacial and vascular defects observed in our patient. In support of our assumption, we found in the literature another patient with a syndromic form of MA who had a deletion involving another FOX gene (FOXC1). In addition to describing the clinical history of our patient, we have reviewed all of the available literature concerning other patients with a 1p32p31 deletion, including cases from the Decipher database, and we have also reviewed the genetic disorders associated with MA, which is a useful guide for the diagnosis of syndromic form of MA