Sudden unexpected death in epilepsy and ictal asystole in patients with autoimmune encephalitis: a systematic review

Objective: As autoimmune encephalitis (AE) often involves the mesial temporal structures which are known to be involved in both sudden unexpected death in epilepsy (SUDEP) and ictal asystole (IA), it may represent a good model to study the physiopathology of these phenomena. Herein, we systematically reviewed the occurrence of SUDEP and IA in AE. Methods: We searched 4 databases (MEDLINE, Scopus, Embase, and Web of Science) for studies published between database inception and December 20, 2022, according to the PRISMA guidelines. We selected articles reporting cases of definite/probable/possible/near-SUDEP or IA in patients with possible/definite AE, or with histopathological signs of AE. Results: Of 230 records assessed, we included 11 cases: 7 SUDEP/near-SUDEP and 4 IA. All patients with IA were female. The median age at AE onset was 30 years (range: 15–65), and the median delay between AE onset and SUDEP was 11 months; 0.9 months for IA. All the patients presented new-onset seizures, and 10/11 also manifested psychiatric, cognitive, or amnesic disorders. In patients with SUDEP, 2/7 were antibody-positive (1 anti-LGI1, 1 anti-GABABR); all IA cases were antibody-positive (3 anti-NMDAR, 1 anti-GAD65). Six patients received steroid bolus, 3 intravenous immunoglobulin, and 3 plasmapheresis. A pacemaker was implanted in 3 patients with IA. The 6 survivors improved after treatment. Discussion: SUDEP and IA can be linked to AE, suggesting a role of the limbic system in their pathogenesis. IA tends to manifest in female patients with temporal lobe seizures early in AE, highlighting the importance of early diagnosis and treatment

What is life? A perspective of the mathematical kinetic theory of active particles

The modeling of living systems composed of many interacting entities is treated in this paper with the aim of describing their collective behaviors. The mathematical approach is developed within the general framework of the kinetic theory of active particles. The presentation is in three parts. First, we derive the mathematical tools, subsequently, we show how the method can be applied to a number of case studies related to well defined living systems, and finally, we look ahead to research perspectives

Groundwater modeling of the withdrawal sustainability of Cannara artesian aquifer (Umbria-Italy)

L\u2019acquifero di Cannara (Umbria, Italia) \ue8 noto da oltre un secolo ed \ue8 uno dei principali punti di approvvigionamento di acqua potabile nella Regione Umbria. All'inizio veniva utilizzato per scopi irrigui, poich\ue9 quest'area era prevalentemente agricola fino agli anni '60. Le acque sotterranee, sfruttate da Umbra Acque S.p.A. (Societ\ue0 che fornisce l\u2019acqua potabile), sono a 150 m al di sotto il livello del suolo e sono contenute in un acquifero poroso confinato, che in origine aveva caratteristiche artesiane. Lo sfruttamento di 200-300 l/s con nove pozzi ha causato una riduzione del livello piezometrico, mantenendo le condizioni di acquifero confinato, ad eccezione di un periodo molto breve durante il quale la falda \ue8 stata depressurizzata in seguito alla siccit\ue0 e per l'aumento dei prelievi di emergenza in sostituzione di altri rifornimenti idrici potabili (da sorgenti). La presenza occasionale di ioni ferro e ammonio conferma il confinamento delle acque sotterranee la loro facies idrochimica in un ambiente redox, mentre nelle aree vicine e negli acquiferi superficiali si registrano contaminanti antropogenici (nitrati e solventi clorurati). Per la protezione di queste acque sotterranee di interesse strategico (il pi\uf9 importante campo pozzi in Umbria), sono stati rivisti tutti i dati idrologici e idrochimici disponibili e studiata la ricarica dell'acquifero. Le aliquote di prelievi idrici sostenibili e le aree di salvaguardia delle acque sotterranee sono state identificate utilizzando un modello numerico di flusso. Sono state proposte ulteriori azioni per monitorare le acque sotterranee negli acquiferi superficiale e artesiano, insieme ad una sistemazione dei pozzi esistenti.The Cannara aquifer (Umbria, Italy) has been known for more than a century, and is one of the main drinking water supplies in the Umbria Region. In the beginning it was used for irrigation purposes, since this area was mainly agricultural up to the 1960s. The groundwater\u2014exploited by Umbra Acque S.p.A. (a Company supplying drinking water)\u2014is 150 m under ground level and is contained in a porous confined aquifer, which originally had artesian characteristics. Exploitation of 200\u2013300 l/s with nine wells caused a reduction of piezometric level, maintaining the confined aquifer conditions, except for a very short period during which the aquifer was depressurised by drought, and for increase of emergency withdrawals replacing other water supplies (from springs) for drinking purposes. The occasional presence of iron and ammonium ions confirms the confinement of the groundwater and their hydrochemical facies in a redox environment, while in nearby areas and shallow aquifers anthropogenic contaminants (nitrates and chlorinated solvents) are reported. For the protection of this aquifer of strategic interest (the most important well field in Umbria), all hydrological and hydrochemical data available have been reviewed, and the aquifer recharge studied. Sustainable rates of withdrawal, and groundwater protection areas have been identified using a numerical flow model. Further action for monitoring groundwater of both shallow and artesian aquifers, together with well-revamping, have been proposed

In Patients with Established RA, Positive Effects of a Randomised Three Month WBV Therapy Intervention on Functional Ability, Bone Mineral Density and Fatigue Are Sustained for up to Six Months

Functional ability is often impaired for people with rheumatoid arthritis (RA), rendering these patients highly sedentary. Additionally, patients with RA often take medication known to negatively affect bone mass. Thus improving functional ability and bone health in this group of patients is important. The aim of this study was to investigate the effects of whole body vibration (WBV) therapy in patients with stable, established RA. Thirty one females with RA were randomly assigned to a control group (CON, n = 15) who continued with their normal activities or a WBV group (n = 16) who underwent a three month WBV therapy intervention, consisting of 15 minutes of intermittent vibration, performed twice per week. Patients were assessed at baseline, three months, and three months post intervention for functional ability using the modified Health Assessment Questionnaire; for RA disease activity using the Clinical Disease Activity Index, for quality of life using self-report fatigue and pain scores; for physical activity profiles using accelerometry, and for BMD and body composition using DXA. Patients in both groups were matched for all variables at baseline. After the intervention period, functional ability was significantly improved in the WBV group (1.22(0.19) to 0.92(0.19), p = 0.02). Hip BMD was significantly reduced in the CON group (0.97(0.05) to 0.84(0.05) g.cm-2, p = 0.01), while no decreases were seen in the WBV group (1.01(0.05) to 0.94(0.05) g.cm-2, p = 0.50). Despite no change in RA disease activity in either group at either follow up, fatigue levels were improved in the WBV group (4.4(0.63) to 1.1(0.65), yet remained unchanged in the CON group at both follow ups (p = 0.01). Ten minute bouts of light to moderate physical activity were significantly reduced in the CON group after the intervention (2.8(0.61) to 1.8(0.64) bouts per day, p = 0.01), and were preserved in the WBV group (3.1(0.59) to 3.0(0.61) bouts per day, p = 0.70). Intermittent WBV shows promise for sustained improvements in functional ability, for attenuating loss of bone mass at the hip, as well as for decreasing fatigue in patients with established RA. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201405000823418

Dietary factors associated with metabolic syndrome in Brazilian adults

<p>Abstract</p> <p>Background</p> <p>Metabolic Syndrome (MS) is defined as the association of numerous factors that increase cardiovascular risk and diet is one of the main factors related to increase the MS in the population. This study aimed to evaluate the association of diet on the presence of MS in an adult population sample.</p> <p>Methodology</p> <p>305 adults were clinically screened to participate in a lifestyle modification program. Anthropometric assessments included waist circumference (WC), body fat and calculated BMI (kg/m²) and muscle-mass index (MMI kg/m²). Dietary intake was estimated by 24 h dietary recall. Fasting blood was used for biochemical analysis. MS was diagnosed using NCEP-ATPIII (2001) criteria with adaptation for glucose (≥ 100 mg/dL). Logistic regression (Odds ratio) was performed in order to determine the odds ratio for developing MS according to dietary intake.</p> <p>Results</p> <p>An adequate intake of fruits, OR = 0.52 (CI:0.28-0.98), and an intake of more than 8 different items in the diet (variety), OR = 0.31 (CI:0.12-0.79) showed to be a protective factor against a diagnosis of MS. Saturated fat intake greater than 10% of total caloric value represented a risk for MS diagnosis, OR = 2.0 (1.04-3.84).</p> <p>Conclusion</p> <p>Regarding the dietary aspect, a risk factor for MS was higher intake of saturated fat, and protective factors were high diet variety and adequate fruit intake.</p

High plasma uric acid concentration: causes and consequences

High plasma uric acid (UA) is a precipitating factor for gout and renal calculi as well as a strong risk factor for Metabolic Syndrome and cardiovascular disease. The main causes for higher plasma UA are either lower excretion, higher synthesis or both. Higher waist circumference and the BMI are associated with higher insulin resistance and leptin production, and both reduce uric acid excretion. The synthesis of fatty acids (tryglicerides) in the liver is associated with the de novo synthesis of purine, accelerating UA production. The role played by diet on hyperuricemia has not yet been fully clarified, but high intake of fructose-rich industrialized food and high alcohol intake (particularly beer) seem to influence uricemia. It is not known whether UA would be a causal factor or an antioxidant protective response. Most authors do not consider the UA as a risk factor, but presenting antioxidant function. UA contributes to > 50% of the antioxidant capacity of the blood. There is still no consensus if UA is a protective or a risk factor, however, it seems that acute elevation is a protective factor, whereas chronic elevation a risk for disease

Quorum Sensing Signaling Molecules Produced by Reference and Emerging Soft-Rot Bacteria (Dickeya and Pectobacterium spp.)

International audienceBACKGROUND: Several small diffusible molecules are involved in bacterial quorum sensing and virulence. The production of autoinducers-1 and -2, quinolone, indole and γ-amino butyrate signaling molecules was investigated in a set of soft-rot bacteria belonging to six Dickeya or Pectobacterium species including recent or emerging potato isolates. METHODOLOGY/PRINCIPAL FINDINGS: Using bacterial biosensors, immunoassay, and chromatographic analysis, we showed that soft-rot bacteria have the common ability to produce transiently during their exponential phase of growth the N-3-oxo-hexanoyl- or the N-3-oxo-octanoyl-l-homoserine lactones and a molecule of the autoinducer-2 family. Dickeya spp. produced in addition the indole-3-acetic acid in tryptophan-rich conditions. All these signaling molecules have been identified for the first time in the novel Dickeya solani species. In contrast, quinolone and γ-amino butyrate signals were not identified and the corresponding synthases are not present in the available genomes of soft-rot bacteria. To determine if the variations of signal production according to growth phase could result from expression modifications of the corresponding synthase gene, the respective mRNA levels were estimated by reverse transcriptase-PCR. While the N-acyl-homoserine lactone production is systematically correlated to the synthase expression, that of the autoinducer-2 follows the expression of an enzyme upstream in the activated methyl cycle and providing its precursor, rather than the expression of its own synthase. CONCLUSIONS/SIGNIFICANCE: Despite sharing the S-adenosylmethionine precursor, no strong link was detected between the production kinetics or metabolic pathways of autoinducers-1 and -2. In contrast, the signaling pathway of autoinducer-2 seems to be switched off by the indole-3-acetic acid pathway under tryptophan control. It therefore appears that the two genera of soft-rot bacteria have similarities but also differences in the mechanisms of communication via the diffusible molecules. Our results designate autoinducer-1 lactones as the main targets for a global biocontrol of soft-rot bacteria communications, including those of emerging isolates