Contribution of ultrasound in the assessment of nerve diseases

Background and purpose:  Recently, ultrasound (US) has been used to assess the peripheral nervous system; however, there is no real study about its possible significant role in routine practice. Our study aims to assess the contribution of US as a routine tool in a neurophysiological laboratory. Methods:  The study assesses 130 patients who presented clinical suspicion of peripheral nerve diseases, excluding motor neuron disease, radiculopathy, hereditary and acquired polyneuropathy. All patients were clinically, neurophysiologically and sonographically assessed in the same session by the same neurologist/neurophysiologist. To avoid interpretation bias, two independent and blinded clinicians, different than the examiners performing electrodiagnosis and US, reviewed clinical, neurophysiological and US findings (also data about follow-up, when available) and classified the contribution of US as follows: Contributive (US had influence on the diagnostic and therapeutic strategies), Confirming (US confirmed the clinical and neurophysiological diagnosis), Non-Confirming (US findings were normal) and Incorrect (US findings led to incorrect diagnosis). Results:  US impacted, namely modified the diagnostic and therapeutic path in 42.3% of cases (55 patients); US had a confirmatory role in 40% (52 patients); US did not confirm clinical and neurophysiological diagnosis in 17.7% (23 cases); no incorrect US findings were observed. Conclusion:  US complements neurophysiological assessment even in routine practice, and this confirms the increasing interest in US for a multidimensional evaluation of peripheral nerve system disease

The missing GeV {\gamma}-ray binary: Searching for HESS J0632+057 with Fermi-LAT

The very high energy (VHE; >100 GeV) source HESS J0632+057 has been recently confirmed as a \gamma-ray binary, a subclass of the high mass X-ray binary (HMXB) population, through the detection of an orbital period of 321 days. We performed a deep search for the emission of HESS J0632+057 in the GeV energy range using data from the Fermi Large Area Telescope (LAT). The analysis was challenging due to the source being located in close proximity to the bright \gamma-ray pulsar PSR J0633+0632 and lying in a crowded region of the Galactic plane where there is prominent diffuse emission. We formulated a Bayesian block algorithm adapted to work with weighted photon counts, in order to define the off-pulse phases of PSR J0633+0632. A detailed spectral-spatial model of a 5 deg circular region centred on the known location of HESS J0632+057 was generated to accurately model the LAT data. No significant emission from the location of HESS J0632+057 was detected in the 0.1-100 GeV energy range integrating over ~3.5 years of data; with a 95% flux upper limit of F_{0.1-100 GeV} < 3 x 10-8 ph cm-2 s-1. A search for emission over different phases of the orbit also yielded no significant detection. A search for source emission on shorter timescales (days--months) did not yield any significant detections. We also report the results of a search for radio pulsations using the 100-m Green Bank Telescope (GBT). No periodic signals or individual dispersed bursts of a likely astronomical origin were detected. We estimated the flux density limit of < 90/40 \mu Jy at 2/9 GHz. The LAT flux upper limits combined with the detection of HESS J0632+057 in the 136-400 TeV energy band by the MAGIC collaboration imply that the VHE spectrum must turn over at energies <136 GeV placing constraints on any theoretical models invoked to explain the \gamma-ray emission.Comment: 11 pages, 4 figures, accepted for publication in Monthly Notices of the Royal Astronomical Society (MNRAS) Main Journa

Exploring risk of falls and dynamic unbalance in cerebellar ataxia by inertial sensor assessment

Background. Patients suffering from cerebellar ataxia have extremely variable gait kinematic features. We investigated whether and how wearable inertial sensors can describe the gait kinematic features among ataxic patients. Methods. We enrolled 17 patients and 16 matched control subjects. We acquired data by means of an inertial sensor attached to an ergonomic belt around pelvis, which was connected to a portable computer via Bluetooth. Recordings of all the patients were obtained during overground walking. From the accelerometric data, we obtained the harmonic ratio (HR), i.e., a measure of the acceleration patterns, smoothness and rhythm, and the step length coefficient of variation (CV), which evaluates the variability of the gait cycle. Results. Compared to controls, patients had a lower HR, meaning a less harmonic and rhythmic acceleration pattern of the trunk, and a higher step length CV, indicating a more variable step length. Both HR and step length CV showed a high effect size in distinguishing patients and controls (p &lt; 0.001 and p = 0.011, respectively). A positive correlation was found between the step length CV and both the number of falls (R = 0.672; p = 0.003) and the clinical severity (ICARS: R = 0.494; p = 0.044; SARA: R = 0.680; p = 0.003). Conclusion. These findings demonstrate that the use of inertial sensors is effective in evaluating gait and balance impairment among ataxic patients

Broad band X-ray spectra of short bursts from SGR 1900+14

We report on the X-ray spectral properties of 10 short bursts from SGR1900+14 observed with the Narrow Field Instruments onboard BeppoSAX in the hours following the intermediate flare of 2001 April 18. Burst durations are typically shorter than 1 s, and often show significant temporal structure on time scales as short as $\sim$10 ms. Burst spectra from the MECS and PDS instruments were fit across an energy range from 1.5 to above 100 keV. We fit several spectral models and assumed Nh values smaller than 5$\times 10^{22}$ cm$^{-2}$, as derived from observations in the persistent emission. Our results show that the widely used optically thin thermal bremsstrahlung law provides acceptable spectral fits for energies higher than 15 keV, but severely overestimated the flux at lower energies. Similar behavior had been observed several years ago in short bursts from SGR 1806-20, suggesting that the rollover of the spectrum at low energies is a universal property of this class of sources. Alternative spectral models - such as two blackbodies or a cut-off power law - provide significantly better fits to the broad band spectral data, and show that all the ten bursts have spectra consistent with the same spectral shape.Comment: Accepted for Publication in The Astrophysical Journa

INTEGRAL observations of the gamma-ray binary 1FGL J1018.6-5856

The Fermi-LAT collaboration has recently reported that one of their detected sources, namely, 1FGL J1018.6-5856, is a new gamma-ray binary similar to LS 5039. This has prompted efforts to study its multi-frequency behavior. In this report, we present the results from 5.78-Ms INTEGRAL IBIS/ISGRI observations on the source 1FGL J1018.6-5856. By combining all the available INTEGRAL data, a detection is made at a significance level of 5.4 sigma in the 18-40 keV band, with an average intensity of 0.074 counts/s . However, we find that, there is non-statistical noise in the image that effectively reduces the significance to about 4 sigma and a significant part of the signal appears to be located in a 0.2-wide phase region, at phases 0.4-0.6 (where even the corrected significance amounts to 90% of the total signal found). Given the scarcity of counts, a variability is hinted at about 3 sigma at the hard X-rays, with an anti-correlation with the Fermi-LAT periodicity. Should this behavior be true, it would be similar to that found in LS 5039, and prompt observations with TeV telescopes at phases anti-correlated with the GeV maximum.Comment: Accepted for publication in Astrophysical Journal Letters; 6 pages, 1 figur