Did Going North Give Us Migraine? An Evolutionary Approach on Understanding Latitudinal Differences in Migraine Epidemiology

This commentary discusses a recent publication by evolutionary biologists with strong implications for migraine experts. The Authors showed that a gene polymorphism associated with migraine gave our ancestors an evolutionary advantage when colonizing northern, and thus colder, territories. They then highlight that the prevalence of migraine may differ among countries because of climatic adaptation. These results may prove useful in planning both epidemiological and physiological studies in the field of migraine

Response to. comment on optic nerve sheath diameter ultrasound evaluation in intensive care unit: possible role and clinical aspects in neurological critical patients' daily monitoring

Comment on "Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients' Daily Monitoring"

The objective assessment of sleep in cluster headache: State of the art and future directions

: Several lines of evidence suggest that cluster headache is related to chronobiology and sleep. Nevertheless, the nature of such a relationship is unclear. In this view, the objective evaluation of sleep in cluster headache has strong theoretical and clinical relevance. Here, we provide an in-depth narrative review of the literature on objective sleep assessment in cluster headache. We found that only a small number of studies (N = 12) focused on this topic. The key research aims were directed to assess: (a) the relationship between cluster headache and sleep breathing disorders; (b) the temporal relationship between sleep stages/events and cluster headache attacks; (c) sleep macrostructure in patients with cluster headache. No studies considered sleep microstructure. The reviewed studies are heterogeneous, conducted by a few research groups, and often characterised by relevant methodological flaws. Results are substantially inconclusive considering the main hypothesis. We outline several methodological points that should be considered for future research, and suggest that evaluating sleep microstructure, local sleep electrophysiology and actigraphic measures may strongly increase knowledge on the relationship between sleep and cluster headache

Promoting post-stroke recovery through focal or whole body vibration: criticisms and prospects from a narrative review

Objective: Several focal muscle vibration (fMV) and whole body vibration (WBV) protocols have been designed to promote brain reorganization processes in patients with stroke. However, whether fMV and WBV should be considered helpful tools to promote post-stroke recovery remains still largely unclear. Methods: We here achieve a comprehensive review of the application of fMV and WBV to promote brain reorganization processes in patients with stroke. By first discussing the putative physiological basis of fMV and WBV and then examining previous observations achieved in recent randomized controlled trials (RCT) in patients with stroke, we critically discuss possible strength and limitations of the currently available data. Results: We provide the first systematic assessment of fMV studies demonstrating some improvement in upper and lower limb functions, in patients with chronic stroke. We also confirm and expand previous considerations about the rather limited rationale for the application of current WBV protocols in patients with chronic stroke. Conclusion: Based on available information, we propose new recommendations for optimal stimulation parameters and strategies for recruitment of specific stroke populations that would more likely benefit from future fMV or WBV application, in terms of speed and amount of post-stroke functional recovery

Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile

Background: We investigated intracerebral fiber bundles using a tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI) data to verify microstructural integrity in patients with episodic (MO) and chronic migraine (CM). Methods: We performed DTI in 19 patients with MO within interictal periods, 18 patients with CM without any history of drug abuse, and 18 healthy controls (HCs) using a 3 T magnetic resonance imaging scanner. We calculated diffusion metrics, including fractional anisotropy (FA), axial diffusion (AD), radial diffusion (RD), and mean diffusion (MD). Results: TBSS revealed no significant differences in the FA, MD, RD, and AD maps between the MO and HC groups. In comparison to the HC group, the CM group exhibited widespread increased RD (bilateral superior [SCR] and posterior corona radiata [PCR], bilateral genu of the corpus callosum [CC], bilateral posterior limb of internal capsule [IC], bilateral superior longitudinal fasciculus [LF]) and MD values (tracts of the right SCR and PCR, right superior LF, and right splenium of the CC). In comparison to the MO group, the CM group showed decreased FA (bilateral SCR and PCR, bilateral body of CC, right superior LF, right forceps minor) and increased MD values (bilateral SCR and right PCR, right body of CC, right superior LF, right splenium of CC, and right posterior limb of IC). Conclusion: Our results suggest that chronic migraine can be associated with the widespread disruption of normal white matter integrity in the brain

Short-term effects of focal muscle vibration on motor recovery after acute stroke: a pilot randomized sham-controlled study

Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group–VG), while 12 underwent the sham treatment (control group–CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2–0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS (p < 0.001), Fugl-Meyer (p = 0.001), and Motricity Index (p < 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients

Tethyan magnetostratigraphy from Pizzo Mondello (Sicily) and correlation to the Late Triassic Newark astrochronological polarity time scale

We present the magnetostratigraphy and stable isotope stratigraphy from an expanded (∼430-m-thick) Upper Triassic marine limestone section at Pizzo Mondello, Sicily, and review published biostratigraphic information that can be used to define the location of the conodont Carnian-Norian and Norian-Rhaetian boundaries in this section. Pizzo Mondello offers good potential for magneto-stratigraphic correlation of marine biostratigraphic and chemostratigraphic data with the continental Newark astrochronological polarity time scale (APTS) for development of an integrated Late Triassic time scale. The relatively stable average values of δ18O centered on 0‰ are a strong indication that the Cherty Limestone at Pizzo Mondello suffered very little diagenetic overprinting. The conodont Carnian-Norian boundary is located 12.5 m above a positive shift of δ13C. A statistical approach was applied to evaluate various Pizzo Mondello to Newark magnetostratigraphic correlations. Two correlation options have the highest correlation coefficients. In option #1, the base of Pizzo Mondello correlates with the middle part of the Newark APTS, whereas in option #2, the base of Pizzo Mondello starts toward the early part of the Newark APTS. We prefer option #2 in which the Carnian-Norian boundary based on conodonts, as well as its closely associated positive δ13C shift, correspond to Newark magnetozone E7 at ca. 228–227 Ma (adopting Newark astrochronology), implying a long Norian with a duration of ∼20 m.y., and a Rhaetian of ∼6 m.y. duration. These ages are in fact not inconsistent with the few high-quality radiometric dates that are available for Late Triassic time scale calibration. Based on its good exposure, accessibility, stratigraphic thickness and continuity, and multiple chronostratigraphic correlation possibilities, we propose Pizzo Mondello as global stratigraphic section and point for the base of the Norian

Tethyan magnetostratigraphy from Pizzo Mondello (Sicily) and correlation to the Late Triassic Newark astrochronological polarity time scale

We present the magnetostratigraphy and stable isotope stratigraphy from an expanded (∼430-m-thick) Upper Triassic marine limestone section at Pizzo Mondello, Sicily, and review published biostratigraphic information that can be used to define the location of the conodont Carnian-Norian and Norian-Rhaetian boundaries in this section. Pizzo Mondello offers good potential for magneto-stratigraphic correlation of marine biostratigraphic and chemostratigraphic data with the continental Newark astrochronological polarity time scale (APTS) for development of an integrated Late Triassic time scale. The relatively stable average values of δ18O centered on 0‰ are a strong indication that the Cherty Limestone at Pizzo Mondello suffered very little diagenetic overprinting. The conodont Carnian-Norian boundary is located 12.5 m above a positive shift of δ13C. A statistical approach was applied to evaluate various Pizzo Mondello to Newark magnetostratigraphic correlations. Two correlation options have the highest correlation coefficients. In option #1, the base of Pizzo Mondello correlates with the middle part of the Newark APTS, whereas in option #2, the base of Pizzo Mondello starts toward the early part of the Newark APTS. We prefer option #2 in which the Carnian-Norian boundary based on conodonts, as well as its closely associated positive δ13C shift, correspond to Newark magnetozone E7 at ca. 228–227 Ma (adopting Newark astrochronology), implying a long Norian with a duration of ∼20 m.y., and a Rhaetian of ∼6 m.y. duration. These ages are in fact not inconsistent with the few high-quality radiometric dates that are available for Late Triassic time scale calibration. Based on its good exposure, accessibility, stratigraphic thickness and continuity, and multiple chronostratigraphic correlation possibilities, we propose Pizzo Mondello as global stratigraphic section and point for the base of the Norian

The potential impact of enhanced hygienic measures during the COVID-19 outbreak on hospital-acquired infections: A pragmatic study in neurological units

Objective: Hospital-acquired infections (HAIs) are frequent complications among acute patients hospitalized in neurological units, especially among those hospitalized for stroke. This study aimed to investigate if enhanced hygienic measures, including the systematic use of personal protective equipment (PPE), determined a decrease in HAI during the recent COVID-19 outbreak in “COVID-free” neurological units. Methods: Patients hospitalized in neurology and stroke units of Policlinico Umberto I Hospital in Rome from March 8, 2020 and discharged prior to May 31, 2020 were included in the study and compared with patients hospitalized during the same period in 2019. Results: A total of 319 patients were included in the study (n = 103 in 2020, n = 216 in 2019). Among patients hospitalized in 2019, the incidence of HAIs was 31.5% (95% confidence interval (CI): 0.25–0.38), compared with 23.3% (95% CI: 0.15–0.32) in 2020 (p = 0.12). Multivariable logistic regression showed that hospitalization during 2020 was independently associated with a lower risk of HAIs (odds ratio: 0.34, 95% CI:0.16–0.71, p = 0.004). Poisson regression models showed that hospitalization during 2020 was also independently associated with both a lower number of HAIs (relative risk [RR]: 0.56, 95% CI:0.38–0.81, p = 0.01) and a lower number of prescribed antibiotics per patient (RR: 0.66, 95% CI: 0.49–0.87, p = 0.02). Conclusion: Our study design provides evidence regarding the impact of stricter hygienic measures, such as increased PPE use, on HAIs. Larger studies are needed to support the extension of preventive measures even after the COVID-19 outbreak in order to limit the occurrence of HAIs

Performance and Reliability Analysis of Cross-Layer Optimizations of NAND Flash Controllers

NAND flash memories are becoming the predominant technology in the implementation of mass storage systems for both embedded and high-performance applications. However, when considering data and code storage in non-volatile memories (NVMs), such as NAND flash memories, reliability and performance be- come a serious concern for systems' designer. Designing NAND flash based systems based on worst-case scenarios leads to waste of resources in terms of performance, power consumption, and storage capacity. This is clearly in contrast with the request for run-time reconfigurability, adaptivity, and resource optimiza- tion in nowadays computing systems. There is a clear trend toward supporting differentiated access modes in flash memory controllers, each one setting a differentiated trade-off point in the performance-reliability optimization space. This is supported by the possibility of tuning the NAND flash memory performance, reli- ability and power consumption acting on several tuning knobs such as the flash programming algorithm and the flash error correcting code. However, to successfully exploit these degrees of freedom, it is mandatory to clearly understand the effect the combined tuning of these parameters have on the full NVM sub-system. This paper performs a comprehensive quantitative analysis of the benefits provided by the run-time reconfigurability of an MLC NAND flash controller through the combined effect of an adaptable memory programming circuitry coupled with run-time adaptation of the ECC correction capability. The full non- volatile memory (NVM) sub-system is taken into account, starting from the characterization of the low level circuitry to the effect of the adaptation on a wide set of realistic benchmarks in order to provide the readers a clear figure of the benefit this combined adaptation would provide at the system leve