The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®).

Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson's disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients' needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to

Successful Deep Brain Stimulation Surgery Using Remifentanil Sedation in a Noncompliant Patient With Holmes Tremor

Holmes tremor is characterized by irregular resting, postural and intention tremors. Deep brain stimulation (DBS) is an effective treatment. A 34-year-old man with Holmes tremor, secondary to head trauma, became agitated during DBS performed under local anesthesia. Remifentanil 0.03 µg/kg/min provided effective sedation and DBS was safety and successful performed. J Curr Surg. 2015;5(4):207-208 doi: http://dx.doi.org/10.14740/jcs288

Sperm quality improvement after natural anti-oxidant treatment of asthenoteratospermic men with leukocytospermia

Aim: To study the immune-modulating and anti-oxidant effects of beta-glucan, papaya, lactoferrin, and vitamins C and E on sperm characteristics of patients with asthenoteratozoospermia associated with leucocytosis. Methods: Fifty-one patients referred to our Sterility Center for semen analysis were selected. Sperm parameters were assessed before and after patient's treatment with beta-glucan, lactoferrin, papaya, and vitamins C and E. DNA damage was assessed by the acridine orange test and sperm structural characteristics were evaluated by transmission electron microscopy. Results: After 90 days of treatment, an increase in the percentage of morphologically normal sperm (17.0 ± 5.2 vs. 29.8 ± 6.5) and total progressive motility (19.0 ± 7.8 vs. 34.8 ± 6.8) were detected. Structural sperm characteristics as well as chromatin integrity were also improved after treatment. In terms of leukocyte concentration in seminal fluid, a significant reduction was recorded (2.2 ± 0.9 vs. 0.9 ± 0.2). Conclusion: The treatment of an inflammatory process by the synergic action of immune modulators and anti-oxidants could protect sperm during maturation and migration, leading to improved sperm function

Expression of selected genes related to energy mobilization and insulin resistance in dairy cows

The physiological and metabolic adaptation characterizing the transition period in the dairy cows is developed by a complex modulation of different metabolic pathways as well as the expression of selected tissue-specific gene. The aim of this study was to evaluate the age effect on expression of selected genes in adipose, hepatic and muscle tissues in dairy cows during their dry period using the quantitative Real Time Polymerase Chain Reaction (qRT-PCR). Twenty-two pluriparous dairy cows were divided into 3 groups in relation to the age: Group A (38 \uc2\ub1 2 months); Group B (52 \uc2\ub1 2 months) and Group C (80 \uc2\ub1 8 months). Lower levels of peroxisome proliferator-activated receptor gamma (PPARG) and higher levels of adiponectin (ADIPOQ) were found in adipose tissue in Group C than Groups A and B (P < 0.05). Higher levels of solute carrier family 2/facilitated glucose transporter member 4 (SLC2A4) were found in muscle in Group C than Group A (P < 0.001) and Group B (P < 0.05). The present study showed in dairy cows that the expression of selected genes associated with mobilization of energy and with insulin resistance are influenced by age demonstrating and highlighting the importance of a genomics approach to assess the metabolic status of dairy cows during the transition period

Glucose infusion response on some metabolic parameters in dairy cows during transition period

Abstract. The aim of this study was to evaluate the effect of glucose tolerance test (GTT) on glucose, insulin, non-esterified fatty acids (NEFA) and β-Hydroxybutyrate (BHB) concentration in dairy cows during prepartum and postpartum period. Forty Two clinically healthy Holstein cows were enrolled in two high producing dairy farms in the Northeast Italy. All animals were divided into two equal groups on the basis of the farm of origin: Group A (farm located in Vicenza) and Group B (farm located in Padua). Body condition score (BCS) was determined for both groups. GTT was performed 7 ± 5 days before and 7 ± 5 days after calving. Blood samples were collected from each animal before (T0) and after the administration of glucose at different times. Plasma concentration of glucose, insulin, NEFA and BHB was evaluated. Application of two way analysis of variance (ANOVA) showed no significant effect of farm and a significant effect of transition period (prepartum and postpartum) on BCS for both groups. Multivariate analysis of variance (MANOVA) was applied to determine significant effects of infusion glucose time, transition period and farm on glucose, insulin, NEFA and BHB. No significant difference was observed between Groups A and B and a significant effect of transi tion period and glucose infusion was found on all parameters studied. Results confirm that glucose is an important direct controller of metabolic response in dairy cows during the transition period because of the inappropriate energetic supply that characterizing this physiological phases

Changes in Corticospinal Circuits During Premovement Facilitation in Physiological Conditions.

Changes in corticospinal excitability have been well documented in the preparatory period before movement, however, their mechanisms and physiological role have not been entirely elucidated. We aimed to investigate the functional changes of excitatory corticospinal circuits during a reaction time (RT) motor task (thumb abduction) in healthy subjects (HS). 26 HS received single pulse transcranial magnetic stimulation (TMS) over the primary motor cortex (M1). After a visual go signal, we calculated RT and delivered TMS at three intervals (50, 100, and 150 ms) within RT and before movement onset, recording motor evoked potentials (MEP) from the abductor pollicis brevis (APB) and the task-irrelevant abductor digiti minimi (ADM). We found that TMS increased MEPAPB amplitude when delivered at 150, 100, and 50 ms before movement onset, demonstrating the occurrence of premovement facilitation (PMF). MEP increase was greater at the shorter interval (MEP50) and restricted to APB (no significant effects were detected recording from ADM). We also reported time-dependent changes of the RT and a TMS side-dependent effect on MEP amplitude (greater on the dominant side). In conclusion, we here report changes of RT and side-dependent, selective and facilitatory effects on the MEPAPB amplitude when TMS is delivered before movement onset (PMF), supporting the role of excitatory corticospinal mechanisms at the basis of the selective PMF of the target muscle during the RT protocol

La misurazione della corruzione attraverso le sentenze della magistratura: una proposta metodologica con strumenti di text mining

The definition of the methods of measurement of corruption is a central topic in the scientific debate and in multilateral contexts where the policies of contrast are developed at a global level. The Authors start from the recognition of the methods used up to now, highlighting the limits and criticalities that characterize the so-called subjective or perceptive measuring instruments. On this premise, the article proposes an innovative methodology, of an interdisciplinary nature, through which to achieve anobjective representation of the corruption phenomenon, as emerges from the judicial sources. In particular, the method presented is based on the application of text mining and statistical techniques to an objective and stable information base, represented by a significant sample of sentences handed down by the Supreme Court of Cassation, in the period between 2015 and January 2020, regarding corruption offenses (arts. 317, 318, 319, 319-quater, 321 of the penal code). This article offers a preliminary exposition of the shown method and highlights its cognitive and applicative potential, which are not limited to the (quantitative) measurement of the observed phenomenon. The automatic analysis, through the text mining, allows to thoroughly interrogate the judicial source (judgments) in order to obtain extremely significant information from the scientific perspective of the qualitative description of the variegated corrupting phenomenology. Finally, the objective-based method presented represents a promising tool for the development of evidence-based polic

Neurophysiological Correlates of Trait Impulsivity in Parkinson's Disease.

BACKGROUND Impulsivity is common in people with Parkinson's disease (PD), with many developing impulsive compulsive behavior disorders (ICB). Its pathophysiological basis remains unclear. OBJECTIVES We aimed to investigate local field potential (LFP) markers of trait impulsivity in PD and their relationship to ICB. METHODS We recorded subthalamic nucleus (STN) LFPs in 23 PD patients undergoing deep brain stimulation implantation. Presence and severity of ICB were assessed by clinical interview and the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), whereas trait impulsivity was estimated with the Barratt Impulsivity Scale (BIS-11). Recordings were obtained during the off dopaminergic states and the power spectrum of the subthalamic activity was analyzed using Fourier transform-based techniques. Assessment of each electrode contact localization was done to determine the topography of the oscillatory activity recorded. RESULTS Patients with (n = 6) and without (n = 17) ICB had similar LFP spectra. A multiple regression model including QUIP-RS, BIS-11, and Unified PD Rating Scale-III scores as regressors showed a significant positive correlation between 8-13 Hz power and BIS-11 score. The correlation was mainly driven by the motor factor of the BIS-11, and was irrespective of the presence or absence of active ICB. Electrode contact pairs with the highest α power, which also correlated most strongly with BIS-11, tended to be more ventral than contact pairs with the highest beta power, which localize to the dorsolateral motor STN. CONCLUSIONS Our data suggest a link between α power and trait impulsivity in PD, irrespective of the presence and severity of ICB. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

The Pain in Dystonia Scale (PIDS)—Development and Validation in Cervical Dystonia

BACKGROUND: A better understanding of pain in adult-onset idiopathic dystonia (AOID) is needed to implement effective therapeutic strategies. OBJECTIVE: To develop a new rating instrument for pain in AOID and validate it in cervical dystonia (CD). METHODS: Development and validation of the Pain in Dystonia Scale (PIDS) comprised three phases. In phase 1, international experts and participants with AOID generated and evaluated the preliminary items for content validity. In phase 2, the PIDS was drafted and revised by the experts, followed by cognitive interviews to ensure self-administration suitability. In phase 3, the PIDS psychometric properties were assessed in 85 participants with CD and retested in 40 participants. RESULTS: The final version of PIDS evaluates pain severity (by body-part), functional impact, and external modulating factors. Test-retest reliability showed a high-correlation coefficient for the total score (0.9, P < 0.001), and intraclass correlation coefficients were 0.7 or higher for all items in all body-parts subscores. The overall PIDS severity score showed high internal consistency (Cronbach's α, 0.9). Convergent validity analysis revealed a strong correlation between the PIDS severity score and the Toronto Western Spasmodic Torticollis Rating Scale pain subscale (0.8, P < 0.001) and the Brief Pain Inventory-short form items related to pain at time of the assessment (0.7, P < 0.001) and impact of pain on daily functioning (0.7, P < 0.001). CONCLUSION: The PIDS is the first specific questionnaire developed to evaluate pain in all patients with AOID, here, demonstrating high-level psychometric properties in people with CD. Future work will validate PIDS in other forms of AOID. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society