Adjunctive treatment and BoNT-A for post-stroke spasticity: are we really focusing on the patient-centered goals?

[no abstract available

Anatomical landmarks for ultrasound‐guided rectus femoris diagnostic nerve block in post‐stroke spasticity

Introduction/Purpose To determine the location of the rectus femoris (RF) motor branch nerve, as well as its coordinates with reference to anatomical and ultrasound landmarks. Methods Thirty chronic stroke patients with stiff knee gait (SKG) and RF hyperactivity were included. The motor nerve branch to the RF muscle was identified medially to the vertical line from anterior superior iliac spine and the midpoint of the superior margin of the patella (line AP) and vertically to the horizontal line from the femoral pulse and its intersection point with the line AP (line F). The point of the motor branch (M) was located with ultrasound, and nerve depth and subcutaneous tissue thickness (ST) were calculated. Results The coordinates of the motor branch to the RF were 2.82 (0.47) cm medially to the line AP and 4.61 (0.83) cm vertically to the line F. Nerve depth and subcutaneous tissue thickness were 2.71 (0.62) cm and 1.12 (0.75) cm, respectively. Conclusion The use of specific coordinates may increase clinicians' confidence when performing RF motor nerve block. This could lead to better decision-making when assessing SKG in chronic stroke patients

Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study

Background: Patients with multiple sclerosis (MS) often receive disease-modifying therapies (DMTs) that can expose them to reactivation of potential occult hepatitis B virus (HBV) infection (pOBI). We aimed to evaluate the MS Centers behavior regarding HBV screening and prophylaxis in a large cohort of MS patients receiving anti-CD20 or cladribine. Methods: Retrospective, multicentric study recruiting Italian MS patients treated with rituximab, ocrelizumab and cladribine. Results: We included 931 MS patients from 15 centers. All but 38 patients performed a complete HBV screening. Patients' age > 50 years was significantly associated with no history of vaccination and HBsAb titres < 100 mIU at baseline (p < 0.001). No significant correlation was found between post-vaccination HBsAb titres and type of treatment (p = 0.5), pre-or post-therapy vaccination (p = 0.2) and number of previous DMTs (p = 0.2). Among pOBI patients (n = 53), 21 received antiviral prophylaxis, while only 13 had HBV DNA monitoring and 19 patients neither monitored HBV DNA nor received prophylaxis. Conclusions: Baseline HBV screening in patients receiving anti-CD20 and cladribine is a consolidated practice. Nonetheless, HBV vaccination coverage is still lacking in such population and age is a significant factor associated with low HBV protection. Rituximab, ocrelizumab and cladribine did not impair HBV vaccine response. Almost 35% of pOBI patients fail to receive HBVr prevention. Management of HBV prophylaxis could be improved in MS patients and further prospective studies are needed to assess the effectiveness of prophylactic strategies in such patients

Il test del disegno della famiglia: una rassegna critica

The review critically examines a series of contributions related to the drawing family test, as a projective technique used in clinical practice and in developmental research. In this perspective, if on one side the authors point out a considerable interest for the drawing family test in the present psychodynamic research on family relationships, on the other they notice the failure of adequate test vaidation attempts

Correlation between DXA and laboratory parameters in normal weight, overweight, and obese patients

Objective: The aim of this study was to review the existence and types of correlations between body composition densitometric parameters and laboratory values associated to cardiometabolic risk. Methods: We retrospectively analyzed data from 316 individuals in the weight range from normality to super-obesity, submitted to total body dual-energy x-ray absorptiometry (DXA) scans and routine biochemistry at S.Orsola-Malpighi Hospital from June 2010 to March 2014. The study included 182 women, 45.8 \ub1 13.4 y of age, with a body mass index (BMI) of 31.5 (\ub1 11) kg/m2 (group F) and 134 men, 45.4 \ub1 13.6 y of age, with a BMI of 27.6 (\ub1 7.8) kg/m2 (group M). All patients underwent whole-body scan (Lunar iDXA, GE Healthcare, Madison, WI, USA) and laboratory analysis (blood fasting glucose, total cholesterol, high-density lipoprotein cholesterol, tricylglycerides [TGs], aspartate aminotransferase, and alanine aminotransferase). Correlation between laboratory values and total body and regional fat mass (including visceral adipose tissue [VAT] and subcutaneous adipose tissue in the android region), and lean mass parameters were analyzed with linear and stepwise regressions analysis (significance limit, P 1395 g and >1479 cm3 for men and >1281 g and >1357 cm3 for women. Conclusions: DXA analysis of VAT is associated with selected laboratory parameters used for the evaluation of cardiometabolic risk and could be per se a helpful parameter in the assessment of clinical risk