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

Spatial behaviour of yellow-necked wood mouse Apodemus flavicollis in two sub-Mediterranean oak coppice stands

Strong mutual relationships exist between rodents and ecosystems. By modifying the structure and functioning of ecosystems, human activity can affect rodent behaviour and ecology. The yellow-necked mouse Apodemus flavicollis is widespread in Europe and its spatial ecology has been studied in various habitats, but studies are lacking for Mediterranean forests often altered by forest management practices. We investigated the spatial behaviour of A. flavicollis in a sub-Mediterranean deciduous oak forest of central Italy subject to forest management. We radio-tracked 27 individuals in two different coppice stands, i.e. a recently cut area and a high forest, differing in terms of species-specific habitat quality and rodent population density. We analysed the size of home ranges in relation to habitat type and sex. Our results revealed that home range and core area size did not differ between habitat types or sexes. The spatial behaviour of A. flavicollis thus did not appear to be influenced by population density and habitat quality. The lack of sex-related differences confirms the current knowledge on the species’ spatial ecology. Our findings provide the first useful information on the spatial behaviour of A. flavicollis in sub-Mediterranean deciduous oak forests, whose ecological processes may be markedly influenced by this key-species at several trophic levels.acceptedVersio

A framework for prioritising present and potentially invasive mammal species for a national list

The European Union (EU) has recently adopted a regulation on invasive alien species that foresees the possibility of developing lists of species of National Concern. We developed a prioritisation process for alien mammals already established in Italy, but not yet included in the EU list (n = 6 species) and a systematic horizon-scanning procedure to obtain ranked lists for those species that are already introduced worldwide or traded in Italy (n = 213). Experts were asked to score these species, by evaluating their likelihood of establishment and spread and the magnitude of their potential impacts on biodiversity, economy, human-health and society. The manageability of each species was also evaluated, both for the proritisation and the horizon-scanning processes. We produced five lists that ranked species according to their potential spread and impacts and their manageability. These will allow policy-makers to select outputs according to a balance between risk assessment and risk management, establishing priorities for alien species management at the national level

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Should I Stay or Should I Go? Seasonal Fluctuations of Wood Mouse Populations in Fields Surrounded by Woodlands

The wood mouse Apodemus sylvaticus is common in woodlands and open areas of the Western Palearctic. Despite extensive research, little is known about its population ecology in fields in the Mediterranean area, where the climate involves great seasonal changes in environmental features. Here, we investigated wood mice seasonal fluctuations in the number of captures and population structure by sampling long-fallow fields and woodlands, i.e., oak forest and conifer plantation, in a heterogeneous landscape of central Italy. Mice were live-trapped every two months for three years (23.814 trap-days). The number of captures, mice body weight, and proportion of adult, residents and breeding individuals were analyzed. Mice dynamics changed across seasons and habitats. In fields, we recorded more captures, more reproductive individuals, and fewer non-adults and resident individuals in the warmer months compared to the colder months; mice were heavier in warmer months. During the cold season, the captures and adult proportion in fields were lower than in resource-rich woodlands. Breeding and non-resident mice were more abundant in fields than in woodlands in warmer months. Overall, the seasonal demographic variations we recorded provide evidence that fields can represent a suboptimal habitat in Mediterranean heterogeneous landscapes, acting nonetheless as a source of food resources, cover, and mates for mice in spring–summer

Spatial behaviour of yellow-necked wood mouse Apodemus flavicollis in two sub-Mediterranean oak coppice stands

Strong mutual relationships exist between rodents and ecosystems. By modifying the structure and functioning of ecosystems, human activity can affect rodent behaviour and ecology. The yellow-necked mouse Apodemus flavicollis is widespread in Europe and its spatial ecology has been studied in various habitats, but studies are lacking for Mediterranean forests often altered by forest management practices. We investigated the spatial behaviour of A. flavicollis in a sub-Mediterranean deciduous oak forest of central Italy subject to forest management. We radio-tracked 27 individuals in two different coppice stands, i.e. a recently cut area and a high forest, differing in terms of species-specific habitat quality and rodent population density. We analysed the size of home ranges in relation to habitat type and sex. Our results revealed that home range and core area size did not differ between habitat types or sexes. The spatial behaviour of A. flavicollis thus did not appear to be influenced by population density and habitat quality. The lack of sex-related differences confirms the current knowledge on the species’ spatial ecology. Our findings provide the first useful information on the spatial behaviour of A. flavicollis in sub-Mediterranean deciduous oak forests, whose ecological processes may be markedly influenced by this key-species at several trophic levels

Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity

BACKGROUND: The COVID-19 pandemic has affected health-care systems worldwide, including the outpatient spasticity care with botulinum neurotoxin toxin type A (BoNT-A). AIM: The aim was to investigate the impact of discontinuation of BoNT-A treatment on patients living with spasticity during the COVID-19 quarantine. DESIGN: A multicentric cross-sectional study. SETTING: Outpatients setting. POPULATION: Patients with spasticity after stroke and traumatic brain injury treated with BoNT-A. METHODS: A phone-based survey was conducted from March to May, 2020. Based on the International Classification of Functioning, Disability and Health (ICF), an ad hoc questionnaire CORTOX (CORonavirus TOXin survey) was developed to investigate patients\u2019 experiences following the discontinuation of their usual treatment for spasticity due to the lockdown and its implication on their health perception. It assessed patients\u2019 condition and explored different ICF domains related to spasticity: unpleasant sensations, mobility, self care, facilitators and psychosocial factors. The sum of those represented the CORTOX score (Max 142). The questionnaire also collected data about the impact of COVID-19 on patients\u2019 wellbeing (mood, sleep, relationships, community life, motivation). RESULTS: A total of 151 participants completed the survey. The majority of participants (72.2 %) experienced a worsening in perceived spasticity, 53% got worse in independence and 70.9% had a negative impact on quality of life. The mean CORTOX score was 52.85 \ub1 27.25, reflecting a perceived worsening in all ICF domains investigated. Moderate to strong correlations were found between different subscores of the questionnaire and severity of spasticity (p<0.001). COVID-19 psychosocial related factors were associated with loss of independence (p < 0.05) but only mood was associated with worsening of spasticity (p < 0.001). The lack of rehabilitation therapy was significantly associated with the worsening of independence but not with the worsening of spasticity. Finally, respondents reported that BoNT-A was useful to their condition and should not be discontinued. CONCLUSIONS: The discontinuation of BoNT-A treatment was associated with worsening of activities and participation and perceived spasticity. COVID-19 related problems and rehabilitation showed an association with loss of independence. CLINICAL REHABILITATION IMPACT: This study will provide useful information in the field of spasticity management using a patient\u2019s centred approach, with consistent quantitative and qualitative information