Tocilizumab treatment in MOGAD: a case report and literature review

: Myelin oligodendrocyte glycoprotein-immunoglobulin G associated disease (MOGAD) is an autoimmune demyelinating disorder of the central nervous system (CNS) which usually occurs with recurrent optic neuritis, transverse myelitis, acute disseminating encephalomyelitis, or brainstem encephalitis. To date, the anti-CD 20 drug rituximab (RTX) is employed in MOGAD although some authors reported the efficacy of Tocilizumab (TCZ) in refractory patients. We present the case of a woman affected by refractory MOGAD who was treated with TCZ after therapy with RTX had failed to prevent relapses. We also conducted a current literature review on TCZ use in MOGAD. A 57-year-old Caucasian woman affected by MOGAD with severe motor impairment and cognitive dysfunction was treated from 2020 to February 2022 with RTX. However, she experienced progressive clinical and cognitive worsening associated with white matter lesions mimicking leukodystrophy. In February 2022, the patient started therapy with TCZ administered with improvement of cognitive performance, walking ability, and brainstem functions. During TCZ, our patient reached the condition of NEDA-3 (no relapse, no increase in disability, no MRI activity on neuroimaging follow-up performed in September 2023). Moreover, the patient experienced paucisymptomatic SARS-CoV-2 infection that did not modify TCZ schedule. To date, there are few evidence on the efficacy and safety of TCZ in MOGAD. However, all the reviewed cases showed that TCZ represents an effective therapy in drug-resistant MOGAD. Our case highlights the efficacy of TCZ in drug resistant MOGAD and strengthens previous reports of TCZ safety and efficacy in MOGAD

Thoracoscopy in pleural effusion –two techniques: awake single-access video-assisted thoracic surgery versus 2-ports video-assisted thoracic surgery under general anesthesia

Awake single access video-assisted thoracic surgery with local anesthesia improves procedure tolerance, reduces postoperative stay and costs. MATERIALS & METHODS: Local anesthesia was made with lidocaine and ropivacaine. We realize one 20 mm incision for the 'single-access', and two incisions for the '2-trocars technique'. RESULTS: Mortality rate was 0% in both groups. Postoperative stay: 3dd ± 4 versus 4dd ± 5, mean operative time: 39 min versus 37 min (p < 0.05). Chest tube duration: 2dd ± 5 versus 3dd ± 6. COMPLICATIONS: 11/95 versus 10/79. CONCLUSION: Awake technique reduce postoperative hospital stay and chest drainage duration, similar complications and recurrence rate. The authors can say that 'awake single-access VATS' is an optimal diagnostic and therapeutic tool for the management of pleural effusions, but above extends surgical indication to high-risk patients

Nodular histiocytic/mesothelial hyperplasia as consequence of chronic mesothelium irritation by sub-phrenic abscess.

Nodular histiocytic/mesothelial hyperplasia (NHMH) is a benign localized alteration, first described in 1975 by Rosai in the hernia sac [1]. Few pulmonary cases have been reported in literature [2–6]. Sometimes it has been reported in the pericardium [7,8] or presenting as an inguinal mass [9]. The ‘mesothelial/monocytic incidental cardiac excrescence’, first described by Weinot et al. in 1994 [10] is now considered a similar lesion to NHMH [11]. It consists of a reactive proliferation of histiocytes and mesothelium secondary to chronic irritation and it has been observed in pleura-damaging processes, such as pneumothorax [5], or as consequence of cardiac catheterization, inflammation, mechanical or tumor stimulation [11]. The rarity of NHMH and the moderate cytological atypia often present, make this lesion difficult to diagnose. It can be easily confused with primary mesothelial lesions and neoplasms such as adenocarcinomas, granulosa cell tumors or Langerhans’ histiocytosis. We report a case of pleural NHMH in a patient with a subphrenic abscess, in which no pulmonary pathogenic noxa was evident. We hypothesize a transdiaphragmatic chronic irritation as a pathogenetic mechanism underlying NHMH

First report of Tomato leaf curl New Delhi virus affecting zucchini squash in an important horticultural area of southern Italy

omato leaf curl New Delhi virus (ToLCNDV) is a bipartite begomovirus (family Geminiviridae) which infects species in the families Cucurbitaceae and Solanaceae (Padidam et al., 1995; Mizutani et al., 2011). Begomoviruses are transmitted by the whitefly Bemisia tabaci in a persistent manner (Rosen et al., 2015). In October 2015, severe symptoms not previously reported by growers in the horticultural area of the Province of Trapani (Sicily, Italy) were observed on zucchini squash (Cucurbita pepo) in open fields. The symptoms included yellow mosaic, severe leaf curling, swelling of veins of young leaves, shortening of internodes, roughness of the skin of fruit and reduced fruit size; the symptoms were reminiscent of those caused by begomoviruses. Total DNA was extracted from young leaves of 22 plants by phenol/chloroform extraction and ethanol precipitation. PCR was performed with the A1F/A1R primer pair (Mizutani et al., 2011) for the DNA-A component and the pair described by Ruiz et al. (2015) for the DNA-B component to amplify a ~1200-bp fragment of DNA-A and a ~890 bp fragment of DNA-B, respectively. All 10 samples were positive by PCR with both primer pairs. No amplification products were obtained using primers specific for the monopartite begomoviruses Tomato yellow leaf curl virus and Tomato yellow leaf curl Sardinia virus (Davino et al., 2008). DAS-ELISA analysis for Cucumber mosaic virus, Papaya ring spot virus and Zucchini yellow mosaic virus (Loewe Phytodiagnostica, Germany) yielded negative results

Sleep and Chronobiology as a Key to Understand Cluster Headache

: The cluster headache is a primary headache characterized by attacks of unilateral pain associated with ipsilateral cranial autonomic features. These attacks recur in clusters during the years alternating with periods of complete remission, and their onset is often during the night. This annual and nocturnal periodicity hides a strong and mysterious link among CH, sleep, chronobiology and circadian rhythm. Behind this relationship, there may be the influence of genetic components or of anatomical structures such as the hypothalamus, which are both involved in regulating the biological clock and contributing even to the periodicity of cluster headaches. The bidirectional relationship manifests itself also with the presence of sleep disturbances in patients affected by cluster headaches. What if the key to studying the physiopathology of such disease could rely on the mechanisms of chronobiology? The purpose of this review is to analyze this link in order to interpret the pathophysiology of cluster headaches and the possible therapeutic implications

Liquid Dynamics in a Horizontal Capillary: Extended Similarity Analysis

Abstract The topic of this study is an extended similarity analysis for a one-dimensional model of liquid dynamics in a horizontal capillary. The bulk liquid is assumed to be initially at rest and is put into motion by capillarity, that is the only driving force acting on it. Besides the smaller is the capillary radius the steeper becomes the initial transitory of the meniscus location derivative, and as a consequence the numerical solution to a prescribed accuracy becomes harder to achieve. Here, we show how an extended scaling invariance can be used to define a family of solutions from a computed one. The similarity transformation involves both geometric and physical feature of the model. As a result, density, surface tension, viscosity, and capillary radius are modified within the required invariance. Within our approach a target problem of practical interest can be solved numerically by solving a simpler transformed test case. The reference solution should be as accurate as possible, and therefore we suggest to use for it an adaptive numerical method. This study may be seen as a complement to the adaptive numerical solution of the considered initial value problems

First report of Southern tomato virus in tomato crops in Italy

Twenty-five tomato plants (Solanum lycopersicum) showing symptoms of viral disease were sampled from different greenhouses in the Ragusa province (Southern Italy) in summer 2015. Plants showed chlorosis on leaves and fruits and deformation and depressed spots of dark colour which later evolved into necrosis (Fig. 1). These symptoms were observed on the entire cluster of fruit making the product unsaleable. Based on these symptoms, samples were analysed for Cucumber mosaic virus, Pepino mosaic virus (PepMV), Potato virus Y (PVY), Tomato mosaic virus and Tomato spotted wilt virus by DAS-ELISA with polyclonal antibodies (Loewe Phytodiagnostica, Germany), and for the emerging Southern tomato virus (STV) by RT-PCR (Candresse et al., 2013). Three of the 25 samples analysed were positive only for PepMV whereas the rest of the samples had mixed infections: fifteen plants were co-infected with PepMV and PVY, and seven with STV, PepMV and PVY. The amplification product (894 bp) obtained from one STV-infected plant was purified using the UltraClean® PCR Clean-Up kit (Mo-Bio, USA) and the consensus nucleotide sequences were determined in both senses using an ABI 3130XL Genetic Analyzer (Life Technologies, USA) and deposited in GenBank under accession number KT948068. The nucleotide identity of the Italian STV isolate was greater than 99% with STV isolates Mexico1 (EF442780), BD-13 (KT634055), CN-12 (KT438549), MS7 (EU413670) and FR (KC333078) from Mexico, Bangladesh, China, USA and France, respectively