Physiotherapy management of nociplastic pain: A Delphi study of Italian specialists

Background and Purpose: Nociplastic pain due to central sensitization (CS) is common in people suffering from chronic pain, but no clinical practice guideline is available in rehabilitative settings for patients' management. The aim of this study is to achieve expert consensus on physiotherapy competencies in the management of people with nociplastic pain and suspected CS mechanisms. Methods: A web-based Delphi process was employed. Experts in the rehabilitation field were recruited following pre-defined eligibility criteria. Following completion of three Delphi rounds, the final list of competencies was generated. Results: In all, 23 participants were recruited. They all completed Round 1 (23/23, 100%), twenty Round 2 and Round 3 (20/23, 87%). Following Round 1, seven areas were identified by the panel as crucial for CS physiotherapy management; 19 competencies out of 40 reached the consensus between experts, and nine additional competencies were added to Round 2 following literary review. Round 2 identified the agreement for all the 29 competencies. During Round 3, all the experts confirmed the final list generated through the consensus process. Discussion: An agreement between experts was found for the final list of competencies that a physiotherapist should implement every time it approaches people with suspected CS mechanisms. Further research is needed to support the clinical utility of our findings and their applicability in daily practice

Polidistrectual vascular involvement in Familial Hyperchilomicronemia

A 72-year-old man was referred to our clinic with a lipid profile, under combination therapy with a statin and ezetimibe, characterized by severe hypertriglyceridemia (7230 mg/dl), hypercholesterolemia (374 mg/dl), low HDL-cholesterol (17 mg/dl), and normal circulating Lp"a". The patient had undergone post-traumatic splenectomy and presented a history of systemic hypertension treated medically with well-controlled blood pressure. The patient had also presented in the past abdominal pain with subsequent diagnosis of chronic pancreatitis complicated by diabetes mellitus, well compensated when he came to our attention. Following a pathological exercise test, a coronary angiogram was performed which showed a significant stenosis of the right coronary artery, which was treated successfully with percutaneous coronary intervention. Clinical work-up revealed ectasia of the abdominal aorta (28 mm), non significant bilateral carotid artery disease, and peripheral artery disease of the femoral-popliteal axis symptomatic for intermittent claudication. A lipidogram was also performed and electrophoretic lipoprotein patterns did not vary 2 hours after heparin infusion, pointing to the existence of lipoprotein lipase deficit. Electrophoresis also showed a broadband of chylomicrons at baseline, at the beginning, and at the end of heparin infusion. Hyperchilomicronemia is a rare genetic disorder with an incidence of 1 per 1000000. Following diagnosis, our patient began plasma exchange therapy with subsequent improvement of his lipid profile. At the present time, he is regularly followed up at our clinic and non invasive imaging has excluded any significant progression of atherosclerosis after 2 years of therapy

Whole blood assessment of antigen specific cellular immune response by real time quantitative PCR: a versatile monitoring and discovery tool

BACKGROUND: Monitoring of cellular immune responses is indispensable in a number of clinical research areas, including microbiology, virology, oncology and autoimmunity. Purification and culture of peripheral blood mononuclear cells and rapid access to specialized equipment are usually required. We developed a whole blood (WB) technique monitoring antigen specific cellular immune response in vaccinated or naturally sensitized individuals. METHODS: WB (300 microl) was incubated at 37 degrees C with specific antigens, in the form of peptides or commercial vaccines for 5-16 hours. Following RNAlater addition to stabilize RNA, the mixture could be stored over one week at room temperature or at 4 degrees C. Total RNA was then extracted, reverse transcribed and amplified in quantitative real-time PCR (qRT-PCR) assays with primers and probes specific for cytokine and/or chemokine genes. RESULTS: Spiking experiments demonstrated that this technique could detect antigen specific cytokine gene expression from 50 cytotoxic T lymphocytes (CTL) diluted in 300 microl WB. Furthermore, the high sensitivity of this method could be confirmed ex-vivo by the successful detection of CD8+ T cell responses against HCMV, EBV and influenza virus derived HLA-A0201 restricted epitopes, which was significantly correlated with specific multimer staining. Importantly, a highly significant (p = 0.000009) correlation between hepatitis B surface antigen (HBsAg) stimulated IL-2 gene expression, as detectable in WB, and specific antibody titers was observed in donors vaccinated against hepatitis B virus (HBV) between six months and twenty years before the tests. To identify additional markers of potential clinical relevance, expression of chemokine genes was also evaluated. Indeed, HBsAg stimulated expression of MIP-1beta (CCL4) gene was highly significantly (p = 0.0006) correlated with specific antibody titers. Moreover, a longitudinal study on response to influenza vaccine demonstrated a significant increase of antigen specific IFN-gamma gene expression two weeks after immunization, declining thereafter, whereas increased IL-2 gene expression was still detectable four months after vaccination. CONCLUSION: This method, easily amenable to automation, might qualify as technology of choice for high throughput screening of immune responses to large panels of antigens from cohorts of donors. Although analysis of cytokine gene expression requires adequate laboratory infrastructure, initial antigen stimulation and storage of test probes can be performed with minimal equipment and time requirements. This might prove important in "field" studies with difficult access to laboratory facilities

Perspectives of 2D and 3D mapping of atmospheric pollutants over urban areas by means of airborne DOAS spectrometers

tants, offering numerous advantages over conventional networks of in situ analysers. We propose some innovative solutions in the field of DOAS (Differential Optical Absorption Spectroscopy) remote systems, utilizing diffuse solar light as the radiation source. We examine the numerous potentialities of minor gas slant column calculations, applying the «off-axis» methodology for collecting the diffuse solar radiation. One of these particular approaches, using measurements along horizontal paths, has already been tested with the spectrometer installed on board the Geophysica aircraft during stratospheric flights up to altitudes of 20 km. The theoretical basis of these new measurement techniques using DOAS remote sensing systems are delineated to assess whether low altitude flights can provide 2D and 3D pollution tomography over metropolitan areas. The 2D or 3D trace gas total column mapping could be used to investigate: i) transport and dispersion phenomena of air pollution, ii) photochemical process rates, iii) gas plume tomography, iv) minor gas vertical profiles into the Planetary Boundary Layer and v) minor gas flux divergence over a large area

Perspectives of 2D and 3D mapping of atmospheric pollutants over urban areas by means of airborne DOAS spectrometers

tants, offering numerous advantages over conventional networks of in situ analysers. We propose some innovative solutions in the field of DOAS (Differential Optical Absorption Spectroscopy) remote systems, utilizing diffuse solar light as the radiation source. We examine the numerous potentialities of minor gas slant column calculations, applying the «off-axis» methodology for collecting the diffuse solar radiation. One of these particular approaches, using measurements along horizontal paths, has already been tested with the spectrometer installed on board the Geophysica aircraft during stratospheric flights up to altitudes of 20 km. The theoretical basis of these new measurement techniques using DOAS remote sensing systems are delineated to assess whether low altitude flights can provide 2D and 3D pollution tomography over metropolitan areas. The 2D or 3D trace gas total column mapping could be used to investigate: i) transport and dispersion phenomena of air pollution, ii) photochemical process rates, iii) gas plume tomography, iv) minor gas vertical profiles into the Planetary Boundary Layer and v) minor gas flux divergence over a large area

Economic optimization of the design and operation of polygeneration energy systems by genetic algorithms

Renewable energies currently represent a significant portion of the sources of heat and electricity all over the world. However, their intermittent nature results in a major challenge for the design and management of the systems which exploit these energy sources. Indeed, the residential and industrial energy demand has to be fulfilled without any interruption. To face the aforementioned problem, this paper suggests to adopt polygeneration energy systems. These systems are distinguished by several sources of electrical and heating power, both renewable and traditional one, which interact to fulfill the thermal and electricity hourly demand considering the geographical location where the system is located. Indeed, the atmospheric condition evolution during the day and over the months significantly affect the energy availability from renewable sources. Considering the presented framework, this paper proposes a genetic algorithm for the economic optimization of the design and operation of polygeneration energy systems. The considered system fulfills the electric load through photovoltaic modules integrated with battery energy storage, whereas a natural gas boiler supplies the required thermal power. Furthermore, a cogenerative engine contributes to the demand of both energy types. An original genetic algorithm is developed to determine the optimal size of each polygeneration system module to minimize the levelized cost of energy, determined by the expenditures of both the system installation and operation phases. The energy flows between the polygeneration modules and the demand load are defined considering the hourly evolution of the external environment, as the atmospheric conditions and the electricity price. Finally, the developed genetic algorithm is tested and validated with a real case study represented by the thermal and electricity loads of an Italian manufacturing plant. The design and operation configuration proposed by the algorithm for the installed polygeneration energy system enables to save 9.2% of the costs of traditional energy source exploitation

Lithium and acute lymphocytic leukemia.

No abstract availabl