Clinical autonomic nervous system laboratories in Europe. A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies

Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49–251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100–360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4–110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe

Consensus protocol for EEG and amplitude-integrated EEG assessment and monitoring in neonates

The aim of this work is to establish inclusive guidelines on electroencephalography (EEG) applicable to all neonatal intensive care units (NICUs). Guidelines on ideal EEG monitoring for neonates are available, but there are significant barriers to their implementation in many centres around the world. These include barriers due to limited resources regarding the availability of equipment and technical and interpretive round-the-clock personnel. On the other hand, despite its limitations, amplitude-integrated EEG (aEEG) (previously called Cerebral Function Monitor [CFM]) is a common alternative used in NICUs. The Italian Neonatal Seizure Collaborative Network (INNESCO), working with all national scientific societies interested in the field of neonatal clinical neurophysiology, performed a systematic literature review and promoted interdisciplinary discussions among experts (neonatologists, paediatric neurologists, neurophysiologists, technicians) between 2017 and 2020 with the aim of elaborating shared recommendations. A consensus statement on videoEEG (vEEG) and aEEG for the principal neonatal indications was established. The authors propose a flexible frame of recommendations based on the complementary use of vEEG and aEEG applicable to the various neonatal units with different levels of complexity according to local resources and specific patient features. Suggestions for promoting cooperation between neonatologists, paediatric neurologists, and neurophysiologists, organisational restructuring, and teleneurophysiology implementation are provided

Interlayer expansion of dimethyl ditallowylammonium montmorillonite as a function of 2-chloroaniline adsorption

The expansion behaviour of an organically modified montmorillonite during the adsorption of increasing amounts of an organic pollutant: 2-chloroaniline (2-CA). The organophilic montmorillonite, a commercial product, was obtained exchanging the inorganic cation with dimethyl ditallowylammonium ions (DMDTA). 2-CA was added to the organoclay, starting from 193.9 ppm up to 23,531.7 ppm going through twenty-two steps of growing quantities of 2-CA. For each of these twenty-two steps – corresponding to a range of adsorbed 2-CA (Cs) between 0.029 mol/kg (grams of 2-CA per kg of organoclay) and 2.763 mol/kg – the basal spacings were determined. The adsorption isotherm was performed according to ASTM D 4646-87 Standard and, by comparing the experimental Cs data with the corresponding d001 values, the basal expansion of the polluted organoclay is characterized by a steep rise for the first steps of adsorption of 2-CA (concentration in water at equilibrium Cwb0.00373 mol/L), then the d001 remains almost constant up to the higher amounts of pollutant adsorbed. The 001 reflections are sharper, their intensity higher, and up to four orders of 00l reflections are observed as the uptake of 2-CA increased. Since in aqueous solution the staking of organoclay platelets is poorly ordered, the observed behaviour may be partially explained by the 2-CA sorbed on the external surface of the clay mineral particles, which brings the silicate layers together. Finally, a tentative interpretation of the adsorption phenomena was carried out by fitting the experimental data according to the most common theoretical models: Freundlich, Langmuir, Dual Mode and Dual Langmuir Model

Spectal analysis of heart rate variability signal and respiration in diabetic subjects

The paper deals with methods of processing ECG and respiration signals which aim at detecting parameters whose values may be correlated to normal and diabetic subjects with or without cardiovascular autonomic neuropathy (CAN). Beatto-beat R-R duration values of the ECG and discrete series of respiration are obtained from original signals using a recognition algorithm. Power spectrum analysis (autospectra, cross-spectra and coherence via autoregressive modelling) is carried out on segments of about 200 consecutive cardiac cycles. Spectral parameters of the R-R variability signal are obtained as follows: total power, power of low-frequency (LF) and high-frequency (HF) components, power of the signal which is (or is not) coherent with respiration, in absolute or in percentage values. The experimental protocol considers 40 diabetic patients (21 of whom have diabetic neuropathy) and 14 normals in three different conditions: resting, standing and controlled respiration. The developed spectral parameters seem sensitive enough to differentiate between normal and pathological subjects. These parameters may constitute a quantitative means to be edded to the classical diabetic tests for the diagnosis of cardiovascular autonomic neuropathy

Phase composition gradient in leached polluted cement monoliths

The long-term behaviour of cement monoliths containing an organic waste, was investigated by means of a 14-month dynamic-leach-testing in deionised water. The degree of hydration and the phase composition were measured by Thermal Analysis (TGA/DTA), X-ray Powder Diffraction (XRD) and Energy Dispersive X-ray Spectroscopy (EDXS). X-ray data, analysed by the Rietveld method, provided a detailed quantitative information on the in-depth crystalline phase distribution in the specimens. Crossed with TGA and spectroscopic data and supported by the results of kinetic/hydration calculations, the diffraction results provide a detailed description of the in-depth phase composition gradient in the leached monoliths. In particular, 14-month old specimens show a clear leaching zone with predominance of CSH and calcite near the surface and low abundance of the other usual cement constituents. The material is not completely effective in retaining the contaminant