Transcranial direct current stimulation: A novel approach in the treatment of vascular depression.

Background: Despite the impact of depression in terms of personal suffering and socioeconomic burden, most currently available treatment options are often ineffective. A particularly difficult-to-treat depressive disorder characteristic of the elderly is vascular depression, a late-life depressive syndrome related to a variety of potential vascular mechanisms. Transcranial Direct Current Stimulation (tDCS), a non-invasive and effective somatic approach to depression, also showed positive effects on cognitive deficits. Aim: We performed a double-blind randomized study to investigate the efficacy of tDCS as augmentation strategy to sertraline in the treatment of vascular depression, hypothesizing a positive effect in both depressive symptoms and cognitive functions. Methods: We enrolled 93 inpatients over 60 years of age with a diagnosis of vascular depression. Depressive symptoms were weekly assessed (T0, T1, T2) with the 21-items Hamilton depression rating scale (HDRS). Cognitive functioning was evaluated with the Milan Overall Dementia Assessment (MODA) at baseline and after the treatment protocol. All patients were randomly assigned into three groups, Group I: one tDCS stimulation per day, Group II: two tDCS stimulations per day, Sham group: one sham tDCS stimulation per day. Stimulation was performed for 10 consecutive working days. Results: A significant interaction time∗treatment was observed on HDRS scores (F = 14, p < 0.001). All groups improved at T1 but whereas Group II significantly differed from the Sham group (p < 0.001) we observed no difference between Sham and Group I. At T2 all groups improved but Group II showed the greater improvement (vs. Sham p < 0.001; vs. Group I p < 0.001) and the Sham group the smallest (vs. Group I p = 0.005). A significant interaction time∗treatment was also observed on MODA scores (F = 3.31, p = 0.04). Only subjects treated with tDCS improved at T2 (Group I: p < 0.001; Group II: p = 0.007). However, no difference between Group I and II was shown. Conclusion: tDCS as augmentation treatment of an adequate pharmacotherapy is a potential strategy in the management of vascular depression, a disease known to be often unresponsive to antidepressants only. Non-invasiveness, the absence of severe side effects and the possibility of administering it to outpatients at an affordable price make tDCS an important tool in clinical practice

High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

New Treatment in Advanced Thyroid Cancer

Thyroid cancer is the most common endocrine tumor. Thyroidectomy, radioactive iodine, and TSH suppression represent the standard treatment for differentiated thyroid cancer. Since chemotherapy has been shown to be unsuccessful in case of advanced thyroid carcinomas, the research for new therapies is fundamental. In this paper, we reviewed the recent literature reports (pubmed, medline, EMBASE database, and abstracts published in meeting proceedings) on new treatments in advanced nonmedullary and medullary thyroid carcinomas. Studies of many tyrosine kinase inhibitors as well as antiangiogenic inhibitors suggest that patients with thyroid cancer could have an advantage with new target therapy. We summarized both the results obtained and the toxic effects associated with these treatments reported in clinical trials. Reported data in this paper are encouraging, but further trials are necessary to obtain a more effective result in thyroid carcinoma treatment

Multi-Sensor Analysis of a Weak and Long-Lasting Volcanic Plume Emission

Volcanic emissions are a well-known hazard that can have serious impacts on local populations and aviation operations. Whereas several remote sensing observations detect high-intensity explosive eruptions, few studies focus on low intensity and long-lasting volcanic emissions. In this work, we have managed to fully characterize those events by analyzing the volcanic plume produced on the last day of the 2018 Christmas eruption at Mt. Etna, in Italy. We combined data from a visible calibrated camera, a multi-wavelength elastic/Raman Lidar system, from SEVIRI (EUMETSAT-MSG) and MODIS (NASA-Terra/Aqua) satellites and, for the first time, data from an automatic sun-photometer of the aerosol robotic network (AERONET). Results show that the volcanic plume height, ranging between 4.5 and 6 km at the source, decreased by about 0.5 km after 25 km. Moreover, the volcanic plume was detectable by the satellites up to a distance of about 400 km and contained very fine particles with a mean effective radius of about 7 &micro;m. In some time intervals, volcanic ash mass concentration values were around the aviation safety thresholds of 2 &times; 10&minus;3 g m&minus;3. Of note, Lidar observations show two main stratifications of about 0.25 km, which were not observed at the volcanic source. The presence of the double stratification could have important implications on satellite retrievals, which usually consider only one plume layer. This work gives new details on the main features of volcanic plumes produced during low intensity and long-lasting volcanic plume emissions

Proximal Monitoring of the 2011–2015 Etna Lava Fountains Using MSG-SEVIRI Data

From 2011 to 2015, 49 lava fountains occurred at Etna volcano. In this work, the measurements carried out from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) instrument, on board the Meteosat Second Generation (MSG) geostationary satellite, are processed to realize a proximal monitoring of the eruptive activity for each event. The SEVIRI measurements are managed to provide the time series of start and duration of eruption and fountains, Time Averaged Discharge Rate (TADR) and Volcanic Plume Top Height (VPTH). Due to its temperature responsivity, the eruptions start and duration, fountains start and duration and TADR are realized by exploiting the SEVIRI 3.9 &mu;m channel, while the VPTH is carried out by applying a simplified procedure based on the SEVIRI 10.8 &mu;m brightness temperature computation. For each event, the start, duration and TADR have been compared with ground-based observations. The VPTH time series is compared with the results obtained from a procedures-based on the volcanic cloud center of mass tracking in combination with the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) back-trajectories. The results indicate that SEVIRI is generally able to detect the start of the lava emission few hours before the ground measurements. A good agreement is found for both the start and the duration of the fountains and the VPTH with mean differences of about 1 h, 50 min and 1 km respectively