Increased orexin A concentrations in cerebrospinal fluid of patients with behavioural variant frontotemporal dementia

Orexins are hypothalamic neuropeptides that regulate several physiological functions, such as appetite, arousal, cognition, stress, sleep and metabolism. Emerging pieces of evidence suggest an orexinergic dysfunction in several neuropsychiatric disorders, including depression, anxiety and addiction. A syndromic overlap between behavioural variant frontotemporal dementia (bvFTD) and several psychiatric disorders was recently demonstrated. Therefore, we analysed cerebrospinal fluid (CSF) orexin A concentrations of 40 bvFTD and 32 non-demented patients, correlating neuropeptide concentrations with several clinical characteristics. A significant increase of orexin A concentrations was found in bvFTD patients when compared to controls (p<0.001). CSF orexin A concentration showed a correlation with Mini-Mental State Examination scores, drug assumption, history of compulsive behaviour and extrapyramidal signs. Moreover, we found a relationship between CSF markers of neurodegeneration, total tau and Aβ(1–42) and CSF orexin A concentrations. Our study provides evidence of an orexinergic dysfunction in bvFTD, correlating with several clinical symptoms. Further larger studies are needed to confirm our data. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10072-021-05250-x

The effectiveness of metal on metal hip resurfacing: a systematic review of the available evidence published before 2002

BACKGROUND: Conventional total hip replacement (THR) may be felt to carry too high a risk of failure over a patient's lifetime, especially in young people. There is increasing interest in metal on metal hip resurfacing arthroplasty (MoM) as this offers a bone-conserving option for treating those patients who are not considered eligible for THR. We aim to evaluate the effectiveness of MoM for treatment of hip disease, and compare it with alternative treatments for hip disease offered within the UK. METHODS: A systematic review was carried out to identify the relevant literature on MoM published before 2002. As watchful waiting and total hip replacement are alternative methods commonly used to alleviate the symptoms of degenerative joint disease of the hip, we compared MoM with these. RESULTS: The data on the effectiveness of MoM are scarce, as it is a relatively new technique and at present only short-term results are available. CONCLUSION: It is not possible to make any firm conclusions about the effectiveness of MoM based on these early results. While the short-term results are promising, it is unclear if such results would be replicated in more rigorous studies, and what the long-term performance might be. Further research is needed which ideally should involve long-term randomised comparisons of MoM with alternative approaches to the clinical management of hip disease

Drain-site tumour recurrence after laparotomy resection for colorectal cancer

We report a case of drain-site tumour recurrence 2 years after right colon resection for adenocarcinoma of the ascending colon. A large number of case reports concerning port-site tumour recurrences after laparoscopic procedures have been reported. However, post-laparotomy incision site cancer recurrence is considered a rare occurrence

Computation of Gait Parameters in Post Stroke and Parkinson’s Disease: A Comparative Study Using RGB‐D Sensors and Optoelectronic Systems

The accurate and reliable assessment of gait parameters is assuming an important role, especially in the perspective of designing new therapeutic and rehabilitation strategies for the remote follow‐up of people affected by disabling neurological diseases, including Parkinson’s disease and post‐stroke injuries, in particular considering how gait represents a fundamental motor activity for the autonomy, domestic or otherwise, and the health of neurological patients. To this end, the study presents an easy‐to‐use and non‐invasive solution, based on a single RGB‐D sensor, to estimate specific features of gait patterns on a reduced walking path compatible with the available spaces in domestic settings. Traditional spatio‐temporal parameters and features linked to dynamic instability during walking are estimated on a cohort of ten parkinsonian and eleven post‐stroke subjects using a custom‐written software that works on the result of a body‐tracking algorithm. Then, they are compared with the “gold standard” 3D instrumented gait analysis system. The statistical analysis confirms no statistical difference between the two systems. Data also indicate that the RGB‐D system is able to estimate features of gait patterns in pathological individuals and differences between them in line with other studies. Although they are preliminary, the results suggest that this solution could be clinically helpful in evolutionary disease monitoring, especially in domestic and unsupervised environments where traditional gait analysis is not usable

Dementia-friendly intervention for hospitalized older adults with cognitive impairments: results of the Italian Dementia-Friendly Hospital Trial (IDENTITÀ)

Objective: To evaluate whether a short training focused on improving dementia care practices of the hospital staff was able to counteract functional loss and to decrease negative outcomes at discharge among hospitalized older adults with cognitive impairment. Method: Sixty-eight hospitalized participants aged 65 and over with cognitive impairment were included in the study, allocated in the control group (n = 34) and intervention group (n = 34). The intervention consisted of a short training of the hospital staff aimed at improving the management of patients with cognitive impairment. Participants were evaluated within 48 h of hospital admission and at discharge using a battery of tests including Barthel Index, Mini-Mental State Examination, and Hospital Anxiety and Depression Scale. Results: The intervention group demonstrated shorter hospital length of stay and a maintenance of the functional status at discharge compared to the control group. We observed no differences in cognitive ability between the two groups, and a trend towards a decrease of anxious symptoms in the intervention group compared to the control group. Conclusion: The results suggest that an intervention, focused on improving dementia care practices in healthcare staff, has the potential to improve the outcomes for hospitalized older adults with cognitive impairment

Atypical postictal transient subcortical T2 hypointensity in a newly diagnosed diabetic patient with seizures

Common postictal MRI findings include transient cortical T2 hyperintensity, restricted diffusion, and gyral and/or adjacent leptomeningeal contrast enhancement. In certain uncommon pathological conditions, other signal abnormalities can be present, suggesting a different underlying pathogenic mechanism. We report the case of a 66-year-old man, recently diagnosed with diabetes mellitus type 2, presenting with new-onset visual and auditory hallucinations, “absence” seizures, and repeated peaks of hyperglycaemia without hyperketonaemia or increased serum osmolarity. EEG confirmed epileptic discharges in the right temporal region and MRI showed vast subcortical T2 hypointensity in the right temporal lobe, without any cortical hyperintensity, restricted diffusion, or contrast enhancement. Subcortical signal abnormality and EEG discharges resolved after a month of follow-up, with a small juxtacortical gliotic focus as a sequela. Peaks in hyperglycaemia have been reported to be responsible for T2 hypointense subcortical abnormalities through a proconvulsant mechanism linked to increased ketone body concentrations. Hyperosmolarity and hyperketonaemia were not evident in this case, however, transient accumulation of free radicals that alter the intercellular space can be considered the presumable cause of this finding. In summary, it is important to consider any unusual findings on postictal MRI in order to avoid errors in interpretation

Neurophysiological evaluation of visual function in iRBD: potential role in stratifying RBD conversion risk

Study objectives: To evaluate neurophysiological alterations of visual function in idiopathic REM sleep Behavior Disorder (iRBD) both as markers and predictors of neurodegenerative disorders. Methods: In a longitudinal follow-up study of 46 consecutive iRBD patients (follow-up duration 8.4 \ub1 3.4 years), the baseline parameters in luminance-contrast pattern (VEPp), red-green color (VEPc) and motion-onset (VEPm) Visual Evoked Potentials in iRBD were compared to early (ePD) and advanced (aPD) Parkinson's Disease subjects. Parameters of latency and amplitude of iRBD converters to neurodegenerative disease were compared with those of the non-converters. Results: The VEP P100 mean latency values for both eyes and for both stimulation checks (30\u2032 and 15\u2019) were significantly longer in all the three groups of patients as compared to controls; moreover latencies were longer in aPD than in the iRBD group who did not differ from the ePD group. The same held true when we analyzed the number of abnormal subjects belonging to each diagnostic group with a higher number of abnormal subjects in the aPD group compared to both the ePD and in iRBD groups. Chromatic and motion potentials were not different from controls and did not differ in the 3 diagnostic groups. The iRBD subjects who converted to a neurodegenerative disorder showed longer P100 latencies and a higher occurrence of VEPp abnormalities than those who did not convert. Again chromatic and motion VEPs were not different depending on conversion. Conclusions: In iRBD patients the detection of an abnormal VEPp should be considered as a red flag for possible synnucleinopathy, eventually contributing in stratifying the risk of phenoconversion

L'agiografia iacoponica

Sulla scorta di un'attenta lettura delle cosiddette "vite antiche" di iacopone da Todi, si ipotizza che l'intera tradizione biografica del poeta tudertino non risalga oltre gli inizi del XV secolo e che il più antico stadio redazionale della "leggenda" vada identificato con quella pubblicata da A. Tobler negli anni 1878-1879