Prevalence and time course of post-stroke pain: A multicenter prospective hospital-based study

OBJECTIVE: Pain prevalence data for patients at various stages after stroke. DESIGN: Repeated cross-sectional, observational epidemiological study. SETTING: Hospital-based multicenter study. SUBJECTS: Four hundred forty-three prospectively enrolled stroke survivors. METHODS: All patients underwent bedside clinical examination. The different types of post-stroke pain (central post-stroke pain, musculoskeletal pains, shoulder pain, spasticity-related pain, and headache) were diagnosed with widely accepted criteria during the acute, subacute, and chronic stroke stages. Differences among the three stages were analyzed with χ(2)-tests. RESULTS: The mean overall prevalence of pain was 29.56% (14.06% in the acute, 42.73% in the subacute, and 31.90% in the chronic post-stroke stage). Time course differed significantly according to the various pain types (P < 0.001). The prevalence of musculoskeletal and shoulder pain was higher in the subacute and chronic than in the acute stages after stroke; the prevalence of spasticity-related pain peaked in the chronic stage. Conversely, headache manifested in the acute post-stroke stage. The prevalence of central post-stroke pain was higher in the subacute and chronic than in the acute post-stroke stage. Fewer than 25% of the patients with central post-stroke pain received drug treatment. CONCLUSIONS: Pain after stroke is more frequent in the subacute and chronic phase than in the acute phase, but it is still largely undertreated

Physiotherapy versus consecutive physiotherapy and cognitive treatment in people with Parkinson's Disease: a pilot randomized cross-over study

Parkinson's disease (PD) is characterized by motor and cognitive dysfunctions that can usually be treated by physiotherapy or cognitive training, respectively. The effects of consecutive physiotherapy and cognitive rehabilitation programs on PD deficits are less investigated

A non-invasive approach to monitor chronic lymphocytic leukemia engraftment in a xenograft mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI).

This work was supported by: Associazione Italiana Ricerca sul Cancro (AIRC) [Grant 5 x mille n.9980, (to M.F., F.M. and A. N.)]; AIRC I.G. [n. 14,326 (to M.F.)], [n.10136 and 16,722 (A.N.)], [n.15426 (to F.F.)]. AIRC and Fondazione CaRiCal co-financed Multi Unit Regional Grant 2014 [n.16695 (to F.M.)]. Italian Ministry of Health 5 × 1000 funds (to F.F). A.G R. was supported by Associazione Italiana contro le Leucemie-Linfomi-Mielomi (AIL) Cosenza - Fondazione Amelia Scorza (FAS). S.M. C.M., F.V., L. E., S. B., were supported by AIRC.Peer reviewedPostprin

Relevance of Stereotyped B-Cell Receptors in the Context of the Molecular, Cytogenetic and Clinical Features of Chronic Lymphocytic Leukemia

Highly homologous B-cell receptors, characterized by non-random combinations of immunoglobulin heavy-chain variable (IGHV) genes and heavy-chain complementarity determining region-3 (HCDR3), are expressed in a recurrent fraction of patients affected by chronic lymphocytic leukemia (CLL). We investigated the IGHV status of 1131 productive IG rearrangements from a panel of 1126 CLL patients from a multicenter Italian study group, and correlated the presence and class of HCDR3 stereotyped subsets with the major cytogenetic alterations evaluated by FISH, molecular prognostic factors, and the time to first treatment (TTFT) of patients with early stage disease (Binet A). Stereotyped HCDR3 sequences were found in 357 cases (31.7%), 231 of which (64.7%) were unmutated. In addition to the previously described subsets, 31 new putative stereotypes subsets were identified. Significant associations between different stereotyped HCDR3 sequences and molecular prognostic factors, such as CD38 and ZAP-70 expression, IGHV mutational status and genomic abnormalities were found. In particular, deletion of 17p13 was significantly represented in stereotype subset #1. Notably, subset #1 was significantly correlated with a substantially reduced TTFT compared to other CLL groups showing unmutated IGHV, ZAP-70 or CD38 positivity and unfavorable cytogenetic lesions including del(17)(p13). Moreover, subset #2 was strongly associated with deletion of 13q14, subsets #8 and #10 with trisomy 12, whereas subset #4 was characterized by the prevalent absence of the common cytogenetic abnormalities. Our data from a large and representative panel of CLL patients indicate that particular stereotyped HCDR3 sequences are associated with specific cytogenetic lesions and a distinct clinical outcome

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis &lt; 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11&nbsp;years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

The somatosensory temporal discrimination threshold changes after a placebo procedure

In a recent study, we showed that tactile perception can be enhanced by applying a placebo manipulation consisting of verbal suggestion and conditioning (Fiorio et al., Neuroscience 217:96-104, 2012). Whether this change in perception is related to a better tactile functioning is still unknown. Aim of this study is to investigate whether placebo-induced enhancement of tactile perception results in better somatosensory temporal discrimination threshold (STDT), as a proxy of tactile acuity. To this purpose, a group of subjects (experimental group) was verbally influenced and conditioned about the effect of an inert cream in enhancing tactile perception, while a control group was informed about the real nature of the cream. In both groups, we measured STDT before and after cream application, by means of pairs of electrical stimuli delivered on the index fingertip and separated by ascending inter-stimulus intervals. STDT was defined as the shortest time interval at which the two stimuli were perceived as separated. Results revealed an increase in subjective perception of stimulus intensity and a reduction of STDT only in the experimental group. This study proves that a placebo procedure, consisting of verbal suggestion and a short conditioning, can reduce the temporal discrimination threshold

Nociceptive pathway function is normal in cervical dystonia: a study using laser-evoked potentials

Cervical dystonia (CD) is often associated with pain in the neck muscles, though the mechanisms underlying pain in this condition are still largely unknown. The aim of this study was to assess laser pain rating and CO2 laser-evoked potentials (LEPs) in CD patients with pain in the posterior neck region. We assessed the N2/P2 LEP complex and laser pain rating in a group of 20 CD patients and in 21 normal subjects. In 11 of the 20 CD patients (group I), the N2/P2 complex was recorded after stimulation of the skin overlying the right and left deltoid muscles (painless and non-dystonic). In the remaining nine CD patients (group II), the N2/P2 complex was recorded after stimulation of the skin over the splenius capitis muscle (painful and dystonic) and after stimulation of the skin overlying the contralateral splenius muscle (painless and non-dystonic). In group I patients, the N2/P2 LEP amplitude and laser pain rating after stimulation of both shoulders did not differ significantly from those obtained in normal subjects. Similarly, in group II patients, the N2/P2 LEP amplitude and laser pain rating after stimulation of the painful and dystonic splenius capitis muscle did not differ significantly from those obtained from either the contralateral painless, non-dystonic splenius capitis or normal subjects. The results of this study demonstrate that cutaneous nociceptive pathway function in CD patients is normal, thereby indicating that muscle pain in CD is not associated with any central sensitization of nociceptive inputs in either painful (dystonic) or non-painful (non-dystonic) body areas

Nociceptive pathway function is normal in cervical dystonia: a study using laser-evoked potentials.

Cervical dystonia (CD) is often associated with pain in the neck muscles, though the mechanisms underlying pain in this condition are still largely unknown. The aim of this study was to assess laser pain rating and CO2 laser-evoked potentials (LEPs) in CD patients with pain in the posterior neck region. We assessed the N2/P2 LEP complex and laser pain rating in a group of 20 CD patients and in 21 normal subjects. In 11 of the 20 CD patients (group I), the N2/P2 complex was recorded after stimulation of the skin overlying the right and left deltoid muscles (painless and non-dystonic). In the remaining nine CD patients (group II), the N2/P2 complex was recorded after stimulation of the skin over the splenius capitis muscle (painful and dystonic) and after stimulation of the skin overlying the contralateral splenius muscle (painless and non-dystonic). In group I patients, the N2/P2 LEP amplitude and laser pain rating after stimulation of both shoulders did not differ significantly from those obtained in normal subjects. Similarly, in group II patients, the N2/P2 LEP amplitude and laser pain rating after stimulation of the painful and dystonic splenius capitis muscle did not differ significantly from those obtained from either the contralateral painless, non-dystonic splenius capitis or normal subjects. The results of this study demonstrate that cutaneous nociceptive pathway function in CD patients is normal, thereby indicating that muscle pain in CD is not associated with any central sensitization of nociceptive inputs in either painful (dystonic) or non-painful (non-dystonic) body areas