Can a pathological model improve the abilities of the paretic hand in hemiplegic children? the PAM-AOT study protocol of a randomised controlled trial

Introduction Action Observation Treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by subsequent repetition. In children with unilateral cerebral palsy (UCP), it improves upper limb function in daily activities. The standard paradigm of AOT requires the observation of healthy models; however, it has been demonstrated that the mirror neuron system of children with UCP is more activated by observation of pathological models, showing a similar motor repertoire, than by the healthy model, suggesting that AOT based on pathological models is superior to the standard paradigm of AOT in the functional rehabilitation of the affected upper limb of children with UCP. Methods and analysis This protocol describes an active two-arm randomised controlled evaluator-blinded trial. Twenty-six children with UCP will participate in 3 weeks of intensive AOT: the experimental group will observe a pathological model, while the control group will observe a typically developed model. The primary outcome is the spontaneous use of the paretic hand, measured with the Assisting Hand Assessment. Secondary outcome measures are the Melbourne Assessment of Unilateral Upper Limb Function, the ABILHAND-Kids and the Activities Scale for Kids-performance. Assessments will be performed at baseline (T0), at the end of intensive AOT (T1), at 8-12 weeks (T2) and at 24-28 weeks (T3) after the end of intensive AOT. Ethics and dissemination The trial was approved by the Area Vasta Emilia Nord Ethics Committee (AVEN prot. n. 133117, 29 November 2018), and it was prospectively registered on ClinicalTrials.gov. The results will be submitted for publication to a peer-reviewed journal, discussed with parents of children participating in the trial and disseminated at suitable conferences. Trial registration number NCT04088994; Pre-results

Can a pathological model improve the abilities of the paretic hand in hemiplegic children? the PAM-AOT study protocol of a randomised controlled trial

Introduction Action Observation Treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by subsequent repetition. In children with unilateral cerebral palsy (UCP), it improves upper limb function in daily activities. The standard paradigm of AOT requires the observation of healthy models; however, it has been demonstrated that the mirror neuron system of children with UCP is more activated by observation of pathological models, showing a similar motor repertoire, than by the healthy model, suggesting that AOT based on pathological models is superior to the standard paradigm of AOT in the functional rehabilitation of the affected upper limb of children with UCP. Methods and analysis This protocol describes an active two-arm randomised controlled evaluator-blinded trial. Twenty-six children with UCP will participate in 3 weeks of intensive AOT: the experimental group will observe a pathological model, while the control group will observe a typically developed model. The primary outcome is the spontaneous use of the paretic hand, measured with the Assisting Hand Assessment. Secondary outcome measures are the Melbourne Assessment of Unilateral Upper Limb Function, the ABILHAND-Kids and the Activities Scale for Kids-performance. Assessments will be performed at baseline (T0), at the end of intensive AOT (T1), at 8-12 weeks (T2) and at 24-28 weeks (T3) after the end of intensive AOT. Ethics and dissemination The trial was approved by the Area Vasta Emilia Nord Ethics Committee (AVEN prot. n. 133117, 29 November 2018), and it was prospectively registered on ClinicalTrials.gov. The results will be submitted for publication to a peer-reviewed journal, discussed with parents of children participating in the trial and disseminated at suitable conferences. Trial registration number NCT04088994; Pre-results

Heterogeneity Governs 3D-Cultures of Clinically Relevant Microbial Communities

The intrinsic heterogeneity of bacterial niches should be retained in in vitrocultures to represent the complex microbial ecology. As a case study,mucin-containing hydrogels -CF-Mu3Gel - are generated by diffusion-inducedgelation, bioinspired on cystic fibrosis (CF) mucus, and a microbial nichechallenging current therapeutic strategies. At breathing frequency, CF-Mu3Gelexhibits aG′andG′′equal to 24 and 3.2 Pa, respectively. Notably, CF-Mu3Gelexhibits structural gradients with a gradual reduction of oxygen tensionacross its thickness (280–194μmol L−1). Over the culture period, a steepdecline in oxygen concentration occurs just a few millimeters below theair–mucus interface in CF-Mu3Gel, similar to those of CF airway mucus.Importantly, the distinctive features of CF-Mu3Gel significantly influencebacterial organization and antimicrobial tolerance in mono- and co-cultures ofStaphylococcus aureusandPseudomonas aeruginosathat standard culturesare unable to emulate. The antimicrobial susceptibility determined inCF-Mu3Gel corroborates the mismatch on the efficacy of antimicrobialtreatment between planktonically cultured bacteria and those in patients.With this example-based research, new light is shed on the understanding ofhow the substrate influences microbial behavior, paving the way for improvedfundamental microbiology studies and more effective drug testing anddevelopment

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

SPOSTAMENTI DELLA SPONDA DI UN LAGO ARTIFICIALE CAUSATI DA CARSISMO DA DISSOLUZIONE DEI GESSI

Il serbatoio Disueri sul F. Gela \ue8 stato creato con una diga di muratura a secco, completata nel 1948, sostituita nel 1997 con una diga di terra. Entrambe le dighe sono fondate su rocce della serie Gessoso-Solfifera che nella zona di sbarramento \ue8 interessata da pieghe e faglie che d\ue0nno luogo a un assetto strutturale estremamente complesso. Sulla sponda sinistra affiora un banco di gessi selenitici interessato da numerose cavit\ue0, parecchie delle quali di grandi dimensioni. L\u2019evoluzione delle cavit\ue0 \ue8 rapida a causa dell\u2019alta velocit\ue0 di dissoluzione dei gessi in condizioni di acqua fluente, e ha dato origine a una grande conca di subsidenza e a spostamenti che lasciano prefigurare la formazione di un vero e proprio meccanismo di rottura della sponda

Preliminary biomechanical study of triple Lutz

In artistic roller skating, there are no quantitative biomechanical studies analysing the Lutz. Therefore, the aim of this research was to analyse the kinematic of the Triple Lutz in world-class athletes. Five subjects were analysed. A motion analysis system was used to reconstruct the position of apposite markers placed on the athlete\u2019s body and on the skate. Relevant biomechanical indices representing linear and angular displacements, angular velocities were analysed in different phases of the considered movement. The pelvis centre raised on average of 25.4 cm at the take-off (range: 19.5 \u2013 34.8 cm). The mean height of the flight trajectory was of 50.5 cm (range: 42.2 \u2013 57.8 cm). The absolute distance between the pelvis centre and the right foot centre at the toe assist was 50.1 cm, whereas at the take-off it was 13.5 cm, i.e. definitely lower, with very wide oscillations between the minimum (2.6 cm) and the maximum (23.6 cm) value. The left knee and the ankle, at the toe assist, were clearly flexed (knee: 62\ub0 and ankle: 24\ub0 of dorsiflexion). Then, the knee showed the maximum extension in correspondence with the take-off of the left skate (12\ub0). In the same instant, the left ankle showed a moderate plantarflexion of 19\ub0. At the take-off of the right foot, the left knee showed a slight flexion (24\ub0), whereas the ankle showed a little flexion (21\ub0). The inclination of the trunk was more pronounced at the toe assist (37\ub0), and less marked in the following phases (end of the gliding: 32\ub0, and take-off: 28\ub0). The peak velocity varied from 4.72 m/s (recorded before the toe assist) to 4.18 m/s. Then, the velocity further reduced at the take-off of the gliding skate (2.71 m/s), and at the take-off of the jump it is 2.69 m/s. Therefore, the horizontal speed at the end of the gliding was almost equal to that at the take-off. It is possible to explain what described about the pelvis motion by analysing the lower limbs kinematics. The toe assisting leg joints showed a loading action just after the toe assist, that was very little for the hip, moderate for the knee (6\ub0), more pronounced for the ankle (21\ub0). The loading time was the shortest for the knee (0.027 s) and the longest for the ankle (0.09 s). Considering the falling time of the pelvis (0.04 s), it can be concluded that the fall is related to the loading of all the three joints of the toe assisting leg. The gliding leg, at the toe assist, was in the neutral position on the frontal plane, whereas it was markedly flexed such as the knee and the ankle. Then, the three joints made an extension movement, continuing up to the end of the gliding phase. The latero-lateral movements (adduction \u2013 abduction) of the hips were less evident in the initial phase for the gliding. Concerning the trunk movements, the subjects showed different strategies about the hip and shoulder movements in the toe assist and take-off points. The upper limbs movements in the toe assist and take-off phases were very different amongst the examined subjects. Therefore, it is not possible to individuate a reference model that can provide useful for a general analysis. In the future, a qualitative analysis of the arms movements will be carried out to understand the different strategies adopted by the various athletes

The shear strength of Opalinus Clay shale in the remoulded state

The Opalinus Clay shale formation is considered as a potential host geomaterial for the Swiss deep geological repository for radioactive waste. It presents different facies and it is characterised by a multi-scale heterogeneous composition, by a typical fissile structure with well-defined bedding planes and by anisotropic hydro-mechanical behaviour. This peculiar complexity makes it difficult to assign a unique set of geomechanical parameters to the material. This paper presents an experimental study aimed at characterising the lowest values of the shear strength parameters. In this sense, the shear behaviour was investigated on remoulded samples where the fabric and the diagenetic bonds of the intact material were eliminated. The results of a triaxial test campaign belonging to different facies of Opalinus Clay shale (“shaly” and “sandy” facies) are presented. Furthermore, with the aim to study the mechanical properties of fault zones in Opalinus Clay, the effect of large cumulated shear displacements on shear strength was also investigated. Ring shear tests were performed to determine the residual shear strength. The main geotechnical property which discriminates the different facies of Opalinus Clay is the grain-size distribution; in this sense, well-defined correlations between this intrinsic characteristic and shear strength angles of the remoulded material are presented

Il ruolo della facies sulla resistenza a taglio di argille estremamente consistenti

L’Opalinus Clay Shale è la formazione che ospiterà il deposito profondo di scorie radioattive di alta attività in Svizzera. A causa della sua composizione fortemente eterogenea, tale materiale è stato classificato in diverse facies. Inoltre, esso è caratterizzato da una struttura fissile e da un comportamento idro-meccanico anisotropo. Queste particolari complessità rendono particolarmente difficile la scelta di parametri geomeccanici unici per l’intera formazione. In questa memoria viene presentato uno studio sperimentale mirato alla caratterizzazione del limite inferiore dei parametri di resistenza al taglio, attraverso l’esecuzione di prove di compressione trias siale e prove di taglio anulare, eseguite su campioni completamente destrutturati appartenenti alle diverse facies. Inoltre, sono state condotte delle osservazioni al microscopio elettronico per valutare la disposizione delle par ticelle lungo le superfici di taglio. I risultati ottenuti hanno permesso di definire delle correlazioni tra la frazione argillosa e gli angoli di resistenza al taglio ultimo e residuo

Abdominal pain and internal hernias after Roux-en-Y gastric bypass: Are we dealing with the tip of an iceberg?

Abdominal pain is the most frequent cause of hospital admission after Roux-en-y gastric bypass (RYGB). Among numerous possible underlying causes, internal hernias represent one of the most peculiar and insidious conditions, setting challenging diagnostic and therapeutic problems for the surgeon. The aim of this study is to analyze aspecific abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias