Trigeminal sensory pathway function in patients with SUNCT

[IF 2.64] Objective: Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a rare primary headache whose origins are unclear. To seek information on its pathophysiology, we studied the trigeminal Ab and Ad pathways by recording trigeminal reflexes and laser evoked potentials (LEPs) in patients with SUNCT. Methods: Trigeminal reflexes and LEPs were recorded in 11 consecutive patients. Ten patients had neuroimaging evidence documenting idiopathic SUNCT and one had a posterior fossa tumour that compressed the trigeminal nerve thus causing symptomatic SUNCT. Results: Whereas the patients with idiopathic SUNCT had normal trigeminal reflex and LEP responses, the patient with symptomatic SUNCT had abnormal responses. Conclusions: Our neurophysiological findings show that idiopathic SUNCT spares the trigeminal sensory pathways whereas symptomatic SUNCT does not. Significance: Neurophysiological testing can easily differentiate the idiopathic and symptomatic forms of SUNCT. It also suggests that the two forms are pathophysiologically distinct entities

Management Zones Delineation through Clustering Techniques Based on Soils Traits, NDVI Data, and Multiple Year Crop Yields

Availability of georeferenced yield data involving different crops over years, and their use in future crop management, are a subject of growing debate. In a 9 hectare field in Northern Italy, seven years of yield data, including wheat (3 years), maize for biomass (2 years), sunflower, and sorghum, and comprising remote (Landsat) normalized difference vegetation index (NDVI) data during central crop stages, and soil analysis (grid sampling), were subjected to geostatistical analysis (semi-variogram fitting), spatial mapping (simple kriging), and Pearson’s correlation of interpolated data at the same resolution (30 m) as actual NDVI values. Management Zone Analyst software indicated two management zones as the optimum zone number in multiple (7 year) standardized yield data. Three soil traits (clay content, total limestone, total nitrogen) and five dates within the NDVI dataset (acquired in different years) were shown to be best correlated with multiple-and single-year yield data, respectively. These eight parameters were normalized and combined into a two-zone multiple soil and NDVI map to be compared with the two-zone multiple yield map. This resulted in 83% pixel agreement in the high and low zone (89 and 10 respective pixels in the soil and NDVI map; 73 and 26 respective pixels in the yield map) between the two maps. The good agreement, which is due to data buffering across different years and crop types, is a good premise for differential management of the soil-and NDVI-based two zones in future cropping seasons

Description of the relationship between NOHL classification in drug-induced sleep endoscopy and initial AHI in patients with moderate to severe OSAS, and evaluation of the results obtained with oral appliance therapy

Descrizione della relazione tra Classificazione NOHL definita durante la Drug-Induced Sleep Endoscopy e AHI iniziale in pazienti con OSAS da moderato a grave, e valutazione dei risultati ottenuti con dispositivi orali

A novel, comprehensive tool for predicting 30-day mortality after surgical aortic valve replacement

OBJECTIVES: We sought to develop and validate a novel risk assessment tool for the prediction of 30-day mortality after surgical aortic valve replacement incorporating a patient's frailty. METHODS: Overall, 4718 patients from the multicentre study OBSERVANT was divided into derivation (n=3539) and validation (n=1179) cohorts. A stepwise logistic regression procedure and a criterion based on Akaike information criteria index were used to select variables associated with 30-day mortality. The performance of the regression model was compared with that of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. RESULTS: At 30 days, 90 (2.54%) and 35 (2.97%) patients died in the development and validation data sets, respectively. Age, chronic obstructive pulmonary disease, concomitant coronary revascularization, frailty stratified according to the Geriatric Status Scale, urgent procedure and estimated glomerular filtration rate were independent predictors of 30-day mortality. The estimated OBS AVR score showed higher discrimination (area under curve 0.76 vs 0.70, P CONCLUSIONS: The OBS AVR risk score showed high discrimination and calibration abilities in predicting 30-day mortality after surgical aortic valve replacement. The addition of a simplified frailty assessment into the model seems to contribute to an improved predictive ability over the EuroSCORE II. The OBS AVR risk score showed a significant association with long-term mortality.Peer reviewe

Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study.

BACKGROUND: Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy. METHODS: PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. RESULTS: Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p\u2009<\u20090.001), whereas median length of hospital stay was 16 (IQR\u2009=\u200913) vs 8 (IQR\u2009=\u20098) days (p\u2009<\u20090.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days. CONCLUSIONS: Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2-3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples

Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine. A post hoc analysis of the randomized, sham-controlled, double-blind PRESTO trial

Background: The PRESTO study of non-invasive vagus nerve stimulation (nVNS; gammaCore®) featured key primary and secondary end points recommended by the International Headache Society to provide Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 h post stimulation. Here, we examined additional data from PRESTO to provide further insights into the practical utility of nVNS by evaluating its ability to consistently deliver clinically meaningful improvements in pain intensity while reducing the need for rescue medication. Methods: Patients recorded pain intensity for treated migraine attacks on a 4-point scale. Data were examined to compare nVNS and sham with regard to the percentage of patients who benefited by at least 1 point in pain intensity. We also assessed the percentage of attacks that required rescue medication and pain-free rates stratified by pain intensity at treatment initiation. Results: A significantly higher percentage of patients who used acute nVNS treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%; sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after the first attack. Similar significant results were seen when assessing the benefit in all attacks. The proportion of patients who did not require rescue medication was significantly higher with nVNS than with sham for the first attack (nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%; P = 0.008). When initial pain intensity was mild, the percentage of patients with no pain after treatment was significantly higher with nVNS than with sham at 60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham, 30.1%; P = 0.037). Conclusions: This post hoc analysis demonstrated that acute nVNS treatment quickly and consistently reduced pain intensity while decreasing rescue medication use. These clinical benefits provide guidance in the optimal use of nVNS in everyday practice, which can potentially reduce use of acute pharmacologic medications and their associated adverse events. Trial registration: ClinicalTrials.gov identifier: NCT02686034

Indications and Limits of Surgery for Spinal Metastases Derived from Lung Cancer: A Single-Center Experience

Lung cancer is the second most frequently diagnosed cancer in the world, and surgery is an integral part of the treatment for spinal metastases. The aims of this retrospective study were to assess the overall survival of surgically treated patients affected by lung cancer spinal metastases and identify any factors related to a better survival rate. We recruited 56 consecutive patients (34 male and 22 female) surgically treated for metastatic lung cancer in the spine from 2009 to 2019. Surgical indications were based on a previously published and validated flow chart following a multidisciplinary evaluation. We assessed the localization of vertebral metastases, the presence of other bone or visceral metastases, neurological status according to the Frankel score, ambulatory autonomy, and general status, measured with the Karnofsky performance scale. The expected prognosis was retrospectively assessed according to the revised Tokuhashi score. The median survival was 8.1 months, with over a third of patients surviving more than 1 year. We observed a global improvement in all clinical parameters after surgical treatment. The Tokuhashi predictive score did not correlate with survival after surgery. The results of this study suggest that the surgical treatment of symptomatic spinal metastases from lung cancer can improve quality of life, even in patients with a shorter life expectancy, by controlling pain and improving autonomy

Potenziale utilizzo di idrolati per il controllo delle infezioni microbiche

Introduzione. Come \ue8 noto, diversi microrganismi costituiscono un diretto pericolo per la nostra salute in quanto possono infettare l'ospite umano: le malattie infettive causate da batteri e funghi sono ogni anno responsabili di morbilit\ue0 e mortalit\ue0 in un numero crescente di individui ospedalizzati e immunocompromessi. Inoltre, negli ultimi anni, la diffusione di ceppi microbici multi-resistenti ai farmaci, (ad es. Staphylococcus aureus, Pseudomonas aeruginosa e Candida spp.), ha provocato infezioni difficili o impossibili da controllare con antimicrobici convenzionali. La necessit\ue0 di nuove terapie per il trattamento delle infezioni microbiche ha portato i ricercatori a concentrarsi su possibili alternative di tipo naturale. L'idrolato (Id), noto anche come idrosol o acqua aromatica, \ue8 la frazione idrofila ottenuta durante il processo di distillazione in corrente di vapore assieme all\u2019olio essenziale (OE), capace di esercitare attivit\ue0 anti-microbiche grazie al contenuto in componenti terpeniche pari a circa l\u20191% v/v. Sebbene entrambe i prodotti della distillazione abbiano una nota azione antimicrobica, non \ue8 mai stata paragonata la loro attivit\ue0 quando estratti dalla stessa pianta. Scopo. Gli scopi di questo lavoro sono stati: (i) quello di paragonare l'attivit\ue0 antimicrobica dell\u2019OE e dell\u2019Id estratti da Monarda citriodora (MC) verso 30 ceppi fungini e batterici coinvolti in infezioni umane, (ii) valutare l\u2019efficacia dell\u2019Id di C. aurantium var. amara (CA) nei confronti di 18 ceppi fungini e batterici potenzialmente responsabili di infezioni cutanee. Materiali e metodi. L\u2019OE e l\u2019Id di MC sono stati ottenuti mediante distillazione in corrente di vapore partendo da piante fiorite coltivate presso l\u2019istituto Scarabelli-Ghini di Imola (fig.1), mentre l\u2019Id-CA era di tipo commerciale. Sono stati eseguiti test di micro-brodo diluizione secondo linee guida internazionali EUCAST per valutare l\u2019efficacia antimicrobica dell\u2019OE-MC (concentrazioni comprese tra 0,0078% e 4%), dell'Id-MC (concentrazioni tra 12,5% e 50%) e dell\u2019Id-CA (concentrazioni tra 3.12% e 50%) vs i ceppi testati. Inoltre, l'OE e gli Id sono stati analizzati in GC-MS per valutarne la composizione terpenica e, nel caso di M. citriodora, paragonare l\u2019efficacia dell\u2019OE a quella dell\u2019Id in funzione del loro contenuto terpenico. Risultati. L'OE-MC e l\u2019Id-CA sono risultati efficaci, a concentrazioni variabili, su tutti i ceppi testati, mentre, l'Id-MC era attivo su tutti i microrganismi tranne che sui ceppi di P. aeruginosa (MIC>4% v/v). Le analisi GC-MS hanno individuato come principali componenti terpeniche il timolo per OE-MC e di Id-MC (19,6% e 66,4% rispettivamente) e il linalolo per Id-CA. Conclusioni. Nonostante sia necessaria una maggiore concentrazione di Id-MC per ottenere lo stesso effetto inibente dell\u2019OE-MC, la quantit\ue0 di terpeni presenti per unit\ue0 di volume nell\u2019Id \ue8 risultata inferiore rispetto all'EO. La maggiore efficacia dei terpeni contenuti nell\u2019Id \ue8 probabilmente dovuta all'ambiente idrofilo che ne promuove una maggiore disponibilit\ue0

Phenotypic heterogeneity and genetic modification of P102L inherited prion disease in an international series

The largest kindred with inherited prion disease P102L, historically Gerstmann-Sträussler-Scheinker syndrome, originates from central England, with émigrés now resident in various parts of the English-speaking world. We have collected data from 84 patients in the large UK kindred and numerous small unrelated pedigrees to investigate phenotypic heterogeneity and modifying factors. This collection represents by far the largest series of P102L patients so far reported. Microsatellite and genealogical analyses of eight separate European kindreds support multiple distinct mutational events at a cytosine-phosphate diester-guanidine dinucleotide mutation hot spot. All of the smaller P102L kindreds were linked to polymorphic human prion protein gene codon 129M and were not connected by genealogy or microsatellite haplotype background to the large kindred or each other. While many present with classical Gerstmann-Sträussler-Scheinker syndrome, a slowly progressive cerebellar ataxia with later onset cognitive impairment, there is remarkable heterogeneity. A subset of patients present with prominent cognitive and psychiatric features and some have met diagnostic criteria for sporadic Creutzfeldt-Jakob disease. We show that polymorphic human prion protein gene codon 129 modifies age at onset: the earliest eight clinical onsets were all MM homozygotes and overall age at onset was 7 years earlier for MM compared with MV heterozygotes (P = 0.02). Unexpectedly, apolipoprotein E4 carriers have a delayed age of onset by 10 years (P = 0.02). We found a preponderance of female patients compared with males (54 females versus 30 males, P = 0.01), which probably relates to ascertainment bias. However, these modifiers had no impact on a semi-quantitative pathological phenotype in 10 autopsied patients. These data allow an appreciation of the range of clinical phenotype, modern imaging and molecular investigation and should inform genetic counselling of at-risk individuals, with the identification of two genetic modifiers