Guidelines for the use and interpretation of diagnostic methods in adult food allergy

Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed

Miomectomia isteroscopica: risultati a lungo termine sui pattern mestruali e sull’outcome riproduttivo

Scopo dello studio è stato quello di valutare retrospettivamente i risultati a distanza della miomectomia isteroscopica sui pattern mestruali e sull’outcome riproduttivo in 77 donne con fibromiomi sottomucosi sintomatici (sanguinamento uterino anormale, algie pelviche, infertilità). L’età media delle pazienti era di 43.9 anni; 72 (93.5%) erano in premenopausa, 5 (6.5%) erano già in postmenopausa. Le dimensioni dei miomi, erano comprese tra 1 e 5 cm di diametro (media 2.8 cm). Per il trattamento preoperatorio sono stati utilizzati, a seconda dei casi, gli analoghi del Gn-RH, il gestrinone, oppure il danazolo. In media, la durata dell’intervento è stata di 22 minuti, la quantità di soluzione impiegata 2.6 litri, quella intravasata o comunque non recuperata di 320 cc. Nel corso degli interventi non si sono avute complicanze importanti ed il decorso post-operatorio è stato regolare. Nel periodo di follow-up (media 2.8 anni), 8 pazienti sono state perse. Delle altre 69, soltanto 5 (7.2%) sono state sottoposte ad isterectomia per persistenza della sintomatologia (sanguinamento, algie pelviche), mentre in 3 su 5 con problemi riproduttivi si è ottenuta la gravidanza. In conclusione, la miomectomia isteroscopica si conferma una tecnica alquanto valida ed efficace per il sanguinamento uterino e l’infertilità da miomi sottomucosi

Multimodal Cues for Gait Rehabilitation With Smart Glasses in Persons With Parkinson’s Disease (PD): A Methodology for the Selection of Effective Design Solutions

Introduction: Persons with PD are affected by motor impairments that compromise their autonomy. Recent advances in wearable systems showed that sensory biofeedback (BF) can improve gait in PD. Through verbal BF, an existing smartphone-based gait rehabilitation system (CuPiD-system) makes PD subjects better aware of their gait performance. Thanks to Smart Glasses (SG), real-time visual and haptic cues are also feasible: this study describes strategies to design an innovative mHealth system obtained by integrating the smartphone-based CuPiD-system with SG. The aim is to rehabilitate postural and transient gait disturbances and to provide gait training at home for persons with PD. Methods: We performed a pilot trial on five subjects not belonging to a particular category of users, following a Human-Centered design research approach. We proposed sensory BF suggesting a rhythm to be followed: auditory by wireless earphones, visual and haptic by the SG. We analyzed the subjects’ qualitative and quantitative responses through an interview and a specific gait analysis protocol. Results: This testing phase investigated how sensory BF influences the user’s gait, the most efficient cues to improve user’s performance, and acceptance of the mHealth system. We applied an ad-hoc redesigned version of the Quality-Function-Deployment (QFD) design tool to manage the complexity of the collected data, Figure 33. Discussion: While visual BF improves spatial gait parameters, auditory and somatosensory BF improve temporal gait features (cadence). QFD’s results confirm the role of sensory BF on gait rehabilitation: auditory and haptic BF reach a higher efficacy than the visual one. Some critical aspects emerged: the gap between the user’s cadence and the target one; the subjects’ sensory preferences. In the next phase on PD subjects, the target cadence will be subject-specific, and questionnaires should be used to evaluate subjects’ sensory preferences and integrate them into the QFD matrix

User-Centered Design Methodologies for the Prototype Development of a Smart Harness and Related System to Provide Haptic Cues to Persons with Parkinson’s Disease

This paper describes the second part of the PASSO (Parkinson smart sensory cues for older users) project, which designs and tests an innovative haptic biofeedback system based on a wireless body sensor network using a smartphone and different smartwatches specifically designed to rehabilitate postural disturbances in persons with Parkinson’s disease. According to the scientific literature on the use of smart devices to transmit sensory cues, vibrotactile feedback (particularly on the trunk) seems promising for improving people’s gait and posture performance; they have been used in different environments and are well accepted by users. In the PASSO project, we designed and developed a wearable device and a related system to transmit vibrations to a person’s body to improve posture and combat impairments like Pisa syndrome and camptocormia. Specifically, this paper describes the methodologies and strategies used to design, develop, and test wearable prototypes and the mHealth system. The results allowed a multidisciplinary comparison among the solutions, which led to prototypes with a high degree of usability, wearability, accessibility, and effectiveness. This mHealth system is now being used in pilot trials with subjects with Parkinson’s disease to verify its feasibility among patients

User-Centered Design of Cues with Smart Glasses for Gait Rehabilitation in People with Parkinson’s Disease: A Methodology for the Analysis of Human Requirements and Cues Effectiveness

none6noAs an alternative to the technical industrial mindset, User-Centered Design has proven to be an effective tool to realize products and services for the Healthcare sector. In this scenario, this project aims to develop an innovative wearable gait rehabilitation solution obtained by integrating the Smart Glasses Vuzix Blade into the smartphone-based CuPiD-system. The specific aims of the testing phase described in this paper were to observe how submitted visual, auditory, and vibratory cues influence the user’s gait; and which were the most impacting and efficient typologies of cues. To achieve these results, we analyze the users’ qualitative and quantitative feedback, respectively obtained from an interview and a specific gait analysis protocol.noneImbesi, Silvia; Corzani, Mattia; Petrocchi, Filippo; Lopane, Giovanna; Chiari, Lorenzo; Mincolelli, GiuseppeImbesi, Silvia; Corzani, Mattia; Petrocchi, Filippo; Lopane, Giovanna; Chiari, Lorenzo; Mincolelli, Giusepp

Is oral contraceptive-induced headache dependent on patent foramen ovale? Clinical dynamics, evidence-based hypothesis and possible patient-oriented management

Secondary headache is one of the most common side effect during oral contraceptive (OC) treatment and it leads many patients to stop the therapy. Patent foramen ovale (PFO) is an interatrial communication that spontaneously closes at birth in about 75% of the population. However, in the rest of adults PFO maintains a direct communication between the right and left side of circulation. In these patients PFO is a tunnel-like structure that could allow a blood clot to pass from the right to the left side of circulation, thus can cause paradoxical embolization. Although an increased frequency of PFO in patients with migraine was already reported, the relationship between PFO and migraine remains uncertain. In patients with migraine, the prevalence of moderate or large PFO is 35% and seems not associated with the presence of aura or the frequency of headache. Basing on these assumptions, we hypothesize that asymptomatic PFO could play a role in secondary headache due to OC. The procoagulant effect of OC improves the production of microemboli that through the POF could pass from the right to the left atrium and than to the brain, where they could be responsible of secondary headache. If our hypothesis would be confirmed in future studies, it would be possible to identify high-risk patients for developing OC-induced headache and other cerebrovascular major diseases through transcranial Doppler and transesophageal echocardiography. This scenario may radically change the management of reproductive-age woman who have to undergo OC therapy for contraception or other medical conditions

Biglycan Involvement in Heart Fibrosis: Modulation of Adenosine 2A Receptor Improves Damage in Immortalized Cardiac Fibroblasts

Cardiac fibrosis is a common pathological feature of different cardiovascular diseases, characterized by the aberrant deposition of extracellular matrix (ECM) proteins in the cardiac interstitium, myofibroblast differentiation and increased fibrillar collagen deposition stimulated by transforming growth factor (TGF)-β activation. Biglycan (BGN), a small leucine-rich proteoglycan (SLRPG) integrated within the ECM, plays a key role in matrix assembly and the phenotypic control of cardiac fibroblasts. Moreover, BGN is critically involved in pathological cardiac remodeling through TGF-β binding, thus causing myofibroblast differentiation and proliferation. Adenosine receptors (ARs), and in particular A2AR, may play a key role in stimulating fibrotic damage through collagen production/deposition, as a consequence of cyclic AMP (cAMP) and AKT activation. For this reason, A2AR modulation could be a useful tool to manage cardiac fibrosis in order to reduce fibrotic scar deposition in heart tissue. Therefore, the aim of the present study was to investigate the possible crosstalk between A2AR and BGN modulation in an in vitro model of TGF-β-induced fibrosis. Immortalized human cardiac fibroblasts (IM-HCF) were stimulated with TGF-β at the concentration of 10 ng/mL for 24 h to induce a fibrotic phenotype. After applying the TGF-β stimulus, cells were treated with two different A2AR antagonists, Istradefylline and ZM241385, for an additional 24 h, at the concentration of 10 µM and 1 µM, respectively. Both A2AR antagonists were able to regulate the oxidative stress induced by TGF-β through intracellular reactive oxygen species (ROS) reduction in IM-HCFs. Moreover, collagen1a1, MMPs 3/9, BGN, caspase-1 and IL-1β gene expression was markedly decreased following A2AR antagonist treatment in TGF-β-challenged human fibroblasts. The results obtained for collagen1a1, SMAD3, α-SMA and BGN were also confirmed when protein expression was evaluated; phospho-Akt protein levels were also reduced following Istradefylline and ZM241385 use, thus suggesting that collagen production involves AKT recruited by the A2AR. These results suggest that A2AR modulation might be an effective therapeutic option to reduce the fibrotic processes involved in heart pathological remodeling

Cycloastragenol as an Exogenous Enhancer of Chondrogenic Differentiation of Human Adipose-Derived Mesenchymal Stem Cells. A Morphological Study

Stem cell therapy and tissue engineering represent a promising approach for cartilage regeneration. However, they present limits in terms of mechanical properties and premature de-differentiation of engineered cartilage. Cycloastragenol (CAG), a triterpenoid saponin compound and a hydrolysis product of the main ingredient in Astragalus membranaceous, has been explored for cartilage regeneration. The aim of this study was to investigate CAG’s ability to promote cell proliferation, maintain cells in their stable active phenotype, and support the production of cartilaginous extracellular matrix (ECM) in human adipose-derived mesenchymal stem cells (hAMSCs) in up to 28 days of three-dimensional (3D) chondrogenic culture. The hAMSC pellets were cultured in chondrogenic medium (CM) and in CM supplemented with CAG (CAG–CM) for 7, 14, 21, and 28 days. At each time-point, the pellets were harvested for histological (hematoxylin and eosin (H&E)), histochemical (Alcian-Blue) and immunohistochemical analysis (Type I, II, and X collagen, aggrecan, SOX9, lubricin). After excluding CAG’s cytotoxicity (MTT Assay), improved cell condensation, higher glycosaminoglycans (sGAG) content, and increased cell proliferation have been detected in CAG–CM pellets until 28 days of culture. Overall, CAG improved the chondrogenic differentiation of hAMSCs, maintaining stable the active chondrocyte phenotype in up to 28 days of 3D in vitro chondrogenic culture. It is proposed that CAG might have a beneficial impact on cartilage regeneration approaches

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services