Diffusion-weighted imaging and apparent diffusion coefficient mapping of head and neck lymph node metastasis: a systematic review

Aim: Head and neck squamous cell cancer (HNSCC) is the ninth most common tumor worldwide. Neck lymph node (LN) status is the major indicator of prognosis in all head and neck cancers, and the early detection of LN involvement is crucial in terms of therapy and prognosis. Diffusion-weighted imaging (DWI) is a non- invasive imaging technique used in magnetic resonance imaging (MRI) to characterize tissues based on the displacement motion of water molecules. This review aims to provide an overview of the current literature concerning quantitative diffusion imaging for LN staging in patients with HNSCC. Methods: This systematic review performed a literature search on the PubMed database (https://pubmed.ncbi.nlm.nih.gov/) for all relevant, peer-reviewed literature on the subject following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria, using the keywords: DWI, MRI, head and neck, staging, lymph node. Results: After excluding reviews, meta-analyses, case reports, and bibliometric studies, 18 relevant papers out of the 567 retrieved were selected for analysis. Conclusions: DWI improves the diagnosis, treatment planning, treatment response evaluation, and overall management of patients affected by HNSCC. More robust data to clarify the role of apparent diffusion coefficient (ADC) and DWI parameters are needed to develop models for prognosis and prediction in HNSCC cancer using MRI

Implementing an ict-based polypharmacy management program in Italy

Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses on multimorbidity and polytherapy management are encouraged. Furthermore a multidisciplinary approach integrating different health care professionals (physicians, pharmacists, and nurses) may positively impact on reducing the sense of fear related to discontinue or substitute drugs prescribed by others; the fragmentation of therapy among different specialists; reducing costs; and improving adverse drug reaction detection and reporting. Aiming at achieving the individualized pharmacotherapy, a multidisciplinary approach starting with identification of patients and risk for drug-related problems, followed by medication review overtime and use of inappropriateness criteria, supported by computerized systems has been proposed

Wearable Electrochemical Sensors in Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disorder associated with widespread aggregation of α-synuclein and dopaminergic neuronal loss in the substantia nigra pars compacta. As a result, striatal dopaminergic denervation leads to functional changes in the cortico-basal-ganglia-thalamo-cortical loop, which in turn cause most of the parkinsonian signs and symptoms. Despite tremendous advances in the field in the last two decades, the overall management (i.e., diagnosis and follow-up) of patients with PD remains largely based on clinical procedures. Accordingly, a relevant advance in the field would require the development of innovative biomarkers for PD. Recently, the development of miniaturized electrochemical sensors has opened new opportunities in the clinical management of PD thanks to wearable devices able to detect specific biological molecules from various body fluids. We here first summarize the main wearable electrochemical technologies currently available and their possible use as medical devices. Then, we critically discuss the possible strengths and weaknesses of wearable electrochemical devices in the management of chronic diseases including PD. Finally, we speculate about possible future applications of wearable electrochemical sensors in PD, such as the attractive opportunity for personalized closed-loop therapeutic approaches

Inhibitory cortical control in healthy subjects: modulation of beta and gamma oscillations in frontal cortical areas

Background The inhibition of an ongoing response is a key component of executive control implying the voluntary suppression of inappropriate behaviours 1 . Physiological mechanisms underlying this response are based on an integrated cortical network, including the inferior frontal gyrus (IFG) and the dorsal premotor cortex (PMd) 2 . Inhibition of unwilling actions can be experimentally probed through a standardised paradigm, the Stop Signal Task (SST) 3-4 , that requires subjects to start a movement as quickly as possible when a Go Signal is presented and to refrain from it if suddenly a Stop Signal appears during the reaction time (RT). This protocol allows for the assessment of the inhibitory ongoing response, reflected by the Stop Signal Reaction Times (SSRT). Recently, it has been demonstrated in healthy subjects (HS) that the activation of these cortical areas during specific behaviours is reflected by modulations of beta-/gamma- oscillations 5 . These oscillations can be experimentally and noninvasively modulated by transcranial alternating current stimulation (tACS) protocols. The aim of this study is to explore the role of cortical beta-/gamma- oscillations in the physiology of inhibitory human behaviours through SST protocol performed during specific tACS paradigms, in HS. Methods Six HS performed the SST during three different tACS protocols (β-, γ- and sham-tACS) randomly delivered over the IFG and PMd, bilaterally, over two different days. The coordinates of right and left IFG and PMd were first assessed through neuronavigation. During the SST paradigm we quantified RT and SSRT. Results Preliminary results suggest that beta- and gamma- tACS differently modulate action inhibition in HS. A two- way repeated measures Anova revealed a significant interaction among the factors Area (IFG; PMd) and tACS(β; γ). Post-hoc comparisons pointed out a significant difference in γ-tACS modulation among the two areas (p=.03); gamma-tACS applied over the IFG decreased RTs, while the stimulation of the PMd increased RTs. Furthermore, gamma-tACS increased SSRTs when applied over both IFG and PMd. Conclusion We demonstrated that beta- and gamma- tACS can modulate cortical oscillations underlying physiological mechanisms of inhibitory control behaviours, in frontal cortical areas, in HS. These preliminary results provide the background for future applications in neurological disorders characterised by deficit of inhibitory control, such as Parkinson's Disease

Pseudocysts and Other Cystic Lesions

In the pancreas, a large amount of lesions with cystic features, both neoplastic and non-neoplastic, could be seen during imaging examinations. Increased detection of cystic pancreatic lesions at cross-sectional imaging has been reported, and it is a widespread everyday experience. The two large subgroups at the beginning evaluation are neoplastic and non-neoplastic. Non-neoplastic pancreatic and peripancreatic cystic lesions will be discussed, and rare pancreatic cystic neoplasms will be presented

Current and promising therapeutic options for Dravet syndrome

Introduction: Dravet Syndrome (DS) is a developmental and epileptic encephalopathy carrying high-level psychobehavioral burdens. Although the disease has been known for almost 4 decades, and despite significant progress in the understanding of its physiopathology and natural course, the pharmacological treatment leaves patients and caregivers with significant unmet needs. This review provides a summary of the current and promising therapeutic options for DS Areas covered: PubMed and ClinicalTrials.gov were screened using ‘Dravet Syndrome’ OR ‘DS,’ AND ‘pharmacotherapy,’ AND ‘treatments.’ Randomized clinical trials, structured reviews, and meta-analyses were selected for in-human application of well-known anti-seizure medications; while in-vivo experiments on models of DS were selected to evaluate the potential of new therapeutic strategies. Expert opinion: The search for new pharmacological treatment options is led by the need for care and defeat of the natural course of the disease, an aspect still largely neglected by the available therapeutic strategies. Yet, the last 6 years have led to a climate of increased interest and availability of clinical trials. Particularly, gene therapy could hopefully prevent DS evolution by directly relieving the specific genetic defect, although the possibility of off-target editing, and the uneasy administration route have still largely prevented its use

Imaging presentation of pancreatic neuroendocrine neoplasms

Abstract Pancreatic neuroendocrine neoplasms (P-NENs) are the second most common solid pancreatic neoplasms. P-NENs have a wide range of imaging features presentations and they can be detected with typical and atypical imaging presentations. Typical and atypical appearances can be explained by pathologic correlations. P-NENs are generally hypervascular lesions, showing a typical enhancement behavior after contrast media injection during imaging methods, but they could also have different imaging features, creating some difficulty in differential diagnosis. For this reason, radiologists should be aware of different imaging presentations of these neoplasms. Radiological evaluation has a critical role in P-NENs identification, characterization, and staging of these neoplasms, especially in those cases in which surgery is the treatment of choice. The present paper shows, indicating the underlying pathologic correlations, typical and atypical presentations of NENs. Key Points • P-NENs have a wide range of imaging features presentations, typical and atypical. • Pathology could help in better understanding the typical P-NENs appearance at imaging. • P-NENs are generally hypervascular lesions. • Radiological evaluation has a critical role in P-NENs identification and management. • Radiologists should know every type of different imaging presentation of P-NENs to better diagnose these kinds of lesions