306,429 research outputs found
Stroke epidemiology and COVID-19 pandemic
No full textPURPOSE OF REVIEW: The aim of this study was to describe the impact of the COVID-19 outbreak on the epidemiology, cause and clinical characteristics of incident stroke in different settings and populations. RECENT FINDINGS: Several studies have shown that there are three main themes in the epidemiology of stroke during the COVID-19 pandemic: COVID-19 seems to be associated with stroke in a significant number of patients. This association has been reported in several clinical series, mainly from China. There is a consistent trend towards a decreased number of hospital admissions of stroke patients during the pandemic. There are no population-based data available on incident stroke in individuals with COVID-19. SUMMARY: In this review, we report on increased rates and severe prognosis of ischemic stroke among individuals with COVID-19, probably explained by hypercoagulability and inflammation, documented since the early phase of disease.We confirm the presence of falling rates of new ischemic stroke admissions in hospitals, probably due to social consequences of the pandemic: fear to be infected or not adequately treated in the hospital. This phenomenon is restricted to mild stroke and transient ischemic attacks.Short and long-term consequences of this trend of new strokes in the pandemic need to be evaluated
The management of epilepsy in the 1990s. Acquisitions, uncertainties and priorities for future research.
No full textAbstract: The pharmacological treatment of epilepsy has made considerable progress during the last decade, due to improved knowledge of the clinical pharmacology of individual drugs, acquisition of new information on the factors affecting response and need for drug treatment, and development of promising new agents. Once a clinical diagnosis of epilepsy has been made (which generally requires the occurrence of more than one seizure), treatment should be started with a single drug selected on the basis of seizure type and tolerability profile. Although there are important regional differences in prescribing patterns and individual circumstances may dictate alternative choices, carbamazepine is generally regarded as the preferred treatment for partial seizures (with or without secondary generalisation) while valproic acid (sodium valproate) is usually the first choice in most forms of generalised epilepsies.
To achieve therapeutic success, the daily dosage must be tailored to meet individual needs, and there is suggestive evidence that in some patients the dosage prescribed initially may be unnecessarily large. Plasma antiepileptic drug concentrations may aid in the individualisation of dosage, but should not be regarded as a substitute for careful monitoring of clinical response.
Although overall about 70% of patients can be completely controlled, response rate is influenced by a number of factors, the most important of which are seizure type and syndromic form. The importance of a correct syndromic classification for rational drug selection has been poorly assessed and represents a major area for future research. Patients who do not respond to the highest tolerated dose of the initially prescribed drug maybe switched to monotherapy with an alternative agent or may be given add-on treatment with a second drug. Appropriate prospective trials are required to assess the merits of either strategy. If add-on therapy is selected and the patient becomes seizure free, it may be possible to discontinue the drug prescribed initially and reinstitute monotherapy. Only a minority of patients are likely to require multiple drug therapy, and it remains to be established whether specific drug combinations are more effective than others.
Until further information becomes available, the new agents should be reserved for patients failing to respond to the conventional treatments of first choice. Patients whose seizures cannot be controlled by available drugs should be reassessed, and polytherapy should be maintained only when there is clear evidence that benefits outweigh possible adverse effects. In many patients who have been seizure free for at least 2 years it may be possible to gradually discontinue all medications. The decision to withdraw treatment is determined largely by the risk of seizure relapse which, in turn, is primarily dependent on the syndromic form
Epilepsy Syndromes in Development. Introduction.
No full textIn the 2001 proposal of classification of epileptic syndromes, the International League Against Epilepsy (ILAE) Commission includes four “epileptic syndromes in development,” namely migrating partial seizures of infancy, myoclonic status in nonprogressive encephalopathies, generalized epilepsies with febrile seizures plus, and familial focal epilepsy with variable foci (Engel, 2001). Actually, several other epileptic conditions are still awaiting a more precise definition. Among these are the syndrome “eyelid myoclonia with or without absences (EMA),” described as a generalized epileptic syndrome more than 30 years ago by Jeavons, and Panayiotopoulos syndrome (PS) evolving from an “early-onset variant of idiopathic (benign) occipital lobe epilepsy” to an “idiopathic partial epilepsy with predominantly autonomic seizures
Headache, anxiety and depressive disorders: the HADAS study. J Headache Pain
No full textHeadache, anxiety and depressive disorders: the HADAS study
J Headache Pain (2010) 11:141–150
Ettore Beghi • Gennaro Bussone • Domenico D’Amico • Pietro Cortelli •
Sabina Cevoli • Gian Camillo Manzoni • Paola Torelli • Maria Clara Tonini •
Giovanni Allais • Roberto De Simone • Florindo D’Onofrio • Sergio Genco •
Franca Moschiano • Massimiliano Beghi • Sara Salvi
Abstract The objective of this paper was to assess
prevalence and characteristics of anxiety and depression in
migraine without aura and tension-type headache, either
isolated or in combination. Although the association
between headache and psychiatric disorders is undisputed,
patients with migraine and/or tension-type headache have
been frequently investigated in different settings and using
different tests, which prevents meaningful comparisons.
Psychiatric comorbidity was tested through structured
interview and the MINI inventory in 158 adults with
migraine without aura and in 216 persons with tension-type
headache or migraine plus tension-type headache. 49
patients reported psychiatric disorders: migraine 10.9%,
tension-type headache 12.8%, and migraine plus tensiontype
headache 21.4%. The MINI detected a depressive
episode in 59.9, 67.0, and 69.6% of cases. Values were
18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for
panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for
obsessive–compulsive disorder. Multivariate analysis
showed panic disorder prevailing in migraine compared
with the other groups (OR 2.9; 95% CI 1.2–7.0). The
association was higher (OR 6.3; 95% CI 1.4–28.5) when
migraine (with or without tension-type headache) was
compared to pure tension-type headache. This also applied
to obsessive–compulsive disorder (OR 4.8; 95% CI 1.1–
20.9) in migraine plus tension-type headache. Psychopathology
of primary headache can reflect shared risk factors,
pathophysiologic mechanisms, and disease burden
Studio angiografico radioisotopico della frazione di eiezione globale e settoriale dopo intervento di rivascolarizzazione miocardica diretta
No full textModulazione del microbiota intestinale aumenta l'effetto antitumorale di Radioterapia e terapia con cellule CAR T
No full textTutt’oggi la prima linea di terapia per i pazienti malati di cancro rimane la chirurgia in combinazione con radioterapia e/o chemioterapia. La nascita di trattamenti immunoterapici come gli inibitori di immune checkpoints e la terapia con le cellule CAR T (Chimeric Antigen Receptor) ha rivoluzionato il panorama della terapia contro il cancro. Ciononostante, una porzione significativa di pazienti non risponde alla cura oppure presenta ricaduta della malattia. Inoltre, la terapia con cellule CAR T ha avuto ancora poco successo nel trattamento contro i tumori solidi. Il microbiota intestinale è l’insieme dei microorganismi commensali presenti nel nostro intestino ed è noto per essere capace di influenzare il sistema immunitario dell’ospite. Di recente, molti studi hanno dimostrato l’impatto del microbiota intestinale sulla funzione delle cellule T, in particolare nell’ambito della terapia con inibitori di immuno checkpoints. È stato dimostrato che l’antibiotico vancomicina è in grado di aumentare l’efficacia delle cellule T tumore-specifiche nei modelli animali. In questo studio, abbiamo analizzato l’impatto del microbiota intestinale sull’esito del trattamento con radioterapia e terapia con cellule CAR T. La radioterapia esercita potenti effetti immuno-modulatori, inducendo cross-priming per antigeni tumore-specifici di cellule T CD8+ e l’effetto ‘abscopal’. Abbiamo testato se il microbiota intestinale fosse capace di modulare la risposta anti-tumorale dopo il trattamento con radioterapia eseguita in un punto lontano dall’intestino. Per cambiare la composizione del microbiota abbiamo utilizzato l’antibiotico vancomicina che ha come target i batteri gram-positivi ed inoltre è noto per non essere assorbito a livello sistemico. Abbiamo osservato che la radioterapia in combinazione con vancomicina è in grado di potenziare la risposta anti-tumorale indotta dalla radioterapia e inibire la crescita del tumore. Questa sinergia è dipendente dalla cross-presentazione di antigeni associati al tumore (TAA) alle cellule T citotossiche e alla presenza di IFN-γ. Il butirrato, che è una molecola prodotta dai batteri target di vancomicina, abolisce l’effetto di vancomicina stessa. La nuova terapia con le cellule CAR T contro l’antigene CD19 ha rivoluzionato il trattamento dei pazienti con malattie del sangue positive per CD19 refrattarie o recidive. Abbiamo deciso dunque di investigare il ruolo del microbiota intestinale nella terapia con le cellule CAR T sia in un modello tumorale liquido che uno solido. Il trattamento combinato con vancomicina per via orale e la terapia con le cellule CAR T ha aumentato la risposta anti-tumorale paragonata al gruppo controllo, portando inoltre ad una prolungata sopravvivenza degli animali in entrambi i modelli tumorali. L’analisi delle differenze nell’espressione dei geni del tessuto tumorale dei topi trattati con vancomicina e terapia con le cellule CAR T ha rivelato che la sinergia dell’effetto antitumorale è dovuta ad un aumento del meccanismo di presentazione dell’antigene. L'infusione di cellule T specifiche per l'antigene tumorale AH1 in topi ‘recipiente’ portatori di un tumore che esprime l'antigene AH1 ma non CD19, isolate dalle milze dei topi trattati con vancomicina per via orale e terapia con cellule CAR T, ha dimostrato che il meccanismo di cross-priming per antigeni tumore-specifici è responsabile per l’aumento dell’efficacia contro il tumore. In conclusione, il nostro studio suggerisce che l’eliminazione di batteri sensibili alla vancomicina aumenta la risposta antitumorale utilizzando il meccanismo di cross-presentazione di antigeni tumore-specifici.Nowadays surgery in combination with chemotherapy or radiotherapy remains the first line of care for cancer patients. Advent of immunotherapy as immune checkpoints blockade and Chimeric Antigen Receptor (CAR) T cell therapy has revolutionized the cancer treatment landscape. However, a significant subset of these patients either fails to respond or eventually relapses and in solid cancers, the CAR T cell immunotherapy has had little to no success in the clinic so far. The gut microbiota is the assemble of the commensal microorganisms present in our intestines and is known to influence the host immune system. Recently, several studies have shown the influence of intestinal microbes on T cell function, in particular in the setting of checkpoint immunotherapy. It has been previously demonstrated that vancomycin can enhance the efficacy of tumor-specific T cells in animal models. In this work, we investigate the impact of gut microbiota on cancer radiotherapy and CD19 CAR T cell therapy outcome. Radiotherapy (RT) exerts potent immune modulatory effects, inducing tumor-associated antigen (TAA) cross-priming with antitumor CD8+ T cell elicitation and abscopal effects. Therefore, we tested whether the gut microbiota modulates antitumor immune response following RT distal to the gut. To modulate gut microbiome composition, we used vancomycin, a well-known antibiotic used to deplete gram-positive bacteria and for its action restricted to the intestine only. We observed that combination treatment of RT and oral vancomycin potentiated the RT-induced antitumor immune response and tumor growth inhibition. This synergy was dependent on TAA cross presentation to cytotoxic CD8+ T cells and on IFN-γ. Notably, butyrate, a metabolite produced by the vancomycin-depleted gut bacteria, abrogated the vancomycin effect. Newly developed CD19-targeting CAR T cells immunotherapy has revolutionized the treatment of patients with relapsed or refractory CD19-positive hematologic malignancies. We decided to investigated the role of the gut microbiota on CAR T cell therapy in a liquid and solid cancer model in vivo. Combination treatment with oral vancomycin and CAR T cell therapy resulted into a significantly improved anti-tumor activity as compared to control mice that translated into an overall survival benefit in both tumor models. Tumor genes differential expression analysis revealed that the synergistic antitumor effect from the antibiotic and CAR T cells combination treatment is due to an increased antigen presentation pathway. Adoptive transfer of AH1 antigen specific CD3+ T cells isolated from mice treated with oral vancomycin and CAR T cell therapy into recepient mice bearing a tumor expressing AH1 but not CD19 antigen, revealed TAA cross-priming as the potential mechanism elicited by antibiotic administration. In conclusion, our study suggests that depletion of vancomycin-sensitive bacteria enhances the antitumor activity of RT and CAR T cells therapy via TAA cross-presentation
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
SHOULD ANTIEPILEPTIC DRUGS BE WITHDRAWN IN SEIZURE-FREE PATIENTS?
No full textDiscontinuation of antiepileptic drug (AED) treatment is a valuable option in patients with epilepsy who have been seizure free for 2 years or longer. However, the decision to withdraw AEDs must be based on a balanced view of the overall risk of seizure relapse, the factors most likely to affect that risk, and the medical, emotional and social implications of treatment continuation versus treatment withdrawal. In a critical review of 28 studies accounting for 4571 patients (2758 children, 1020 adults and a combined group of 793), most with at least 2 years of seizure remission, the proportion of patients with relapses during or after AED withdrawal ranged from 12 to 66%. Using life-table analysis, the cumulative probability of remaining seizure-free in children was 66-96% at 1 year and 61-91% at 2 years after withdrawal of AEDs. The corresponding values in adults were 39-74% and 35-57%, respectively. The relapse rate was highest in the first 12 months (especially in the first 6 months) after withdrawal and tended to decrease thereafter. Based on a previously published meta-analysis of data published up to 1992, the pooled relapse risk was 25% (95% CI 21, 30%) at 1 year and 29% (95% CI 24, 34%) at 2 years after AED withdrawal. The factors associated with a higher-than-average risk of seizure relapse included adolescent-onset epilepsy, partial seizures, the presence of an underlying neurological condition, and abnormal EEG findings at the time of AED withdrawal in children. Factors associated with a lower-than-average risk were childhood-onset epilepsy, idiopathic generalised epilepsy and - for children - a normal EEG. Selected epilepsy syndromes (e.g. benign epilepsy with centrotemporal spikes and juvenile myoclonic epilepsy) may be associated with significantly different outcomes after AED withdrawal. All these factors and their combinations may contribute to the development of guidelines for practising physicians to help them in making the best decision related to treatment discontinuation. The decision plan should also take into account social factors (driving license, job and leisure activities) as well as emotional and personal factors, and must be tailored to and discussed with the individual patient and his/her family
Confronto tra l’impatto ambientale dell’analisi tradizionale e mediante spettroscopia NIR sull’oliva
No full textObiettivi
Le analisi che tradizionalmente si effettuano sulle olive richiedono l’utilizzo di molteplici strumentazioni, lunghi tempi di analisi, l’utilizzo di solventi potenzialmente dannosi, sia per la salute umana che per l’ecosistema, e la distruzione del campione. Le stesse analisi effettuate con una tecnologia ottica, non distruttiva (spettroscopia nella regione del visibile e vicino infrarosso, Vis-NIR), permettono la stima dei parametri di interesse, in modo molto rapido, con una sola lettura, anche condotta dagli addetti alla raccolta. L’unico aspetto laborioso è la costruzione di robuste calibrazioni. Il grande vantaggio sarebbe un ridotto impatto ambientale della tecnologia ottica, la cui valutazione, a confronto con i metodi tradizionali, è lo scopo di questo lavoro. Esso è parte di un progetto AGER (Progetto Agroalimentare e Ricerca), denominato “Sustainability of the Olive-Oil System - S.O.S.”, il cui obiettivo è quello di migliorare e rafforzare la sostenibilità della filiera dell’olio extravergine di oliva in Italia.
Metodologia
Le analisi tradizionali per la valutazione qualitativa delle olive individuate come riferimento sono state: contenuto di acqua, olio e fenoli totali. Il confronto è stato effettuato per le stesse determinazioni mediante analisi ottica.
Il metodo Life Cycle Assessment (ISO 14040:2006, ISO 14044:2006), è stato applicato per valutare l’impatto ambientale mediante un preciso schema di esecuzione.
L’approccio utilizzato (from cradle to grave), ha considerato tutti gli input e output di ogni analisi, tenendo conto della strumentazione necessaria per l’esecuzione (estrazione materie prime, costruzione, utilizzo e smaltimento), dei solventi utilizzati (ottenimento solvente, utilizzo e smaltimento), delle risorse energetiche necessarie. Inoltre, per la strumentazione Vis-NIR sono state considerate le analisi necessarie per la calibrazione dello strumento. I dati raccolti sono stati elaborati con il software SimaPro.
Risultati
Il confronto tra l’impatto ambientale delle analisi tradizionali e quello delle analisi ottiche ha evidenziato un netto vantaggio nell’applicazione della strumentazione ottica la quale, non solo garantisce la non distruzione del campione e un risultato in tempi brevi ma, ha un impatto sull’ambiente 36 volte inferiore rispetto alle analisi tradizionali di riferimento. Se le maggiori voci di impatto ambientale per le analisi tradizionali sono la corrente elettrica, la strumentazione e le sostanze chimiche, per l’analisi non distruttiva, l’impatto ambientale è dettato maggiormente dalla necessità di calibrare lo strumento, attività che richiede di effettuare su un relativamente elevato numero di campioni (500 per la calibrazione iniziale, 200 per il mantenimento) sia le analisi tradizionali che le letture ottiche (Vis-NIR)
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