38 research outputs found
Rehabilitation interventions for improving balance in Parkinson's disease: a narrative review
No full textFrancesco Lena, PhD, Nicola Modugno, Giulio Greco, Monica Torre, Simone Cesarano, Marco Santilli,
Auwal Abdullahi, Giuseppe Giovannico, and Mohammad Etoom
Introduction: Postural instability is one of the latest clinical manifestations
of Parkinson disease. Because of the limited therapeutic effect
of pharmacological therapies, a favorable consideration has now become
toward rehabilitation interventions. Thus, this study aimed to
synthesize literature evidence to summarize the effects of rehabilitation
interventions for improving balance in Parkinson disease.
Materials and Methods:We conducted a narrative reviewof randomizedcontrolled
clinical trials comparing the effects of interventions, control
interventions, and no interventions on balance-related outcomes. A
comprehensive search using the MEDLINE database was conducted
fromJanuary 2000 to September 2021. This reviewincluded the following
causes of balance-related impairments: inability to control body
weight in the base of support, impaired attention and focus on balance,
postural deformities, proprioceptive deficiency, sensory-motor integration,
and coordination disorders, including visual and auditory-motor
coordination.
Results: Twenty randomized-controlled clinical trialswere included in
the review.Various balance-related outcomeswere included. The included
studies focused on the effectiveness of different rehabilitation interventions,
including physical therapy, virtual reality and telerehabilitation,
treadmill training, hydrotherapy, action observation training, balance
and cues training interventions, and cognitive rehabilitation.
Conclusions: The results suggest that most of the included rehabilitation
interventions have promising therapeutic effects in improving balance
in Parkinson disease
Anthropogenic and environmental factors affect the tree line position of Fagus sylvatica along the Apennines (Italy)
No full textAim: High-elevation forest line or tree line is an ecological ecotone representing the upper elevation thermal limit for forest development. The current tree line position is the result of the past human activity interacting with climatic and topographic conditions. In this study, we investigate how climate, local topographic factors and anthropogenic disturbance currently affect tree line distribution. Location: Apennine Mountains, 900 km latitudinal gradient along the Italian Peninsula. Methods: Overall, 302 mountain peaks were studied, comprising 3,622 km of measured tree lines. The position of the Fagus sylvatica tree line in all peaks was assessed and correlated with 58 selected variables representing climate, topography and human disturbance. Results: The mean tree line elevation was 1,589 m a.s.l., with considerable variability among peaks. Contrary to our expectations, the tree line elevation was lower in the warmer southerly exposed slopes compared to north-facing aspects, where we found the highest tree line (2,141 m a.s.l.). Correlation analysis indicates that both climatic and human density variables are associated with tree line elevation, with the climate having more influence in high elevation mountains, while human impact plays a prominent role in low elevation mountain peaks. Specifically, we found negative correlations between density of the resident population around each peak and tree line elevation at all examined dates (1861, 1921, and 2011), suggesting a pervasive negative impact of human activity on tree lines. As regards climatic variables, tree line elevation showed a stronger negative correlation with winter and spring months temperature than with mean annual temperature. Noteworthy, climatic variables had stronger effect on high elevation peaks (>1,900 m a.s.l.) compared with low elevation ones (<1,900 m a.s.l.). Main Conclusion: Our data provide evidence that the current position of the F. sylvatica tree line in the Apennines is heavily depressed as a result of a complex interaction between climatic factors and the past human pressure
Developmental trends in headache: an Italian school-based study of age- and gender-related changes in clinical characteristics and burden from childhood to adolescence
No full textBackground: Pediatric headache disorders are a significant public health issue, affecting school performance, social participation, and quality of life. Objective: Our aim was to explore the age- and gender-related changes in the characteristics and burden of headaches from childhood to adolescence, with a focus on diagnostic shifts, frequency, intensity, and quality-of-life. Design: We conducted a cross-sectional survey on five primary and secondary schools in the L'Aquila district, Italy. Methods: Using the translated Italian version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation questionnaire, we collected data on headache frequency, intensity, duration, associated symptoms, and impact. Diagnoses were algorithmically assigned through International Classification of Headache Disorders, 3rd edition criteria. Statistical analyses examined the effects of age, gender, and their interaction on clinical and quality-of-life outcomes. Results: In total, 431 students were included (mean age: 9.82 ± 2.28 years; range: 6-15; 52.9% female). Findings indicated that as children grow older, headaches become increasingly frequent, longer in duration, and more intensely experienced. The progression from primary to secondary school was accompanied by a transition in diagnosis, with undifferentiated headaches giving way to more specific categories, such as probable or definite migraine and, to a lesser extent, tension-type headache. Age-by-gender interactions revealed that older females experienced greater frequency and a more pronounced impact, while headache frequency affected quality of life with increasing age. Conclusion: Findings highlight gender-specific developmental trends in headache, characterized by increased frequency, intensity, and diagnostic clarity from childhood to adolescence. The burden of headache, particularly among older students, underscores the need for early recognition and age-appropriate interventions
Staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of bilateral essential tremor and Parkinson’s disease related tremor: a systematic review and critical appraisal of current knowledge
No full textIntroductionEssential tremor (ET) and Parkinson’s Disease (PD) are debilitating neurodegenerative disorders characterized by tremor as a predominant symptom, significantly impacting patients’ quality of life. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) Thalamotomy is an innovative therapeutic option for the treatment of unilateral medically refractory tremor with fewer adverse effects compared to traditional surgical interventions. A recent CE approval allows appropriate patients to have their second side treated.ObjectiveThe objective of this systematic review was to analyze available current knowledge about the use of MRgFUS for the treatment of bilateral ET and PD related tremor, to identify the effectiveness and the risks associated with bilateral treatment.MethodsEligible studies were identified by searching published studies in PubMed and Scopus databases from May 2014 to January 2024 and by identifying ongoing studies registered on the clinicaltrials.gov website. Data were summarized by considering the following information topics: the number of patients involved, the selected lesion target, the assessment tool used to evaluate clinical changes, the observed improvement, the reported side effects, and the time interval between the two treatments. The study was registered in PROSPERO (ID: CRD42024513178).ResultsNine studies were eligible for this review, 7 for ET and 2 for PD. The involved population included a variable number of patients, ranging from 1 to 11 subjects for ET and from 10 to 15 subjects for PD. The main lesional targets were the ventral intermediate nucleus of the thalamus, the pallidothalamic tract and the cerebellothalamic tract bilaterally. All studies investigated the tremor relief through the Clinical Rating Scale for Tremor (CRST) in patients with ET, and through the Unified Parkinson’s Disease Rating Scale (UPDRS) in patients with PD. A variable degree of improvement was observed, with all patients expressing overall satisfaction with the bilateral treatment. Adverse events were mild and transient, primarily involving gait disturbances, dysarthria, and ataxia. A standardized protocol for administering the two consecutive treatments was not identifiable; typically, the timing of the second treatment was delayed by at least 6 months.ConclusionAvailable evidence supports the effectiveness and safety of staged bilateral MRgFUS treatments for ET and PD-related tremor
Physiological effects of awake prone position in acute hypoxemic respiratory failure
No full textAbstract Background The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure. Methods Fifteen patients with acute hypoxemic respiratory failure and PaO2/FiO2 0.99) and ΔP L (9 [7–11] cmH2O vs. 8 [5–9], p = 0.17). Airway resistance and time constant were higher in prone vs. supine position (9 cmH2O s arbitrary units−3 [4–11] vs. 6 [4–9], p = 0.05; 0.53 s [0.32–61] vs. 0.40 [0.37–0.44], p = 0.03). Prone position increased EELI (3887 arbitrary units [3414–8547] vs. 1456 [959–2420], p = 0.002) and promoted V T distribution towards dorsal lung regions without affecting V T size and lung compliance: this generated lower dynamic strain (0.21 [0.16–0.24] vs. 0.38 [0.30–0.49], p = 0.004). The magnitude of pendelluft phenomenon was not different between study phases (55% [7–57] of V T in prone vs. 31% [14–55] in supine position, p > 0.99). Conclusions Prone position improves oxygenation, increases EELI and promotes V T distribution towards dependent lung regions without affecting V T size, ΔP L, lung compliance and pendelluft magnitude. Prone position reduces respiratory rate and increases ΔP ES because of positional increases in airway resistance and prolonged expiratory time. Because high ΔP ES is the main mechanistic determinant of self-inflicted lung injury, caution may be needed in using awake prone position in patients exhibiting intense ΔP ES. Clinical trail registeration: The study was registered on clinicaltrials.gov (NCT03095300) on March 29, 2017
Mercantilists and classicals: insights from doctrinal history
No full textMonetary theory ; Economists
On birationally trivial families and adjoint quadrics
No full textCopyright © 2022 The Author(s).Let π: X → B be a family whose general fibre Xb is a (d1, ⋯, da)-polarization on a general abelian variety, where 1 ≤ di ≤ 2, i = 1, ⋯, a and a ≥ 4. We show that the fibres are in the same birational class if all the (m, 0)-forms on Xb are liftable to (m, 0)-forms on X, where m = 1 and m = a - 1. Actually, we show a general criteria to establish whether the fibres of certain families belong to the same birational class.11Nsciescopu
