المؤلفون: Giovanni Malferrari, Andrea Zini, Giorgia Arnone, Ludovica Migliaccio, Matteo Paolucci, Giorgia Gentile, Mariateresa Lefemine, Franco Accorsi, Attilia Maria Pizzini, Mauro Silingardi, Nicola Carraro, Vittoria Maria Sarra, Giorgio Meneghetti, Claudio Baracchini, Giuseppe Pistollato, Patrizio Prati, Luciano Paolo Marchionno, Daniela Monaco, Maria Vittoria De Angelis, Chiara Vincenzi, Simone Quintana, Amedeo Bianchini, Giuseppe Pulito, Donatella Mastria, Francesco Paolo Sellitti, Fabrizio Calliada, Domenico Laterza, Lorenzo Coppo, Daniela Mastroiacovo, Francesco Prada, Sabrina Rossi, Cristiano Azzini, Nicola Merli, Maura Pugliatti, Francesco Ciccirillo, Antonio Siniscalchi, Enzo Sanzaro, Fabio Melis, Michele Pacilli, Vincenzo Inchingolo

المصدر: Journal of Biomedical Practitioners, Vol 8, Iss 1 (2024)

مصطلحات موضوعية: stenosi carotidea, eco color Doppler, NASCET, ECST, stenosi carotidee classificazioni, neu-rosonologia clinica., Medicine, Therapeutics. Pharmacology, RM1-950

الوصف: Da oltre quarant’anni si utilizzano gli ultrasuoni per rilevare una placca carotidea e per seguire nel tempo la sua evoluzione. I protocolli terapeutici hanno ridotto enormemente il suo impatto sulla salute delle persone ma la scelta fra terapia medica e chirurgica si fonda su una valutazione clinica e strumentale che è solo apparentemente semplice. Nei referti di un esame ultrasonografico riportiamo il più delle volte delle percentuali di stenosi, a volte puntuali, a volte in termini di range oppure ci esprimiamo con aggettivi che descrivono la gravità della stenosi ma spesso ci facciamo confondere dai numeri e dalle differenti modalità di calcolo del range di stenosi ed è indubbio che, a volte, le conclusioni risultano ambigue ed estremamente dipendenti dall’interpretazione dell’operatore. Il problema è che l’angiografia digitale, gold standard diagnostico per la stenosi carotidea, adotta delle metriche non del tutto riproducibili con gli ultrasuoni. Con questo documento vogliamo condividere la ricerca di un linguaggio comune, a partire dal referto dei nostri esami. Noi refertiamo così… voi?

وصف الملف: electronic resource

العلاقة: https://ojs.unito.it/index.php/jbp/article/view/10241Test; https://doaj.org/toc/2532-7925Test

الوصول الحر: https://doaj.org/article/07418ef4e0bd4671896348281f0d09dbTest

المؤلفون: Jacopo Camporesi, Silvia Strumia, Andrea Di Pilla, Matteo Paolucci, Diego Orsini, Chiara Assorgi, Maria Gabriella Cacciuttolo, Maria Lucia Specchia

المصدر: BMC Health Services Research, Vol 23, Iss 1, Pp 1-9 (2023)

مصطلحات موضوعية: Stroke pathway, Pharmacological thrombolysis, COVID-19, Performance assessment, Public aspects of medicine, RA1-1270

الوصف: Abstract Background and Aim Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic. Methods A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3 m-mRS) and NIHSS score 24 h after the ischemic event onset (24 h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020). Results 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000). A statistically significant reduction over the years was found for DTN, going from 90 min to 61 min (p = 0.000) with also an increase in the number of thrombolysis performed within the “golden hour” – more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs. 0.72, p = 0.048). The pre-hospital process indicator OTD increased from 88.13 to 118.48 min, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3 m-mRS, NHISS and 24 h-NHISS. Conclusions The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients’ outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1472-6963Test

الوصول الحر: https://doaj.org/article/67fc1eee1af5409b8054b7cdba695f72Test

المؤلفون: Simone Migliore, Matteo Paolucci, Livia Quintiliani, Claudia Altamura, Sabrina Maffi, Giulia D’Aurizio, Giuseppe Curcio, Fabrizio Vernieri

المصدر: Frontiers in Human Neuroscience, Vol 14 (2020)

مصطلحات موضوعية: emotion regulation, emotion recognition (ER), psychopatological profile, medication overuse headache (MOH), behavioral approach, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

الوصف: The psychopathological profile of patients with medication overuse headache (MOH) appears to be particularly complex. To better define it, we evaluated their performance on a targeted psychological profile assessment. We designed a case-control study comparing MOH patients and matched healthy controls (HC). Headache frequency, drug consumption, HIT-6, and MIDAS scores were recorded. All participants filled in the following questionnaires: Beck Depression Inventory-II Edition (BDI-2), trait subtest of State-Trait Anxiety Inventory (STAI-Y), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), Toronto Alexithymia Scale (TAS-20). The primary endpoint was to establish if MOH patients have an altered psychopathological profile. The secondary endpoint was to establish whether the worst profile correlates with the worsening of headache and disability measures. We enrolled 48 consecutive MOH patients and 48 HC. MOH patients showed greater difficulty in recognition/regulation of emotions (DERS, TAS-20), depression (BDI-2), anxiety (STAI-Y), and impulsiveness (BIS-11). We found a positive correlation among DERS, BDI-2, STAI-Y, and BIS scores and MIDAS and HIT-6 scores and among DERS and headache frequency and drug consumption. MOH patients showed a high rate of emotion regulation difficulties, depression, and anxiety, which may negatively affect their headaches. The ability to regulate/recognize emotions may play a central role in sustaining medication overuse.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fnhum.2020.571035/fullTest; https://doaj.org/toc/1662-5161Test

الوصول الحر: https://doaj.org/article/50830f81d4e34f1b8dd2e7a958f5e5b7Test

المؤلفون: Marco Iosa, Alex Martino Cinnera, Fioravante Capone, Alessandro Cruciani, Matteo Paolucci, Vincenzo Di Lazzaro, Stefano Paolucci, Giovanni Morone

المصدر: Applied Sciences, Vol 11, Iss 24, p 12123 (2021)

مصطلحات موضوعية: stroke, upper extremities, motor control, range of motion, robot, exoskeleton, Technology, Engineering (General). Civil engineering (General), TA1-2040, Biology (General), QH301-705.5, Physics, QC1-999, Chemistry, QD1-999

الوصف: In the past two decades, many studies reported the efficacy of upper limb robotic rehabilitation in patients after stroke, also in its chronic phase. Among the possible advantages of robotic therapy over conventional therapy are the objective measurements of kinematic and kinetic parameters during therapy, such as the spatial volume covered by the patient’s upper limb and the weight support provided by the robot. However, the clinical meaning and the usability of this information is still questioned. Forty patients with chronic stroke were enrolled in this study and assessed at the beginning of upper limb robotic therapy (Armeo® Power) and after two weeks (ten sessions) of therapy by recording the working volume and weight support provided by the robot and by administering six clinical scales to assess upper limb mobility, strength, spasticity, pain, neurological deficits, and independency. At baseline, the working volume significantly correlated with spasticity, whereas weight support significantly correlated with upper limb strength, pain, spasticity, and neurological deficits. After two weeks of robotic rehabilitation, all the clinical scores as well as the two parameters improved. However, the percentage changes in the working volume and weight support did not significantly correlate with any of the changes in clinical scores. These results suggest caution in using the robotic parameters as outcome measures because they could follow the general improvement of the patient, but complex relationships with clinical features are possible. Robotic parameters should be analyzed in combination with the clinical scores or other objective measures because they may be informative about therapy progression, and there is a need to combine their clinical, neuroscientific, and biomechanical results to avoid misleading interpretations.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2076-3417/11/24/12123Test; https://doaj.org/toc/2076-3417Test

الوصول الحر: https://doaj.org/article/813a79c7675a413fba3c7629e210e3ceTest

المؤلفون: Matteo Paolucci, Chiara Vincenzi, Michele Romoli, Giulia Amico, Isabella Ceccherini, Simona Lattanzi, Anna Bersano, Marco Longoni, Simona Sacco, Fabrizio Vernieri, Rosario Pascarella, Franco Valzania, Marialuisa Zedde

المصدر: Genes, Vol 12, Iss 12, p 1953 (2021)

مصطلحات موضوعية: Congenital Heart Defects, Atrial Septal Defects, paradoxical embolism, Genetics, QH426-470

الوصف: Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest the involvement of the Notch pathway and other cardiac transcription factors (GATA4, TBX20, NKX2-5) in Foramen Ovale closure. This review evaluates the contribution of genetic alterations in PFO development. We systematically reviewed studies that assessed rare and common variants in subjects with PFO. The protocol was registered with PROSPERO and followed MOOSE guidelines. We systematically searched English studies reporting rates of variants in PFO subjects until the 30th of June 2021. Among 1231 studies, we included four studies: two of them assessed the NKX2-5 gene, the remaining reported variants of chromosome 4q25 and the GATA4 S377G variant, respectively. We did not find any variant associated with PFO, except for the rs2200733 variant of chromosome 4q25 in atrial fibrillation patients. Despite the scarceness of evidence so far, animal studies and other studies that did not fulfil the criteria to be included in the review indicate a robust genetic background in PFO. More research is needed on the genetic determinants of PFO.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2073-4425/12/12/1953Test; https://doaj.org/toc/2073-4425Test

الوصول الحر: https://doaj.org/article/506af5fe40034094a6db30942b1cac2bTest

المؤلفون: Paola Maggio, Claudia Altamura, Domenico Lupoi, Matteo Paolucci, Riccardo Altavilla, Francesco Tibuzzi, Francesco Passarelli, Roberto Arpesani, Guido Di Giambattista, Rosario Francesco Grasso, Giacomo Luppi, Fabrizio Fiacco, Mauro Silvestrini, Patrizio Pasqualetti, Fabrizio Vernieri

المصدر: Cerebrovascular Diseases Extra, Vol 7, Iss 1, Pp 1-8 (2017)

مصطلحات موضوعية: Carotid artery stenting, Diffusion-weighted images, White matter hyperintensities, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background: White matter hyperintensities (WMH) are a common finding in aged individuals affected by carotid artery disease and are a risk factor for first-ever and recurrent stroke. We investigated if white matter damage increases the risk of brain microembolism during carotid artery stenting (CAS), as evaluated by the appearance of new areas of restricted diffusion on diffusion-weighted images (DWI). Methods: We evaluated 47 patients with severe internal carotid artery (ICA) stenosis undergoing CAS, comparing preprocedural clinical, ultrasound and radiological characteristics. WMH volume was computed on FLAIR images before CAS. After CAS, the DWI scan was looked over for areas of restricted diffusion (DWI lesions). A first univariate analysis was adopted to compare groups according to the occurrence of DWI lesions. Then, the variable DWI lesion was modelled by means of a logistic regression model. Results: Seventeen patients developed at least 1 DWI lesion after CAS. Compared with non-DWI, DWI patients were more commonly treated in the left ICA (p = 0.007) and had a more severe WMH damage (p = 0.027). Indeed, the risk of a DWI lesion was higher in left versus right stenosis (OR = 9.0, 95% CI 1.9-42.7, p = 0.005) and increased for each log-unit of WMH lesion load (OR = 7.05, 95% CI 1.07-46.49, p = 0.042). A WMH lesion load of at least 5.25 cm3 had a 50% probability of occurrence of a new DWI lesion. Conclusions: Treated side and preexisting white matter damage are risk conditions for brain microembolism during CAS. This should be taken into account to optimize severe carotid artery disease management.

وصف الملف: electronic resource

العلاقة: http://www.karger.com/Article/FullText/452717Test; https://doaj.org/toc/1664-5456Test

الوصول الحر: https://doaj.org/article/f79ec462776f44c885aac9271183122cTest

المؤلفون: Claudia Altamura, Matteo Paolucci, Nicoletta Brunelli, Angelo Cascio Rizzo, Gianluca Cecchi, Federica Assenza, Mauro Silvestrini, Fabrizio Vernieri

المصدر: PLoS ONE, Vol 14, Iss 8, p e0220637 (2019)

مصطلحات موضوعية: Medicine, Science

الوصف: Patent Foramen Ovale and impaired cerebral hemodynamics were proposed among the pathophysiological mechanisms explaining the increased risk for stroke in patients with Migraine with Aura (MA). Our study aimed at comparing the vasomotor reactivity (VMR) of the anterior and the posterior cerebral circulation in patients with Migraine with Aura, in patients with acute vascular ischemic accidents, and in controls. We hypothesized that VMR in MA patients is preserved in the anterior circulation and reduced in the posterior circulation. We prospectively assessed with Transcranial Doppler the vasomotor reactivity to breath holding of the Middle and Posterior Cerebral Arteries (MCA, PCA) in MA patients, in acute vascular patients and healthy controls. We also evaluated the possible effect of clinical characteristics of MA (attack frequency, aura length or type, disease history), vascular factors and the presence of right-to-left shunt on VMR. Diverging from our hypothesis, MA patients displayed a higher breath-holding index (BHI) than controls in the MCA (1.84±0.47%/s vs 1.53±0.47%/s, p = .001) as well as in the PCA (1.87±0.65%/s vs 1.47±0.44%/s, p < .001). In MA patients, MCA BHI was higher in those with large right-to-left shunts (2.09±0.42 vs 1.79±0.47, p = .046) and lower in those taking estrogens (1.30±0.30%/s vs 1.9±0.45%/s, p = .009). We did not observe an effect of MA characteristics on BHI. The increased BHI in MA patients with large right-to-left shunts could be explained by the vasoactive effect in the cerebral circulation of substances bypassing the deactivating pulmonary filters or by a constitutional trait of the vascular system associating persistent right-to-left shunts and hyper-reactive hemodynamics. Our results discourage the hypothesis that altered hemodynamics contribute to increasing the stroke risk in all MA patients. However, estrogens can lower VMR, curtailing the hemodynamic resources of MA patients.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/ccef1e8505c94647969340c935fcd611Test

المؤلفون: Claudia Altamura, Gianluca Cecchi, Maria Bravo, Nicoletta Brunelli, Alice Laudisio, Paola Di Caprio, Giorgia Botti, Matteo Paolucci, Yeganeh Manon Khazrai, Fabrizio Vernieri

المصدر: Nutrients, Vol 12, Iss 6, p 1579 (2020)

مصطلحات موضوعية: migraine, healthy diet, carb, Nutrition. Foods and food supply, TX341-641

الوصف: We aimed at evaluating the effect of the Healthy Eating Plate (HEP) education on migraine frequency and disability. At three evaluation times (T-12 = screening, 12 weeks before the intervention; T0 = time of the educational HEP intervention; and T12 = 12-week follow-up), the enrolled subjects underwent assessment of anthropometric and dietary patterns, monthly migraine days (MMDs), and disability scales (Migraine Disability Assessment score (MIDAS), MIDAS A, MIDAS B). The HEP score estimated adherence to dietary advice. We enrolled 204 out of 240 screened migraineurs, of these, 97 patients completed the follow-up. We defined ADHERENTS as patients presenting an increase in HEP scores from T0 to T12 and RESPONDERS as those with a reduction of at least 30% in MMDs. ADHERENTS presented a significant decrease in MMDs from T0 to T12. In particular, RESPONDERS reduced red, processed meat and carb intake compared to NON-RESPONDERS. Reduction in carb consumption also related to a decrease in perceived disability (MIDAS) and headache pain intensity (MIDAS B). Logistic regression confirmed that the HEP score increase and total carb decrease were related to a reduction in MMDs. This study showed that adherence to the HEP advice, particularly the reduction in carb, red and processed meat consumption, is useful in migraine management, reducing migraine frequency and disability. Trial registration: ISRCTN14092914.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2072-6643/12/6/1579Test; https://doaj.org/toc/2072-6643Test

الوصول الحر: https://doaj.org/article/ec72955bf0d34d35a5796dcd29577932Test

المؤلفون: Angelo Cascio Rizzo, Matteo Paolucci, Riccardo Altavilla, Nicoletta Brunelli, Federica Assenza, Claudia Altamura, Fabrizio Vernieri

المصدر: Frontiers in Neurology, Vol 8 (2017)

مصطلحات موضوعية: ear acupuncture, medication overuse headache, vagus nerve, neuromodulation, transcutaneous vagal stimulation, Neurology. Diseases of the nervous system, RC346-429

الوصف: Daith piercing is an ear piercing located at the crus of the helix, bilaterally. It is getting great consent on social media as alternative treatment in chronic migraine. No data about its efficacy and action are available in scientific literature so far. We present the case of a 54-year-old male patient suffering from refractory chronic migraine with medication-overuse, who substantially improved after bilateral ear daith piercing. His migraine was refractory to symptomatic as well as prophylactic therapies. He used to treat headaches with up to five symptomatic drugs per attack and had attempted several pharmacological preventive therapies, including Onabotulinumtoxin A. He also underwent detoxification treatments with intravenous steroids and diazepam, without durable benefit. At the time of daith piercing, the headache-related disability measures showed a HIT-6 score of 64, a MIDAS-score of 70, and a 11-point Box scale of 5. On his own free will, he decided to get a “daith piercing.” After that, he experienced a reduction of migraine attacks, which became very rare, and infrequent, less disabling episodes of tension-type headache (HIT-6 score of 56; MIDAS score of 27, 11-point Box scale of 3). Painkiller assumption has much decreased: he takes only one tablet of indomethacin 50 mg to treat tensive headaches, about four times per month. Beyond a placebo effect, we can speculate a vagal modulation as the action mechanism of daith piercing: a nociceptive sensory stimulus applied to trigeminal and vagal areas of the ear can activate ear vagal afferents, which can modulate pain pathways by means of projections to the caudal trigeminal nucleus, to the locus coeruleus and to the nucleus raphe magnus. Currently, daith piercing cannot be recommended as migraine treatment because of the lack of scientific evidence, the unquantified rate of failure and the associated risks with insertion. However, given the increasing but anecdotal evidence, we think that the mechanism needs testing by means of a controlled clinical trial in a population of chronic migraineurs.

وصف الملف: electronic resource

العلاقة: http://journal.frontiersin.org/article/10.3389/fneur.2017.00624/fullTest; https://doaj.org/toc/1664-2295Test

الوصول الحر: https://doaj.org/article/0dbcfd96e360457dbbe88849ce8a3a20Test

المؤلفون: Giovanni Assenza, Fioravante Capone, Lazzaro di Biase, Florinda Ferreri, Lucia Florio, Andrea Guerra, Massimo Marano, Matteo Paolucci, Federico Ranieri, Gaetano Salomone, Mario Tombini, Gregor Thut, Vincenzo Di Lazzaro

المصدر: Frontiers in Aging Neuroscience, Vol 9 (2017)

مصطلحات موضوعية: neuromodulation, non-invasive brain stimulation, oscillations, TMS/tDCS, EEG, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

وصف الملف: electronic resource

العلاقة: http://journal.frontiersin.org/article/10.3389/fnagi.2017.00252/fullTest; https://doaj.org/toc/1663-4365Test

الوصول الحر: https://doaj.org/article/e5bb30f0446741c08db514753b63045dTest