Chronological information on the composition and structure of agrocenoses and detailed features of land cover referring to specific areas are uncommon in ethnobotanical studies, especially for periods before the XIX century. The aim of this study was to analyse the type of crop or the characteristics of soil cover from the XVI century to the present.
This diachronic analysis was accomplished through archival research on the inventories of the Parish of St. Mary and those of the Municipality of Pignone and from recent surveys conducted in an area of eastern Liguria (Italy).
Archival data revealed that in study area the primary means of subsistence during the last five centuries, until the first half of the XX century, was chestnuts. In the XVIII and XIX centuries, crop diversification strongly increased in comparison with previous and subsequent periods. In more recent times, the abandonment of agricultural practices has favoured the re-colonisation of mixed woodland or cluster-pine woodland.
Ancient documents in the ecclesiastic or municipal inventories can be a very useful tool for enhancing the knowledge of agricultural practice, as well as of subsistence methods favoured by local populations during a particular time and for reconstructing land use change over time.
The outgrowth formation in inorganic thin films is a dramatic problem that has limited the technological impact of many techniques and materials. Outgrowths are often themselves part of the films, but are detrimental for vertical junctions since they cause short-circuits or work as defects, compromising the reproducibility and in some cases the operation of the corresponding devices. The problem of outgrowth is particularly relevant in ablation-based methods and in some complex oxides, but is present in a large variety of systems and techniques. Here we propose an efficient local electrochemical method to selectively decompose the outgrowths of conductive oxide thin films by electrochemical decomposition, without altering the properties of the background film. The process is carried out using the same set-up as for local oxidation nanolithography, except for the sign of the voltage bias and it works at the nanoscale both as serial method using a scanning probe and as parallel method using conductive stamps. We demonstrated our process using La0.7Sr0.3MnO3 perovskite as a representative material but in principle it can be extended to many other conductive systems.
Recently, there has been debate regarding the definition of ‘breakthrough pain’ and the patients to whom the term applies, with suggestions made to broaden the definition to include both patients with uncontrolled and controlled baseline pain, rather than only patients with controlled pain. To contribute to this discussion, the authors assessed the occurrence and characteristics of breakthrough pain among patients with controlled and uncontrolled baseline pain.
Breakthrough pain (BTP) is traditionally defined as a pain exacerbation in patients with chronic controlled pain. However, this definition has recently been challenged.
To evaluate the prevalence of unsatisfactory control in patients with chronic cancer pain, and investigate the frequency and intensity of BTP episodes.
A total of 665 patients with chronic cancer pain attending 21 pain therapy units in Italy were evaluated for baseline pain intensity and number of BTP episodes over a 30-day period. All patients started, continued or modified treatment for BTP at enrollment, according to medical judgment.
The number of BTP events was higher in patients with uncontrolled baseline pain, although the intensity and duration of episodes were similar. In patients with uncontrolled baseline pain, the number of events decreased with time and reached values comparable with those reported in patients with controlled pain. Both the intensity of the pain and the duration of the BTP events exhibited similar values in the two groups at all time points, following increased monitoring and the prescription of analgesic medication.
Patients with uncontrolled baseline pain experienced BTP flares with higher frequency, but similar intensity and duration with respect to patients with controlled pain at baseline. Notably, a close follow-up and adequate management of the BTP episodes led to an improvement of BTP in the observed patients.
BTP; Oncological pain; Pain treatment
Cancer patients undergo routine computed-tomography (CT) scans and, therefore, iodinated contrast media (ICM) administration. It is not known whether a time-dependent correlation exists between chemotherapy administration, contrast enhanced CT and onset of acute ICM-related adverse reactions (ARs).
All consecutive contrast-enhanced CTs performed from 1 January 2010 to 31 December 2012 within 30 days of the last chemotherapy administration were retrospectively reviewed. Episodes of acute ICM-related ARs were reported to the pharmacovigilance officer. We analyzed time to CT evaluation calculated as the time elapsed from the date of the CT performed to the date of the last chemotherapy administration. Patients were classified into 4 groups based on the antineoplastic treatment: platinum-based, taxane-based, platinum plus taxane and other group.
Out of 10,472 contrast-enhanced CTs performed, 3,945 carried out on 1,878 patients were considered for the study. Forty acute ICM-related ARs (1.01%; 95% CI, 0.70-1.33) were reported. No differences were seen among immediate (within 10 days of the last chemotherapy administration), early (11–20 days) and delayed (21–30 days) CTs. Median time to CT in patients who experienced an acute ICM-related AR by treatment group was not statistically different: 20 days (range 6–30), 17 days (range 5–22), 13 days (range 8–17), 13 days (range (2–29) for the platinum, taxane, platinum plus taxane and other group, respectively (P =0.251).
Our results did not reveal any correlation between time to CT and risk of acute ICM-related ARs in cancer patients.
Iodinated contrast media; Time to adverse reaction; Hypersensitivity; Contrast-enhanced CT; Cancer patients and chemotherapy
To determine whether pre-treatment growth rate of vestibular schwannomas (VS) predict response to radiosurgery.
A retrospective review of a prospectively maintained database of all VS patients treated with 12Gy prescription dose between September 2005 and June 2011 at our institution using the Leksell Model 4C Gamma Knife Unit was conducted. Patients who had a minimum of 12-months clinical and radiological assessment before and after radiosurgery were included in this study. Tumor growth rates were calculated using specific growth rate (SGR). Tumor volumes were measured on FIESTA-MRI scans using ITK-SNAP v2.2.
Following radiosurgery, twenty-seven (42.9%) patients showed a significant decrease in volume after one year, twenty-nine (46.0%) stabilized, and seven (11.1%) continued to grow. There was no correlation between VS pre-treatment SGRs with post-treatment SGRs (p = 0.34), and incidence of adverse radiation effects (ARE). The reduction in tumors' SGRs after radiosurgery was proportional to pre-treatment SGRs, although this correlation was not statistically significant (p = 0.19). Analysis of risk factors revealed a positive correlation between post-treatment SGRs and incidence of non-auditory complications, most of which were attributed to ARE (p = 0.047).
Pre-treatment growth rate of VS does not predict tumor response to radiosurgery or incidence of ARE. VS with higher SGRs post-radiosurgery are more likely to experience ARE.
Proteasome inhibition represents one of the more important therapeutic targets in the treatment of multiple myeloma (MM), since by suppressing nuclear factor-κB activity, which promotes myelomagenesis, it makes plasma cells susceptible to proapoptotic signals. Bortezomib, the first proteasome inhibitor approved for MM therapy, has been shown to increase response rate and improve outcome in patients with relapsed/refractory disease and in the frontline setting, particularly when combined with immunomodulatory drugs and alkylating agents. Among second-generation proteasome inhibitors, ixazomib (MLN9708) is the first oral compound to be evaluated for the treatment of MM. Ixazomib has shown improved pharmacokinetic and pharmacodynamic parameters compared with bortezomib, in addition to similar efficacy in the control of myeloma growth and prevention of bone loss. Ixazomib was found to overcome bortezomib resistance and to trigger synergistic antimyeloma activity with dexamethasone, lenalidomide, and histone deacetylase inhibitors. Phase I/II studies using ixazomib weekly or twice weekly in relapsed/refractory MM patients suggested antitumor activity of the single agent, but more promising results have been obtained with the combination of ixazomib, lenalidomide, and dexamethasone in newly diagnosed MM. Ixazomib has also been used in systemic amyloidosis as a single agent, showing important activity in this difficult-to-treat plasma-cell dyscrasia. More frequent side effects observed during administration of ixazomib were thrombocytopenia, nausea, vomiting, diarrhea, fatigue, and rash, whereas severe peripheral neuropathy was rare. Here, we review the chemical characteristics of ixazomib, as well as its mechanism of action and results from preclinical and clinical trials.
ixazomib; MLN9708; proteasome inhibitors; multiple myeloma
Tumor cells killed by radiation therapy (RT) are a potentially good source of antigens for dendritic cell (DC) uptake and presentation to T-cells. RT upregulates cell death receptors such as Fas/CD95 and MHC-I, induces the expression of co-stimulatory molecules on tumor cells, and promotes production of pro-inflammatory cytokines. High-dose interleukin-2 (HD-IL-2) bolus has been shown to obtain objective response rates ranging from 15% to 17% in patients with metastatic melanoma or renal cell carcinoma (RCC), with 6% to 8% of cases experiencing a durable complete response. However, HD-IL-2 is also associated with severe side-effects; if it is to remain a component of the curative treatment strategy in patients with metastatic melanoma or RCC, its therapeutic efficacy must be improved and patients who are most likely to benefit from treatment must be identified a priori. We designed a clinical study combining immunomodulating RT and HD-IL-2 to evaluate their clinical and immunological efficacy and to explore the predictive and prognostic value of 1) tumor-specific immune response and 2) serum levels of proangiogenic cytokines.
The primary endpoint of this proof-of-principle phase II study is immune response. Secondary endpoints are the identification of biomarkers potentially predictive of response, toxicity, response rate and overall survival. Three daily doses of booster radiotherapy (XRT) at 6–12 Gy will be administered to at least one metastatic field on days −3 to −1 before the first and third cycle. Treatment with IL-2 (dose 18 MIU/m2/day by continuous IV infusion for 72 hours) will start on day +1 and will be repeated every 3 weeks for up to 4 cycles and then every 4 weeks for a further 2 cycles. Immune response against tumor antigens expressed by melanoma and/or RCC will be evaluated during treatment. Circulating immune effectors and regulators, e.g. cytotoxic T lymphocytes and regulatory T cells, as well as serum levels of proangiogenic/proinflammatory cytokines will also be quantified.
This study aims to evaluate the potential immunological synergism between HD-IL-2 and XRT, and to identify biomarkers that are predictive of response to IL-2 in order to spare potentially non responding patients from toxicity.
EudraCT no. 2012-001786-32
ClinicalTrials.gov Identifier: NCT01884961
HD-IL-2; Melanoma; RCC; Radiotherapy
It has been suggested that the human mirror neuron system can facilitate learning by imitation through coupling of observation and action execution. During imitation of observed actions, the functional relationship between and within the inferior frontal cortex, the posterior parietal cortex, and the superior temporal sulcus can be modeled within the internal model framework. The proposed biologically plausible mirror neuron system model extends currently available models by explicitly modeling the intraparietal sulcus and the superior parietal lobule in implementing the function of a frame of reference transformation during imitation. Moreover, the model posits the ventral premotor cortex as performing an inverse computation. The simulations reveal that: i) the transformation system can learn and represent the changes in extrinsic to intrinsic coordinates when an imitator observes a demonstrator; ii) the inverse model of the imitator’s frontal mirror neuron system can be trained to provide the motor plans for the imitated actions.
Vaccination with dendritic cells (DC) loaded with tumor antigens elicits tumor-specific immune responses capable of killing cancer cells without inducing meaningful side-effects. Patients with advanced melanoma enrolled onto our phase II clinical studies have been treated with autologous DC loaded with autologous tumor lysate/homogenate matured with a cytokine cocktail, showing a clinical benefit (PR + SD) in 55.5% of evaluable cases to date. The beneficial effects of the vaccine were mainly restricted to patients who developed vaccine-specific immune response after treatment. However, immunological responses were only induced in about two-thirds of patients, and treatments aimed at improving immunological responsiveness to the vaccine are needed.
This is a phase II, “proof-of-principle”, randomized, open-label trial of vaccination with autologous DC loaded with tumor lysate or homogenate in metastatic melanoma patients combined with immunomodulating RT and/or preleukapheresis IFN-α. All patients will receive four bi-weekly doses of the vaccine during the induction phase and monthly doses thereafter for up to a maximum of 14 vaccinations or until confirmed progression. Patients will be randomized to receive:
(1.) three daily doses of 8 Gy up to 12 Gy radiotherapy delivered to one non-index metastatic field between vaccine doses 1 and 2 and, optionally, between doses 7 and 8, using IMRT-IMAT techniques;
(2.) daily 3 MU subcutaneous IFN-α for 7 days before leukapheresis;
(3.) both 1 and 2;
(4.) neither 1 nor 2.
At least six patients eligible for treatment will be enrolled per arm. Daily 3 MU IL-2 will be administered subcutaneously for 5 days starting from the second day after each vaccine dose. Serial DTH testing and blood sampling to evaluate treatment-induced immune response will be performed. Objective response will be evaluated according to immune-related response criteria (irRC).
Based upon the emerging role of radiotherapy as an immunologic modifier, we designed a randomized phase II trial adding radiotherapy and/or preleukapheresis IFN-α to our DC vaccine in metastatic melanoma patients. Our aim was to find the best combination of complementary interventions to enhance anti-tumor response induced by DC vaccination, which could ultimately lead to better survival and milder toxicity.
Vaccine; Melanoma; Radiotherapy; Dendritic cell
The performance of reaching movements to visual targets requires complex kinematic mechanisms such as redundant, multijointed, anthropomorphic actuators and thus is a difficult problem since the relationship between sensory and motor coordinates is highly nonlinear. In this article, we present a neural model able to learn the inverse kinematics of a simulated anthropomorphic robot finger (ShadowHand™ finger) having four degrees of freedom while performing 3D reaching movements. The results revealed that this neural model was able to control accurately and robustly the finger when performing single 3D reaching movements as well as more complex patterns of motion while generating kinematics comparable to those observed in human. The long term goal of this research is to design a bio-mimetic controller providing adaptive, robust and flexible control of dexterous robotic/prosthetics hands.
This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.
This study was undertaken to investigate combined toxic and genotoxic effects of cadmium (Cd) and arsenic (As) on white clover, a pollutant sensitive plant frequently used as environmental bioindicator. Plants were exposed to soil spiked with increasing concentrations of cadmium sulfate (20, 40 and 60 mg Kg−1) or sodium arsenite (5, 10 and 20 mg Kg−1) as well as with their combinations. Metal(loid) bioavailability was assessed after soil contamination, whereas plant growth, metal(loid) concentration in plant organs and DNA damage were measured at the end of plant exposition. Results showed that individual and joint toxicity and genotoxicity were related to the concentration of Cd and As measured in plant organs, and that As concentration was the most relevant variable. Joint effects on plant growth were additive or synergistic, whereas joint genotoxic effects were additive or antagonistic. The interaction between Cd and As occurred at both soil and plant level. In soil the presence of As limited the bioavailability of Cd, whereas the presence of Cd increased the bioavailability of As. Nevertheless only As biovailability determined the amount of As absorbed by plants. The amount of Cd absorbed by plant was not linearly correlated with the fraction of bioavailable Cd in soil suggesting the involvement of additional factors, such as plant uptake mechanisms. These results reveal that the simultaneous presence in soil of Cd and As, although producing an additive or synergistic toxic effect on Trifolium repens L. growth, generates a lower DNA damage.
Human leukocyte antigen-G (HLA-G) is a non-classical HLA class I molecule that differs from classical HLA class I molecules by low polymorphism and tissue distribution. HLA-G is a tolerogenic molecule with an immune-modulatory and anti-inflammatory function on both innate and adaptative immunity. This peculiar characteristic of HLA-G has led to investigations of its role in pathological conditions in order to define possible uses in diagnosis, prevention and treatment. In recent years, HLA-G has been shown to have an important implication in different inflammatory and autoimmune diseases, pregnancy complications, tumor development and aggressiveness, and susceptibility to viral infections. In fact, HLA-G molecules have been reported to alternate at both genetic and protein level in different disease situations, supporting its crucial role in pathological conditions. Specific pathologies show altered levels of soluble (s)HLA-G and different HLA-G gene polymorphisms seem to correlate with disease. This review aims to update scientific knowledge on the contribution of HLA-G in managing pathological conditions.
Human leukocyte antigen-G; Pathology; Prognosis; Diagnosis; Treatment; Marker
Sinonasal polyposis (SNP) is a chronic inflammatory pathology with an unclear aetiopathogenesis. Human papillomavirus (HPV) infection is one candidate for the development of SNP for its epithelial cell trophism, hyperproliferative effect, and the induction of immune-modulatory molecules as HLA-G. We enrolled 10 patients with SNP without concomitant allergic diseases (SNP-WoAD), 10 patients with SNP and suffering from allergic diseases (SNP-WAD), and 10 control subjects who underwent rhinoplasty. We analyzed the presence of high- and low-risk HPV DNA and the expression of membrane HLA-G (mHLA-G) and IL-10 receptor (IL-10R) and of soluble HLA-G (sHLA-G) and IL-10 by polyp epithelial cells. The results showed the presence of HPV-11 in 50% of SNP-WoAD patients (OR:5.5), all characterized by a relapsing disease. HPV-11 infection was absent in nonrelapsing SNP-WoAD patients, in SNP-WAD patients and in controls, supporting the hypothesis that HPV-11 increases risk of relapsing disease. HPV-11 positive SNP-WoAD patients presented with mHLA-G and IL-10R on epithelial cells from nasal polyps and showed secretion of sHLA-G and IL-10 in culture supernatants. No HLA-G expression was observed in HPV negative polyps. These data highlight new aspects of polyposis aetiopathogenesis and suggest HPV-11 and HLA-G/IL-10 presence as prognostic markers in the follow-up of SNP-WoAD.
Microalgae produce a wide range of lipid compounds of potential commercial interest. Total lipid extraction performed by conventional extraction methods, relying on the chloroform-methanol solvent system are too laborious and time consuming for screening large numbers of samples. In this study, three previous extraction methods devised by Folch et al. (1957), Bligh and Dyer (1959) and Selstam and Öquist (1985) were compared and a faster single-step procedure was developed for extraction of total lipids from green microalgae. In the single-step procedure, 8 ml of a 2∶1 chloroform-methanol (v/v) mixture was added to fresh or frozen microalgal paste or pulverized dry algal biomass contained in a glass centrifuge tube. The biomass was manually suspended by vigorously shaking the tube for a few seconds and 2 ml of a 0.73% NaCl water solution was added. Phase separation was facilitated by 2 min of centrifugation at 350 g and the lower phase was recovered for analysis. An uncharacterized microalgal polyculture and the green microalgae Scenedesmus dimorphus, Selenastrum minutum, and Chlorella protothecoides were subjected to the different extraction methods and various techniques of biomass homogenization. The less labour intensive single-step procedure presented here allowed simultaneous recovery of total lipid extracts from multiple samples of green microalgae with quantitative yields and fatty acid profiles comparable to those of the previous methods. While the single-step procedure is highly correlated in lipid extractability (r2 = 0.985) to the previous method of Folch et al. (1957), it allowed at least five times higher sample throughput.
Bendamustine demonstrated synergistic efficacy with bortezomib against multiple myeloma (MM) cells in vitro and seems an effective treatment for relapsed-refractory MM (rrMM). This phase II study evaluated bendamustine plus bortezomib and dexamethasone (BVD) administered over six 28-day cycles and then every 56 days for six further cycles in patients with rrMM treated with ⩽4 prior therapies and not refractory to bortezomib. The primary study end point was the overall response rate after four cycles. In total, 75 patients were enrolled, of median age 68 years. All patients had received targeted agents, 83% had 1–2 prior therapies and 33% were refractory to the last treatment. The response rate⩾partial response (PR) was 71.5% (16% complete response, 18.5% very good PR, 37% partial remission). At 12 months of follow-up, median time-to-progression (TTP) was 16.5 months and 1-year overall survival was 78%. According to Cox regression analysis, only prior therapy with bortezomib plus lenalidomide significantly reduced TTP (9 vs 17 months; hazard ratio=4.5; P=0.005). The main severe side effects were thrombocytopenia (30.5%), neutropenia (18.5%), infections (12%), neuropathy (8%) and gastrointestinal and cardiovascular events (both 6.5%). The BVD regimen is feasible, effective and well-tolerated in difficult-to-treat patients with rrMM.
bendamustine plus bortezomib and dexamethasone; relapsed-refractory multiple myeloma; overall response rate; overall survival; time-to-progression; safety
Despite the variety of functional properties of molecular materials, which make them of interest for a number of technologies, their tendency to form inhomogeneous aggregates in thin films and to self-organize in polymorphs are considered drawbacks for practical applications. Here, we report on the use of polymorphic molecular fluorescent thin films as time temperature integrators, a class of devices that monitor the thermal history of a product. The device is fabricated by patterning the fluorescent model compound thieno(bis)imide-oligothiophene. The fluorescence colour of the pattern changes as a consequence of an irreversible phase variation driven by temperature, and reveals the temperature at which the pattern was exposed. The experimental results are quantitatively analysed in the range 20–200°C and interpreted considering a polymorph recrystallization in the thin film. Noteworthy, the reported method is of general validity and can be extended to every compound featuring irreversible temperature-dependent change of fluorescence.
Ichthyoses are a common group of keratinization disorders. A non-inflammatory
generalized persistent skin desquamation is observed. It is characterized by
increased cell turnover, thickening of the stratum corneum and functional changes of
sebaceous and sweat glands. All of these favor fungal proliferation. Dermatophytes
may infect skin, hair and nails causing ringworm or tinea. They have the ability to
obtain nutrients from keratinized material. One of its most prevalent genera is
Trichophyton rubrum. Although tineas and ichthyoses are quite common, the association
of the two entities is rarely reported in the literature. Three cases of ichthyosis
associated with widespread infection by T. rubrum are presented. Resistance to
several antifungal treatments was responsible for worsening of ichthyosis signs and
Dermatomycoses; Ichthyosis; Therapeutics; Tinea
In order to approach human hand performance levels, artificial anthropomorphic hands/fingers have increasingly incorporated human biomechanical features. However, the performance of finger reaching movements to visual targets involving the complex kinematics of multi-jointed, anthropomorphic actuators is a difficult problem. This is because the relationship between sensory and motor coordinates is highly nonlinear, and also often includes mechanical coupling of the two last joints. Recently, we developed a cortical model that learns the inverse kinematics of a simulated anthropomorphic finger. Here, we expand this previous work by assessing if this cortical model is able to learn the inverse kinematics for an actual anthropomorphic humanoid finger having its two last joints coupled and controlled by pneumatic muscles. The findings revealed that single 3D reaching movements, as well as more complex patterns of motion of the humanoid finger, were accurately and robustly performed by this cortical model while producing kinematics comparable to those of humans. This work contributes to the development of a bioinspired controller providing adaptive, robust and flexible control of dexterous robotic and prosthetic hands.
It has been suggested that the human mirror neuron system (MNS) plays a critical role in action observation and imitation. However, the transformation of perspective between the observed (allocentric) and the imitated (egocentric) actions has received little attention. We expand a previously proposed biologically plausible MNS model by incorporating general spatial transformation capabilities that are assumed to be encoded by the intraparietal sulcus (IPS) and the superior parietal lobule (SPL) as well as investigating their interactions with the inferior frontal gyrus and the inferior parietal lobule. The results reveal that the IPS/SPL could process the frame of reference and the viewpoint transformations, and provide invariant visual representations for the temporo-parieto-frontal circuit. This allows the imitator to imitate the action performed by a demonstrator under various perspectives while replicating results from the literatures. Our results confirm and extend the importance of perspective transformation processing during action observation and imitation.
The genus Vibrio is a member of the family Vibrionaceae, and among their
disease-causing species, Vibrio vulnificus, a lactose-positive
gram-negative bacillus, is one of the most virulent pathogen of the noncholerae
vibrios. We describe the case of a 39-year-old male patient, who was using
immunosuppressive therapy, admitted to the hospital for liver transplantation. Twelve
hours later, the patient presented high fever, myalgia, anuria and erythematous
plaques on lower limbs, of rapid growth and proximal progression. The patient was
treated with ceftriaxone, meropenem and oxacillin, however he expired within 30
hours. Blood cultures showed growth of a gram-negative bacillus, which was later
identified as Vibrio vulnificus.
Immunosuppression; Immunocompromised host; Seafood; Sepsis; Shellfish; Skin diseases
Neuropathic pain is commonly associated with cancer. Current treatments include combination opioid and adjuvant therapies, but no guidelines are available for dose escalation strategies. This phase II study compared the efficacy and tolerability of two dose escalation strategies for oxycodone and pregabalin combination therapy.
Patients (N = 75) with oncological neuropathic pain, previously untreated with pregabalin, were recruited in 5 Italian institutions between 2007 and 2010. Patients were randomised to two different dose escalation strategies (arm A; N = 38) oxycodone at a fixed dose with increasing pregabalin doses; (arm B; N = 37) pregabalin at a fixed dose with increasing oxycodone doses. Patients were evaluated from daily diaries and follow-ups at 3, 7, 10, and 14 days after beginning treatment with a numerical rating scale (NRS), neuropathic pain scale (SDN), and well-being scale (ESAS). The primary endpoint was a ≥1/3 reduction in pain (NRS); secondary endpoints included the time to analgesia and adverse effects. The study had a 90% probability of detecting the best strategy for a true difference of at least 15%.
More patients in arm A (76%) than arm B (64%) achieved ≥1/3 overall pain reduction even after controlling for baseline factors (gender, baseline pain). Group A reported fewer side effects than group B; constipation 52.8% vs. 66.7%; nausea: 27.8% vs. 44.4%; drowsiness: 44.4% vs. 55.6%; confusion: 16.7% vs. 27.8%; itching: 8.3% vs. 19.4%.
Both strategies effectively controlled neuropathic pain, but according to the adopted selection design arm A is preferable to arm B for pain control.
Bone marrow stimulation techniques in cartilage repair such as drilling are limited by the formation of fibrous to hyaline-like repair tissue. It has been suggested such techniques can be enhanced by covering the defect with scaffolds. We present an innovative approach using a polyglycolic acid (PGA)-hyaluronan scaffold with platelet-rich-plasma (PRP) in drilling.
We asked whether (1) PRP immersed in a cell-free PGA-hyaluronan scaffold improves patient-reported 1-year outcomes for the Knee injury and Osteoarthritis Score (KOOS), and (2) implantation of the scaffold in combination with bone marrow stimulation leads to the formation of hyaline-like cartilage repair tissue.
Patients and Methods
We reviewed 52 patients who had arthroscopic implantation of the PGA-hyaluronan scaffold immersed with PRP in articular cartilage defects of the knee pretreated with Pridie drilling. Patients were assessed by KOOS. At 9 months followup, histologic staining was performed in specimens obtained from five patients to assess the repair tissue quality.
The KOOS subscores improved for pain (55 to 91), symptoms (57 to 88), activities of daily living (69 to 86), sports and recreation (36 to 70), and quality of life (38 to 73). The histologic evaluation showed a homogeneous hyaline-like cartilage repair tissue.
The cell-free PGA-hyaluronan scaffold combined with PRP leads to cartilage repair and improved patient-reported outcomes (KOOS) during 12 months of followup. Histologic sections showed morphologic features of hyaline-like repair tissue. Long-term followup is needed to determine if the cartilage repair tissue is durable.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
This study investigated changes in brain hemodynamics, as measured by functional near infrared spectroscopy, during performance of a cognitive-motor adaptation task. The adaptation task involved the learning of a novel visuomotor transformation (a 60° counterclockwise screen-cursor rotation), which required inhibition of a prepotent visuomotor response. A control group experienced a familiar transformation and thus, did not face any executive challenge. Analysis of the experimental group hemodynamic responses revealed that the performance enhancement was associated with a monotonic reduction in the oxygenation level in the prefrontal cortex. This finding confirms and extends functional magnetic resonance imaging and electroencephalography studies of visuomotor adaptation and learning. The changes in prefrontal brain activation suggest an initial recruitment of frontal executive functioning to inhibit prepotent visuomotor mappings followed by a progressive de-recruitment of the same prefrontal regions. The prefrontal hemodynamic changes observed in the experimental group translated into enhanced motor performance revealed by a reduction in movement time, movement extent, root mean square error and the directional error. These kinematic adaptations are consistent with the acquisition of an internal model of the novel visuomotor transformation. No comparable change was observed in the control group for either the hemodynamics or for the kinematics. This study (1) extends our understanding of the frontal executive processes from the cognitive to the cognitive-motor domain and (2) suggests that optical brain imaging can be employed to provide hemodynamic based-biomarkers to assess and monitor the level of adaptive cognitive-motor performance.
visuomotor adaptation-learning; frontal executive; functional near infrared spectroscopy; internal models; arm reaching movement
In life, everyone goes through hurtful events caused by significant others: a deceiving friend, a betraying partner, or an unjustly blaming parent. In response to painful emotions, individuals may react with anger, hostility, and the desire for revenge. As an alternative, they may decide to forgive the wrongdoer and relinquish resentment. In the present study, we examined the brain correlates of forgiveness using functional Magnetic Resonance Imaging (fMRI). Healthy participants were induced to imagine social scenarios that described emotionally hurtful events followed by the indication to either forgive the imagined offenders, or harbor a grudge toward them. Subjects rated their imaginative skills, levels of anger, frustration, and/or relief when imagining negative events as well as following forgiveness. Forgiveness was associated with positive emotional states as compared to unforgiveness. Granting forgiveness was associated with activations in a brain network involved in theory of mind, empathy, and the regulation of affect through cognition, which comprised the precuneus, right inferior parietal regions, and the dorsolateral prefrontal cortex. Our results uncovered the neuronal basis of reappraisal-driven forgiveness, and extend extant data on emotional regulation to the resolution of anger and resentment following negative interpersonal events.
forgiveness; reappraisal; emotional regulation; functional Magnetic Resonance Imaging; effective connectivity