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Prey adjust their antipredator behavioral tactics to minimize the risk of an encounter with predators. Spatiotemporal responses of prey to predators have been reported, but the nature of antipredator response is not ubiquitous and it is the object of increasing interest, especially considering the recent recovery of large carnivores in Europe, and the potential for behavioral antipredator responses to elicit consequences at the ecosystem level. We have tested multiple antipredator responses by fallow deer Dama dama to wolf Canis lupus in a Mediterranean protected area recently recolonized by this apex predator. Through intensive camera trapping, we tested for temporal and spatial association between predator and prey, and we have also studied deer vigilance in forest habitats where focal observations are usually impossible. Wolf detection rates were spatially associated with those of fallow deer. Accordingly, no evidence was found for fallow deer avoiding sites with higher predator detection rates. Temporal activity patterns were significantly different between the 2 species, with the wolf being mainly nocturnal whereas fallow deer was active especially during daylight. A comparison with a preliminary study strongly suggests an increase in the diurnal activity of fallow deer along with the stabilization of wolf presence in the area. Both the rate and the duration of vigilance of female fallow deer increased with the local frequency of wolf activity. We suggest an antipredator response based on temporal-rather than spatial-avoidance, as well as increased vigilance.
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[This corrects the article DOI: 10.3389/fpsyg.2021.818659.].
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BACKGROUND: Chronic airway diseases are prevalent and costly conditions. Interdisciplinary rehabilitation programs that include Acceptance and Commitment-based (ACT) components could be important to tackle the vicious circle linking progression of the disease, inactivity, and psychopathological symptoms. METHODS: A retrospective evaluation of routinely collected data of an interdisciplinary rehabilitation program was performed. The program included group sessions including patient education, breathing exercise, occupational therapy and an ACT-based psychological treatment, and individual sessions of physical therapy. Demographic data, clinical characteristics of the patients and the values of outcome variables (health status, quality of life, anxiety, and depression) before treatment, at discharge, at 3 months, and at 6 months were extracted from medical records. Multiple imputation was employed to address missing data. Linear mixed models were employed to assess changes over time. Multivariable logistic regression was performed to assess predictors of a minimum clinically important change of health status from baseline to the 6-months follow-up. RESULTS: Data from 31 patients with chronic obstructive pulmonary disease (COPD) and 12 patients with bronchiectasis were extracted. Health status improved from baseline to discharge to the 3 months follow-up, but not to the 6 months follow-up. Anxiety and depression improved across all the time points. Quality of life did not improve over time. Having a worse health status at baseline and fewer depressive symptoms were significantly associated with achieving a minimum clinically important change of health status at 6 months. The effects of the interdisciplinary program were not different for patients with COPD or with bronchiectasis. DISCUSSION: Interdisciplinary programs including ACT-based components are promising treatments for the rehabilitation of patients with chronic airway diseases.
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Huntington's disease (HD) is a neurodegenerative disorder characterized by motor disturbances, cognitive decline, and behaviour changes. A well-recognized feature of advanced HD is dysphagia, which leads to malnutrition and aspiration pneumonia, the latter being the primary cause of death in HD. Previous studies have underscored the importance of dysphagia in HD patients with moderate-to-advanced stage disease, but it is unclear whether dysphagia affects patients already at an early stage of disease and whether genetic or clinical factors can predict its severity. We performed fiberoptic endoscopic evaluation of swallowing (FEES) in 61 patients with various stages of HD. Dysphagia was found in 35% of early-stage, 94% of moderate-stage, and 100% of advanced-stage HD. Silent aspiration was found in 7.7% of early-stage, 11.8% of moderate-stage, and 27.8% of advanced-stage HD. A strong correlation was observed between disease progression and dysphagia severity: worse dysphagia was associated with worsening of motor symptoms. Dysphagia severity as assessed by FEES correlated with Huntington's Disease Dysphagia Scale scores (a self-report questionnaire specific for evaluating swallowing in HD). The present findings add to our understanding of dysphagia onset and progression in HD. A better understanding of dysphagia onset and progression in HD may inform guidelines for standard clinical care in dysphagia, its recognition, and management.
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Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Enfermedad de Huntington/complicaciones , Enfermedad de Huntington/fisiopatología , Estudios de Casos y Controles , Deglución/fisiología , Progresión de la Enfermedad , Esofagoscopía , Tecnología de Fibra Óptica , Humanos , Neumonía por Aspiración/etiología , Neumonía por Aspiración/fisiopatología , Aspiración Respiratoria/etiología , Aspiración Respiratoria/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
AIM OF THE STUDY: The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared with SLT alone (communicative-pragmatic approach: Promoting Aphasic's Communicative Effectiveness) in stroke patients with chronic aphasia. MATERIALS AND METHODS: The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions during the same period. Psychological and speech language assessment were made before (T0) and after (T1) the treatments. RESULTS: The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohen's d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi-square test = 4.114; p = 0.043). CONCLUSIONS: The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of patients with aphasia than SLT alone.
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Afasia/rehabilitación , Isquemia Encefálica/rehabilitación , Lenguaje , Musicoterapia , Habla/fisiología , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Anciano de 80 o más Años , Afasia/etiología , Isquemia Encefálica/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Accidente Cerebrovascular/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to assess the incidence and clinical impact of balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR) with the CoreValve prosthesis (Medtronic Inc., Minneapolis, Minnesota). BACKGROUND: BPD is a widely adopted strategy to reduce the degree of paraprosthetic regurgitation in case of transcatheter heart valve underexpansion. However, controversies still remain regarding its real effectiveness and safety. METHODS: The ClinicalService (a nation-based data repository and medical care project) dataset was analyzed. All patients were dichotomized according to the need for BPD during the index procedure. RESULTS: Among 1,376 patients, BPD of the transcatheter heart valve was performed in 272 (19.8%). In 37% of cases, it was unsuccessful at reducing the paravalvular regurgitation to mild or less. No case of valve embolization, new intravalvular regurgitation, coronary occlusion, and aortic root injury occurred during BPD. There were no statistically significant differences between the 2 groups in the incidence of in-hospital all-cause and cardiovascular mortality, neurological events, myocardial infarction, bleeding, conversion to open-chest surgery, and the need for a permanent pacemaker. The need for BPD did not emerge as an independent risk factor for all-cause (adjusted hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.81 to 2.19, p = 0.264) and cardiovascular (adjusted HR: 1.48, 95% CI: 0.74 to 2.97, p = 0.265) mortality at 1 year after the procedure. In addition, BPD did not predispose to higher odds of neurological events during 12 months after TAVR (HR: 0.92, 95% CI: 0.45 to 1.88, p = 0.815). CONCLUSIONS: This large study showed that BPD after TAVR was safe and not associated with increased rates of cerebrovascular events, mortality, myocardial infarction, and aortic root injury.
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Estenosis de la Válvula Aórtica/terapia , Válvula Aórtica/fisiopatología , Valvuloplastia con Balón , Cateterismo Cardíaco/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Anciano , Anciano de 80 o más Años , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/prevención & control , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Valvuloplastia con Balón/efectos adversos , Valvuloplastia con Balón/mortalidad , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Trastornos Cerebrovasculares/etiología , Bases de Datos Factuales , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Hemodinámica , Mortalidad Hospitalaria , Humanos , Italia , Estimación de Kaplan-Meier , Masculino , Infarto del Miocardio/etiología , Diseño de Prótesis , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS: Transcatheter aortic valve implantation (TAVI) can be associated with varying degrees of new renal impairment. The aim of this multicentre analysis was to determine the impact and predictors of periprocedural acute kidney injury (AKI) on prognosis after TAVI. METHODS AND RESULTS: From the ClinicalService (a nation-based data repository and medical care project) dataset, 1,157 patients with severe aortic stenosis treated with the third-generation CoreValve prosthesis in seven Italian sites, and with creatinine data available at baseline and during the post-TAVI in-hospital course, were included in this analysis. All outcomes were defined according to the VARC criteria. Overall, AKI occurred in 231 (20.0%): 15.4% stage 1, 2.7% stage 2, and 1.9% stage 3. Compared to patients without AKI, patients who suffered post-procedural AKI had significantly higher three-year all-cause mortality (31% vs. 12%; adjusted HR: 2.09; 95% CI: 1.52-2.87, p<0.001) and cardiovascular mortality (14% vs. 6%; adjusted HR: 2.28; 95% CI: 1.41-3.71, p=0.001). No significant differences in terms of stroke, spontaneous MI, and bleeding were reported. Female gender (adjusted OR: 1.37, 95% CI: 1.01-1.87; p=0.045), baseline renal insufficiency (adjusted OR: 11.02, 95% CI: 5.12-23.73; p<0.001), general anaesthesia (adjusted OR: 1.37, 95% CI: 1.00-1.87; p=0.050), and transfusion ≥3 red blood cell (RBC) units within 72 hrs from TAVI (adjusted OR: 1.65, 95% CI: 1.02-2.68; p=0.041) were found to be independent predictors of AKI. CONCLUSIONS: Acute kidney injury is a frequent complication and significantly impacts on both early and long-term TAVI survival. Females, subjects with impaired renal function at baseline, patients undergoing TAVI under general anaesthesia, and patients receiving ≥3 RBC units after the procedure should be considered populations at high risk for the development of AKI after TAVI.
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Lesión Renal Aguda/epidemiología , Estenosis de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/epidemiología , Insuficiencia Renal Crónica/epidemiología , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Anestesia General/estadística & datos numéricos , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estudios de Cohortes , Ecocardiografía , Transfusión de Eritrocitos/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Modelos Logísticos , Masculino , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores Sexuales , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze the risk reduction of cardiopulmonary bypass complications between on-pump and off-pump coronary artery bypass grafting in high-risk patients. METHODS: This multicenter, prospective, randomized, parallel trial enrolled patients for elective or urgent isolated coronary artery bypass grafting with an additive European System for Cardiac Operative Risk Evaluation of 6 or more. The patients in cardiogenic shock were excluded. The composite primary end point included operative mortality, myocardial infarction, stroke, renal failure, reoperation for bleeding and adult respiratory distress syndrome within 30 days after surgery. The total sample size was 693 patients, according to a scheduled interim analysis at 400 patients enrolled (α-spending = 0.029, Pocock method). RESULTS: A total of 411 patients were included in the interim analysis. Randomization assigned 203 patients to on-pump and 208 patients to off-pump treatment. Of the 411 patients, 24 crossed over; thus, 195 patients were actually treated on-pump and 216 off-pump. According to the intention to treat analysis, the rate of the composite primary end point was significantly lower (unadjusted P = .009, adjusted P = .010) in the off-pump group (5.8% vs 13.3%). The risk of experiencing the primary end point was significantly greater for the on-pump group (unadjusted odds ratio, 2.51; 95% confidence interval, 1.23-5.10; P = .011; adjusted odds ratio, 3.07; 95% confidence interval, 1.32-7.14; P = .009). CONCLUSIONS: Off-pump coronary artery bypass grafting reduces early mortality and morbidity in high-risk patients.
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Puente Cardiopulmonar , Puente de Arteria Coronaria Off-Pump , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Anciano , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria Off-Pump/mortalidad , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Italia , Modelos Logísticos , Masculino , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Oportunidad Relativa , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/cirugía , Estudios Prospectivos , Insuficiencia Renal/etiología , Insuficiencia Renal/prevención & control , Reoperación , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/prevención & control , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Suiza , Factores de Tiempo , Resultado del TratamientoRESUMEN
In order to increase the knowledge of locomotor disturbances in children with autism, and of the mechanism underlying them, the objective of this exploratory study was to reliably and quantitatively evaluate linear gait parameters (spatio-temporal and kinematic parameters), upper body kinematic parameters, walk orientation and smoothness using an automatic motion analyser (ELITE systems) in drug naïve children with Autistic Disorder (AD) and healthy controls. The children with AD showed a stiffer gait in which the usual fluidity of walking was lost, trunk postural abnormalities, highly significant difficulties to maintain a straight line and a marked loss of smoothness (increase of jerk index), compared to the healthy controls. As a whole, these data suggest a complex motor dysfunction involving both the cortical and the subcortical area or, maybe, a possible deficit in the integration of sensory-motor information within motor networks (i.e., anomalous connections within the fronto-cerebello-thalamo-frontal network). Although the underlying neural structures involved remain to be better defined, these data may contribute to highlighting the central role of motor impairment in autism and suggest the usefulness of taking into account motor difficulties when developing new diagnostic and rehabilitation programs.