Listening to the neurological teams for multiple sclerosis: the SMART project.

OBJECTIVE: Aim of the research was to define the quality of life of Italian neurologists and nurses' professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. MATERIAL AND METHODS: One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. RESULTS: Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. CONCLUSION: The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it.

Modified silver nanowire transparent electrodes with exceptional stability against oxidation.

We report an easy method to prepare thin, flexible and transparent electrodes that show enhanced inertness toward oxidation using modified silver nanowires (Ag NWs). Stabilization is achieved through the adsorption of triphenylphosphine (PPh3) onto the Ag NW hybrid dispersions prior to their 2D organization as transparent electrodes on polyethylene terephtalate (PET) films. After 110 days in air (20 °C) under atmospheric conditions, the transmittance of the PET/Ag NW/PPh3 based films is nearly unchanged, while the transmittance of the PET/Ag NW-based films decreases by about 5%. The sheet resistance increases for both materials as time elapses, but the rate of increase is more than four times slower for films stabilized by PPh3. The improved transmittance and conductivity results in a significantly enhanced stability for the figure of merit σ dc/σ op. This phenomenon is highlighted in highly oxidative nitric acid vapor. The tested stabilized films in such conditions exhibit a decrease to σ dc/σ op of only 38% after 75 min, whereas conventional materials exhibit a relative loss of 71%. In addition, by contrast to other classes of stabilizers, such as polymer or graphene-based encapsulants, PPh3 does not alter the transparency or conductivity of the modified films. While the present films are made by membrane filtration, the stabilization method could be implemented directly in other liquid processes, including industrially scalable ones.

Effect of the disclosure of MS diagnosis on anxiety, mood and quality of life of patients: a prospective study.

BACKGROUND: In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients' anxiety, mood and quality of life (QoL). METHODS: Eligible participants were all patients referred for the first time to the Neurological Unit who had manifested symptoms suggestive of MS for no more than 6 months. All patients were evaluated for (i) QoL (SEIQoL and MS-QoL54), (ii) Anxiety (STAI) and Depression (CMDI) on study inclusion (T0), 30 days after diagnosis disclosure (T30), and after 1 (T1y) and 2 (T2y) years' follow-up. RESULTS: Two hundred and twenty-nine patients were enrolled; 93 of these were unaware of their diagnosis. Patients who already knew their diagnosis (100 with CIS and 22 with MS) were excluded from the main analyses and used to perform control analyses. At the end of the screening, an MS diagnosis was disclosed to 18 of the 93 patients, whereas a CIS diagnosis was disclosed to 62 patients (12 patients received a diagnosis other than MS or CIS). Thirty days after diagnosis disclosure, irrespective of the diagnosis disclosed, both QoL and Anxiety and Depression were significantly rated as better compared to the start of screening, (p(s) < 0.03), and this improvement remained stable over the two annual follow-ups. However, as suggested by a significant 'Time' × 'Diagnosis' interaction with regard to both QoL and Anxiety and Depression (p(s) < 0.02), the effect of the disclosure in the short term differed depending on CIS or MS diagnosis. Specifically, on MSQoL, which is a health-related QoL scale, we found a statically significant improvement, immediately after the diagnosis disclosure, in both the MS and CIS groups (p(s) < 0.01). Differently, on SEIQoL, which is a non health-related QoL measure, and on the anxiety scale, we observed a statistically significant improvement only in the group which received a MS diagnosis (p(s) < 0.03). CONCLUSIONS: This first prospective study provides objective data showing that early disclosure of MS diagnosis improves both the patient's QoL and psychological well-being. In addition, the results seem to suggest that CIS disclosure does not lead to the same favourable effects.

Substantial improvement of nanotube processability by freeze-drying.

As-produced carbon nanotubes often contain a fraction of impurities such as metal catalysts, inorganic supports, and carbon by-products. These impurities can be partially removed by using acidic dissolution. The resulting nanotube materials have to be dried to form a powder. The processability of nanotubes subjected to regular (thermal vaporisation) drying is particularly difficult because capillary forces pack and stick the nanotubes irreversibly, which limits their dispersability in polymeric matrices or solvents. We show that this dramatic limitation can be circumvented by using freeze-drying instead of regular-drying during nanotube purification process. In this case, the nanotubes are trapped in frozen water which is then sublimated. As a result the final powder is significantly less compact and, more important, the nanotubes can be easily dispersed with no apparent aggregates, thereby greatly enhancing their processability, e.g., they can be used to make homogeneous composites and fibers. Results from coagulation spinning from water-based dispersions of regularly-dried and freeze-dried nanotubes are compared. We also show that freeze-dried materials, in contrast to regularly-dried materials, can be dissolved in organic polar solvents using alkali-doped nanotubes. High resolution TEM and XRD analysis demonstrate that the nanotube structure and quality are not affected at the nanoscale by freeze-drying treatments.

Molecular assembling of DNA with amphipathic peptides.

The self-assembling of double-stranded DNA with short synthetic peptides has been analysed using the fluorescent properties of the intercalating dye, ethidium bromide. Two membrane-active peptides with appropriate sequences of lysine and leucine amino acids and a short polylysine have been probed. The results revealed that the secondary structure of the peptide decisively aimed the peptide-DNA complex formation: only the longest peptide, which is the only one to exhibit an alpha-helical structure in solution, could achieve DNA compacting before charge neutralisation. The obtained complex retained a significant membrane activity as demonstrated by calcein leakage experiments. This shows that short synthetic peptides of elementary sequence can combine both membrane activity and DNA-condensing properties. The potential of these constructs as DNA carriers will be discussed.

High dose intravenous immune globulins and plasma exchange in Guillain-Barré Syndrome.

We report the effects of treatment with plasma-exchange (PE) and intravenous immune globulins (IVIg) in 36 out of 50 patients with Guillain-Barré syndrome (GBS) recruited by an incidence study in the Emilia-Romagna region of Italy. Comparison of the patients treated with PE and IVIg showed no significant differences in terms of effectiveness in improving the clinical course of GBS: at one month, respectively 11.1% and 25% had recovered, and 55.5% and 58.3% had improved by at least one grade. These results are in agreement with those of the Dutch GBS trial. No relapses were observed in either group. Moreover, our results showed no difference in clinical outcome at 1 and 3 months between the patients receiving only one therapy and those receiving two; a second cycle of therapy did not seem to improve the clinical course of the disease significantly. We conclude that PE and IVIg are both safe and effective therapies for GBS.

Unusual case of Fahr syndrome with motoneuron disease.

After commenting briefly on the literature on Fahr syndrome, we describe a patient with an unusual association of cerebral calcifications and motoneuron disease. We discuss the possible role of brain calcifications in the clinical picture and stress the importance of the routine use of CT scanning and MRI to show further similar associations, possibly leading to a better understanding of the pathophysiology.

Sexual dysfunction after excision of the rectum.

From January 1986 up January 1988 a series of 18 patients--age average 49--were studied. All of them had undergone the amputation of the rectum for carcinoma with the Miles resection technique (15 p.), or for ulcerous rectumcolitis (3 p.). Six months after operation the patients were given a questionnaire in order to obtain information about their sexual activity. Exams on the liverkidney functioning, the hormone dosage (FSH, LH, prolactin, testosterone), penile Doppler flowmetry, and the sacral latency test were performed. The patients were also given a Jonas erectiometer to be used at home. The procedures followed have shown in most patients normal hormonal, vascular, and neurologic parameters, thus confirming the absence of relevant erectile deficits. Only one patient no longer had erections after the surgical intervention. It was reported a decrease and some sort of difficulty in the sexual intercourse owing to the presence of colostomy conditioning the physical and psychological relations with the partner. Spermatic fluid results altered after operation: absent in 8 cases, backwards in 3, diminished in 6, and normal in 4.