Condensed tannins fed to dairy goats: Effects on digestibility, milk production, blood parameters, methane emission, and energy and nitrogen balances.

Condensed tannins (CT) are plant polyphenols that can affect feed digestibility and are potentially able to reduce enteric CH4 emissions in ruminants. In this in vivo trial with 8 lactating goats, we investigated the effects of 4 levels of inclusion of a commercial CT extract from quebracho (0%, 2%, 4%, and 6% on dry matter basis; CON, Q2, Q4, and Q6, respectively). The experimental design was a repeated 4 × 4 Latin square with 28-d periods (24 d of diet adaptation and 4 d of sample collection) using metabolic cages and 4 open-circuit respiration chambers. The inclusion of CT in the diets did not affect the dry matter intake (DMI) but caused a linear decrease in diet digestibility, with reductions up to -11% for dry matter, -21% for crude protein (CP), -23% for α-amylase- and sodium sulfite-treated neutral detergent fiber corrected for insoluble ash (aNDFom), and -13% for gross energy, when comparing the Q6 and CON diets. However, ruminal total volatile fatty acids (VFA) concentration was not affected by CT, although there were changes in VFA proportions. Milk yield was highest for Q4 (3,371 g/d) and lowest for Q6 (3,066 g/d). In terms of milk composition, CT induced a linear reduction of fat and CP concentrations. The reduction in CP digestibility resulted in a linear reduction in the milk urea level, up to -37% with Q6. Positively, CT linearly reduced the somatic cells count expressed as linear score. The feed efficiency was linearly decreased by CT inclusion. Furthermore, a shift from urinary to fecal nitrogen excretion was observed with CT. The retained nitrogen was always negative (on average -1.93 g/d). The CH4 yield (on average 19.2 g of CH4/kg DMI) was linearly reduced by CT inclusion, up to -18% with Q6. Regarding the CH4 intensity, CT induced a linear reduction when expressed per kilogram of milk, but not per kilogram of fat and protein-corrected milk. Moreover, the CH4 production per kilogram of digestible aNDFom was linearly increased by CT. The metabolizable energy intake (MEI) was not affected by the treatments, but the metabolizability (q = MEI/gross energy intake) was reduced as CT inclusion increased. From the results of the present study, it turned out that CT have a negative impact on feed digestibility and feed use efficiency. Condensed tannins can lower CH4 emissions from ruminants; however, the main mechanism of action is likely the decrease in feed digestibility. Furthermore, CT did not improve the N use efficiency. According to these findings, the positive environmental impacts of CT are only related to the shift from urinary to fecal N excretion.

Evaluation of Intergovernmental Panel on Climate Change (IPCC) equations to predict enteric methane emission from lactating cows fed Mediterranean diets.

The study aimed to evaluate Intergovernmental Panel on Climate Change (IPCC) Tier 2 (2006 and 2019) to predict enteric CH4 emissions from lactating cows fed Mediterranean diets. The effects of the CH4 conversion factor (Ym; CH4 energy loss as a percentage of gross energy intake) and digestible energy (DE) of the diet were evaluated as model predictors. A data set was created using individual observations derived from 3 in vivo studies on lactating dairy cows housed in respiration chambers and fed diets typical of the Mediterranean region based on silages and hays. Five models using different Ym and DE were evaluated following a Tier 2 approach: (1) average values of Ym (6.5%) and DE (70%) from IPCC (2006); (2) average value of Ym (5.7%) and DE (70.0%) from IPCC (2019; 1YM); (3) Ym = 5.7% and DE measured in vivo (1YMIV); (4) Ym = 5.7 or 6.0%, depending on dietary NDF, and DE = 70% (2YM); and (5) Ym = 5.7 or 6.0%, depending on dietary NDF, and DE measured in vivo (2YMIV). Finally, a Tier 2 model for Mediterranean diets (MED) was derived from the Italian data set (Ym = 5.58%; DE = 69.9% for silage-based diets and 64.8% for hay-based diets) and validated on an independent data set of cows fed Mediterranean diets. The most accurate models tested were 2YMIV, 2YM, and 1YMIV with predictions of 384, 377, and 377 (g of CH4/d), respectively, versus the in vivo value of 381. The most precise model was 1YM (slope bias = 1.88%; r = 0.63). Overall, 1YM showed the highest concordance correlation coefficient value (0.579), followed by 1YMIV (0.569). Cross-validation on an independent data set of cows fed Mediterranean diets (corn silage and alfalfa hay) resulted in concordance correlation coefficient of 0.492 and 0.485 for 1YM and MED, respectively. The prediction of MED (397) was more accurate than 1YM (405) in comparison with the corresponding in vivo value of 396 g of CH4/d. The results of this study showed that the average values proposed by IPCC (2019) can adequately predict CH4 emissions from cows fed typical Mediterranean diets. However, the use of specific factors for the Mediterranean area, such as DE, improved the accuracy of the models.

Milk production, methane emissions, nitrogen, and energy balance of cows fed diets based on different forage systems.

Eight lactating Italian Friesian cows were housed in individual respiration chambers in a repeated Latin square design to determine their dry matter intake (DMI) and their milk and methane production, as well as to collect the total feces and urine to determine the N and energy balances. Four diets, based on the following forages (% of dry matter, DM), were tested: corn silage (CS, 49.3), alfalfa silage (AS, 26.8), wheat silage (WS, 20.0), and a typical hay-based Parmigiano Reggiano cheese production diet (PR, 25.3 of both alfalfa and Italian ryegrass hay). The greatest DMI was observed for cows fed PR (23.4 vs. 20.7 kg/d, the average of the other 3 diets). The DM digestibility was lower for PR (64.5 vs. 71.7%, the average of the other diets). The highest ash-free neutral detergent fiber digestibility values were obtained for CS (50.7%) and AS (47.4%). In the present study, no differences in milk production were observed between diets, although PR showed a higher milk yield trend. The highest milk urea N concentration (mg/dL) was found for the cows fed the WS diet (13.8), and the lowest was observed for the cows fed AS (9.24). The highest milk urea N concentration for the cows fed WS was also correlated with the highest urinary N excretion (g/d), which was found for the cows fed that same diet (189 vs. 147 on average for the other diets). The protein digestibility was higher for the cows fed the CS and WS diets (on average 68.5%) than for the cows fed AS and PR (on average 57.0%); dietary soybean inclusion was higher for CS and WS than for AS and PR. The rumen fermentation pattern was affected by the diet; the cows fed the PR diet showed a higher rumen pH and decreased propionate production than those fed CS, due to the lower nonfiber carbohydrate content and higher ash-free neutral detergent fiber content of the PR diet than the CS diet. Feeding cows with PR diet increased the acetate:propionate ratio in comparison with the CS diet (3.30 vs. 2.44 for PR and CS, respectively). Cows fed the PR diet produced a greater daily amount of methane and had a greater methane energy loss (% of digestible energy intake) than those fed the CS diet (413 vs. 378 g/d and 8.67 vs. 7.70%), but no differences were observed when methane was expressed as grams per kilogram of DMI or grams per kilogram of milk. The PR diet resulted in a smaller net energy for lactation content than the CS diet (1.36 vs. 1.70 Mcal/kg of DM for the PR and CS diets, respectively). Overall, our research suggests that a satisfactory milk production can be attained by including different high-quality forages in balanced diets without any negative effect on milk production or on the methane emissions per kilogram of milk.

Blood parameters in fattening pigs fed whole-ear corn silage and housed in group pens or in metabolic cages.

The aim of this work was to evaluate the effects of the inclusion of whole-ear corn silage (WECS) in diets for advanced fattening heavy pigs (substitution for part of the dry corn and wheat bran) allocated or not in metabolic cages on the main blood parameters. The high-moisture shelled corn is largely used in pig feeding while WECS is less often used despite the fact that it increases the DM crop yield. Three experimental diets were fed to 27 barrows (Italian Large White × Italian Duroc), with an average BW of 98.2 (±5.6) kg at the start of the trial, and randomly allotted to 3 experimental groups including a control diet (CON) containing cereal meals (corn, barley, and wheat, 80.2% DM in total), soybean meal (9% DM), wheat bran (8% DM), minerals and supplements (2.8% DM), and 2 diets containing WECS (15 or 30% DM referred to as 15WECS and 30WECS, respectively) in partial or complete substitution for wheat bran and corn meal. The pigs were randomly housed in 9 pens with 3 animals per pen and 3 pens per dietary treatment. Six pigs per each of the 3 treatments were moved from the pens to individual metabolic cages for 3 consecutive periods (2 pigs per treatment per period). Each period lasted 14 d, and blood was collected at the start and at the end of the periods. Blood was drawn from the jugular vein before feed distribution in the morning, at 14 d intervals, and analyzed for hematological, metabolic, and serum protein profiles. The effect of the metabolic cage housing was included in the statistical model to compare the results obtained in the 2 different environments of restrained and group-housed barrows. The WECS affected the neutrophil to lymphocyte ratio and mean corpuscular hemoglobin concentration. The main diet effect on plasma metabolites was recorded for plasma NEFA, with higher values in WECS diets compared with the CON. The metabolic cage housing affected both hematological (red blood cell count, hemoglobin, hematocrit) and metabolic (protein and its fractions) items, which can be markers of hemodilution. These results indicate the possibility to use this feed in the diet of heavy pigs without negative effects on physiology. The absolute values from metabolic profile of pigs in metabolic cages must be considered with caution for possible comparisons with values obtained on-field in group pens, particularly because a different hemodilution may affect the results.

Effect of dietary starch concentration and fish oil supplementation on milk yield and composition, diet digestibility, and methane emissions in lactating dairy cows.

The aim of this study was to evaluate the effects of diets with different starch concentrations and fish oil (FO) supplementation on lactation performance, in vivo total-tract nutrient digestibility, N balance, and methane (CH4) emissions in lactating dairy cows. The experiment was conducted as a 4×4 Latin square design with a 2×2 factorial arrangement: 2 concentrations of dietary starch [low vs. high: 23.7 and 27.7% on a dry matter (DM) basis; neutral detergent fiber/starch ratios: 1.47 and 1.12], the presence or absence of FO supplement (0.80% on a DM basis), and their interaction were evaluated. Four Italian Friesian cows were fed 1 of the following 4 diets in 4 consecutive 26-d periods: (1) low starch (LS), (2) low starch plus FO (LSO), (3) high starch (HS), and (4) high starch plus FO (HSO). The diets contained the same amount of forages (corn silage, alfalfa and meadow hays). The starch concentration was balanced using different proportions of corn meal and soybean hulls. The cows were housed in metabolic stalls inside open-circuit respiration chambers to allow measurement of CH4 emission and the collection of separate urine and feces. No differences among treatments were observed for DM intake. We observed a trend for FO to increase milk yield: 29.2 and 27.5kg/d, on average, for diets with and without FO, respectively. Milk fat was affected by the interaction between dietary starch and FO: milk fat decreased only in the HSO diet. Energy-corrected milk (ECM) was affected by the interaction between starch and FO, with a positive effect of FO on the LS diet. Fish oil supplementation decreased the n-6:n-3 ratio of milk polyunsaturated fatty acids. High-starch diets negatively influenced all digestibility parameters measured except starch, whereas FO improved neutral detergent fiber digestibility (41.9 vs. 46.1% for diets without and with FO, respectively, and ether extract digestibility (53.7 vs. 67.1% for diets without and with FO, respectively). We observed a trend for lower CH4 emission (g/d) and intensity (g/kg of milk) with the high-starch diets compared with the low-starch diets: 396 versus 415g/d on average, respectively, and 14.1 versus 14.9g/kg of milk, respectively. Methane intensity per kilogram of ECM was affected by the interaction between starch and FO, with a positive effect of FO for the LS diet: 14.5 versus 13.3g of CH4/kg of ECM for LS and LSO diets, respectively.

Digestibility and metabolic utilization of diets containing whole-ear corn silage and their effects on growth and slaughter traits of heavy pigs.

The aim was to evaluate 2 levels of dietary inclusion of chopped whole-ear corn silage (WECS) on energy and nutrient utilization, growth, and slaughter performances of heavy pigs. Two in vivo experiments were conducted to determine digestibility and metabolic utilization of WECS using 18 barrows weighing 118 ± 8 kg BW on average, metabolic cages and respiration chambers (Exp. 1), and the effect of WECS on the growth performance and carcass traits on 42 barrows from 90 to 170 kg BW (Exp. 2). In both experiments, pigs were fed 3 experimental diets: a control diet (CON) containing cereal meals, extracted soybean meal, and wheat bran (80%, 9%, and 8% of DM, respectively) and 2 diets containing 15% (15WECS) or 30% WECS (30WECS) on a DM basis in place of wheat bran and corn meal. The diets were prepared daily by mixing the WECS to a suitable compound feed. Feed intake was always restricted to allow a daily DMI of 7.2% BW(0.75) in Exp. 1 and from 8.0% to 6.5% BW(0.75) in Exp. 2. Diets had similar NDF contents (15.2% to 15.8% of DM), and WECS inclusion resulted in a slight reduction in CP content (from 14.0% to 13.6% of DM) and a considerable decrease in P content (from 0.47% to 0.30% of DM). Digestibility of OM, CP, and fat was similar among diets, whereas P digestibility was lower (P < 0.05) for the 30WECS diet (33.5%) in comparison with the CON and 15WECS diets (45.5% and 44.1%, respectively). Nitrogen lost in feces and urine and N retained were not different among diets, whereas P retained decreased with the increase of WECS (5.4, 3.7, and 2.2 g/d for the CON, 15WECS, and 30WECS diets, respectively; P < 0.05). No difference among diets was observed for energy balance. The WECS contained 13.48 MJ ME and 9.39 MJ NE/kg DM. In Exp. 2, feed intake was not depressed by WECS inclusion, and the ADG for the whole experiment was not different among dietary treatments (from 737 to 774 g/d). Fecal pH was lower (P < 0.05) for the WECS diets than the control diet (7.10 and 7.00 vs. 7.40) and for the sampling at 150 kg BW than that at 130 and 110 kg BW (6.96 vs. 7.29 and 7.24). At slaughter, lean percentage in the carcass was lower in the 30WECS diet than those of the other 2 diets (46.8% vs. 48.3% and 48.6%, P = 0.05). The overall experimental data obtained in both trials indicate that substitution of wheat bran and corn meal for WECS (up to 30% of DM) does not affect, with the exception of P utilization and carcass leanness, energy and nutrient utilization and performance of heavy pigs in the last phase of growing.

Milk production, nitrogen balance, and fiber digestibility prediction of corn, whole plant grain sorghum, and forage sorghum silages in the dairy cow.

Total mixed rations containing corn (CS), whole plant grain sorghum (WPGS), or forage sorghum (FS) silages were fed to 6 primiparous Italian Friesian cows to determine the effects on lactation performance, nutrient digestibility, and N balance. Furthermore, the relationship between in vivo total-tract neutral detergent fiber (NDF) digestibility (ttNDFD) and the ttNDFD derived by the Cornell Net Carbohydrate and Protein System (CNCPS) model was assessed. Cows were assigned to 1 of 3 diets in a replicated 3 × 3 Latin square with 28-d periods. The experimental treatment was silage type and 3 different silages were included in the diets. The diets were formulated to be iso-NDF. Accordingly, each diet was formulated to contain 41.5% CS silage, 36.7% WPGS silage, or 28.0% FS silage, on a DM basis. Starch content was balanced by adding the appropriate amount of corn meal. Separate collection of total urine and feces was performed. Dietary forages were analyzed for in vitro NDF digestibility (6 and 24h of incubation) to predict fiber digestion rate with 2 NDF pools (digestible and indigestible). Rumen digestibility of the potentially digestible NDF pool was predicted using CNCPS version 6.1, using the in vitro forage fiber digestion rate. The ttNDFD was predicted assuming that intestinal digestibility of the NDF amount escaping rumen digestion was 20%, according to the CNCPS model. Dry matter intake was decreased by approximately 1.8 kg/d in cows fed the FS diet compared with the other diets, probably for the greater particle size of FS diet. Hence, milk yield (kg/d) was lowest for FS (23.6), intermediate for WPGS (24.6), and highest for the CS diet (25.4). Milk urea N (mg/dL) was highest for FS (12.9), intermediate for WPGS (11.9), and lowest for CS (10.7) diet. In vivo ttNDFD (%) was 51.4 (CS), 48.6 (WPGS), and 54.1 (FS); this was probably due to a higher retention time of FS diet in the rumen rather than to a better quality of the FS silage, as confirmed by in situ and in vitro results. Urinary N excretion (% N intake) was highest for FS (31.8), intermediate for WPGS (29.3), and lowest for the CS (27.5) diet. The predicted ttNDFD (37.7, 36.3, and 39.5% for CS, WPGS, and FS, respectively) were lower than the in vivo results. Providing an adequate starch supplementation, whole plant grain sorghum silage can replace corn silage in dairy cows TMR. Forage sorghum silage had rumen NDF digestibility comparable to the other silages; however, it had a negative effect on dry matter intake and milk production, probably due to an inadequate effect of processing.

[Is viscoelastic the corneal tissue?]. / Il tessuto corneale è viscoelastico?

PURPOSE: To compare the known viscoelastic properties of soft tissues with singular published observations on the behaviour of corneal tissue. MATERIALS AND METHODS: The behaviour of the maxwellian element, typical viscoelastic biomechanical model, is compared with that of various previously studied soft tissues of animals. The same comparison can be made between stress-strain curves of riboflavin and UVA treated and untreated strips of human and porcine corneal tissue, stretched at constant velocity, from the literature. RESULTS: The asymptotic stress-strain curves of the various soft tissues previously examined could be faithfully simulated by the Maxwell viscoelastic element. The exponential stress-strain curves of samples of corneal tissue were clearly different. CONCLUSIONS: The observed divergence demonstrates incompatibility between the alleged behaviour of corneal tissue and the viscoelastic properties attributed to it. Thus there are two possibilities: either corneal tissue is viscoelastic and the experiment showing exponential behaviour suffers from some technical problem, or the data is correct and corneal tissue is not viscoelastic. In either case further research is necessary for correct interpretation of the mechanism of cross-linking and for consequent therapeutic choices.

Cocoa husks in diets of Italian heavy pigs.

The aim of the present study was to evaluate the effect of cocoa husks feeding on liver composition of the Italian heavy pig. Cocoa husks are by-products derived from chocolate production and have a high content of proteins, lipids, and NDF. Cocoa husks are also rich in antioxidants, polyphenols in particular. Eight finishing pigs were divided into 2 groups: control group fed a traditional diet, based on cereals, and treatment group fed a diet obtained by substitution of 10% of the control diet with coarsely ground cocoa husks. The trial was conducted during the hot season and lasted 6 wk, at the end of which all the pigs were slaughtered. Cocoa husks diet reduced dry matter intake (P < 0.01) and energy intake (P < 0.01) but neither body weight nor backfat thickness was affected by cocoa husks diet. Treatment did not influence carcass weight and hot dressing percentage but reduced liver weight (P < 0.05), liver dry matter percentage (P < 0.01), DNA (P = 0.01), and glycogen content (P = 0.01). By contrast, cocoa husks increased liver ether extract (P = 0.05) without affecting cholesterol content. Liver weight loss, reduction of protein synthesis, and a shift toward glycogen use instead of fat oxidation are considered metabolic strategies to reduce heat production under hot conditions. It is possible, therefore, that cocoa husks feeding promoted the process of acclimation because pigs needed less feeding to reach similar body and carcass weight as control pigs.

[The new magnetic therapy TAMMEF in the treatment of simple shoulder pain]. / Il nuovo sistema di magnetoterapia TAMMEF nel trattamento della spalla dolorosa semplice.

AIMS: Numerous studies have demonstrated the utility of extremely low frequencies (ELF) electromagnetic fields in the treatment of pain. Moreover, the effects of these fields seems to depend on their respective codes (frequency, intensity, waveform). In our study we want to assess the effects of the TAMMEF (Therapeutic Application of a Musically Modulated Electromagnetic Field) system, whose field is piloted by a musical signal and its parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all possible codes can occur during a single application. PATIENTS AND METHODS: Sixty subjects, affected by shoulder periarthritis were enrolled in the study and randomly divided into three groups of 20 patients each: A exposed to TAMMEF, B exposed to ELF, C exposed to a simulated field. All subjects underwent a cycle of 15 daily sessions of 30 minutes each and a clinical examination upon enrollment, after 7 days of therapy, at the end of the cycle and at a follow-up 30 days later. RESULTS: All the patients of groups A and B completed the therapy without the appearance of side effects: they presented a significant improvement of the subjective pain and the functional limitation, which remained stable at the follow-up examination. In group C, there was no improvement of the pain symptoms or articular functionality. CONCLUSIONS: This study suggests that the TAMMEF system is efficacious in the control of pain symptoms and in the reduction of functional limitation in patients with shoulder periarthritis. Moreover, the effects of the TAMMEF system cover those produced by the ELF field.

[Preliminary results of the effects of electromagnetic fields ELF and TAMMEF on human lymphocytes: evaluation of some biological parameters]. / Studio preliminare sugli effetti di campi elettromagnetici, ELF e TAMMEF, nei linfociti umani: valutazione di alcuni parametri biologici.

AIMS: The Authors have evaluated the effects of low frequency electromagnetic fields on human peripheral blood lymphocytes metabolism. MATERIALS AND METHODS: It has been assayed total proteins and the activities of some purine metabolism enzymes after exposure of the cells to sinusoidal ELF fields (100 Hz frequency) or to the new TAMMEF system fields, characterized by variable frequency, intensity and shape of wave. RESULTS: The protein lymphocytes content, increased after both treatments. Instead, the enzyme activities did not vary, with the exception of Myokinase activity, which, respect to the control, increased after ELF field treatment, and slightly decreased after TAMMEF treatment. This preliminary result was interpreted as a variation of the cellular electric charge stability, stimulated by ELF fields, which induce the Myokinase to increase its rate, to rearrange the correct equilibrium, while the TAMMEF field were useless to maintain the cellular electric charge at normal levels. CONCLUSIONS: We interpreted these preliminary results as follow: the ELF fields influence the cellular electric charge stability, so that the cells must increase MK activity to restore the correct equilibrium, while TAMMEF fields are useful to maintain and regulate cellular electric charge. The results obtained by this preliminary study opens interesting prospective to be further investigated.

Effect of chestnut tannin on fermentation quality, proteolysis, and protein rumen degradability of alfalfa silage.

Two experiments were conducted on alfalfa to investigate the effects of the addition of commercial chestnut hydrolyzable tannin at ensiling on 1) silage fermentation quality in lab-scale silos and protein degradation in the rumen, and 2) silage fermentation quality and proteolysis in bale silages. Wilted alfalfa was prepared with 4 tannin levels (0, 2, 4, and 6% on a dry matter (DM) basis; T0, T1, T2, T3, respectively) and ensiled in lab-scale silos. Silages (33% DM) were analyzed for fermentation quality, protein rumen degradability in situ, and organic matter digestibility in vitro through gas production after 120 d of conservation. Wilted alfalfa containing 0 and 4% tannin (T0 and T2) was harvested at 40% DM (wilting level I) and 53% DM (wilting level II) for bale (600 mm diameter) silage. Silages were analyzed for fermentation quality after 78 d of conservation. All the silages were well fermented with no butyric acid. Lab-scale silages showed reductions in ammonia, nonprotein nitrogen (NPN) and DM losses in T2 and T3 treatments, while the fermentation acid profiles were unaffected. In experiment 1, the untreated silage (T0) had the highest protein degradability after being incubated in the rumen. The addition of tannin reduced crude protein ruminal disappearance in a dose-dependent manner. However, the tannin reduced the organic matter digestibility by 5.1% for all of the tannin addition levels. The tannin positively affected the silage quality in the round bale silages, in particular reducing ammonia and NPN in the lowest wilting level. In both experiments, T2 treatment reduced proteolysis without any influence of DM on the binding reaction and reduced the NPN by 15% in comparison to the control.

[On statistical evaluation of efficacy for dichotomous test result]. / Sulla valutazione statistica dell'efficacia di un test diagnostico a risultato dicotomico.

Today in our country multivariate statistical analysis in health science are not very widespread, they are used only in few selected health center. So I will try to elucidate some multidimensional procedure to evaluate dichotomous results in diagnostic test. Anyway, someone can take a further advantage to apply these techniques to complex therapeutic treatments. New technologies make possible everyone to process data by means of the multivariate methodology, so I propose tested techniques like logistic regression combined with area under the ROC (Receiver Operating Characteristic) curve.

Myasthenia gravis self-administered questionnaire: development of regional domains.

The objective was to develop regional domains from the Myasthenia Gravis Questionnaire (MGQ) to better assess generalised, bulbar and ocular involvement in patients with myasthenia gravis (MG) and to evaluate their responsiveness. Some items from the MGQ were aggregated into 3 domains: bulbar, generalised and ocular. The study was carried out at the Institute of Neurology, EMG Service, Universita Cattolica, Rome, and the Department of Neurology, University Hospital, Modena, Italy. Ninety-three MG patients were prospectively enrolled in two neurological departments; furthermore, outcome after treatment was studied in 23 patients to evaluate responsiveness. Disease severity was scored according to a modified version of the Osserman classification and MGQ. The questionnaire appeared more sensitive than clinical examination and history to assess bulbar and ocular involvement. For example, according to the bulbar domain, 67 patients experienced bulbar symptoms whereas on clinical examination 51 of 67 were completely normal in the bulbar region. The MGQ domains appeared reliable and sensitive. Results of global MG score (GMG) and of domains appeared reliable. Domains were able to better assess the functional involvement of anatomical regions than main GMG, clinical examination and history.

[Posterior mediastinum neoplasms: a case of schwannoma]. / I tumori del mediastino posteriore: un caso di schwannoma.

The Authors report the case of a 33-year-old male affected with an asymptomatic schwannoma of the posterior mediastinum, and review the relevant Literature, discussing the difficulties in making the differential diagnosis of the posterior mediastinum lesions, particularly in the pre-clinical phase. Neurogenic tumors represent about 75 percent of all tumors of mediastinum and about one third of all tumors of the mediastinum. They can originate from the peripheral nervous system group, from the sympathetic nervous system group or, in rare cases, from the vagus nerve. In adult patients, they are usually found by chance during radiographic examination of the thorax, and they are usually asymptomatic and benign. During preoperative evaluation, a magnetic resonance examination of rachis should be done to exclude the possibility of intraspinal involvement. If there are no contraindications, the treatment of choice should be surgical resection by means of thoracoscopy or thoracotomy, when size and location of the tumors allow it in order to prevent malignant evolution.