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1.
Br J Clin Psychol ; 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34651307

RESUMO

OBJECTIVE: Huntington's disease (HD) is a dramatic neurodegenerative disorder encompassing severe motor symptoms coupled to significant cognitive and social cognition deficits. However, it is not clear whether and how patients' neuropsychological profile changes between the prodromal and the manifest stages of the condition. The aim of the present in-depth review is to consider cognitive and social cognition impairment in HD patients by differentiating deficits arising before diagnosis from those evident from the manifest phase onwards. METHODS: Electronic databases were searched between January 1st , 2010 and December 31st , 2020 by using multiple combinations of keywords related to the investigation of neuropsychological profile in HD for preliminary search, and by defining strict selection criteria for studies to be included. RESULTS: Forty-two studies were included. Evidence suggests that the neuropsychological profile in HD reflects a complex pathological spectrum of deficits. It includes impairment in the realms of executive functions, memory, attention, information processing, and social cognition. Interestingly, patients' profiles differ significantly between the manifest and the prodromal stages of their condition, not only in quantitative terms but also from a qualitative point of view. CONCLUSIONS: Researchers and clinicians should thus include in clinical routine timely and specific neuropsychological assessments in order to monitor patients' cognitive status as time goes by, with the ultimate goal to implement effective clinical management strategies. PRACTITIONER POINTS: The neuropsychological profile in HD encompasses a complex pathological spectrum of deficits. Patients' profiles differ significantly between the manifest and the prodromal stages of their condition. Clinicians should include in everyday practice a timely and specific neuropsychological assessment. Detecting patients' cognitive status during the early stages of the condition already can contribute significantly to implement effective clinical management strategies.

2.
Int J Mol Sci ; 22(14)2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34299276

RESUMO

1-cyclohexyl-x-methoxybenzene is a novel psychoactive substance (NPS), first discovered in Europe in 2012 as unknown racemic mixture of its three stereoisomers: ortho, meta and para. Each of these has structural similarities with the analgesic tramadol and the dissociative anesthetic phencyclidine. In light of these structural analogies, and based on the fact that both tramadol and phencyclidine are substances that cause toxic effects in humans, the aim of this study was to investigate the in vitro and in vivo pharmacodynamic profile of these molecules, and to compare them with those caused by tramadol and phencyclidine. In vitro studies demonstrated that tramadol, ortho, meta and para were inactive at mu, kappa and delta opioid receptors. Systemic administration of the three stereoisomers impairs sensorimotor responses, modulates spontaneous motor activity, induces modest analgesia, and alters thermoregulation and cardiorespiratory responses in the mouse in some cases, with a similar profile to that of tramadol and phencyclidine. Naloxone partially prevents only the visual sensorimotor impairments caused by three stereoisomers, without preventing other effects. The present data show that 1-cyclohexyl-x-methoxybenzene derivatives cause pharmaco-toxicological effects by activating both opioid and non-opioid mechanisms and suggest that their use could potentially lead to abuse and bodily harm.


Assuntos
Analgésicos Opioides/toxicidade , Anisóis/toxicidade , Derivados de Benzeno/toxicidade , Alucinógenos/toxicidade , Fenciclidina/toxicidade , Psicotrópicos/toxicidade , Receptores Opioides/metabolismo , Tramadol/toxicidade , Analgésicos Opioides/química , Animais , Anisóis/química , Derivados de Benzeno/química , Células Cultivadas , Cricetinae , Alucinógenos/química , Técnicas In Vitro , Masculino , Camundongos , Camundongos Endogâmicos ICR , Modelos Animais , Fenciclidina/química , Psicotrópicos/química , Tramadol/química
3.
Ann Ist Super Sanita ; 57(2): 144-150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34132212

RESUMO

At the end of the 90s in Europe, the new psychoactive substances (NPS) phenomenon was limited to a small number of molecules created to mimic the actions and psychoactive effects of licensed medicines and existing drugs that are controlled by the United Nations drug conventions and therefore traded as their "legal" replacements. NPS were mostly circulating in rave parties and electronic music festivals. The globalization, the evolution of e-commerce and the growing popularity of NPS, facilitated the development of a wide illegal market in constant expansion. The dynamic nature of this phenomenon has led to an evolution in the prevention and monitoring of NPS trafficking within the European Union. The European legislative system has been amended with the aim of creating a faster and more effective regulatory system to tackle NPS diffusion and ban their sale and circulation. At the end of 2008, in compliance with the European Council Decision 2005/387/JHA, the Anti-Drug Policies Department of the Presidency of the Council of Ministers activated the National Early Warning System to promote a rapid exchange of information on NPS between Italy and the EU.

4.
Brain Sci ; 11(5)2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33919244

RESUMO

Most prevalent neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia, Parkinson's disease and multiple sclerosis are heterogeneous in their clinical profiles and underlying pathophysiology, although they typically share the presence of cognitive impairment that worsens significantly during the course of the disease. Viable pharmacological options for cognitive symptoms in these clinical conditions are currently lacking. In recent years, several studies have started to apply Computerized Cognitive Training (CCT) and Virtual Reality (VR) tools to try and contrast patients' cognitive decay over time. However, no in-depth literature review of the contribution of these promising therapeutic options across main neurodegenerative diseases has been conducted yet. The present paper reports the state-of-the-art of CCT and VR studies targeting cognitive impairment in most common neurodegenerative conditions. Our twofold aim is to point out the scientific evidence available so far and to support health professionals to consider these promising therapeutic tools when planning rehabilitative interventions, especially when the access to regular and frequent hospital consultations is not easy to be provided.

5.
Medicina (Kaunas) ; 57(3)2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33673455

RESUMO

Background and Objectives: Neurodegenerative diseases that typically affect the elderly such as Alzheimer's disease, Parkinson's disease and frontotemporal dementia are typically characterised by significant cognitive impairment that worsens significantly over time. To date, viable pharmacological options for the cognitive symptoms in these clinical conditions are lacking. In recent years, various studies have employed neuromodulation techniques to try and contrast patients' decay. Materials and Methods: We conducted an in-depth literature review of the state-of-the-art of the contribution of these techniques across these neurodegenerative diseases. Results: The present review reports that neuromodulation techniques targeting cognitive impairment do not allow to draw yet any definitive conclusion about their clinical efficacy although preliminary evidence is very encouraging. Conclusions: Further and more robust studies should evaluate the potentialities and limitations of the application of these promising therapeutic tools to neurodegenerative diseases.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doenças Neurodegenerativas , Doença de Parkinson , Idoso , Doença de Alzheimer/terapia , Humanos , Doenças Neurodegenerativas/terapia , Doença de Parkinson/terapia
6.
J Biomech ; 115: 110138, 2021 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-33288210

RESUMO

Multi-fragment fractures are still a challenge: current clinical practice relies on plates and screws. Treatment of fractures of the proximal humerus has the intra-operative risk of articular damage when inserting multiple screws. Distal-varus collapse of the head is a frequent complication in osteoporotic patients. The aim of this biomechanical study was to investigate if an Innovative-cement-technique (the screws are replaced by injection of cement) provides the same or better stability of the reconstructed head compared to the Standard-technique (locking screws). A four-fragment fracture was simulated in twelve pairs of humeri, with removal of part of the cancellous bone to simulate osteoporotic "eggshell" defect. One humerus of each pair was repaired either with a Standard-technique (locking plate, 2 cortical and 6 locking screws), or with the Innovative-cement-technique (injection of a partially-resorbable reinforced bone substitute consisting of PMMA additivated with 26% beta-TCP). Cement injection was performed both in the lab and under fluoroscopic monitoring. The reconstructed specimens were tested to failure with a cyclic force of increasing amplitude. The Innovative-cement-technique withstood a force 3.57 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative-cement-technique was 3.56 times larger than the contralateral Standard-technique. These differences were statistically significant. The Innovative-cement-technique, based on the reinforced bone substitute, demonstrated better biomechanical properties compared to the Standard-technique. These findings, along with the advantage of avoiding the possible complications associated with the locking screws, may help safer and more effective treatment in case of osteoporotic multi-fragment humeral fractures.


Assuntos
Substitutos Ósseos , Fraturas do Ombro , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Cadáver , Fixação Interna de Fraturas , Humanos , Fraturas do Ombro/cirurgia
7.
Brain Sci ; 10(9)2020 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-32961718

RESUMO

(1) Background: Cognitive features of patients with amyotrophic lateral sclerosis (ALS) have never been specifically analyzed according to the lateralization of motor impairment. In the present study we investigated the cognitive performances of ALS patients to describe the relationship between motor and cognitive dysfunction, according to site and side of disease onset. (2) Methods: Six-hundred and nine ALS patients underwent a comprehensive neuropsychological evaluation at diagnosis in Turin ALS Centre Tests included-mini-mental state examination (MMSE), frontal assessment battery (FAB), trail-making test A/B (TMT A-B), digit span forward and backward (digit span FW/digit span BW), letter fluency test (FAS), category fluency test (CAT), Rey auditory verbal learning test (RAVLT), Babcock story recall test (BSRT), Rey-Osterrieth complex figure test (ROCFT), Wisconsin card sorting test (WCST), Raven's coloured progressive matrices (CPM47). Cognitive performances of patients, grouped by side and site of onset, were statistically compared using z-scores, as appropriate. (3) Results: Bulbar patients and bilateral spinal onset patients (Sbil) were generally characterized by lower cognitive performances in most neuropsychological tests, when compared to patients with lateralized onset (right-side spinal onset, Sri and left-side spinal onset, Sle). Digit span backward and visual memory task (ROCFT) median z-scores were significantly higher, reflecting a better cognitive performance, in Sri patients when compared to bulbar/Sbil patients, while verbal memory tasks (RAVLT and BRST) resulted in significantly higher scores in Sle patients. Our results are in keeping with hemispheric functional lateralization of language and visuospatial abilities. (4) Conclusions: In ALS patients, as in other neurodegenerative diseases, we found a direct relationship between lateralized motor and cognitive features.

8.
Med Eng Phys ; 82: 97-103, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32709270

RESUMO

Multi-fragmented fractures of the proximal humerus are difficult to treat, especially in the case of osteoporotic bone. Intra-operative risks include cartilage damage when inserting multiple screws. A common post-operative complication is distal-varus collapse of the head. The aim of this study was to investigate if an Innovative technique (reduced number of screws and injection of a beta-TCP additivated partially resorbable cement) provides the same or better stability of the reconstructed head compared to the Standard technique (using more screws). A four-fragment fracture was simulated in six pairs of humeri, with partial removal of the cancellous bone to simulate osteoporotic "eggshell" defect. One humerus of each pair was repaired with a Standard (locking plate, 2 cortical and 6 locking screws), and the other with the Innovative technique (same plate, 2 cortical and only 3 locking screws, plus cement injection). The reconstructed specimens were subjected to a biomechanical test where a cyclic force of increasing amplitude was applied axially until failure. The Innovative reconstructions withstood a force 3.49 times larger than the contralateral Standard reconstructions before failure started. The maximum force before final collapse for the Innovative reconstructions was 4.24 times larger than the contralateral Standard reconstructions. These differences were statistically significant. The Innovative reconstructions, based on fewer screws and beta-TCP additivated acrylic cement, showed positive results, demonstrating better biomechanical properties compared to the Standard reconstructions. These laboratory findings, along with the advantages of a reduced number of screws, may help perform a surgically safer, and more effective procedure in osteoporotic patients.


Assuntos
Substitutos Ósseos , Fraturas do Ombro , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Cadáver , Fixação Interna de Fraturas , Humanos , Fraturas do Ombro/cirurgia
9.
J Surg Res ; 252: 1-8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32203731

RESUMO

BACKGROUND: Surgical repair of critical-sized bone defects still remains a big challenge in orthopedic surgery. Biological enhancement, such as growth factors or cells, can stimulate a better outcome in bone regeneration driven by well-established treatments such as allogenic bone graft. However, despite the surgical options available, correct healing can be slowed down or compromised by insufficient vascular supply to the injured site. MATERIALS AND METHODS: In this pilot study, critical size bone defects in rabbit radius were treated with allograft bone, in combination with vascular bundle and autologous bone marrow concentrate seeded onto a commercial collagen scaffold. Microtomographical, histological and immunohistochemical assessments were performed to evaluate allograft integration and bone regeneration. RESULTS: Results showed that the surgical deviation of vascular bundle in the bone graft, regardless from the addition of bone marrow concentrate, promote the onset of healing process at short experimental times (8 wk) in comparison with the other groups, enhancing graft integration. CONCLUSION: The surgical procedure tested stimulates bone healing at early times, preserving native bone architecture, and can be easily combined with biological adjuvant.


Assuntos
Transplante de Medula Óssea/métodos , Regeneração Óssea , Transplante Ósseo/métodos , Rádio (Anatomia)/lesões , Aloenxertos , Animais , Colágeno , Modelos Animais de Doenças , Humanos , Projetos Piloto , Coelhos , Rádio (Anatomia)/irrigação sanguínea , Tecidos Suporte , Transplante Autólogo , Transplante Homólogo , Cicatrização
10.
J Mech Behav Biomed Mater ; 100: 103373, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31369957

RESUMO

Osteoporosis (OP) is a skeletal disorder responsible for the weakening of the bone structure and, consequently, for an increased fracture risk in the elderly population. In the past, bone mineral density (BMD) variation was considered the best OP indicator, but recently the focus has shifted toward the variation of microstructural bone parameters. This work is based on the characterisation of 8-mm cylindrical biopsies harvested from proximal humeral heads belonging to healthy and osteoporotic patients, in order to assess the OP-related variations of bone properties at different scale lengths. In particular, bone biopsies underwent micro-computed tomography analysis to study the most relevant features of bone architecture and extrapolate the tissue mineral density (TMD) value of bone trabeculae. Compression tests and nanoindentations were performed to investigate the macro- and micromechanical properties of bone biopsies, respectively. In addition, XRD analyses were performed to obtain the mean hydroxyapatite (HA) crystallite size, while Raman spectroscopy investigated the collagen secondary structure. Thermogravimetric analysis was performed to evaluate the ratio between organic and inorganic phases. From the obtained results, OP samples showed a more anisotropic and less interconnected structure responsible for reduced compression strength. From this, it can be supposed that OP caused an alteration of bone structure that led to inferior macroscopic mechanical properties. Furthermore, OP samples possessed higher TMD and bigger HA crystals that are correlated to an increase of the hardness value obtained by means of nanoindentation. This less controlled HA crystal growth is probably due to an alteration of the organic matrix structure, as revealed by the increase of the random coil contribution in the Raman spectra of the OP bone. This higher crystal content led to an increase in trabecular density and hardness. In conclusion, the obtained data showed that OP affects bone properties at different scale lengths causing an alteration of its morphological, structural and mechanical features.


Assuntos
Osso Esponjoso/fisiopatologia , Cabeça do Úmero/fisiopatologia , Osteoporose/fisiopatologia , Fraturas por Osteoporose/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia , Biópsia , Colágeno/química , Força Compressiva , Durapatita/química , Feminino , Humanos , Modelos Lineares , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Análise Espectral Raman , Estresse Mecânico , Termogravimetria , Difração de Raios X , Microtomografia por Raio-X
11.
BMC Biomed Eng ; 1: 21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32903314

RESUMO

Background: In virtual reality (VR) applications such as games, virtual training, and interactive neurorehabilitation, one can employ either the first-person user perspective or the third-person perspective to perceive the virtual environment; however, applications rarely offer both perspectives for the same task. We used a targeted-reaching task in a large-scale virtual reality environment (N=30 healthy volunteers) to evaluate the effects of user perspective on the head and upper extremity movements, and on user performance. We further evaluated how different cognitive challenges would modulate these effects. Finally, we obtained the user-reported engagement level under the different perspectives. Results: We found that first-person perspective resulted in larger head movements (3.52±1.3m) than the third-person perspective (2.41±0.7m). First-person perspective also resulted in more upper-extremity movement (30.08±7.28m compared to 26.66±4.86m) and longer completion times (61.3±16.4s compared to 53±10.4s) for more challenging tasks such as the "flipped mode", in which moving one arm causes the opposite virtual arm to move. We observed no significant effect of user perspective alone on the success rate. Subjects reported experiencing roughly the same level of engagement in both first-person and third-person perspectives (F(1.58)=0.9,P=.445). Conclusion: User perspective and its interaction with higher-cognitive load tasks influences the extent of movement and user performance in a virtual theater environment, and may influence the choice of the interface type (first or third person) in immersive training depending on the user conditions and exercise requirements.

12.
J Appl Gerontol ; 38(7): 1035-1044, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29295652

RESUMO

INTRODUCTION: We investigated the stability of effects of a computerized cognitive training previously administered to a large group of early stage Alzheimer's disease (AD) patients, as compared with a control group. METHOD: Eighty AD patients were randomized in two groups and underwent a computerized cognitive training, or a control intervention. RESULTS: A Repeated Measures General Linear Model (RM-GLM) showed a significant interaction effect for the following neuropsychological tests: the digit span forward and backward, and the two-syllable words test, as measures of short-term memory and working memory; the Rivermead Behavioural Memory Test (RBMT) story immediate and the RBMT story delayed, as measures of ecologically oriented memory; the Token test, as measure of language comprehension; and the Brixton test, as an executive functions measure. CONCLUSION: Patients in the experimental group showed a significant improvement in various neuropsychological domains due to the training, and these effects decreased after 12 months.


Assuntos
Doença de Alzheimer/psicologia , Doença de Alzheimer/reabilitação , Terapia Cognitivo-Comportamental/métodos , Testes Neuropsicológicos , Terapia Assistida por Computador/métodos , Idoso , Diagnóstico Precoce , Função Executiva , Feminino , Humanos , Masculino , Desempenho Psicomotor , Resultado do Tratamento
13.
Injury ; 49 Suppl 3: S84-S93, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30415675

RESUMO

INTRODUCTION: Only few case series of capitellar and trochlear fractures have been reported. Some of them assume that the presence of a posterior comminution (type B according to Dubberley classification) can represent a negative risk factor for treatment and prognosis respect to the type A cases (without posterior comminution). Nevertheless, how this parameter impacts the treatment and the prognosis has never been quantified before. MATERIALS AND METHODS: All the capitellar and trochlear fractures treated from 2007 to 2015 have been retrospectively reviewed. The presence of posterior comminution on a pre-operative CT-scan was correlated to the surgical technique, to the timing of initiation of rehabilitation and to clinical outcomes. RESULTS: 45 Consecutive patients have been selected, 17 not presenting a posterior comminution (type A), and 28 with posterior comminution (type B). In all the type A fractures a lateral approach (Kocher o Kocher extensile) was used and the fragment fixation was always performed using only screws. Elbow replacement or olecranon osteotomy were performed only to treat type B fractures. Augmented fixations, using plates and k-wires, or prosthetic replacement have been used only in type B fractures. The post-operative immobilization was significantly inferior for type A fracture. Better results have been obtained in type A fractures: mean MEPI score was 86 in type A and 73 in type B, the range of motion was significatively higher in type A both in flexion-extension and in pronation-supination. In type B fractures a significant higher number of complications have been observed (64% vs 29%) along with more reoperations. DISCUSSION: The study has confirmed that, even without considering the extension of the fracture on the coronal plane, the presence of posterior comminution represents an evident negative risk factor, influencing the surgical approach and treatment, the fixation technique, the post-operative rehabilitation, the clinical outcomes, the complications and re-operation rates. CONCLUSIONS: The analysis of the present case series shows how the treatment and the outcomes can be significantly anticipated based on the presence or absence of posterior comminution. Patients with type A fracture are more likely treated with a Kocher approach, screw fixation, an early rehabilitation is performed. In type A fractures better outcomes and low complications rate are expected.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Corpos Livres Articulares/cirurgia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Feminino , Consolidação da Fratura/fisiologia , Fraturas Cominutivas/classificação , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/fisiopatologia , Guias como Assunto , Humanos , Fraturas do Úmero/classificação , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Corpos Livres Articulares/classificação , Corpos Livres Articulares/diagnóstico por imagem , Corpos Livres Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fraturas do Rádio/classificação , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-30130194

RESUMO

Data clustering is a common unsupervised learning method frequently used in exploratory data analysis. However, identifying relevant structures in unlabeled, high-dimensional data is nontrivial, requiring iterative experimentation with clustering parameters as well as data features and instances. The number of possible clusterings for a typical dataset is vast, and navigating in this vast space is also challenging. The absence of ground-truth labels makes it impossible to define an optimal solution, thus requiring user judgment to establish what can be considered a satisfiable clustering result. Data scientists need adequate interactive tools to effectively explore and navigate the large clustering space so as to improve the effectiveness of exploratory clustering analysis. We introduce Clustrophile 2, a new interactive tool for guided clustering analysis. Clustrophile 2 guides users in clustering-based exploratory analysis, adapts user feedback to improve user guidance, facilitates the interpretation of clusters, and helps quickly reason about differences between clusterings. To this end, Clustrophile 2 contributes a novel feature, the Clustering Tour, to help users choose clustering parameters and assess the quality of different clustering results in relation to current analysis goals and user expectations. We evaluate Clustrophile 2 through a user study with 12 data scientists, who used our tool to explore and interpret sub-cohorts in a dataset of Parkinson's disease patients. Results suggest that Clustrophile 2 improves the speed and effectiveness of exploratory clustering analysis for both experts and non-experts.

16.
BMC Musculoskelet Disord ; 19(1): 312, 2018 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-30157823

RESUMO

BACKGROUND: Acute Essex-Lopresti injury is a rare and disabling condition of longitudinal instability of the forearm. When early diagnosed, patients report better outcomes with higher functional recovery. Aim of this study is to focus on the different lesion patterns causing forearm instability, reviewing literature and the cases treated by the Authors and to propose a new terminology for their identification. METHODS: Five patients affected by acute Essex-Lopresti injury have been enrolled for this study. ELI was caused in two patients by bike fall, two cases by road traffic accident and one patient by fall while walking. A literature search was performed using Ovid Medline, Ovid Embase, Scopus and Cochrane Library and the Medical Subject Headings vocabulary. The search was limited to English language literature. 42 articles were evaluated, and finally four papers were considered for the review. RESULTS: All patients were operated in acute setting with radial head replacement and different combinations of interosseous membrane reconstruction and distal radio-ulnar joint stabilization. Patients were followed for a mean of 15 months: a consistent improvement of clinical results were observed, reporting a mean MEPS of 92 and a mean MMWS of 90.8. One case complained persistent wrist pain associated to DRUJ discrepancy of 3 mm and underwent ulnar shortening osteotomy nine months after surgery, with good results. DISCUSSION: The clinical studies present in literature reported similar results, highlighting as patients properly diagnosed and treated in acute setting report better results than patients operated after four weeks. In this study, the definitions of "Acute Engaged" and "Undetected at Imminent Evolution" Essex-Lopresti injury are proposed, in order to underline the necessity to carefully investigate the anatomical and radiological features in order to perform an early and proper surgical treatment. CONCLUSIONS: Following the observations, the definitions of "Acute Engaged" and "Undetected at Imminent Evolution" injuries are proposed to distinguish between evident cases and more insidious settings, with necessity of carefully investigate the anatomical and radiological features in order to address patients to an early and proper surgical treatment.


Assuntos
Acidentes por Quedas , Terminologia como Assunto , Traumatismos do Punho/classificação , Traumatismos do Punho/diagnóstico por imagem , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Fraturas do Rádio/classificação , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Síndrome , Resultado do Tratamento , Fraturas da Ulna/classificação , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia , Traumatismos do Punho/cirurgia
17.
Arch Bone Jt Surg ; 6(2): 112-118, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29600263

RESUMO

Background: High tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the results of HTO. In this prospective study we have investigated the safety and also results of HTO associated with autologous bone marrow derived cells (BMDC) implantation in relatively young and middle aged active individuals with early osteoarthritis of the knee. Methods: A total of 24 patients (mean age of 47.9 years) with varus knee and symptomatic medial compartment osteoarthritis were treated with medial opening-wedge high tibial osteotomy in conjunction with implantation of bone marrow derived cells into the chondral lesions. The clinical outcomes were assessed by IKDC, KOOS, VAS, and Tegner scores. The radiographic studies were performed preoperatively and at follow-ups. Results: No major complications were seen during the operations and postoperative follow-ups. All clinical scores were significantly improved for the IKDC score (from 32.7±15 to 64±21) (P<0.005), KOOS score (from30±11 to 68±19) (P<0.005), VAS (from 7.5 to 3) and Tegner score (from 1.2 to 2.1) (P<0.004). Conclusion: HTO in conjunction with BMDC implantation is a safe and feasible treatment and is associated with good results in short term follow up for early medial compartment osteoarthritis in varus knees.Level of evidence: IV.

18.
Front Psychol ; 9: 74, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29487548

RESUMO

Background: Treatment of recurrent depressive disorders is currently only moderately successful. Increasing evidence suggests a significant relationship between adverse childhood experiences and recurrent depressive disorders, suggesting that trauma-based interventions could be useful for these patients. Objectives: To investigate the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) in addition to antidepressant medication (ADM) in treating recurrent depression. Design: A non-inferiority, single-blind, randomized clinical controlled trial comparing EMDR or CBT as adjunctive treatments to ADM. Randomization was carried out by a central computer system. Allocation was carried out by a study coordinator in each center. Setting: Two psychiatric services, one in Italy and one in Spain. Participants: Eighty-two patients were randomized with a 1:1 ratio to the EMDR group (n = 40) or CBT group (n = 42). Sixty-six patients, 31 in the EMDR group and 35 in the CBT group, were included in the completers analysis. Intervention: 15 ± 3 individual sessions of EMDR or CBT, both in addition to ADM. Participants were followed up at 6-months. Main outcome measure: Rate of depressive symptoms remission in both groups, as measured by a BDI-II score <13. Results: Sixty-six patients were analyzed as completers (31 EMDR vs. 35 CBT). No significant difference between the two groups was found either at the end of the interventions (71% EMDR vs. 48.7% CBT) or at the 6-month follow-up (54.8% EMDR vs. 42.9% CBT). A RM-ANOVA on BDI-II scores showed similar reductions over time in both groups [F(6,59) = 22.501, p < 0.001] and a significant interaction effect between time and group [F(6,59) = 3.357, p = 0.006], with lower BDI-II scores in the EMDR group at T1 [mean difference = -7.309 (95% CI [-12.811, -1.806]), p = 0.010]. The RM-ANOVA on secondary outcome measures showed similar improvement over time in both groups [F(14,51) = 8.202, p < 0.001], with no significant differences between groups [F(614,51) = 0.642, p = 0.817]. Conclusion: Although these results can be considered preliminary only, this study suggests that EMDR could be a viable and effective treatment for reducing depressive symptoms and improving the quality of life of patients with recurrent depression. TRIAL REGISTRATION: ISRCTN09958202.

19.
Conscious Cogn ; 58: 186-192, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29305042

RESUMO

We investigated whether agency triggered by body ownership shares similar temporal constraints with agency induced by actual movements. We compared agency over the movements of the own hand, a fake hand and an embodied fake hand when they pressed a button delivering a stimulus to the participant's body after 500, 1000 or 2000 ms. In the first two delays, the movement of the embodied fake hand was misattributed to the participant's own will and the stimulus intensity was attenuated, as it happened when the own hand delivered the stimulus. With the longest delay, the movement of the embodied fake hand was neither misattributed to the participant's will nor the stimulus intensity was attenuated, as it happened when the fake non-embodied hand delivered the stimulus. By showing that illusory and veridical agency arise under similar temporal constraints, we further demonstrated that body ownership per se acts upon agency attribution.


Assuntos
Mãos/fisiologia , Ilusões/fisiologia , Atividade Motora/fisiologia , Propriocepção/fisiologia , Percepção do Tato/fisiologia , Percepção Visual/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propriedade , Fatores de Tempo , Adulto Jovem
20.
J Nerv Ment Dis ; 206(2): 149-151, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29373457

RESUMO

Chronic and life-threatening illnesses, such as multiple sclerosis (MS), have been identified as significant stressors potentially triggering posttraumatic stress disorder (PTSD). The study aims to investigate the prevalence of PTSD according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria in a large sample of patients with MS. A total of 988 patients with MS were screened with the Impact of Event Scale-Revised, and then assessed with the PTSD module of the Structured Clinical Interview for DSM-IV and with the Clinician-Administered PTSD Scale to confirm PTSD diagnosis. Posttraumatic symptoms were reported by 25.5% of the sample. A confirmed diagnosis of PTSD was found in 5.7% of patients, but prevalence could reach 8.5%, including also dropout patients. Further studies are needed to evaluate if adjustment disorder could better encompass the frequently encountered subthreshold posttraumatic stress symptoms and how clinicians can deal with these symptoms with appropriate interventions.


Assuntos
Esclerose Múltipla/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Feminino , Humanos , Entrevista Psicológica , Masculino , Esclerose Múltipla/complicações , Prevalência , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia
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