Sphingolipids in ischemic stroke

Determination of new biomarkers involved in the pathogenesis of ischemic stroke is an extremely important task from the point of view of identifying possible mechanisms for preventing the occurrence of an acute event, better diagnosis, and influencing the stages of pathogenesis to reduce the inflammatory focus. Sphingolipids belong to new biomarkers of atherosclerosis, which are involved in inflammation, apoptosis, and ischemia. The widespread introduction of mass spectrometry has made it possible to study sphingolipids in more detail. This review aims to summarize the available data on the role of sphingolipids in ischemic stroke.

346 Baroreflex sensitivity and autonomic function in Takotsubo syndrome long after the acute phase

Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a central role in the development of TS, whether an impaired sympatho-vagal balance may persist long after the acute phase, despite the recovery of left ventricular function, is still an open issue. Interestingly, recent evidences suggest that an impairment in central autonomic network not only persist long after the acute event but also may be pre-existent before the acute onset of TS. The Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. Methods and results We evaluated 67 patients (91% female, mean age 66 ± 8 years) divided into three groups: 24 with a history of TS (1 year after acute event), 21 subjects with a previous history of acute coronary syndrome (ACS) and complete LV ejection fraction recovery (1 year after acute event) and 22 age- and gender-matched healthy subjects. All patients underwent a non-invasive beat-to-beat arterial blood pressure and heart rate recording (short term: 5 min), after at least 3 days of β-blockers wash-out, to obtain heart rate variability (HRV) and spontaneous baroreflex sensitivity (sBRS) data. An overall autonomic dysfunction was found in both TS and ACS groups compared to controls. In particular, a lower heart rate variability, expressed as lower SDNN, has been found in TS and ACS groups compared to controls (31 ± 12 vs. 25 ± 11 vs. 41 ± 22; P = 0.006—Figure A) as a consequence of blunted vagal tone, expressed as lower RMSSD (20 ± 12 vs. 19 ± 11 vs. 40 ± 37; P = 0.007—Figure B) and higher sympathetic tone, expressed as higher LF/HF ratio (P = 0.007 Figure C) which was found to be higher in TS even when compared to ACS (TS: 3.5 ± 2.5 vs. ACS: 2.1 ± 1.7; P = 0.011). Moreover, fractal analysis of HRV showed higher complexity of heart rate regulation, expressed as higher fractal dimension (DFA 1.48 ± 0.06 vs. 1.53 ± 0.05 vs. 1.40 ± 0.10; P < 0.0001—Figure D), in both TS and ACS compared to controls. Interestingly, spontaneous BRS showed the lowest values in the TS group (sSBP: 5.6 ± 2.6 vs. 7.5 ± 3.0 vs. 12.1 ± 11.9; P = 0.027—Figure E), associated with highest levels of sympathetic peripheral control of systolic blood pressure (SBP), expressed as LF-BRS (13.7 ± 9.6 vs. 8.3 ± 5.2 ± 6.8 ± 5.8; P = 0.008—Figure F). Conclusions An autonomic dysfunction, characterized by a hyper-sympathetic tone, reduced baroreflex sensitivity and increased peripheral adrenergic control of blood pressure, persists in TS patients long after the acute phase.

Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study

Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians’ perceived usability of ExoFlex.

Toward Computational Accuracy in Realistic Systems to Aid Understanding of Field-Level Water Quality Issues

Contemplating what will unfold in this new decade and those after, it is not difficult to imagine the increasing importance of conservation and protection of clean water supplies. A worrying but predictable offshoot of humanity’s technological advances is the seemingly ever-increasing chemical load burdening our waterways. In this perspective are presented a few modest areas where computational chemistry modelling could provide benefit to these efforts by harnessing the continually improving computational power available to the field. In the acute event of a chemical spill incident, true quantum-chemistry-based predictions of physicochemical properties and surface-binding behaviors can be used to help decision making in remediating the spill threat. The chronic burdens of microplastics and perfluorinated “forever chemicals” can also be addressed with computational modelling to fill the gap between feasible laboratory experiment timescales and the much-longer material lifetimes. For all of these systems, field-level accuracy models will avail themselves as the model computational systems are able to incorporate more realistic features that are relevant to water quality issues.

Partial Renal Transplant Torsion as a Cause of Abdominal Pain

Allograft torsion is a rare but potentially devastating outcome of renal transplantation. Patients typically present with an acute onset of abdominal pain, though symptoms are non-specific and can easily be missed in favor of more common diagnoses. Imaging, in particular ultrasound and computed tomography, can aid in the diagnosis of renal transplant torsion by demonstrating characteristic features, and once recognized immediate surgery is typically performed in an attempt to salvage the allograft. However, renal transplant torsion needs not be an acute event; patients can instead present with chronic, waxing, and waning symptoms if the allograft undergoes partial or intermittent torsion. The aforementioned characteristic imaging findings may not be present in this situation. It is essential to recognize partial, intermittent torsion as well, for which imaging can again play a role.

Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis

Osteomyelitis of the hand is rare, even more so in the carpal bones. Patients with rheumatoid arthritis (RA) have a higher infection rate overall, and up to a 14-fold increase in the incidence of septic arthritis of the hand. The destruction of immunologic barriers, such as cartilage and joint capsules, as well as the use of immunosuppressive medications will have an impact on the higher incidence of articular infections and osteomyelitis in these patients. Infection in these cases is often overlooked because of the similarity of presentation to an acute event of RA. When osteomyelitis is present, rapid and aggressive treatment should be given. Surgical debridement, lavage, and excision of necrotic bone is the best choice, followed by cemented antibiotic impregnated spacer to resolve the acute scenario. Vascularized bone grafts (VBG) can then be used for a definitive solution, as these have great biologic properties that increase the possibility of a good outcome. We hereby present a report of a wrist arthrodesis, using a free medial femoral condyle VBG for the treatment of destructive osteomyelitis of the carpal bones in a female patient with RA.

From Acute Events to Chronic Disease Conditions: An Integrated Model for Ethics Consultation Along the Continuum of Care

"The Ethics Consultant (EC), where present, is called on to offer a resolution to ethical dilemmas at different times over the course of treatment. However, it is not yet clear under which particular circumstances the intervention of the EC should be requested when chronic diseases occur following an acute event. As part of the treatment of these evolutionary chronic conditions, the pathway is often complex and may involve multiple actors (i.e. departments, hospitals, and others). The role of the EC is often limited to a single department and to an isolated event. Therefore, there is frequently no possibility to take into consideration all of the options inherent to the entire continuum of care and of their consequences for the patient. From intensive care units, rehabilitation wards, long-term hospitalization, through to palliative care, the pathway presents important ethical-clinical questions for the patient, for the healthcare team, and for family members. For these reasons, our objective is to develop a model of consultation integrating the EC along the continuum of care. By analyzing a series of cases, we developed an integrated model of consultation allowing the EC to intervene at different subsequent stages of the process. Our findings suggest that this model is an effective means to allow the EC to provide support in relation to single events but also to coherently pursue – within a collaborative setting across different departments – a specific course of treatment which is respectful of clinical indications and of patients’ and caregivers’ preferences along the whole pathway. "

Covid-19 pneumonia: Timing of pneumomediastinum and pneumothorax in 11 patients

Purpose: As the pandemic continues, many complications, previously recognized as rare, are now being reported as more than frequent complications of Covid-19 pneumonia. Of those, pneumomediastinum and pneumothorax are gaining attention. Their mechanism of occurrence/trigger is not fully understood, but the timing at which they occur is unclear.Methods: This is a case series of 11 Covid-19 patients with pneumomediastinum; retrospectively, we shed light on some of the patients’ characteristics, the role of mechanical ventilation, and the timing of pneumomediastinum after initiation of mechanical ventilation.Results: We found that despite following the lung-protective strategy and despite keeping a plateau pressure at an acceptable range, most of our patients had an acute event around the same timing of mechanical ventilation.Conclusions: The similar timing raises questions about other risk factors that remain unknown. Timing and steroids can contribute to the higher incidence of these complications.

Biceps, Brachialis, and Triceps

Tendon injuries at the elbow affect mostly the distal biceps and can progressively degenerate over time or rupture in an acute event. The degree of retraction may depend on the integrity of the lacertus fibrosus, a fibrous expansion that merges with the forearm flexor fascia. Biceps disorders are frequently associated with fluid or synovitis of the adjacent bicipital bursa; primary bursal disorders (primary inflammatory synovitis) can also be observed. Distal triceps is less frequently injured than the distal biceps, and tears usually manifest as distal ruptures with avulsion of a small flake of bone from the tip of the olecranon. Brachialis injuries are uncommon and the consequence of sudden muscle stretching during forced elbow hyperextension, as in posterior elbow luxation.