P. Bramanti

Four‐week trunk‐specific rehabilitation treatment improves lateral trunk flexion in Parkinson's disease

People with Parkinsons disease (PD) often have a posture characterized by lateral trunk flexion poorly responsive to antiparkinsonian drugs. To examine the effects of a rehabilitation programme (daily individual 90‐minute‐sessions, 5‐days‐a‐week for 4‐consecutive weeks) on lateral trunk flexion and mobility, 22 PD patients with mild to severe lateral trunk flexion, and 22 PD patients without trunk flexion were studied. Patients were evaluated using the Unified Parkinsons Disease Rating Scale motor subscale (UPDRS‐III) score, and the kinematic behavior of the trunk was recorded by means of an optoelectronic system to determine: a) trunk flexion, inclination and rotation values in the erect standing posture; b) ranges of trunk flexion and inclination during trunk movements. After the treatment, significant decreases in trunk flexion [24°(4) vs. 14°(3), P < 0.001] and inclination in the static condition [23°(5) vs. 12°(4), P < 0.001)] were observed, both of which were maintained at the 6‐month follow up. During the trunk flexion task, a significantly increased range of trunk flexion [64°(15) vs. 83°(15), P < 0.001] was observed; similarly, during the lateral bending task, the range of trunk inclination was found to be significantly increased, both toward the side of the trunk deviation [29°(8) vs. 42°(13), P < 0.01] and toward the contralateral side [14°(6) vs 29°(11), P < 0.01]. No further significant changes were observed at the 6‐month follow‐up. Trunk flexion and inclination values in the upright standing posture correlated slightly with the UPDRS‐III score. Our findings show that significant improvements in axial posture and trunk mobility can be obtained through the 4‐week rehabilitation programme described, with a parallel improvement in clinical status.

Sleep spindles in the initial stages of the vegetative state

The aim of this study was to look for the presence of spindling in the different stages of remission of the vegetative state to underline all possible correlations with lesional sites, severity of coma and final outcome. The nocturnal polygraphic recordings from 30 patients were examined: 20 (15M, 5F, mean age 31.7 years, range 16–41) had originally suffered a traumatic brain injury, 10 (4M, 6F, mean age 40.5 years, range 24–48) had hypoxic brain lesions. Evidence of spindling, always reduced in density and duration, was found in 44% of these patients, prevalently in the traumatic patients (53.3% versus 30% of hypoxic patients). No subjects in the full stage 0, 0–1 of the vegetative state (apallic syndrome) presented spindling. No significant correlation was found between spindling and the following parameters: gender, the time between the onset of coma and the polygraphic recording, or the site of the lesion.SommarioScopo del lavoro è stato quello di osservare la presenza di fusi da sonno nei vari stadi di remissione dello stato vegetativo (sindrome apallica) e valutarne le eventuali correlazioni con le sedi della lesione, la severità del coma e loutcome finale. Le registrazioni poligrafiche notturne sono state effettuate su 30 pazienti: 20 (15 maschi, 5 femmine, età media 31,7 anni, range 16–41) traumatizzati cranici, 10 (4 maschi, 6 femmine, età media 40,5 anni, range 24–48) con lesioni da ipossia cerebrale. La presenza di fusi da sonno sebbene ridotta di densità e durata, è stata riscontrata nel 44% dei pazienti, con una prevalenza nei traumatizzati cranici del 53,3% contro il 30% degli ipossici. Non sono stati riscontrati fusi da sonno nei primissimi stadi di remissione (0 e 0–1) dello stato vegetativo. Non è stata osservata alcuna correlazione tra la presenza di fusi da sonno ed i seguenti parametri: sesso, intervallo tra insorgenza del coma e momento della registrazione e sede della lesione.

Fingolimod-Associated Peripheral Vascular Adverse Effects

Fingolimod is the first oral disease-modifying drug approved for the treatment of multiple sclerosis. The drug is usually well tolerated, and common adverse effects include bradycardia, headache, influenza, diarrhea, back pain, increased liver enzyme levels, and cough. Fingolimod is thought to provide therapeutic benefit by preventing normal lymphocyte egress from lymphoid tissues, thus reducing the infiltration of autoaggressive lymphocytes into the central nervous system. However, because the drug acts on different sphingosine-1-phosphate receptors, it may induce several biological effects by influencing endothelial cell-cell adhesion, angiogenesis, vascular development, and cardiovascular function. We describe a patient with multiple sclerosis who, after 3 weeks of fingolimod administration, developed purplish blotches over the dorsal surface of the distal phalanges of the second and fifth digits and the middle phalanx of the fourth ray, itching, and edema on his left hand, without other evident clinical manifestations. When fingolimod therapy was discontinued, the clinical picture regressed within a few days but reappeared after a rechallenge test. Physicians should be aware of unexpected peripheral vascular adverse effects due to fingolimod use, and patients with vascular-based acropathies should be carefully screened and monitored when taking this drug.

A Hybrid Storage Service for the Management of Big e-Health Data: A Tele-Rehabilitation Case of Study

This paper presents a hybrid storage solution for the management of e-health data. Such a solution merges SQL-like strategies with NoSQL document based approaches in order to provide an efficient, scalable and secure storage system that can be used from one or many health care units. Starting from an Entity Relationship (E-R) model for e-health data, the paper discusses how pieces of information should be organized and stored for a quick and efficient retrieval. The paper also discusses a real use case where the proposed storage solution is adopted to manage data for neurologic Tele-Rehabilitation (TR) of patients at home. During the treatment at home, patients use wireless sensing devices to monitor their status and to provide real-time feedback during exercises. Such devices produce a hugh amount of e-health data that are sent and stored into the hybrid storage system. Experiments are performed adopting the e-health data model on both NoSQL and SQL-like implementations.

Cerebrovascular Diseases: Post-stroke Depression and Anhedonia

Increasing interest in depression within acute and chronic cerebrovascular pathology is justified for its clinical relevance, since its identification and management is of use in reducing disability, the caregiver’s burden and the social-economic impact of cerebrovascular disease. Anhedonia, or markedly diminished interest or pleasure, is a hallmark symptom of major depression, schizophrenia and other neuropsychiatric disorders, including cerebrovascular disorders. Since stroke survivors frequently suffer from depression, research has focused on the incidence, phenomenology, course and risk factors of post-stroke depression (PSD), paying special attention to the biological explanatory models, such as the lesion location and vascular depression hypotheses. Small vessel pathology and microvascular lesions are no longer considered as minor players in the fields of cognitive impairment and mood regulation. Unlike cognition, the relationship between these lesions and mood dysregulation is still a matter of intense debate. However, the chronic accumulation of lacunes in thalamus, basal ganglia and deep white matter has been recently considered as a strong correlate of PSD.

Big Data HIS of the IRCCS-ME Future: The Osmotic Computing Infrastructure

Nowadays, we are observing a massive digitalization of clinical tasks in Hospital Information Systems (HIS). Even more medical devices belongs to Internet of Things (IoT) applications that generate a huge amount of clinical data. Therefore, the healthcare industry is looking at modern big data storage, processing and analytics technologies. In this context, traditional HIS presents several issues, such as a mismanagement of data generated from medical devices. Starting from the experience of IRCCS Centro Neurolesi “Bonino Pulejo” placed in Messina (Italy), i.e., a clinical and research center, in this paper, we motivate the need to move traditional HIS into an innovative infrastructure based on the Osmotic computing paradigm. In particular, studying the healthcare domain, we specifically focus on production and research tasks.

Caffeine and Taurine and Energy Drink Abuse

Caffeine is one of the most common central nervous system stimulants due to its adjunction in many products, including energetic beverages. Caffeine is reported to have a boosting activity on mental and physical performance. Nevertheless, excessive caffeine intake may induce mild physical dependence and addiction. Energetic beverage intake has become very popular since its association with boosting mental and physical performance within sports and enhancing an active lifestyle. Nonetheless, energetic beverages are usually highly caffeinated and contain many other substances that can induce addiction, such as sugar, taurine, and guarana. The combination of energetic beverage consumption, particular lifestyles, and other social/familiar conditions could represent an alarming opportunity to experiment with other substances, especially in teenagers. Because of energetic beverages potential side effects and addiction, it is our opinion that further studies should be fostered to investigate energetic beverages health-related issues, while a more stringent policy is required from consumers, health care providers, and regulatory agencies.