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Background There are limited data regarding the effectiveness of levodopa-carbidopa intestinal gel (LCIG) for dyskinesia. Objective Compare the effectiveness of LCIG versus oral optimized medical treatment (OMT) for dyskinesia in patients with advanced Parkinson's disease (PD) using the Unified Dyskinesia Rating Scale (UDysRS). Methods This phase 3b, open-label, multicenter, 12-week, interventional study (NCT02799381) randomized 63 LCIG naive patients with advanced PD (UDysRS >= 30) to LCIG (N = 30) or OMT (N = 33) treatment. Dyskinesia impact was assessed at baseline through week 12 using the UDysRS. PD-related motor and non-motor symptoms, and quality of life (QoL) were also assessed. Results Dyskinesias measured by UDysRS were significantly reduced in the LCIG group (n = 24; -17.37 +/- 2.79) compared with the OMT group (n = 26; -2.33 +/- 2.56) after 12 weeks (-15.05 +/- 3.20; 95% CI, -21.47 to -8.63; P < 0.0001). At week 12, LCIG versus OMT also demonstrated significant improvements in "On" time without troublesome dyskinesia (P = 0.0001), QoL (P < 0.0001), global impression of change (P < 0.0001), activities of daily living (P = 0.0006), and Unified Parkinson's Disease Rating Scale (UPDRS) Part III (P = 0.0762). Treatment-emergent adverse events were reported in 27 (44.3%) patients (LCIG, 18 [64.3%]; OMT, 9 [27.3%]). Serious adverse events occurred in 2 (7.1%) LCIG-treated patients. Conclusions LCIG significantly reduced dyskinesia compared with OMT. LCIG showed efficacy for treatment of troublesome dyskinesia in patients with advanced PD while demonstrating benefits in both motor and non-motor symptoms and QoL. (c) 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Periodontitis is a plaque induced disease characterized by tissue destruction. The extent of the alveolar bone loss depends on the host response stimulated by bacterial infection. Recently researchers have focused on the role of the immune system, of RANK/RANKL/OPG pathway and of cytokines network. Another recent field of interest is osteoimmunology that try to explain the relationship between immune and bone cells in activating bone resorption. Advances in the understanding of the pathogenic mechanisms allowed a better understanding of the relationship with other diseases like osteoporosis and also to hypothesize new therapies based on modulation of host response (host modulatory therapy - HMT). The purpose of this mini-review is to briefly discuss these topics.

To describe the obstetrical outcome and long-term cardiac follow-up of a group of patients who had surgery for atrial septal defect repair before pregnancy and a group who underwent pregnancy before surgical correction.Retrospective.Public Institution.Eighty women (mean age 20.15 +/- 4.5 years) complaining of atrial septal defect, 60 of which had surgical correction before pregnancy and subsequently had 115 pregnancies, and 20 of which underwent pregnancy before the correction of cardiac defect and subsequently had 48 pregnancies.Surgical correction of atrial septal defect: 49 by open heart technique (13 with cardiopulmonary bypass, 36 with light hypothermic circulatory arrest), 11 by closed heart techniques.Patients who underwent pregnancy before surgery had an increased incidence of miscarriage, pre-term delivery and cardiac symptoms during pregnancy. Patients operated before pregnancy required more frequently cesarean section and pharmacological therapy. The frequency of stillbirths, malformations in the offspring and long-term cardiac complications were similar in both groups.Surgical correction of atrial septal defect before pregnancy is recommended even in case of apparently well compensated hemodinamic situation for the low rate of surgical complications in spite of the higher incidence of obstetrical problems in case of medical therapy alone.

The Authors have elaborated four range charts of mammalian (large and micro), molluscs and fresh-water and brackish ostracodes faunas, for the selected Plio-Pleistocene fossiliferous localities of the Italy. A new Mammal Age (Aurelian) correlatable to late Middle and Late Pleistocene has been defined. Inside this age two Faunal Units (Torre in Pietra and Vitinia) have been defined as characteristic for Early and Middle Aurelian, while no gisements have been chosen for the late Aurelian. Biochronological units are calibrated on magnetostratigraphic and isotopic scales and by radiometric datings., Rivista italiana di Paleontologia e Stratigrafia, Vol 103, No 3

The RFX-mod experiment (R/a = 2.0/0.46 m), originally designed to produce high current Reversed Field Pinch plasmas (plasma current up to 2 MA), is currently operated also as a low current tokamak (Bt ~ 0.55 T, Ip ~150 kA @ qa ?2). Circular, double-null [1] and single null configurations have been successfully already achieved. Such tokamak configurations may be prone to several MHD instabilities, usually classified resorting to the toroidal mode number n: current-driven n=1 Resistive Wall Modes [2], due to relatively low safety factor; n=0 RWM (vertical instability) [1], due to non-vanishing elongation of the plasma configuration. For the active control of these instabilities, RFX-mod is equipped with a state-of-the-art MHD control system made by 192 (4 poloidally x 48 toroidally) independently fed active coils, with more than 600 magnetic sensors acquired in real time; the feedback system is operated under the MARTe framework. The evolution and the control of these instabilities, being RWM, are evidently strongly dependent on the features and the geometry of the (active and passive) conducting structures surrounding the plasma. In order to provide the required accuracy in their description, several computational tools will be applied to the plasma configurations under analysis: linearized axisymmetric models (CREATE_L [3]), linearized 3D models (CarMa0 [4], CarMa [5]), nonlinear evolutionary equilibrium models including 3D volumetric structures (CarMa0NL [6]). The different assumptions and approximations of the various models will allow a clear identification of the key phenomena ruling the evolution of the aforementioned instabilities in RFX-mod tokamak discharges and hence will provide fundamental information in the planning and the execution of related experiments and in refining the control system design. [1] G. Marchiori et al., 41st EPS Conference on Plasma Physics, Berlin, June 2014, paper P5.040 [2] G. Marchiori et al., 38th EPS Conference on Plasma Physics, Strasbourg, June 2011, paper P2.110 [3] R. Albanese and F. Villone, Nucl. Fusion 38 (1998) 723 [4] F. Villone et al., Plasma Phys. Control. Fusion 54 (2012) 085003 [5] F. Villone et al., Phys. Rev. Lett. 100 (2008) 255005 [6] F. Villone et al., Plasma Phys. Control. Fusion 55 (2013) 09500

Fluctuations in motor performance are the major problems in chronic management of Parkinson's disease. Most of these fluctuations reflect the decline of levodopa availability. As a consequence, levodopa dosage might be increased and the interdose interval progressively shortened. The postsynaptic dopamine receptors at this point are exposed to a nonphysiologic shift in dopamine level, which may induce changes at the receptor site and contribute to the appearance of "on-off" phenomena and dyskinesias. We compared a group of 18 patients treated for 60 consecutive months with continuous subcutaneous lisuride infusion with a group of 20 patients treated with conventional oral levodopa treatment. The clinical evaluations performed during the study showed in the lisuride group only a worsening of dyskinesias, whereas the other symptoms remained unchanged. In the other group the evaluation scores showed a significant worsening of all long-term treatment complications. The slow-release preparations of levodopa may ensure a more continuous dopaminergic stimulation than standard formulations. However, the use of these compounds is difficult in severely fluctuating patients because the lack of a plasma peak level usually leads to a very long delay before patients turn "on." We studied the pharmacokinetic and clinical effects of the two slow-release preparations of levodopa [Madopar HBS and Sinemet controlled-release (CR)] and a combination of Sinemet CR plus standard Sinemet in 13 fluctuating parkinsonian patients. The results of this study show that the combination of standard Sinemet and Sinemet CR ensures a more prolonged clinical effect with a very short latency to the "on" phase.

Introduction In vitro hemolysis is the primary cause of sample/test rejection by the laboratory. Case report A 10-year-old, admitted with an asthma attack in the emergency-room, medicated with albuterol sulphate (intravenous bronchodilator that could induce hypokalemia), needed laboratory test monitoring. The physician prescribed the technical-nurse to perform blood sampling for: complete blood count, electrolytes, glucose, and blood gas analysis–within 30min after therapy. Samples were delivered to laboratory with a note “I had difficult to locate an appropriate access to perform the blood collection”. Laboratory results Glucose: 4.77 mmol/L. Complete blood count revealed discreet eosinophilia 0.13x109/L, and thrombocytopenia 18x109/L. However, platelet clumps were observed in peripheral blood smear. Blood gas analysis was unreported, laboratory informed that sample had micro clots. Electrolytes: laboratory did not report the results; sample hemolyzed. 0.9 g/L of free hemoglobin is the cut-off defined by the laboratory; the sample presented 2.3 g/L of free hemoglobin. 3.9 mmol/L of potassium was the unreported result vs 2.1 mmol/L in the new sample. Briefly, the laboratory technician was trained to hide potassium results on hemolyzed sample due to the potential overestimation. Even if the hemolyzed sample presented a potassium value close to the lower reference range value (3.5-5.1 mmol/L), reporting the potassium result could allow the physician starting proper therapy to revert the hypokalemia by albuterol sulfate. Conclusion The laboratory should be aware of the clinical patient conditions and of the related physician needs, before hiding results. Therefore, both the laboratory and the clinic personnel should communicate in order to guarantee the patient safety.

Objectives Primary focused question for this systematic review (SR) was “Which is the evidence about surfaces decontamination and protection masks for SARS‐Cov‐2 in dental practice?” Secondary question was “Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?” Materials and Methods PRISMA guidelines were used. Studies on surface decontamination and protective masks for SARS‐CoV‐2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question. Results No studies are available for SARS‐CoV‐2. Four studies on surface disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seem to be effective in reducing infectivity by > 3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory‐diagnosed influenza, laboratory‐diagnosed respiratory infection, and influenza‐like illness. A meta‐analysis was not considered appropriate. Conclusions There is lack of evidence on the efficacy of surface disinfection and protective masks to reduce the spread of SARS‐CoV‐2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surface disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.

Current evidence suggests that SARS-CoV-2, the virus that causes COVID-19, is predominantly spread from person to person. Aim of this narrative review is to explore transmission modality of SARS-CoV-2 to provide appropriate advice to stakeholders, in order to support the implementation of effective public health measures and protect healthcare workers that primary face the disease. “In vivo” and “in vitro” studies from laboratories and hospitals confirmed the presence of surface contamination and provided insight of SARS-CoV-2 detection in the air, particularly in indoor settings with poor ventilation where aerosol-generating procedures were performed. Measures for aerosol reduction, in conjunction with other effective infection control strategies, are needed to prevent the spread of SARS-CoV-2 in dental setting.

The presently predicted total heating power of the demonstration fusion reactor DEMO is ∼3 times the ITER value, while the major radius is only 1.5 times larger (R. Wenninger, et al., The DEMO Wall Load Challenge, Nucl. Fusion 57 (2017) 046002 (11pp)) [1] . The current DEMO technological wall heat load removal capability is limited to ∼1 MW/m 2 , due to structural material limitations and the tritium breeding requirements, while the ITER first wall (FW) is designed for values up to 4.7 MW/m 2 . This paper focuses on the evaluation of the effect of the engineering constraints on the required limitation of charged particle heat load. First, a 2D field-mapping tool is used together with a simple model to take into account the peaking factors present on an engineering 3D wall design. A sensitivity analysis is performed on a set of realistic FW 3D features considering a preliminary estimate of misalignments. The impact on the heat flux to the wall due to different machine geometries, plasma shapes variation, stationary plasma and plasma transients, is presented. An automatic procedure to define the 2D poloidal contour of the FW for minimized particle loads is presented. A subset of the resulting engineering wall design is analyzed using the 3D field line tracing code PFCflux.

In recent years, research activities about fire events in tunnel have received a significant impulse, especially after several accidents. The Computational Fluid Dynamic (CFD) has a fundamental role about. Researchers have spent resources on various topics involving numerical tools as the performance of a ventilation system, the influence of this on the air flow motion in the tunnel or the methods for fire schematization, fire-induced smoke characterization, turbulence models, etc. One of the main phenomena to consider for the safety when a fire occurs in a tunnel is the possibility of the fire-induced smoke to rise the tunnel (backlayering). A well-designed ventilation system shall provide almost a defined value of ventilation velocity (critical ventilation velocity) in order to avoid this phenomenon. The aim of this paper is to give an overview as complete as possible on numerical aspects about the cases of fire in road tunnel. Numerical strategies and schematization methods are presented for several cases, then a specific overview on the critical ventilation velocity formulations is proposed. Here, results show a variety of equations, each one slightly different from the others, aimed to relate the critical ventilation velocity to the main parameters able to influence it (e.g., heat release rate, tunnel geometry, etc.). This variety is mainly due to the wide range of factors that can influence the backlayering and the difficulty to keep them together in a single and “global” equation.

A strategy is presented for the derivation of simplified equivalent axisymmetric models of vertical instabilities in the EAST tokamak device. The qualitative understanding and the quantitative results obtained from a 3D model can suggest and quantify suitable modifications of the axisymmetric structures in order to fit both the growth rate and the stability margin for a wide range of different experimental configurations.

Discrepancies in magnetic field maps produced by confinement coils in thermonuclear fusion reactors may drive plasma to lose stability and must be carefully controlled during the whole time evolution of each shot using suitable correction coils. Even when kept below safety thresholds, these error fields (EFs) may alter the geometry of magnetic flux lines, defining the plasma geometry. This paper, using high accuracy 3-D magnetic field computations for confinement coils, addresses the issue of evaluating the effect of EFs on the plasma boundary shape during the shot, modeled as a sequence of equilibrium configurations. In particular, a procedure that can compute the shape perturbations due to given deformations of the coils has been set up and used to carry out an analysis of relationship between the EF and shape perturbations during the time evolution of International Tokamak Experimental Reactor programmed scenario.

Heat and particle loads on the plasma facing components are among the most challenging issues to be solved for a reactor design. Alternative magnetic configurations may enable tokamak operation with a lower peak heat load than a standard single null (SN) divertor. This papers reports on the creation and control of one of such alternatives: a two-null nearby divertor configuration. An important element of this study is that this two-null divertor was produced on a large superconducting tokamak as an experimental advanced superconducting tokamak. A preliminary experiment with the second null forming a configuration with significant distance between the two nulls and a contracting geometry near the target plates was performed in 2014. These configurations have been designed using the FIXFREE code and optimized with CREATE-NL tools and are discussed in the paper. Predictive edge simulations using the TECXY code are also presented by comparing the advanced divertor and SN configuration. Finally, the experimental results of ohmic and low confinement (L-mode) two-null divertor and SN discharges and interpretative two-dimensional edge simulations are discussed. Future experiments will be devoted to varying the distance between the two nulls in high confinement (H-mode) discharges. © 2015 EURATOM.

With reference to toroidal fusion devices, we solve axisymmetric nonlinear evolutionary equilibrium equations, describing the plasma behaviour, self-consistently coupled to eddy currents equations, describing surrounding three-dimensional (3D) structures. This formulation allows the analysis of nonlinear plasma quasi-static evolution in the presence of 3D volumetric conductors. Several validations and test cases are presented, suggesting the potential applications of the proposed method to the analysis of various situations of scientific and technical interest for future fusion devices such as ITER and DEMO, like for instance disruptions.