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ABSTRACTThe article presents results from an interview study on migrant bachelors and discusses differences between Bangladeshi migrants in Italy and Syrian migrants in Sweden, in how they present as singles. Interviewees articulate a simplified distinction between singlehood in Europe and singlehood in Bangladesh or Syria. Singlehood has been theorized as wavering between a period of waiting and a lifestyle with its own inherent value. In our sample, while Bangladeshis describe bachelorhood as a period of waiting, distancing themselves from what they see as European singlehood, Syrians tend to embrace singlehood as inherently valuable and prefer a ‘European way’ of being single. We argue that this difference between the groups is connected not primarily to national or regional cultures, but to how racialized borders shape the two groups in Europe, as well as to the role of class positionalities in determining attitudes toward singlehood.

The peculiar electrophysiological properties of the sinoatrial node and the cardiac conduction system are key components of the normal physiology of cardiac impulse generation and propagation. Multiple genes and transcription factors and metabolic proteins are involved in their development and regulation. In this review, we have summarized the genetic underlying causes, key clinical findings, and the latest available clinical evidence. We will discuss clinical diagnosis and management of the genetic conditions associated with conduction disorders that are more prevalent in clinical practice, for this reason, very rare genetic diseases presenting sinus node or cardiac conduction system abnormalities are not discussed.

ABSTRACTInappropriate land preparation before vineyard establishment can lead to soil degradation and vine health issues, with consequent reductions in the quantity and quality of the grapes. In the present short-term trial, the effects of dry mulching, green manure and compost treatments were evaluated as restoration strategies to enhance soil functionality in degraded vineyard areas at two Tuscan farms that had been under organic management for different lengths of time. Soil nematode community, soil physical and chemical properties were monitored as indicators of soil quality. The restoration treatments scarcely affected soil chemical or physical qualities; only the compost application increased soil total organic carbon (TOC). Bacterial feeder nematodes increased under dry mulching in response to the organic carbon inputs on the farm in conversion. Plant-parasitic nematodes decreased only after the first year of the restoration treatments and predators decreased during all 3 years. Nematode indicators showed only a few differences between the different management regimes; the diversity weighted abundance expressed as biomass indicated that the restoration practices sometimes represented a disturbing factor in ecosystem services regulation. The abundance of nematode taxa was differently affected by soil physico-chemical properties. On the farm that had been managed organically for longer, the higher proportion of large sized stable aggregates and greater soil porosity benefitted large nematodes such as predators, while the higher moisture levels were unfavourable for some plant-parasitic nematodes. However, on the farm still in conversion, increases in TOC and C/N ratio values were associated with a reduction in plant-parasitic nematodes.

AbstractBackgroundHighlighting the relationship between obsessive–compulsive disorder (OCD) and tic disorder (TD), two highly disabling, comorbid, and difficult-to-treat conditions, Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) acknowledged a new “tic-related” specifier for OCD, ie, obsessive–compulsive tic-related disorder (OCTD). As patients with OCTD may frequently show poor treatment response, the aim of this multicenter study was to investigate rates and clinical correlates of response, remission, and treatment resistance in a large multicenter sample of OCD patients with versus without tics.MethodsA sample of 398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from 10 different psychiatric departments across Italy. For the purpose of the study, treatment response profiles in the whole sample were analyzed comparing the rates of response, remission, and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to identify possible factors associated with treatment response.ResultsThe remission group was associated with later ages of onset of TD and OCD. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts emerged in the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement.ConclusionsAlthough remission was associated with later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response with a significant impairment in quality of life for both patients and their caregivers, suggesting a worse profile of treatment response for patients with OCTD.

Background and Rationale Hyperkinetic movement disorders represent a heterogeneous group of diseases, different from a genetic and clinical perspective. In the past, neurophysiological approaches provided different, sometimes contradictory findings, pointing to an impaired cortical inhibition as a common electrophysiological marker. Our aim was to evaluate changes in interhemispheric communication in patients with idiopathic cervical dystonia (ICD) and spinocerebellar ataxias (SCAs).Materials and Methods Eleven patients with ICD, 7 with genetically confirmed SCA2 or SCA3, and 10 healthy volunteers were enrolled. The onset latency and duration of the ipsilateral silent period (iSPOL and iSPD, respectively), as well as the so-called transcallosal conduction time (TCT), were then recorded from the abductor pollicis brevis of the right side using an 8-shaped focal coil with wing diameters of 70 mm; all these parameters were evaluated and compared among groups. In SCAs, changes in neurophysiological measures were also correlated to the mutational load.Results iSPD was significantly shorter in patients with SCA2 and SCA3, when compared both to control and ICD (P< .0001); iSPOL and TCT were prolonged in SCAs patients (P< .001). Changes in iSPD, iSPOL, and TCT in SCAs are significantly correlated with the mutational load (P= .01, P= .02, and P= .002, respectively).Discussion This is the first study to assess changes in interhemispheric communication in patients with SCAs and ICD, using a transcranial magnetic stimulation protocol. Together with previous data in Huntington’s disease, we suggest that these changes may underlie, at least in part, a common disease mechanism of polyglutamine disorders.

Purpose: The relationship between autism spectrum disorders (ASDs) and eating disorders (EDs) has been widely studied in the last decades. We aimed to directly compare patients with EDs, individuals with high-functioning ASDs (HF-ASDs) and healthy controls (HC) at measures detecting: (1) symptoms of eating disorders, (2) eating disturbances known to be characteristic of autism. Methods: Thirty-four patients with EDs, 34 individuals with HF-ASDs and 35 HC, all females, completed the eating attitude test (EAT-26) and the Swedish eating assessment for autism spectrum disorders (SWEAA), two self-report questionnaires assessing, respectively, symptoms and concerns characteristic of eating disorders and ASD-related eating disturbances. Results: At the EAT-26, patients with EDs scored significantly higher than individuals with HF-ASDs, and both of them scored higher than HC (p&lt; 0.05, ηp2= 0.283). Conversely, at the SWEAA, no differences between individuals with HF-ASDs and patients with EDs emerged (p= 901), but they both scored higher than HC (p&lt; 0.05, ηp2= 0.247). Conclusion: Individuals with HF-ASDs did not seem to reach the same level of EDs symptomatology as patients with EDs. Patients with EDs did not seem to present a different amount of autistic-eating behaviours than subjects with HF-ASDs. Patients with EDs and individuals with HF-ASDs scored higher than HC at both scales. Our results give further preliminary evidence of the overlap between autistic traits and EDs symptomatology, and should be taken into account in the definition of a shared model between EDs and ASDs. Level of evidence: Level II; Evidence obtained from controlled trial without randomization.

IMPORTANCE: Patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) may experience life-threatening arrhythmic events (LTAEs) despite β-blocker treatment. Further complicating management, the role of implantable cardioverter defibrillator (ICD) in CPVT is debated. OBJECTIVE: To investigate the long-term outcomes of patients with RYR2 CPVT treated with β-blockers only and the cost to benefit ratio of ICD. DESIGN, SETTINGS, AND PARTICIPANTS: This prospective cohort study conducted from January 1988 to October 2020 with a mean (SD) follow-up of 9.4 (7.5) years included patients who were referred to the Molecular Cardiology Clinics of ICS Maugeri Hospital, Pavia, Italy. Participants included consecutive patients with CPVT who were carriers of a pathogenic or likely pathogenic RYR2 variant with long-term clinical follow-up. EXPOSURES: Treatment with selective and nonselective β-blocker only and ICD implant when indicated. MAIN OUTCOME AND MEASURES: The main outcome was the occurrence of the first LTAE while taking a β-blocker. LTAE was defined as a composite of 3 hard end points: sudden cardiac death, aborted cardiac arrest, and hemodynamically nontolerated ventricular tachycardia. RESULTS: The cohort included 216 patients with RYR2 CPVT (121 of 216 female [55%], median [IQR] age 14, [9-30] years). During a mean (SD) follow-up of 9.4 (7.5) years taking β-blockers only, 28 of 216 patients (13%) experienced an LTAE (annual rate, 1.9%; 95% CI, 1.3-2.7). In multivariable analysis, experiencing either an LTAE (hazard ratio [HR], 3.3; 95% CI, 1.2-8.9; P = .02) or syncope before diagnosis (HR, 4.5; 95% CI, 1.8-11.1; P = .001) and carrying a C-terminal domain variant (HR, 18.1; 95% CI, 4.1-80.8; P &lt; .001) were associated with an increased LTAE risk during β-blocker therapy only. The risk of LTAE among those taking selective β-blockers vs nadolol was increased 6-fold (HR, 5.8; 95% CI, 2.1-16.3; P = .001). Conversely, no significant difference was present between propranolol and nadolol (HR, 1.8; 95% CI, 0.4-7.3; P = .44). An ICD was implanted in 79 of 216 patients (37%) who were followed up for a mean (SD) of 8.6 (6.3) years. At the occurrence of LTAE, ICD carriers were more likely to survive (18 of 18 [100%]) than non-ICD carriers (6 of 10 [60%]; P = .01). CONCLUSIONS AND RELEVANCE: In this cohort study, selective β-blockers were associated with a higher risk of LTAE as compared with nadolol. Independently from treatment, LTAE and syncope before diagnosis and C-terminal domain variants identified patients at higher risk of β-blocker failure, and the ICD was associated with reduced mortality in high-risk patients with CPVT.

AbstractIntroductionObsessive-compulsive disorder (OCD) is a prevalent and disabling condition with frequent chronic course. Staging models applied to psychiatric disorders seek to define their extent of progression at a particular time-point and differentiate early, milder clinical phenomena from those characterizing illness progression and chronicity. In OCD patients, a staging model has been recently proposed but not tested yet. This was the aim of the present study.MethodsFrom an overall sample of 198 OCD patients, recruited across two psychiatric clinics in Northern Italy, 70 patients on stable treatment completed a follow-up assessment ranging from 12 to 24 months. At follow-up initiation, patients had been divided into four staging groups, according to the model proposed by Fontenelle and Yucel. At the end of the follow-up, patients were subdivided into three groups (no stage change, improved stage, or worsened stage) compared with statistical analyses.ResultsAt the end of the follow-up, 67.1% patients showed no stage changes, 24.3% a stage improvement, and 8.6% a stage progression. Worsened patients showed higher rates of comorbid disorders and higher rates of unfavorable employment characteristics compared to the other subgroups (P< .05). Patients with worsened stage showed higher prevalence of somatic obsessions (P< .05), while patients with improved stage showed higher rates of magical thinking and violence/harm obsessions compared to other groups (P< .05).DiscussionThe present results provide epidemiologic and clinical correlates of the first application of a staging model in a sample of OCD patients, encouraging further studies to assess the utility of this approach in the field.

Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel NaV1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on NaV1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings.

AbstractBackgroundLittle is known about the post-acute effects of repetitive transcranial magnetic stimulation (rTMS) in patients with major depression. The present study focused on the 6-month follow-up of a sample of patients with major depression, after the completion of an acute 4 weeks rTMS trial, with the aim of evaluating response (in terms of sustained and late response) and relapse rates.MethodsFollowing the completion of an acute trial of rTMS (T0-T4), 31 drug-resistant depressed patients (bipolar or unipolar) entered a naturalistic follow-up period of 6 months, with three timepoints (T5, T6, and T7) during which they were assessed with the Hamilton Depression Rating Scale and the Young Mania Rating Scale.ResultsResults showed that in the 6 months following an acute transcranial magnetic stimulation (TMS) trial, a higher rate of late responders was observed among previously acute TMS nonresponders (63.64%, 7 out of 11) compared to the rate of relapse among those who had acutely responded to TMS (10%, 2 out of 20). In addition, an overall high rate of maintained response (90%) was observed.ConclusionPresent findings seem to support the possibility of obtaining a clinical response also after the end of an acute TMS trial in patients with major depression. The concomitant low rate of relapse observed at the end of follow-up along with a high rate of maintained response provides further support to the post-acute efficacy of TMS. Nonetheless, further controlled studies, with larger samples and longer follow-up observation, are needed to confirm the reported results.

Purpose: To explore the prevalence of symptoms of anxiety and depression, along with PTSD- and ED-related symptoms, across a sample of patients with Eating Disorders (EDs) compared to a group of healthy controls (HC) during the lockdown period in Italy; to assess whether patients’ reported aforementioned psychiatric symptoms improved, remained stable or worsened with the easing of the lockdown measures. Methods: t0 assessment (during lockdown): 59 ED patients and 43 HC completed an online survey, including the Depression, Anxiety and Stress Scale-21 items (DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale (PSS), and specific ad-hoc questions extracted from the Eating Disorder Examination-Questionnaire; t1 assessment (post-lockdown): 40 EDs patients, a subset of the t0 sample, completed the same assessment 2 months after t0. Results: EDs patients scored higher than HC at the DASS-21, IES-R and PSS. At t1, levels of stress, anxiety and depression were not different than at t0, but symptoms related to post-traumatic stress disorder (PTSD), patients’ reported level of psychological wellbeing and specific EDs symptomatology improved. Discussion: During the lockdown, EDs patients presented significantly higher levels of stress, anxiety, depression, PTSD- and ED-related symptoms than HC. With the easing of the lockdown, PTSD- and ED-related symptoms improved, but high levels of stress, anxiety and depression persisted. Level of evidence: Level I, experimental study.

AbstractBackgroundObsessive-compulsive disorder (OCD) and tic disorder (TD) represent highly disabling, chronic and often comorbid psychiatric conditions. While recent studies showed a high risk of suicide for patients with OCD, little is known about those patients with comorbid TD (OCTD). Aim of this study was to characterize suicidal behaviors among patients with OCD and OCTD.MethodsThree hundred and thirteen outpatients with OCD (n = 157) and OCTD (n = 156) were recruited from nine different psychiatric Italian departments and assessed using an ad-hoc developed questionnaire investigating, among other domains, suicide attempt (SA) and ideation (SI). The sample was divided into four subgroups: OCD with SA (OCD-SA), OCD without SA (OCD-noSA), OCTD with SA (OCTD-SA), and OCTD without SA (OCTD-noSA).ResultsNo differences between groups were found in terms of SI, while SA rates were significantly higher in patients with OCTD compared to patients with OCD. OCTD-SA group showed a significant male prevalence and higher unemployment rates compared to OCD-SA and OCD-noSA sample. Both OCTD-groups showed an earlier age of psychiatric comorbidity onset (other than TD) compared to the OCD-SA sample. Moreover, patients with OCTD-SA showed higher rates of other psychiatric comorbidities and positive psychiatric family history compared to the OCD-SA group and to the OCD-noSA groups. OCTD-SA and OCD-SA samples showed higher rates of antipsychotics therapies and treatment resistance compared to OCD-noSA groups.ConclusionsPatients with OCTD vs with OCD showed a significantly higher rate of SA with no differences in SI. In particular, OCTD-SA group showed different unfavorable epidemiological and clinical features which need to be confirmed in future prospective studies.

Purpose: It has been widely shown that dissociative features might play a fundamental role in producing body image distortions in patients affected by eating disorders. Here, we hypothesize that the Mirror Gazing Test (MGT), a task consisting in mirror exposure in a condition of sensory deprivation, would elicit dissociative symptoms in a group of patients with anorexia nervosa (AN). Methods: Fourteen patients with AN and fourteen healthy controls (HC) underwent a 10 min MGT and completed the Strange Face Questionnaire and a short version of the Clinician-Administered Dissociative States Scale, along with a psychological assessment for eating disorders psychopathology, anxiety and depression. Results: AN patients reported a higher number of strange-face apparitions and dissociative sensations than HC during the MGT. Dissociative identity (compartmentalization of two or more identities) and depersonalization (detachment of bodily-self) were much higher in patients with AN than in HC. These findings were correlated with body dissatisfaction and disruption in interoceptive awareness. Conclusion: Dissociation and body image dysfunction are strongly connected in the pathophysiology of anorexia nervosa. Future research should investigate the same aspects in other psychiatric conditions characterized by body image distortions, such as Body Dysmorphic Disorder. Level of evidence: I, Experimental studies.

Left ventricular myocardial work (LVMW) is a novel method to assess left ventricular (LV) function using pressure-strain loops that takes into consideration LV afterload. The estimation of LV afterload in patients with severe aortic stenosis (AS) may be challenging, and no study so far has investigated LVMW in this setting. The aim of this study was to develop a method to calculate LVMW in patients with severe AS and to analyze its relationship with heart failure symptoms.

This special issue stems from a panel we organised at the European Conference on South Asian Studies in 2018, under the title ‘Banglascapes in Southern Europe: comparative perspectives’. Not all the panel participants from that conference feature in this special issue, and not all the authors included here were present at the conference. Nevertheless, the panel represents a first important moment in which we began to collect case-studies and insights on a relatively new aspect of the so-called Bengali, or Bangladeshi, ‘diaspora’.

‘Our parents couldn’t teach us the true meaning of what spirituality and faith can be!’. This assertion, made by a 24-year-old youth, epitomises the critical stance of a group of young Italian-Bangladeshi Muslims towards the religiosity of their former generation. Based on ethnographic research in Rome (Italy), this article illustrates the apparently oxymoronic characteristics of a discourse of Muslimness which, despite stressing the importance of a return to the primary sources of Islam, combines this attitude with a peculiar emphasis on ‘integration’. I will show how this counter-intuitive combination is not only inspired by a scholarly concept of ‘European Islam’, but first and foremost it is grounded in the concrete life conditions of youths who are both well placed within the Italian society and animated by religious zeal. In this way, I seek to shed light on the mutual entanglement of religious stances and life experiences, and to point up the limits of ‘exceptionalist’ and ‘literalist’

Objective: Hereditary spastic paraplegia (HSP) represents a heterogeneous group of neurodegenerative diseases characterized by progressive spasticity and lower limb weakness. We assessed the effects of transcutaneous spinal direct current stimulation (tsDCS) in HSP.Design:A double-blind, randomized, crossover and sham-controlled study.Setting: Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan.Participants: eleven patients with HSP (six men, mean age ± SD: 37.3 ± 8.1 years), eight affected by spastin/SPG4,1 by atlastin1/SPG3a, 1 by paraplegin/SPG7 and 1 by ZFYVE26/SPG15.Interventions: tsDCS (anodal or sham, 2.0 mA, 20’, five days) delivered over the thoracic spinal cord (T10-T12).Outcome measures:Motor-evoked potentials (MEPs), the H-reflex (Hr), F-waves, the Ashworth scale for clinical spasticity, the Five Minutes Walking test and the Spastic Paraplegia Rating Scale (SPRS) were assessed. Patients were evaluated before tsDCS (T0), at the end of the stimulation (T1), after one week (T2), one month (T3) and two months (T4).Results:The score of the Ashworth scale improved in the anodal compared with sham group, up to two months following the end of stimulation (T1, P = .0137; T4, P = .0244), whereas the Five Minutes Walking test and SPRS did not differ between the two groups. Among neurophysiological measures, both anodal and sham tsDCS left Hr, F-waves and MEPs unchanged over time.Conclusions:Anodal tsDCS significantly decreases spasticity and might be a complementary strategy for the treatment of spasticity in HSP.

Stringent variant interpretation guidelines can lead to high rates of variants of uncertain significance (VUS) for genetically heterogeneous disease like long QT syndrome (LQTS) and Brugada syndrome (BrS). Quantitative and disease-specific customization of American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines can address this false negative rate.

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Several studies have found a link between nutritional status and neurodegenerative diseases, such as Parkinson’s disease (PD). The aim of our study was to assess both nutritional status and dietary habits of PD patients with respect to controls and to compare disease progression in relation to dietary habits, such as protein distribution diet (PRD) adherence. We collected anthropometric measurements, Mini Nutritional Assessment (MNA) score, dietary habits, micro- and macronutrients intakes, body composition by Bioelectrical Impedance Analysis (BIA), muscle strength and gait speed of 66 PD patients and 58 controls (40 healthy controls and 18 subjects with essential tremor). Clinical scales and progression indexes were recorded in PD group. No significant differences emerged between PD and controls in anthropometric and BIA measurements; a comparable dietary intake between the two groups was recorded. Sarcopenia and dynapenia were comparable between the two groups. PD resulted more at risk of malnutrition than controls to MNA, only three patients and one control were malnourished. A notable inverse correlation was observed between MNA and PD Questionnaire 8. PD following a PRD showed a slower progression index. Nutritional status of PD patients is not so different from elderly controls. PRD is recommended for patients with PD.

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The diagnostic workflow of patients with cognitive decline needs an extensive clinical evaluation. The use of FDG-PET can be helpful because the finding of a rather specific pattern of hypometabolism could point to specific neurodegenerative disorders. In patients with memory impairment and visuo-spatial deficits, FDG-PET may reveal a pattern of temporo-parietal hypometabolism that is associated with Alzheimer’s disease or a more extended area of hypometabolism that spreads to the occipital cortex, as in posterior cortical atrophy indicating signs of neurodegeneration in the associative visual cortex. In the spectrum of fronto-temporal lobe degeneration, FDG-PET is used to support the diagnosis by excluding AD and to identify areas of hypometabolism that are associated with the behavioural variant of FTD or with progressive primary aphasia. When cognitive impairment develops along with parkinsonism, FDG-PET can be used to differentiate among the different forms of disorders, such as dementia with Lewy bodies, progressive supranuclear palsy and cortico-basal degeneration, occurring with different specific pattern of altered metabolism. In this pictorial essay, we present a series of clinical cases in which the use of FDG-PET contributed to the final diagnosis.

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Background: Cerebellar ataxias represent a wide and heterogeneous group of diseases characterized by balance and coordination disturbance, dysarthria, dyssynergia and adyadococinesia, caused by a dysfunction in the cerebellum. In recent years there has been growing interest in discovering therapeutical strategy for specific forms of cerebellar ataxia. Together with pharmacological studies, there has been growing interest in non-invasive cerebellar stimulation techniques to improve ataxia and limb coordination. Both transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are non-invasive techniques to modulate cerebro and cerebellar cortex excitability using magnetic or electric fields. Methods: Here we aim to review the most relevant studies regarding the application of TMS and tDCS for the treatment of cerebellar ataxia. Conclusion: As pharmacological strategies were shown to be effective in specific forms of cerebellar ataxia and are not devoid of collateral effects, non-invasive stimulation may represent a promising strategy to improve residual cerebellar circuits functioning and a complement tool to pharmacotherapy.

Patients with cancer may report neuropsychiatric abnormalities including cognitive impairment, behavioral disturbances, and psychiatric disorders that potentially worsen their quality of life, reduce their treatment response, and aggravate their overall prognosis. Neuropsychiatric disturbances have a different pathophysiology, including immuno-inflammatory and neuroendocrine mechanisms, as a consequence of oncologic treatments (chemo- and radio-therapy). Among clinicians involved in the management of such patients, psychiatrists need to pay particular attention in recognizing behavioral disturbances that arise in oncologic patients, and determining those that may be effectively treated with psychotropic medications, psychotherapeutic interventions, and an integration of them. Through the contribution of different clinicians actively involved in the management of oncological patients, the present review is ultimately aimed at updating psychiatrists in relation to the pathophysiological mechanisms responsible for the onset of cognitive, affective, and behavioral syndromes in these patients, along with epidemiologic and clinical considerations and therapeutic perspectives.

Brain stimulation techniques, such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) are used to treat psychiatric and neurological diseases. It elicits physical, cognitive, and mood benefits by promoting neuroplasticity. However, at the same time, several studies showed that these techniques could also alter moral judgment and social behaviour, leading to aggressive and prosocial behaviour; thus, there arises an ethical consideration about their effects and usability. Morality has been debated over centuries as the social behaviour regulator in our society. It is required for cognitive executive functions, problem solving, consequence anticipation, conflict management, and emotional evaluation. From an anatomical point of view, in addition to its philosophical and psychological complexity, we know that morality involves different brain areas and neural circuits both cortical and subcortical. In this mini-review, we report a number of recent results related to the use of brain stimulation techniques for modulating moral and social behaviour in human beings.

Cardiac dysfunction including arrhythmias and myocardial ischemia have often been reported in carbon monoxide poisoning; scattered punctiform hemorrhages throughout the heart have been documented in autopsy samples. An appropriate diagnostic approach is crucial to assess carbon monoxide cardiac damage. This evaluation may be confounded by several factors, including the absence of overt symptoms and of specific ischemic changes in the electrocardiogram. In experimental studies, laboratory animals can develop cardiac changes similar to those seen in humans and therefore proved to be useful models to study the effects and the mechanisms of cardiac damage due to carbon monoxide. These investigations, as well as others performed in vitro, provide support for a direct action of carbon monoxide on the heart, in addition to systemic hypoxia produced by carboxyhemoglobin formation. This review focuses on the diagnostic aspects of carbon monoxide cardiotoxicity. Experimental results obtained in animals and in vitro models are also discussed. Key Words: Carbon monoxide; Cardiotoxicity; Diagnosis, INTRODUCTION It has long been known that carbon monoxide (CO) is cardiotoxic and both cardiac failure and myocardial ischemia have been described in humans after acute intoxication (1,2). CO-induced cardiac [...]

Background: Cardiovascular disorders including myocardial ischemia and heart failure have been described in both laboratory animals and humans following carbon monoxide poisoning. Carbon monoxide cardiotoxicity may be clinically occult and often remains undiagnosed because of the lack of overt symptoms and specific ischemic changes in the electrocardiogram. Routine myocardial necrosis markers have low diagnostic efficiency, particularly in patients with concomitant skeletal muscle necrosis or multiple organ failure complicating carbon monoxide poisoning. Carbon monoxide-induced cardiotoxicity has been investigated rarely in children. Case Report: This paper describes carbon monoxide poisoning in a 12-year-old child who suffered from occult cardiac damage despite mild symptoms and low carboxyhemoglobin concentrations. Myocardial and mitral valve dysfunctions were observed, suggesting an ischemia-like syndrome. Cardiac damage was completely reversible within 1 month. Conclusion: This case report supports that a prolonged carbon monoxide exposure can cause cardiac damage in children even in the absence of specific symptoms, cerebral failure and high carboxyhemoglobin concentrations. Key Words: Carbon monoxide; Acute poisoning; Child; Long QT; Cardiotoxicity, INTRODUCTION Cardiovascular disorders including heart rate changes and myocardial ischemia have been described in both laboratory animals (1,2) and humans (3-5) following carbon monoxide (CO) poisoning. Focal areas of myocardial [...]

The primary objective of this study was to provide an assessment of NK cells in patients with ANCA‐associated vasculitis (AAV). Patients were classified based on the presence or absence of ANCAs and compared with healthy controls (HCs). By multiparameter flow cytometry, we evaluated the number and proportion of NK cells (CD3‐CD56+) and the CD56dim, CD56bright, CD56dimCD57brightsubsets; TLR2 and TLR9 expression; intracellular IFN‐γ production upon stimulation with TLR2 and TLR9 ligands; degranulation activity; serum cytokines; immunohistochemical staining of available biopsies. No differences in the number and proportion of NK cells between patients and HC were observed, except for a lower proportion of CD56dimsubset in ANCA‐negative patients than in HC (P= 0.02). With respect to HC, TLR2 expression levels were reduced in NK cells from ANCA‐negative patients (P= 0.03), in the CD56dimsubset of ANCA‐positive (P= 0.02) and ANCA‐negative patients (P= 0.01), in the CD56brightsubset of ANCA‐positive patients (P= 0.007), and in the CD56dimCD57brightsubset of ANCA‐positive (P= 0.04) and ANCA‐negative patients (P= 0.03). No differences between patients and HC were found concerning IFN‐γ production and degranulation activity. IL‐22 levels were lower in ANCA‐positive patients than in HC (P= 0.01). The immunohistochemical analysis showed sporadic CD56+ cells in one renal biopsy, and a diffuse and moderate infiltrate of IL‐22+ cells in all renal biopsies and in skin tissue. Our data suggest a role of infectious stimuli triggering NK cells in AAV pathogenesis. Poor detection of NK cells in affected tissues suggests a marginal involvement in local inflammatory responses. © 2017 International Clinical Cytometry Society

Primary Sjögren’s syndrome (pSS) is a common chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands and peripheral lymphocyte perturbation. In the current study, we aimed to investigate the possible pathogenic implication of autophagy in T lymphocytes in patients with pSS. Thirty consecutive pSS patients were recruited together with 20 patients affected by sicca syndrome and/or chronic sialoadenitis and 30 healthy controls. Disease activity and damage were evaluated according to SS disease activity index, EULAR SS disease activity index, and SS disease damage index. T lymphocytes were analyzed for the expression of autophagy-specific markers by biochemical, molecular, and histological assays in peripheral blood and labial gland biopsies. Serum interleukin (IL)-23 and IL-21 levels were quantified by enzyme-linked immunosorbent assay. Our study provides evidence for the first time that autophagy is upregulated in CD4+T lymphocyte salivary glands from pSS patients. Furthermore, a statistically significant correlation was detected between lymphocyte autophagy levels, disease activity, and damage indexes. We also found a positive correlation between autophagy enhancement and the increased salivary gland expression of IL-21 and IL-23, providing a further link between innate and adaptive immune responses in pSS. These findings suggest that CD4+T lymphocyte autophagy could play a key role in pSS pathogenesis. Additionally, our data highlight the potential exploitation of T cell autophagy as a biomarker of disease activity and provide new ground to verify the therapeutic implications of autophagy as an innovative drug target in pSS.

Comparar o uso de ácido tranexâmico (AT) tópico e intravenoso na artroplastia total de joelho com relação à perda de sangue e necessidade de transfusão.

IMPORTANCE: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially lethal genetic arrhythmia syndrome characterized by polymorphic ventricular tachycardia with physical or emotional stress, for which current therapy with β-blockers is incompletely effective. Flecainide acetate directly suppresses sarcoplasmic reticulum calcium release—the cellular mechanism responsible for triggering ventricular arrhythmias in CPVT—but has never been assessed prospectively. OBJECTIVE: To determine whether flecainide dosed to therapeutic levels and added to β-blocker therapy is superior to β-blocker therapy alone for the prevention of exercise-induced arrhythmias in CPVT. DESIGN, SETTING, AND PARTICIPANTS: This investigator-initiated, multicenter, single-blind, placebo-controlled crossover clinical trial was conducted from December 19, 2011, through December 29, 2015, with a midtrial protocol change at 10 US sites. Patients with a clinical diagnosis of CPVT and an implantable cardioverter-defibrillator underwent a baseline exercise test while receiving maximally tolerated β-blocker therapy that was continued throughout the trial. Patients were then randomized to treatment A (flecainide or placebo) for 3 months, followed by exercise testing. After a 1-week washout period, patients crossed over to treatment B (placebo or flecainide) for 3 months, followed by exercise testing. INTERVENTIONS: Patients received oral flecainide or placebo twice daily, with the dosage guided by trough serum levels. MAIN OUTCOMES AND MEASURES: The primary end point of ventricular arrhythmias during exercise was compared between the flecainide and placebo arms. Exercise tests were scored on an ordinal scale of worst ventricular arrhythmia observed (0 indicates no ectopy; 1, isolated premature ventricular beats; 2, bigeminy; 3, couplets; and 4, nonsustained ventricular tachycardia). RESULTS: Of 14 patients (7 males and 7 females; median age, 16 years [interquartile range, 15.0-22.5 years]) randomized, 13 completed the study. The median baseline exercise test score was 3.0 (range, 0-4), with no difference noted between the baseline and placebo (median, 2.5; range, 0-4) exercise scores. The median ventricular arrhythmia score during exercise was significantly reduced by flecainide (0 [range, 0-2] vs 2.5 [range, 0-4] for placebo; P &lt; .01), with complete suppression observed in 11 of 13 patients (85%). Overall and serious adverse events did not differ between the flecainide and placebo arms. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with CPVT, flecainide plus β-blocker significantly reduced ventricular ectopy during exercise compared with placebo plus β-blocker and β-blocker alone. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01117454

This study sought to evaluate the phenotypic and functional expression of an apparent hotspot mutation associated with short QT syndrome (SQTS).

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