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Alopecia areata (AA) is a clinically heterogeneous, immune‐mediated, non‐scarring hair loss disorder. This real‐world chart review sought to characterize treatment patterns and healthcare resource use among patients with severe AA in South Korea. A web‐based chart review of 40 dermatologists was conducted in which the medical charts of 151 adult patients diagnosed with severe AA between May 2019 and April 2021 were reviewed. Anonymized data on patient characteristics, treatment patterns, healthcare resource use, and clinical outcomes were extracted from the date of severe disease diagnosis until the date of data collection (September–November 2022). Sixty‐six percent of patients were diagnosed with severe disease at initial presentation, while 34% were re‐classed to severe during the disease course. Mean estimated patient age at the time of diagnosis of severe AA was 37.1 (range 22–68) years. Fifty‐three percent of patients were male. Most patients (93.4%) received pharmacological treatment for their condition; 45.5% received ≥2 lines of treatment with a mean duration of 24 months. First‐line treatment discontinuation due to lack of efficacy occurred in 46.0% of cases. Hair regrowth occurred in 71.0% of patients, 59.2% of whom experienced major regrowth (≥60%) during the follow‐up period. Median (95% confidence interval) time to regrowth was 13.7 (11.0–20.6) months. Treatment visit rates per person‐year ranged from two (phototherapy) to 10 (topical treatment), dermatologist visits occurred at a rate of 12.9 per person‐year and 6.0% of patients were hospitalized due to alopecia areata. The majority of hospitalizations were related to treatment and occurred in patients who received pulse systemic corticosteroid therapy. The patient and economic burden of AA in South Korea is high and there remains a critical unmet need among patients with severe AA with respect to the effectiveness of commonly used treatment strategies. [ABSTRACT FROM AUTHOR]

Past orbital analogues to the current interglacial, such as Marine Isotope Stage 19c (MIS 19c, ca. 800 ka), can provide reliable reference intervals for evaluating the timing and the duration of the Holocene and factors inherent in its climatic progression. Here we present the first high-resolution paleoclimatic record for MIS 19 anchored to a high-precision 40Ar/39Ar chronology, thus fully independent of any a priori assumptions on the orbital mechanisms underlying the climatic changes. It is based on the oxygen isotope compositions of Italian lake sediments showing orbital- to millennial-scale hydrological variability over the Mediterranean between 810 and 750 ka. Our record indicates that the MIS 19c interglacial lasted 10.8 ± 3.7 k.y., comparable to the time elapsed since the onset of the Holocene, and that the orbital configuration at the time of the following glacial inception was very similar to the present one. By analogy, the current interglacial should be close to its end. However, greenhouse gas concentrations at the time of the MIS 19 glacial inception were significantly lower than those of the late Holocene, suggesting that the current interglacial could have already been prolonged by the progressive increase of the greenhouse gases since 8-6 ka, possibly due to early anthropogenic disturbance of vegetation.

Geological survey and geochronological analyses were conducted in the Campo Imperatore plain to understand its Quaternary morpho-sedimentary and tectonic evolution. In the Late Pliocene-Early Pleistocene, low relief energy and steady and warm climatic conditions promoted a long phase of areal peneplanation, resulting in the formation of gently sloping landscape. With further regional uplift and changes in frequency/amplitude of the glacial-interglacial cycles (Early-Middle Pleistocene transition) and after establishment of the expansion-contraction cycles of the Apennine glaciers (Middle Pleistocene), the morpho-sedimentary processes become highly dynamic. In Middle Pleistocene, more than 100 meters of breccias deposited all along the slopes of the Gran Sasso range, followed by higher frequency processes of sedimentation, erosion and pedogenesis of Middle-Late Pleistocene to Holocene fluvio-glacial deposits. These have been progressively offset by synthetic and antithetic normal faults belonging to the Gran Sasso fault system, a 40-km-long seismogenic structure which released in the past earthquakes of Mw~7. [ABSTRACT FROM AUTHOR]

Our objective was to assess the association between amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases such as Alzheimer's disease (AD), frontotemporal dementia (FTD) and Parkinson's disease (PD). From May 2007 through August 2012 we investigated 146 patients with newly diagnosed ALS and 146 age- and gender-matched controls. Each individual was screened for cardinal extrapyramidal signs (neurological examination) and cognitive dysfunction (Mini Mental State Examination, MMSE and Frontal Assessment Battery, FAB). Results demonstrated that rigidity was present in 8.2% of cases and 2.1% of controls (adjusted odds ratio, adjOR 5.7; 95% CI 1.5–22.0). The corresponding percentages for bradykinesia and postural instability were, respectively, 8.2 vs. 2.7% (adjOR 4.8; 95% CI 1.4–16.5) and 2.7 vs. 9.6% (adjOR 0.3; 95% CI 0.1–0.9). FAB ≤ 13.4 was recorded in 24.8 vs. 9.6%; adjOR 2.9; 95% CI 1.5–5.7). Tremor and abnormal FAB score were predicted by an older age at onset while an abnormal FAB score was associated with cramps and family history of neurodegenerative diseases. In conclusion, our data support the notion that newly diagnosed ALS carries a higher than expected risk of extrapyramidal signs and FTD. [ABSTRACT FROM PUBLISHER]

The 23 km long Sulmona normal fault flanks the southwestern slope of the Mount Morrone range in the central Apennines. To date, the recent activity of this structure is uncertain, as the faulting evidence concerns only undated deposits and the fault cannot be associated with any of the strong historical earthquakes (Mw > 6.5) of the region. Our observation from ~ 1 Ma offset slope breccias, coupled with new tephrochronological data on faulted early Last Glacial lacustrine infilling of the Sulmona basin, implies a vertical slip rate of ~0.5 mm/yr over both the long term and middle term. Moreover, at the apex of a Late Pleistocene alluvial fan, radiocarbon dating of offset stratigraphy uncovered in four paleoseismological trenches shows that repeated earthquakes resulted in more than 4 m of vertical offset since ~9 ka, providing again a minimum Holocene vertical slip rate of ~0.5 mm/yr. In combination with the results of the trench exposure, we define four faulting events in the past ~9 ky B.P., and at least one before then. The most recent is constrained by robust radiocarbon dates as the middle of the second century A.D. The penultimate event was around the middle of the fifth millennium B.P., whereas the other two events are dated in a time between 8.5 ky to 6.5 ky B.P. and around 9 ky cal B.P. The oldest occurred before 9.5 ky B.P. As well as revealing the unexpected paleoseismic history of the Sulmona silent fault, our data provide a recurrence time for Mw >6.5 earthquakes of ~2.4 ky versus an elapsed time of ~ 1.85 ky since the last event. The latter matches with an earthquake previously hypothesized through archaeoseismic clues collected from several Roman settlements of the Sulmona Plain, all of which were dated to halfway through the second century A.D. [ABSTRACT FROM AUTHOR]

Background: There is only one small single-center study on the reliability of the diagnosis of focal dystonia. The aim of this study was to assess the inter-rater reliability of dystonia diagnosis among neurologists with different professional experience. Methods: Twenty-nine adults (18 with dystonia, 9 with other movement disorders, and 2 healthy controls) were videotaped while undergoing neurological examination and during the process of collecting information on the history of their condition. Each case was diagnosed by 35 blind raters (12 general neurologists, 21 neurology residents, and 2 experts in movement disorders) from different hospitals. Sensitivity and specificity were calculated confronting raters with the gold standard (the caring physician). Inter-rater agreement was measured by the Kappa statistic. Results: Specificity and sensitivity were 95.2 and 66.7%, 76.3 and 75.2%, 84.6 and 71.6% for experts, general neurologists, and residents, respectively. Kappa values on dystonia diagnosis ranged from 0.30 to 0.46. The agreement was moderate for experts and residents (0.40–0.60) and fair for general neurologists (0.20–0.40). Kappas were the highest among experts for cranial and laryngeal dystonia (0.61–1), but not for cervical dystonia (0.37). Conclusions: The diagnosis of dystonia is difficult and only partially mirrors a physician’s background. [ABSTRACT FROM AUTHOR]

We present the first evidence of surface rupture along the causative fault of the 14 January 1703 earthquake (Mw 6.9, Italian central Apennines). This event was sourced by the ~30 km-long, Norcia fault system, responsible for another catastrophic event in Roman times, besides several destructive earthquakes in the last millennium. A dozen paleoseismological excavations have already investigated the surface ruptures occurred during the Holocene along the Cascia-Mt Alvagnano segments, as well as along secondary splays close to the Medieval Norcia Walls. Remarkably, the master fault bounding the Norcia-Campi basins have never be proved to rupture at the surface. An antique limekiln that was improvidently set across the main fault scarp provides the amazing evidence of an abrupt offset in the 1703 earthquake, which likely occurred during a liming process of carbonate stones. Obviously, the limekiln became useless, and was progressively buried by slope debris. The amount of the offset and the kinematics indicators surveyed in the site allow the strengthening of our knowledge on the seismogenic potential of the Norcia fault system, on its geomorphic rule, and on its impact on the human activities. [ABSTRACT FROM AUTHOR]