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Coronavirus disease-2019 (COVID-19) pandemic had a great impact over all elective neurosurgical activity and important implications in management of neurosurgical urgencies. During the pandemic, some pediatric hospitals reported their experiences. After the emergency phase of the COVID-19 pandemic, the health care system needs to be reorganized to again manage all nonurgent activities, while ensuring safety of both patients and health care workers. We developed preventive measures to limit any possibility of COVID-19 spread, according to the principles of epidemiologic prevention and suggestions from recent literature. To evaluate the efficacy of these measures, we retrospectively reviewed the neurosurgical activity at our institution from May 4 to July 15, 2020. One hundred nineteen patients were admitted to the neurosurgical ward, and 80 surgical procedures were performed. Furthermore, 130 outpatient clinics were scheduled. A total of 258 nasopharyngeal swabs and 249 specific interviews were performed. In our series, no cases of positivity for severe acute respiratory syndrome coronavirus-2 infection were found, and no surgical cases were postponed. We present the management of the neurosurgical activity after the emergency phase at the Neurosurgical Department of Giannina Gaslini Children's Hospital in Genoa, Italy. The Italian health care system is undertaking a process of reorganization of resources, in an attempt to restore all nonurgent activities while ensuring safety. After the emergency phase, we are learning to live together with COVID-19 and, although epidemiologic data are encouraging, we must be prepared for an eventual second peak. [ABSTRACT FROM AUTHOR]

Introduction: Although levodopa/carbidopa intestinal infusion (LCIG) proved a sustained efficacy on Parkinson's disease (PD) motor fluctuations, there is a lack of studies on mortality of LCIG patients. In this study, we aimed at analyzing mortality and its predictors in a cohort of 105 PD patients treated with LCIG for over 10 years.Methods: The death rate, death causes, mortality predictors, and serious adverse events (SAEs) were analyzed. A Cox regression model was used to estimate the influence of several demographic and clinical factors on mortality, and a binary logistic regression to evaluate the association between SAEs number and mortality. Kaplan-Meier and Log-rank test was used for a survival comparison between patients with an early drop-out (within 3 years since LCIG start) and patients continuing LCIG.Results: Ninety-eight advanced PD patients treated with LCIG were included. During follow-up, 34.7% of patients died at a mean age of 74.7 years, with a mean survival time of 4.6 years since LCIG start and 18 years since PD onset. The only predictor of mortality identified was the Mini Mental State Examination score at LCIG start (p:0.034). A total of 222 SAEs occurred in 87.9% of LCIG patients. The number of SAEs did not correlate with the mortality of LCIG patients (p:0.370). No survival difference exists between early drop-out patients and those continuing LCIG (p:0.341).Conclusion: Our findings do not indicate an association between SAEs or LCIG treatment duration and mortality and highlight the importance of cognitive alterations as a mortality predictor of LCIG patients. [ABSTRACT FROM AUTHOR]

Bilateral lambdoid and posterior sagittal synostosis is a rarely encountered multisutural craniosynostosis accounting for 0.3%−0.7% of all craniosynostoses. It has been named "Mercedes−Benz Syndrome" (MBS) because of the bone ridges that resemble the Mercedes−Benz logo. The typical head shape is usually described as anterior turricephaly combined with mild brachycephaly. We describe a case of pure MBS without involvement of other sutures. Since we believe that MBS is a different pathology when other sutures are involved, we will discuss our case with a review of the literature, including all reported cases of bilateral lambdoid and posterior sagittal synostosis with no other sutures involved but sagittal and bilateral lambdoid. A 3-month-old female baby came to our attention because of a turrycephalic appearance of the head. Findings of the neurologic examination were unremarkable. Computed tomography scan showed premature fusion of posterior third of sagittal suture and bilateral lambdoid suture. Magnetic resonance imaging did not show relevant intracranial abnormalities. She underwent sagittal decompression extended posteriorly below the lambdoid suture combined with biparietal decompression to obtain expansion of both parieto-frontal bones and posterior fossa. Post-operative course was uneventful. Follow-up at 3 months showed a good aesthetic result, and results of the neurologic examination were unremarkable. Pure MBS is a rare condition that unlike other multisutural complex craniosynostosis is rarely associated with genetic syndromes, has a low rate of associated intracranial anomalies, and has less need for more skull-remodeling surgery. The choice of the most suitable surgical procedure must be tailored on the patient, considering preoperative head appearance and eventually associated anomalies. [ABSTRACT FROM AUTHOR]

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral microangiopathy presenting with variable features, including migraine, psychiatric disorders, stroke, and cognitive decline and variable disability. On neuroimaging, CADASIL is characterized by leukoencephalopathy, multiple lacunar infarcts, and microbleeds. Previous studies suggest a possible role of endothelial impairment in the pathogenesis of the disease.Methods: We assessed plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) and the blood levels of endothelial progenitor cells (EPCs) and circulating progenitor cells (CPCs) in 49 CADASIL patients and 49 age-matched controls and their association with clinical/functional and neuroimaging features.Results: In multivariate analysis, CADASIL patients had significantly higher vWF and lower EPC levels. TM levels were similar in the 2 groups. CADASIL patients with a more severe clinical phenotype (history of stroke or dementia) presented lower CPC levels in comparison with patients with a milder phenotype. On correlation analysis, lower CPC levels were associated with worse performances on neuropsychological, motor and functional tests, and with higher lesion load on brain magnetic resonance imaging (degree of leukoencephalopathy and number of lacunar infarcts).Conclusions: This is the first CADASIL series in which multiple circulating biomarkers have been studied. Our findings support previous studies on the presence and the possible modulating effect of endothelial impairment in the disease. Furthermore, our research data suggest that blood CPCs may be markers of disease severity. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient’ life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient’ life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used. [ABSTRACT FROM AUTHOR]

Aedes albopictus (Skuse) is one of the most invasive mosquito species capable of transmitting various harmful pathogens to humans. Failure of vector control strategies against this species requires the development of new effective vector control methods. Among the alternative genetic control measures under development, the sterile insect technique (SIT) is today receiving a renewed interest as a possible effective tool to be integrated in an area-wide pest management approach. The monitoring of the abundance, distribution, movements and ratio of released sterile and wild fertile males is a fundamental requirement for the successful management of any pest control activities integrating an SIT component. Although several traps exist for adult female mosquito surveillance and population control, effective methods to monitor large quantities of non-biting males were less researched in the past and more difficult to obtain. In this study we analyzed the response of A. albopictus males to various sound stimuli produced with different volumes and frequencies in association with visual cues for the optimization of male catches. The production of modulated frequencies continuously varying within the typical female sound emission range (500–650 Hz) showed the best results for a sound pressure level between 75 and 79 dB measured at the speaker level. The black color of the trap, however, seems decisive to attract males in the vicinity of sound traps and the combined effect produced by these stimuli is additive. We also observed that males increase their response to acoustic stimulation up to 4 days of age and then show a continuous and progressive decline of their sound responsiveness. A plastic sound trap prototype capable of producing the most effective sound stimuli tested at laboratory conditions showed a good A. albopictus males’ attractiveness in the field despite a reduced use of color stimuli. The use of sound stimuli therefore appears to be a promising prospect to increase the capture rate of A. albopictus males in new or in already existing mosquito traps. [ABSTRACT FROM AUTHOR]

Abstract: In most Western economies, the flourishing of the Welfare State has coincided with a decline of the role of the family: divorce has been introduced, and the number of married couples has decreased relative to that of cohabiting ones. We argue that divorce is a costly process and that its likelihood may be overestimated by limitedly rational agents; hence, it may act as a reason for the reduction of the number of marriages and the increase of cohabitation. We also show that the model's predictions are more in line with the stylised facts than those coming from a standard model with full rationality. [Copyright &y& Elsevier]

Abstract: The constrained stabilization of linear uncertain systems is investigated via the set-theoretic framework of control Lyapunov R-functions. A novel composition rule allows the design of a composite control Lyapunov function with external level set that exactly shapes the maximal controlled invariant set and inner sublevel sets arbitrarily close to any choice of smooth ones, generalizing both polyhedral and truncated ellipsoidal control Lyapunov functions. The feasibility test of the proposed smooth control Lyapunov functions can be cast into matrix inequalities conditions. The constrained linear quadratic control is addressed as an application. [Copyright &y& Elsevier]

Abstract: This paper proposes a smooth control Lyapunov function with maximal controlled domain of attraction for the state-feedback control of constrained uncertain linear systems describing the dynamics of multivariable processes. Constructive algorithms are shown to build such a control Lyapunov function within a merging procedure due to the so-called R-functions. Robustness with respect to polytopic model uncertainties and disturbance rejection are also discussed. The controlled dynamics of two chemical reactions are simulated to show the benefits of the proposed strategy. [Copyright &y& Elsevier]

Abstract: We analyse a model of income tax avoidance with heterogenous agents who face monetary as well as psychic costs in order to successfully hide their income from the fisc. We argue that, in general, the stigmatisation of tax dodging is motivated by the desire to make redistribution more effective. In this context, we demonstrate two results. First, we study the policy preferences of the agents, identify a median-agent political equilibrium, and show that the psychic cost of tax dodging leads to a highly progressive income tax. Second, we model the endogenous formation of stigma as a “conformism game”, and argue that, since high levels of stigma are favoured by the low-income agents, a society-wide condemnation of tax dodging will be established only in robust democracies where these agents possess enough social influence. [ABSTRACT FROM AUTHOR]

Abstract: Biofilm formation by Klebsiella pneumoniae is modulated by quorum sensing through the synthesis of interspecies AI-2 autoinducers. We characterized in K. pneumoniae the genes homologous to those described in Escherichia coli involved in AI-2 transport, and created two isogenic mutants deleted of lsrCD and tqsA. The levels of extracellular AI-2 with lsrCD and tqsA knockout mutants showed increased and lowered concentrations of AI-2, respectively. The level of transcripts of luxS, the gene responsible for AI-2 synthesis, was increased in sessile cells of the tqsA mutant. In contrast, the expression of the AI-2 import regulator genes lsrR and lsrK was decreased. In addition, the two mutants lsrCD and tqsA formed biofilms with greater biomass but impaired architecture. Since exopolysaccharides play a main role in K. pneumoniae biofilm formation, we investigated their relationship with AI-2 synthesis. None of the mutations in luxS and the AI-2 transport systems affected the expression of three capsule polysaccharide-related genes (wzi, wza and wzx), but all induced an increase in the expression of two lipopolysaccharide (LPS)-synthesis-related genes, wbbM and wzm. AI-2 therefore seems to act as a regulator of biofilm formation and LPS synthesis in sessile K. pneumoniae cells. [Copyright &y& Elsevier]

Summary: In the last years an increasing number of subjects experienced respiratory failure and underwent tracheostomy. The aim of the present study was to analyze tracheal aspirates from the inflammatory point of view. Samples were collected from 38 consecutive tracheostomized patients: 13 COPD, 6 with neurologic disorders and 19 with other different causes of respiratory failure. We analyzed cells and soluble mediators related to inflammation and/or infection. We also compared results obtained in the tracheal aspirate of COPD patients with the same determination in the sputum of another group of non-tracheostomized COPD patients (n =41). Regardless of the underlying diagnosis, most of the samples were Pseudomonas aeruginosa positive and cells and soluble mediator did not differ. Treatment with steroids was associated with lower amount of total cells, neutrophils and lymphocytes, whereas treatment with antibiotics was not. Tracheal aspirate neutrophils correlated with PaCO2 values; neutrophils and eosinophils correlated with their percentages in blood. As compared with sputa obtained from another group of culture-positive non-tracheostomized COPDs, tracheal aspirates showed similar cell count, proportions of inflammatory cells, and infection/inflammatory mediators. In conclusion tracheal aspirates presented high amounts of viable cells and soluble mediators independently to the cause of respiratory failure leading to tracheotomy and they represent suitable specimens to study infection/inflammation interactions. [Copyright &y& Elsevier]

Abstract: We present a model of courtship in which the timing of marriage is affected by the cognitive dissonance between perceived norms and personal aims. We argue that as long as the family has been the main provider of social protection, marriage has been favoured by strongly felt social norms, and thus people accepted less-than-ideal partners early on in their search in order to minimise the dissonance caused by the non-adherence to the custom. Once the Welfare state has replaced the family, these norms have lost their strength, so that agents can afford the luxury of searching their preferred partners at length without feeling at odds with their social duties. The model yields predictions in line with relevant stylised facts: the raising age of marriage, the prevalence of assortative mating and the common occurrence of divorce in the early years of marriage. We finally discuss the impact of late marriages on fertility, and argue that there need not be negative consequences if the declining role of the family becomes socially accepted, and alternative arrangements are made possible and indeed encouraged by means of an appropriate family policy. [Copyright &y& Elsevier]

Abstract: The extracellular concentration of guanidinoacetate (GAA) in the brain increases in guanidino acetate methyl transferase (GAMT) deficiency, an inherited disorder. We tested whether the levels which this substance can reach in the brain in GAMT deficiency are able to activate GABAA receptors in key cerebellar neurons such as the cerebellar granules. GAA in fact activates these receptors in rat cerebellar granules in culture although at quite high concentrations, in the millimolar range. However, these millimolar GAA levels are not reached extracellularly in the brain in GAMT deficiency. In addition, GAA does not act as a partial agonist on granules’ GABAA receptors. This appears to deny an effect by this molecule on cerebellar function in the disease via interference with granule cells’ GABAA receptors. Study of partial blockage by furosemide of chloride currents activated by GABA and GAA in granule cells allowed us to distinguish two populations of GABAA receptors presumably involved in granule cells’ tonic inhibition. One is devoid of α6 subunit and another one contains it. The latter when activated by GABA has a decay kinetics much slower than the former. GAA does not distinguish between these two populations. In any case, the very high extracellular GAA concentrations able to activate them are not likely to be reached in GAMT deficiency. [Copyright &y& Elsevier]

A structural requirement for high-Tc (HTS) cuprates is the simultaneous presence in a layered structure of two different functional blocks, individually non-superconducting: the charge reservoir (CR) block and the infinite layer (IL) block. Artificially layered 2×m superlattices were grown, by pulsed laser deposition, stacking epitaxially m layers of (Ba0.9Nd0.1)CuO2+δ and two layers of CaCuO2. Starting from superlattices with m=2, the thickness of CR block, namely the Ba–Cu–O block, which separates adjacent Ca–Cu–O IL blocks, was gradually increased up to m=10. In the superlattices with m>4 the superconducting layers are completely decoupled, showing, relative to the m=2 superlattice, a negligible decrease of the transition temperature and a strong increase of the anisotropy. Superconductivity at 55 K was found in both the ultrathin films, only consisting of two CR blocks sandwiching a (CaCuO2)2 layer, and the superlattices with thick CR blocks, demonstrating that the interlayer coupling in such heterostructures is unimportant. Moreover it has been shown that a single CaCuO2 layer is still superconducting. [Copyright &y& Elsevier]

Background: Atypical Parkinsonisms (APs) -including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB)- are neurodegenerative diseases lacking satisfying symptomatic therapies. Deep Brain Stimulation (DBS) is an established neurosurgical option for advanced Parkinson disease (PD). Although DBS effectiveness in PD fed expectations for the treatment of APs, DBS is still not recommended for APs on the basis of expert consensus and lack of clinical trials.Objective: In this systematic review, we sought to analyze current evidence on the safety and efficacy of DBS in APs, discussing clinical indications, anatomical targets, and ethical issues.Methods: Following the PRISMA guidelines, we systematically searched PubMed for studies reporting the outcome of patients with APs treated with DBS.Results: We identified 25 eligible studies for a total of 66 patients with APs treated with DBS: 31 PSP, 22 MSA, 12 DLB, 1 unspecified parkinsonism with tongue tremor. Targeted nuclei were subthalamic nucleus (STN), globus pallidus pars-interna (GPi), pedunculopontine nucleus (PPN), and nucleus basalis of Meynert (nbM). Only 3/25 studies were randomized controlled trials, and most studies showed a high risk of bias.Conclusion: Taking into account study biases and confounding factors, current evidence does not support the use of DBS in APs. However, some interesting insights arise from the literature, such as the high frequency of cognitive/neurobehavioral issues in MSA patients treated with STN-DBS, the low frequency of complications in trials of nbM-DBS for DLB, and the possible good response of dystonic symptoms in PSP with GPi DBS. [ABSTRACT FROM AUTHOR]