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Multiple sclerosis (MS) is a complex autoimmune disease with multiple players. In particular, peripheral (myelin-reactive CD4+ T lymphocytes) and central immune cells (microglia) are involved in the neuroinflammatory process and are found in MS brain lesions. New nanotechnological approaches that can cross the blood-brain barrier and specifically target the key players in the disease using biocompatible nanomaterials with low immunoreactivity represent an important challenge. To this end, nanoparticles and nanovesicles have been studied to induce immune tolerance to a wide range of myelin-derived antigens as potential approaches against MS. To this aim, we extracted myelin from bovine brain and produced myelin-based nanovesicles (MyVes) by nanoprecipitation. MyVes have a diameter of about 100 nm, negative zeta potential and contain the typical proteins of the myelin sheath. The results showed that MyVes are not cytotoxic, are hemocompatibile and do not induce an inflammatory response. In vitro experiments showed that MyVes are specifically taken up by microglial cells and are able to induce the expression of the anti-inflammatory cytokine IL-4. In addition, we have used biodistribution experiments to show that MyVes are able to reach the brain after intranasal administration. Finally, MyVes induced the production of the anti-inflammatory cytokines IL-10 and IL-4 in peripheral blood mononuclear cells isolated from MS patients. Taken together, these data provide proof of concept that MyVes may represent a safe nanosystem capable of promoting anti-inflammatory effects by modulating both central and peripheral immune cells to treat neuroinflammation in MS. Recently, nanoparticles and nanovesicles have been investigated as potential approaches for the treatment of neurodegenerative diseases. We propose the use of myelin nanovesicles (MyVes) as a potential application to counteract neuroinflammation in multiple sclerosis (MS). Approximately 2.8 million people worldwide are estimated to live with MS. It is an autoimmune disease directed toward various myelin-derived antigens. Both peripheral immune cells (lymphocytes) and central immune cells (microglia) actively contribute to MS brain lesions. MyVes, due to their myelin nature, specific characteristics (size, zeta potential, and presence of myelin proteins), biocompatibility, and ability to cross the blood-brain barrier, could represent the first nanosystem capable of promoting anti-inflammatory actions by modulating both central and peripheral immune cells to treat neuroinflammation in MS. [Display omitted] [ABSTRACT FROM AUTHOR]

Adequate bowel cleansing is essential for colonoscopy quality. A novel 1 L polyethylene glycol plus ascorbate (1 L PEG+ASC) solution has been recently introduced. Nevertheless, the efficacy of 1 L PEG+ASC as compared to that of high-volume bowel preparation in both inpatients and outpatients is still unclear. This single-blinded, non-inferiority study randomized patients undergoing colonoscopy to receive split-dose 1 L PEG+ASC or 4 L PEG. The primary endpoint was the overall cleansing success. Secondary endpoints were excellent cleansing and high-quality cleansing of the right colon, as well as lesions detection rate, patient compliance, tolerability and safety. Overall, 478 patients were randomized to 1 L PEG+ASC (N = 236) or 4 L PEG (N = 242). The 1 L PEG+ASC showed higher cleansing success rate (91.8% vs 83.6%; P =0.01) and a high-quality cleansing of the right colon (52.3% and 38.5%; P =0.004) compared to 4 L PEG. Moreover, 1 L PEG+ASC achieved a higher cleansing success in out-patients (96.3%% vs 88.6%; P =0.018), and a similar success rate in the in-patients (84.7% vs 76.7%; P =0.18). Adenoma detection rate, tolerability and incidence of adverse events were comparable between preparations. The 1 L PEG+ASC showed higher efficacy in achieving adequate colon cleansing compared with 4 L PEG, particularly in the right colon. No differences in the tolerability and safety were detected. [ABSTRACT FROM AUTHOR]

[Display omitted] This article describes a technique for arthroscopic fixation of an osteochondritis dissecans (OCD) lesion of the medial talar dome with headless compression screws. This technique involves creation of a medial transmalleolar portal using a guide and drill. The medial transmalleolar portal grants perpendicular access for screw fixation of OCD lesions in addition to the potential for osteochondral autograft transplantation (OAT). Advantages include access to the medial talar dome without performing a medial malleolar osteotomy. After completion of OCD fixation, an inverted osteochondral plug can be used to backfill the portal. [ABSTRACT FROM AUTHOR]

The effectiveness of bowel cleansing is a key element for high-quality colonoscopy. Recently, a 1 L polyethylene glycol plus ascorbate (PEG-ASC) solution has been introduced, but effectiveness and safety of this preparation have not been assessed in IBD patients. This study aims to evaluate effectiveness and safety of 1 L PEG-ASC solution in patients with IBD compared to controls. We retrospectively analysed prospectively collected data on a cohort of 411 patients performing a colonoscopy after preparation with 1 L PEG-ASC, consecutively enrolled in 5 Italian centres. Overall, 185/411 (45%) were patients with IBD and 226/411 (55%) served as controls. A significantly higher cleansing success was achieved in IBD patients (92.9% vs 85.4%, p = 0.02). The multiple regression model showed that presence of IBD (OR=2.514, 95%CI=1.165–5.426; P = 0.019), lower age (OR=0.981, 95%CI=0.967–0.996; P = 0.014), split preparation (OR=2.430, 95%CI=1.076–5.492; P = 0.033), absence of diabetes (OR=2.848, 95%CI=1.228–6.605; P = 0.015), and of chronic constipation (OR=3.350, 95%CI=1.429–7.852; P = 0.005), were independently associated with cleansing success. The number of treatment-emergent adverse events (TEAEs) (51 vs 62%, p = 0.821), and of patients with TEAEs (22.2% vs 21.2%, p = 0.821), were similar in IBD patients and in controls, respectively. Results from this study support the effectiveness and safety of 1 L PEG-ASC solution in IBD patients, which may improve the definition of endoscopic outcomes both in Crohn's disease and ulcerative colitis. [ABSTRACT FROM AUTHOR]

Fixation of osteochondral fractures after patellar dislocation is typically done using an open approach due to the location of the defect. This is traditionally performed through a medial parapatellar arthrotomy to allow adequate visualization. By using the joystick method, adequate visualization is achieved with a smaller arthrotomy. Careful placement of the joystick in the planned anchor site of the medial patellofemoral ligament reconstruction reduces the number of drill sites in the patella. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Late-onset UC represents an important issue for the near future, but its outcomes and relative therapeutic strategies are yet poorly studied. Aim To better define the natural history of late-onset ulcerative colitis. Methods In a multicenter retrospective study, we investigated the disease presentation and course in the first 3 years in 1091 UC patients divided into 3 age-groups: diagnosis ≥65 years, 40–64 years, and <40 years. Disease patterns, medical and surgical therapies, and risk factors for disease outcomes were analyzed. Results Chronic active or relapsing disease accounts for 44% of patients with late-onset UC. Across all age-groups, these disease patterns require 3–6 times more steroids than remitting disease, but immunomodulators and, to a lesser extent, biologics are less frequently prescribed in the elderly. Advanced age, concomitant diseases and related therapies were found to be inversely associated with the use of immunomodulators or biologics, but not with surgery. Conclusions The conclusion that late-onset UC follows a mild course may apply only to a subset of patients. an important percentage of elderly patients present with more aggressive disease. Since steroid use and surgery rates did not differ in this subgroup, lower use of immunosuppressive therapy and biologics may reflect concerns in prescribing these therapies in the elderly. [ABSTRACT FROM AUTHOR]

Background A pelvic magnetic resonance imaging (MRI) represents the front-line method for evaluating perianal disease in patients with inflammatory bowel disease (IBD). Recently, transperineal ultrasonography (TPUS) has been proposed as a simple, safe, time-sparing and useful diagnostic technique to assess different pathological conditions of the pelvic floor. Aim The aim of this prospective single centre study was to evaluate the accuracy of TPUS versus MRI for the detection and classification of perineal disease in IBD patients. Methods From November 2013 to November 2014, 28 IBD patients underwent either TPUS or MRI. Fistulae and abscesses were classified according to Parks’ and AGA's classification methods. A concordance was assessed by k statistics. Results Overall, 33 fistulae and 8 abscesses were recognized by TPUS (30 and 7 by MRI, respectively). The agreement between TPUS and MRI was 75% according to Parks’ classification ( k = 0.67) and 86% according to AGA classification ( k = 0.83), while it was 36% ( k = 0.34) for classifying abscesses. Conclusions TPUS proved to be as accurate as MRI for detecting superficial and small abscesses and for classifying perianal disease. Both examinations may be performed at the initial presentation of the patient, but TPUS is a cheaper, time-sparing procedure. The optimal use of TPUS might be in follow-up patients. [ABSTRACT FROM AUTHOR]

Mycoplasma hyopneumoniae is the etiological agent of enzootic pneumonia (EP), an economically important chronic respiratory disease in pigs. M. hyopneumoniae impacts the mucociliary clearance system by disrupting the cilia and modulates the immune response, resulting in intermittent dry non-productive cough. For progressive control of EP in Switzerland, a corresponding programme was fully implemented in 2004. It is based on total depopulation strategies of affected fattening farms as well as partial depopulation in breeding farms. Surveillance of EP status in Switzerland is mainly based on real-time PCR of nasal swabs from coughing animals or suspicious lungs and thereby sporadic cases are still observed every year. In order to obtain information on the seroprevalence, serum samples of 5021 sows from 968 farms collected in 2018 at eight different slaughterhouses were analyzed for the presence of M. hyopneumoniae -specific antibodies using a commercial ELISA kit. The overall seroprevalence was low with 0.98% of sows testing positive and these seropositive animals could be allocated to 3.92% of farms tested. Most seropositive farms presented weakly positive singleton reactors and only one farm showed several strongly seropositive animals. In conclusion, the serological status mirrors the successful progressive control of M. hyopneumoniae in the Swiss domestic pig population over the years. The current study underlines the added value of serological testing in the surveillance of EP in a country with low prevalence and confirms the sustained benefit of strategic control programmes. • Switzerland has progressively controlled enzootic pneumonia (EP) without vaccination. • In 2018, the seroprevalence in Switzerland for M. hyopneumoniae was < 1% for sows and <4% for farms keeping sows. • Recent cases of EP have been reported close to the Swiss border and in regions with relatively high numbers of wild boars. [ABSTRACT FROM AUTHOR]

Abstract: A sample of 170 Italian children was assessed for reading accuracy, reading speed, text comprehension and spelling in Grades 1 and 3 in order to investigate the concurrent and longitudinal relationships among literacy skills. Main results from multivariate analyses (regression, discriminant and path analyses) indicated that reading speed was the best predictor of later literacy and that spelling was the most stable measure and influenced text comprehension and reading speed. An asymmetry was also observed in the longitudinal relationship between reading and spelling errors, with reading errors predicting later spelling errors and a non-significant result in the opposite direction. [Copyright &y& Elsevier]

Abstract: Background: Only a small proportion of subjects referring to hospitals for hepatitis C virus (HCV) positivity receives antiviral therapy. Aim: To evaluate the rate of antiviral treatment and the causes for no treatment in HCV-RNA positive subjects seen in hospital settings. Patients and methods: A prospective study enrolling over a 6-month period (February–July 2009) all consecutive anti-HCV positive subjects initially referred (naïve patients) to 12 liver units in Southern Italy for HCV treatment. Results: Out of 608 subjects evaluated, 74 (12.2%) had no detectable HCV-RNA in the serum and thus were excluded. Of the remaining 534 HCV-RNA positive subjects, 357 (66.9%) were not treated for the following reasons: 49.9% were older than 65 years of age (75% of them >70 years), 14.3% had normal liver enzymes, 13.2% had compensated/decompensated cirrhosis, 10.4% refused treatment, 9.8% had ongoing substance or alcohol abuse. Multivariate analysis showed that females (O.R. 2.27; C.I. 95% 1.05–4.90) and subjects with low educational level (O.R. 4.38; C.I. 95% 1.27–15.11) were more likely to decline therapy. Conclusions: The majority of patients with HCV infection does not receive antiviral treatment. The effectiveness of the current standard therapy for HCV infection is low despite its good efficacy. [ABSTRACT FROM AUTHOR]

Abstract: Higher plasma concentrations of the N-terminal fragment of brain natriuretic peptide (NT-pro-BNP) and the tumor necrosis factor-α (TNF-α) have been observed in patients affected by chronic heart failure (CHF). Recent clinical studies have tried to correlate the plasma levels of these biomarkers with severity of the disease. To evaluate the role of NT-pro-BNP, TNF-α and C-reactive protein (CRP) in a population of geriatric patients affected by CHF, and to assess their different plasma levels in diabetics and in normoglycemic patients, we enrolled 57 patients affected by CHF: 29 patients were diabetic and 28 were normoglycemic. Clinical and echocardiographic examinations were performed in all patients, in order to evaluate the NYHA-class and the left ventricular ejection fraction (EF). All of them had been stabilized with medical therapy from at least 3 weeks. Plasma NT-pro-BNP, TNF-α and CRP levels were measured in each recruited patient. In the whole population we observed a linear correlation between NT-pro-BNP levels, EF and NYHA-class (p <0.05) but there was no significant correlation between TNF-α or CRP and the clinical or echocardiographic data (p =0.588 and p =0.9, respectively). Finally we evaluated, if there were significant differences in the biomarker concentrations between diabetics and normoglycemics. Both the clinical and the echocardiographic parameters of systolic dysfunction were comparable in these two groups. We observed a significant difference in CRP levels between the two groups (3.76±2.85 in diabetics vs. 1.42±2.35 in normoglycemics; p <0.001). The NT-pro-BNP levels were also higher in diabetics than in normoglycemic patients (12867.8±18042.0 vs. 6400.89±5655.0; p =0.07). Plasma TNF-α levels (23.03±11.52 vs. 23.31±12.0; p =0.93) and left ventricular EF (35.65±4.03 vs. 35.18±3.55; p =0.63) were similar in the two groups. In agreement with recent studies, we confirm a linear correlation between NT-pro-BNP, EF and the severity of disease in CHF patients. We also observed a greater cytokine activation in diabetics than in normoglycemic patients, demonstrating probably that in this group a greater inflammatory reaction is present. [Copyright &y& Elsevier]

Focuses on the use of ketogenic diet for seizure control in children with epilepsy. Program development for ketogenic diet; Response of patients on the program; Evaluation on the program.