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Since its first introduction, levodopa has remained the cornerstone treatment for Parkinson's disease. However, as the disease advances, the therapeutic window for levodopa narrows, leading to motor complications like fluctuations and dyskinesias. Clinicians face challenges in optimizing daily therapeutic regimens, particularly in advanced stages, due to the lack of quantitative biomarkers for continuous motor monitoring. Biochemical sensing of levodopa offers a promising approach for real-time therapeutic feedback, potentially sustaining an optimal motor state throughout the day. These sensors vary in invasiveness, encompassing techniques like microdialysis, electrochemical non-enzymatic sensing, and enzymatic approaches. Electrochemical sensing, including wearable solutions that utilize reverse iontophoresis and microneedles, is notable for its potential in non-invasive or minimally invasive monitoring. Point-of-care devices and standard electrochemical cells demonstrate superior performance compared to wearable solutions; however, this comes at the cost of wearability. As a result, they are better suited for clinical use. The integration of nanomaterials such as carbon nanotubes, metal-organic frameworks, and graphene has significantly enhanced sensor sensitivity, selectivity, and detection performance. This framework paves the way for accurate, continuous monitoring of levodopa and its metabolites in biofluids such as sweat and interstitial fluid, aiding real-time motor performance assessment in Parkinson's disease. This review highlights recent advancements in biochemical sensing for levodopa and catecholamine monitoring, exploring emerging technologies and their potential role in developing closed-loop therapy for Parkinson's disease.

The study's aim was to determine the prevalence of depression and anxiety in children with Beckwith-Wiedemann syndrome (BWS) and their effects on social relationships and family acceptance. The Pediatric Symptom Checklist-35 items (PSC-35), Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Vineland Adaptive Behavior Scale Second Edition (VABS-II) were administered to the children. The parental Acceptance Rejection/Control Questionnaire (PARQ/Control) and Zarit Burden Inventory (ZBI) were administered to parents. In total, 6 patients and 10 parents were included. Patients showed a significant presence of internalizing behavior in PSC-35 (mean, 7.66 ± 3.67), anxiety symptoms (SCARED: mean, 46.33 ± 17.50) and socialization difficulties (mean, 90.83 ± 10.09). Parents reported a perceived good acceptance (mean, 56.33 ± 1.03) and a moderate control (mean, 24.17 ± 1.83), but the burden level was ranked moderate to severe (mean, 59.33 ± 16.78). It was found that the severity of the burden level reported by parents was related to internalizing behavior (OR = 2.000; 95% CI = 0.479-3.521; p = 0.022) and anxiety symptoms (SCARED total score: OR = 3.000; 95% CI = 1.479-4.521; p = 0.005) of children. During psychological counseling in the context of BWS treatment, it is important to identify specific resources that can support patients and families in dealing with stress and identify any critical areas that could hinder the adaptation process.

Here, we report the perioperative management of a clinical case of a 6 year, 5 month old girl suffering from Beckwith-Wiedemann syndrome undergoing a partial glossectomy procedure in a patient with surgical indication for obstructive sleep apnea syndrome (OSAS), difficulty swallowing, feeding, and speech. On surgery day, Clonidine (4 µg/kg) was administered. Following this, a general anesthesia induction was performed by administering Sevoflurane, Fentanyl, continuous intravenous Remifentanil, and lidocaine to the vocal cords, and a rhinotracheal intubation with a size 4.5 tube was carried out. Before starting the procedure, a block of the Lingual Nerve was performed with Levobupivacaine. Analgosedation was maintained with 3% Sevoflurane in air and oxygen (FiO 2 of 40%) and Remifentanil in continuous intravenous infusion at a rate of 0.08-0.15 µg/kg/min. The surgical procedure lasted 2 h and 32 min. At the end of the surgery, the patient was under close observation during the first 72 h. In the pediatric patient with Beckwith-Wiedemann syndrome submitted to major maxillofacial surgery, the difficulty in managing the airways in the preoperative phase during intubation and in the post-operative phase during extubation should be considered.

Since its first introduction, levodopa has become the cornerstone for the treatment of Parkinson's disease and remains the leading therapeutic choice for motor control therapy so far. Unfortunately, the subsequent appearance of abnormal involuntary movements, known as dyskinesias, is a frequent drawback. Despite the deep knowledge of this complication, in terms of clinical phenomenology and the temporal relationship during a levodopa regimen, less is clear about the pathophysiological mechanisms underpinning it. As the disease progresses, specific oscillatory activities of both motor cortical and basal ganglia neurons and variation in levodopa metabolism, in terms of the dopamine receptor stimulation pattern and turnover rate, underlie dyskinesia onset. This review aims to provide a global overview on levodopa-induced dyskinesias, focusing on pathophysiology, clinical manifestations, therapy management strategies and future directions.

Introduction: The present study explores brain connectivity in Parkinson's disease (PD) and in age matched healthy controls (HC), using quantitative EEG analysis, at rest and during a motor tasks. We also evaluated the diagnostic performance of the phase locking value (PLV), a measure of functional connectivity, in differentiating PD patients from HCs., Methods: High-density, 64-channels, EEG data from 26 PD patients and 13 HC were analyzed. EEG signals were recorded at rest and during a motor task. Phase locking value (PLV), as a measure of functional connectivity, was evaluated for each group in a resting state and during a motor task for the following frequency bands: (i) delta: 2-4 Hz; (ii) theta: 5-7 Hz; (iii) alpha: 8-12 Hz; beta: 13-29 Hz; and gamma: 30-60 Hz. The diagnostic performance in PD vs. HC discrimination was evaluated., Results: Results showed no significant differences in PLV connectivity between the two groups during the resting state, but a higher PLV connectivity in the delta band during the motor task, in HC compared to PD. Comparing the resting state versus the motor task for each group, only HCs showed a higher PLV connectivity in the delta band during motor task. A ROC curve analysis for HC vs. PD discrimination, showed an area under the ROC curve (AUC) of 0.75, a sensitivity of 100%, and a negative predictive value (NPV) of 100%., Conclusions: The present study evaluated the brain connectivity through quantitative EEG analysis in Parkinson's disease versus healthy controls, showing a higher PLV connectivity in the delta band during the motor task, in HC compared to PD. This neurophysiology biomarkers showed the potentiality to be explored in future studies as a potential screening biomarker for PD patients.

Carpobrotus acinaciformis and C. edulis are well-known invasive alien plants native to South Africa, whose detrimental effects on native communities are widely documented in the Mediterranean basin and thus largely managed in coastal ecosystems. Most of the literature on these species focuses on their impacts on habitats of sandy coastal dunes, while the effects of Carpobrotus spp. invasion on other habitats such as rocky cliffs and coastal scrubs and garrigues are almost neglected. We present a study case conducted on a small Mediterranean island where Carpobrotus spp. invaded three different natural habitats listed within the Habitat Directive 92/43/CEE (Natura 2000 codes 1240, 1430, and 5320). We surveyed the presence and abundance of native species and Carpobrotus spp. on 44 permanent square plots of 4 m 2 in invaded and uninvaded areas in each of the three habitats. We found impacts on plant alpha diversity (intended as the species diversity within each sampled plot) in all the habitats investigated in terms of a decrease in species richness, Shannon index, and abundance. Invaded communities also showed a severe change in species composition with a strong homogenization of the floras of the three habitats. Finally, the negative effect of invasion emerged even through the analyses of beta diversity (expressing the species diversity among sampled plots of the same habitat type), with Carpobrotus spp. replacing a large set of native species., Competing Interests: The authors declare no conflict of interest.

Dystonia diagnosis is based on clinical examination performed by a neurologist with expertise in movement disorders. Clues that indicate the diagnosis of a movement disorder such as dystonia are dystonic movements, dystonic postures, and three additional physical signs (mirror dystonia, overflow dystonia, and geste antagonists/sensory tricks). Despite advances in research, there is no diagnostic test with a high level of accuracy for the dystonia diagnosis. Clinical neurophysiology and genetics might support the clinician in the diagnostic process. Neurophysiology played a role in untangling dystonia pathophysiology, demonstrating characteristic reduction in inhibition of central motor circuits and alterations in the somatosensory system. The neurophysiologic measure with the greatest evidence in identifying patients affected by dystonia is the somatosensory temporal discrimination threshold (STDT). Other parameters need further confirmations and more solid evidence to be considered as support for the dystonia diagnosis. Genetic testing should be guided by characteristics such as age at onset, body distribution, associated features, and coexistence of other movement disorders (parkinsonism, myoclonus, and other hyperkinesia). The aim of the present review is to summarize the state of the art regarding dystonia diagnosis focusing on the role of neurophysiology and genetic testing.

Narrow endemic plants constitute a pivotal group for conservation, being often reduced to a small contingent of individuals and frequently threatened. However, effective conservation actions require reliable basic information about distribution range, ecological requirements, and population traits. Nevertheless, such knowledge results are incomplete or even completely missing for some neglected or recently described plants, such as Cirsium alpis-lunae , a thistle exclusive to the N-Apennines (Italy). To fill this gap, all sites where C. alpis-lunae grow were monitored, and data on the site and population traits were collected. Our results indicated that this plant is restricted to 16 scattered sites, varied in surface area and number of individuals. Reproductive and juvenile plants showed to be affected by roughly the same variables, in particular the surface of the site, the slope aspect, and the canopy cover. The narrow ecological niche of C. alpis-lunae was mainly determined by the canopy cover, and where coverage increases, the number of individuals decreases. The individuals only grow at forest edges, where the peculiar ecological conditions are limiting factors for the development of forestry cover; some other factors (i.e., high inclination and instability of the substrate) contribute to limiting the development of forestry vegetation and guarantee the persistence of these ecotones. Despite the great difficulties in accessing the sites where this species grows, this study presents, for the first time, a complete picture of the C. alpis-lunae population and yielded important data to identify effective conservation measures.

Dystonia is a hyperkinetic movement disorder characterized by abnormal movement or posture caused by excessive muscle contraction. Because of its wide clinical spectrum, dystonia is often underdiagnosed or misdiagnosed. In clinical practice, dystonia could often present in association with other movement disorders. An accurate physical examination is essential to describe the correct phenomenology. To help clinicians reaching the proper diagnosis, several classifications of dystonia have been proposed. The current classification consists of axis I, clinical characteristics, and axis II, etiology. Through the application of this classification system, movement disorder specialists could attempt to correctly characterize dystonia and guide patients to the most effective treatment. The aim of this article is to describe the phenomenological spectrum of dystonia, the last approved dystonia classification, and new emerging knowledge.

COVID-19 is a viral infection, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and characterized by a complex inflammatory process and clinical immunophenotypes. Nowadays, several alterations of immune response within the respiratory tracts as well as at the level of the peripheral blood have been well documented. Nonetheless, their effects on COVID-19-related cell heterogeneity and disease progression are less defined. Here, we performed a single-cell RNA sequencing of about 400 transcripts relevant to immune cell function including surface markers, in mononuclear cells (PBMCs) from the peripheral blood of 50 subjects, infected with SARS-CoV-2 at the diagnosis and 27 healthy blood donors as control. We found that patients with COVID-19 exhibited an increase in COVID-specific surface markers in different subsets of immune cell composition. Interestingly, the expression of cell receptors, such as IFNGR1 and CXCR4, was reduced in response to the viral infection and associated with the inhibition of the related signaling pathways and immune functions. These results highlight novel immunoreceptors, selectively expressed in COVID-19 patients, which affect the immune functionality and are correlated with clinical outcomes.

The escalation of Coronavirus disease 2019 (COVID-19) has required the development of safe and effective vaccines against the severe acute respiratory syndrome coronavirus 2-associated (SARS-CoV-2), which is the causative agent of the disease. Here, we determined the levels of antibodies, antigen-specific B cells, against a recombinant GFP-tagged SARS-CoV-2 spike (S) protein and total T and NK cell subsets in subjects up to 20 days after the injection of the BNT162b2 (Pfizer-BioNTech) vaccine using a combined approach of serological and flow cytometry analyses. In former COVID-19 patients and highly responsive individuals, a significant increase of antibody production was detected, simultaneous with an expansion of antigen-specific B cell response and the total number of NK-T cells. Additionally, through a genetic screening of a specific polymorphic region internal to the 3' regulatory region 1 (3'RR1) of human immunoglobulin constant-gene (IgH) locus, we identified different single-nucleotide polymorphic (SNP) variants associated with either highly or lowly responsive subjects. Taken together, these results suggest that favorable genetic backgrounds and immune profiles support the progression of an effective response to BNT162b2 vaccination.

Background and Aims: The WHO has solicited all countries to eliminate HCV by 2030. The Italian government started routine screening for HCV infection in January 2021, initially targeting subjects born between 1969 and 1989. With the aim of achieving micro-elimination, we designed a hospital-wide project focusing on inpatients born from 1935 to 1985 and conducted it in our institution., Method: All inpatients aged 35 to 85, admitted from 10 February 2020 to 9 February 2021 for many different diseases and conditions underwent HCV antibody (HCVAb) testing by third-generation ELISA. When positive, reflex HCV RNA testing and genotyping were performed. Clinical history, fibrosis diagnosis, laboratory data and concomitant medications were available for all., Results: The HCV screening rate of inpatients was 100%. In total, 11,748 participants were enrolled, of whom 53.50% were male. The HCVAb positivity rate was 3.03%. The HCVAb rate increased with age and was higher for patients born between 1935 and 1944 (4.81%). The rate of HCV RNA positivity was 0.97%. The vast majority (80.70%) of HCV RNA-positive participants were 55 or older; in about 40% of cases, HCV RNA-positive patients were unaware of their infection. Although 16 patients died after HCV chronic infection diagnosis (two due COVID-19) or HCV treatment prescription (one due to COVID-19), 74.56% of patient HCV diagnoses were linked to HCV treatment, despite their co-morbidities. All patients older than 65 who died had an active HCV infection., Conclusion: The present study revealed a rate of active HCV infections among inpatients lower than what has been reported in the past in the general population; this appears to be a result of the widespread use of pangenotypic direct-acting antiviral agents (DAAs). The overall rate of active infection was lower than the rate observed in the 1935-1954 cohort. The high rate of inpatients unaware of HCV infections and the high number of deaths among subjects with an active HCV infection born from 1935 to 1954, suggest that, at least in southern Italy, targeted screening of this birth cohort may be required to reduce the number of undiagnosed cases and hidden infections.

Background: The diagnosis of Coronavirus disease 2019 (COVID-19) relies on the positivity of nasopharyngeal swab. However, a significant percentage of symptomatic patients may test negative. We evaluated the reliability of COVID-19 diagnosis made by radiologists and clinicians and its accuracy versus serology in a sample of patients hospitalized for suspected COVID-19 with multiple negative swabs., Methods: Admission chest CT-scans and clinical records of swab-negative patients, treated according to the COVID-19 protocol or deceased during hospitalization, were retrospectively evaluated by two radiologists and two clinicians, respectively., Results: Of 254 patients, 169 swab-confirmed cases and one patient without chest CT-scan were excluded. A total of 84 patients were eligible for the reliability study. Of these, 21 patients died during hospitalization; the remaining 63 underwent serological testing and were eligible for the accuracy evaluation. Of the 63, 26 patients showed anti-Sars-Cov-2 antibodies, while 37 did not. The inter-rater agreement was "substantial" (kappa 0.683) between radiologists, "moderate" (kappa 0.454) between clinicians, and only "fair" (kappa 0.341) between radiologists and clinicians. Both radiologic and clinical evaluations showed good accuracy compared to serology., Conclusions: The radiologic and clinical diagnosis of COVID-19 for swab-negative patients proved to be sufficiently reliable and accurate to allow a diagnosis of COVID-19, which needs to be confirmed by serology and follow-up.