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Acute vertigo is defined as the perception of movement of oneself or the surroundings in the absence of actual motion and it is a frequent cause for emergency department admissions. The utilization of medical resources and the duration of hospital stay for this kind of symptom is high. Furthermore, the efficiency of brain imaging in the acute phase is low, considering the limited sensitivity of both CT and MRI for diagnosing diseases that are the causes of central type of vertigo. Relying on imaging tests can provide false reassurance in the event of negative results or prolong the in-hospital work-up improperly. On the other hand, clinical examinations, notably the assessment of nystagmus' features, have proven to be highly accurate and efficient when performed by experts. Literature data point out that emergency physicians often do not employ these skills or use them incorrectly. Several clinical algorithms have been introduced in recent years with the aim of enhancing the diagnostic accuracy of emergency physicians when evaluating this specific pathology. Both the 'HINTS and 'STANDING' algorithms have undergone external validation in emergency physician hands, showing good diagnostic accuracy. The objective of this consensus document is to provide scientific evidence supporting the clinical decisions made by physicians assessing adult patients with acute vertigo in the emergency department, particularly in cases without clear associated neurological signs. The document aims to offer a straightforward and multidisciplinary approach. At the same time, it tries to delineate benchmarks for the formulation of local diagnostic and therapeutic pathways, as well as provide a base for the development of training and research initiatives., (© 2024. The Author(s).)

Background: The aims of this analysis were: to evaluate the impact of timing of ablation on the rate of atrial arrhythmias recurrence, verify if the timing of ablation impact differently in patients with paroxysmal and persistent AF., Methods: Three thousand two hundred and five patients (60.5 ± 10 years, female 28.4%%, 78.8%% paroxysmal AF) were included in the analysis. All patients underwent only cryoballoon (CB) pulmonary vein (PV) isolation during the index procedure., Results: The mean procedure time was 102.8 ± 50 min, with a mean fluoroscopy time of 26.3 ± 49 min. Acute PV isolation was achieved in 11760/11793 (99.7%) PVs. A total of 91 (2.8%) patients experienced a procedure-related complication. During the observation period 913/3205 (28.5%) patients had at least one atrial arrhythmias episode: 28% of patients with paroxysmal AF vs 33% of patients with persistent AF. In multivariate analysis, persistent AF together with time from symptomatic AF diagnosis to ablation, female sex, and ablation time showed to be significant predictors for AF recurrence. In particular, months from first symptomatic AF episode > 18 months was a significant predictor of AF recurrence (HR = 1.23, 95% CI = 1.03-1.46, p = 0.020). In patients with paroxysmal AF, the multivariate analysis confirmed that months from first symptomatic AF episode > 18 month was an independent predictor of AF recurrence together with age > 62 years and female sex. In patients with persistent AF, the time from persistent AF showed to be significant predictor for AF recurrence., Conclusions: In this multicenter analysis, time from first symptomatic AF episode > 18 months was a significant predictor of AF recurrence after CB PV isolation., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of patients with symptomatic atrial fibrillation (AF). AF symptoms are highly subjective; however, they are important outcomes for the patient. The aim is to describe the use and impact of a web-based App to collect AF-related symptoms in a population of patients who underwent PVI-C in seven Italian centers., Methods: A patient App to collect AF-related symptoms and general health status was proposed to all patients who underwent an index PVI-C. Patients were divided into two groups according to the utilization of the App or the non-usage., Results: Out of 865 patients, 353 (41%) subjects composed the App group, and 512 (59%) composed the No-App group. Baseline characteristics were comparable between the two cohorts except for age, sex, type of AF, and body mass index. During a mean follow-up of 7.9±13.8 months, AF recurrence was found in 57/865 (7%) subjects with an annual rate of 7.36% (95% CI:5.67-9.55%) in the No-App versus 10.99% (95% CI:9.67-12.48%) in the App group, p=0.007. In total, 14,458 diaries were sent by the 353 subjects in the App group and 77.1% reported a good health status and no symptoms. In only 518 diaries (3.6%), the patients reported a bad health status, and bad health status was an independent parameter of AF recurrence during follow-up., Conclusions: The use of a web App to record AF-related symptoms was feasible and effective. Additionally, a bad health status reporting in the App was associated with AF recurrence during follow-up., (© 2023. The Author(s).)

Background: Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF). The CHA 2 DS 2 -VASc score is a well-established predictor of AF-related stroke. Whether the CHA 2 DS 2 -VASc score can also be useful in predicting the long-term clinical outcomes following PVI-C is still unsettled. The aim of this analysis was to evaluate the role of the CHA 2 DS 2 -VASc score in predicting AF recurrence after PVI-C., Methods: Patients with symptomatic AF underwent an index PVI-C. Data were collected prospectively in the framework of the 1STOP ClinicalService project. Patients were categorized into two groups: low risk (LR) and high risk (HR) based on CHA 2 DS 2 -VASc score (0-1 and ≥ 2, respectively)., Results: Out of 3313 patients, 1910 (57.6%) had a CHA 2 DS 2 -VASc score between 0 and 1, while 1403 (42.3%) had CHA 2 DS 2 -VASc > = 2. Patient characteristics were significantly different between the two cohorts, including age, sex, BMI, paroxysmal AF, history of stroke, diabetes, and ischemic cardiomyopathy. On the contrary, procedural times and acute complications were comparable. The 36-month freedom from AF after a single procedure was 72.5% (95% CI: 69.8-75.0) in the LR group and 65.9% (95% CI: 62.3-69.2) in the HR score group (HR: 1.26, 95% CI: 1.08-1.47, p = 0.001). After multivariate analysis, higher CHA 2 DS 2 -VASc score was still a significant predictor of the risk of AF recurrence (HR: 1.33; 1.10-1.60, p = 0.003)., Conclusions: PVI-C is highly effective in the treatment of AF over the long term. A CHA 2 DS 2 -VASc score ≥ 2 is an independent predictor of AF recurrence during the follow-up and should be considered during the clinical management after the index procedure., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Pulmonary vein isolation (PVI) using cryoablation (PVI-C) is a widespread therapy for treating symptomatic, recurrent atrial fibrillation (AF). The impacts of sex on efficacy and safety of PVI-C in a real-world clinical practice is lacking. In a multicenter prospective project, we evaluated whether clinical characteristics, procedure parameters, procedural complications, long-term AF recurrence rates, and/or AF-related symptoms differed according to sex in patients treated with PVI-C., Methods: Data from the study population were collected in the framework of the 1STOP ClinicalService® project, involving 47 Italian cardiology centers. Multivariable statistical analyses were conducted to determine if any baseline clinical characteristics impacted the efficacy of PVI-C., Results: From April 2012, 2125 patients (27% female, 59 ± 11 years, 73% paroxysmal AF, and mean left atrial diameter = 42 ± 8 mm) underwent PVI-C. According to baseline characteristics, women were more likely to be older, with higher clinical risk scores (e.g., CHA 2 DS 2 -VASc), and a higher number of tested antiarrhythmic drugs before the index PVI-C procedure. Male and female cohorts showed comparable procedure time (mean = 107.7 ± 46.8 min) and a similar incidence of periprocedural complications (4.5% overall), even after adjustment for baseline characteristics (P = 0.880). The multivariable analyses demonstrated that the strongest predictor of AF recurrences was sex (0.74; 95% CI 0.58-0.93; P = 0.011). After propensity score adjustment, the hazard ratio from a multivariable model, which included age and AF type (persistent) as covariates, was 0.76 (0.60-0.97) (P = 0.025)., Conclusions: According to the 1STOP project, in a real-world setting, PVI-C was relatively safe regardless of the patient's sex; however, when considering efficacy of the procedure, female patients had a lower long-term efficacy in comparison to males., Clinical Trial Registration: NCT01007474.

The species of the Drosophila fasciola subgroup Wasserman represent the dominant section of the Drosophila repleta group Wasserman in the American rainforests and have a broad geographical distribution in the New World. However, despite of its wide range, the D. fasciola subgroup is one of the most overlooked D. repleta subgroups. Here, we report a molecular phylogenetic analysis focused on the D. fasciola subgroup using two mitochondrial [cytochrome oxidase subunit I (COI), cytochrome oxidase subunit II (COII)] and two nuclear [elongation factor-1alpha F1 (EF-alphaF1) and transformer (tra)] genes. Overall, we found that this subgroup is a monophyletic taxon, subdivided into two main internal branches: named Fas1 and Fas2 clades. The diversification of these clades is estimated to have begun in the middle Miocene, around 12 Ma [95% high posterior density (HPD) 9.0-15 Ma], and might be associated with the colonization of South America by Central America populations after the closure of Isthmus of Panama due to the temporal congruence between these events. The terminal branches had their origins estimated to be in the Pliocene or the Plio-Pleistocene transition. For the later estimates, both the geomorphological influences and the climatic oscillations of the Pleistocene may have played a role in shaping the diversification of the D. fasciola group.

Background: Surgical management of Ménière's disease (MD) is recommended in case of medical and intratympanic treatment failures. Translabyrinthine vestibular nerve section has been considered the gold standard for denervation procedures in order to control vertigo attacks, although at the cost of sacrificing residual hearing. To the best of our knowledge, no work has been published with regard to a group of patients submitted to translabyrinthine vestibular neurectomy and simultaneous cochlear implant for MD. The aim of the present study was to assess the effectiveness of translabyrinthine vestibular nerve section and simultaneous cochlear implant in a prospective study., Methods: All adult patients (over 18 years of age) with a diagnosis of intractable unilateral definite MD and useless residual hearing function were enrolled after medical and intratympanic treatment failures. Pre- and postoperative otoneurological evaluation concerned: frequency of vertigo attacks, head impulse test and caloric testing, pure tone average and speech perception audiometry in quiet conditions, tinnitus handicap inventory test, functional level scale and rate of vertigo control, dizziness handicap inventory test, and MD patient-oriented severity index. At least 6 months of follow-up were needed to be enrolled in the study., Results: Four patients were included in the study. Translabyrinthine vestibular nerve section and simultaneous cochlear implant seemed to considerably improve the disabling effects of MD, achieving a good control of vestibular symptoms (mean pre/postoperative vertigo attacks per month: 16.5/0), resolving hearing loss (mean pre/postoperative pure tone average in the affected ear: 86.2/32.5 dB), improving the tinnitus (mean pre/postoperative tinnitus handicap inventory test: 77.2/6), and finally increasing the overall quality-of-life parameters., Conclusions: In our preliminary report, translabyrinthine vestibular nerve section and simultaneous cochlear implant showed encouraging results in order to definitively control both vestibular and cochlear symptoms during the same therapeutic procedure.

In this work, we investigated the morphological variation of the intromittent male copulatory organ (aedeagus) of specimens from natural populations of two cactophilic Drosophila species distributed in the southeast region of Brazil, Drosophila gouveai Tidon-Sklorz & Sene and Drosophila antonietae Tidon-Sklorz & Sene. It was explored how the within-species variability is arranged for both species, considering their historical and ecological features. Our results showed two distinct aedeagal morphologies for these species, and differences within species were observed only in D. gouveai as specimens could be distinguished by their population origin. In contrast, after size discrepancies correction, this feature was not detected in D. antonietae. The contrasting patterns of intraspecific variation, together with the other features exhibited by these two species, are most likely to be explained by differences in the historical host plant association and distribution and in demographic events, which determined the evolutionary history of these two South American cactophilic Drosophila species.