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In most patients, shoulder pain has a neuromusculoskeletal cause. However, it might conceal other types of disorders, hiding a non-neuromusculoskeletal condition. The main aim of this scoping review is to map and summarise findings to identify red flags for gastrointestinal and hepatic diseases in the assessment of patients with shoulder pain.Five databases were searched up to 31 May 2021. Additional studies have been identified through grey literature, and the reference lists of the included studies have been screened. Any study design and publication type have been considered to be eligible for inclusion. No time, geographical setting and language restrictions have been applied.A total of 157 records have been identified, with 40 studies meeting the inclusion criteria (37 case reports, 2 retrospective studies and 1 systematic review with meta-analysis). The most prevalent red flags associated with shoulder pain were abdominal pain (14 cases) and abdominal discomfort (3 cases), reported by 47% of patients. As for comorbidities, hepato-gastric, cardiac, visceral and systemic diseases were the most common ones.Abdominal pain, right and left hypochondriac pain, and epigastric pain represent the most prevalent symptoms in patients with an abdominal disease that could mimic a shoulder problem. Clinicians should be encouraged to screen for red flags when assessing patients with shoulder pain.

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia.

Objectives The treatment program ‘Metacognitive training for patients with schizophrenia’ (MCT) addresses cognitive biases assumed to play a crucial role in the pathogenesis of delusions (e.g., jumping to conclusions, theory of mind deficits). The aim of our study was to examine the effectiveness and the feasibility of this intervention targeted to early phases of psychosis (MCT young version). Design An experimental design included two groups of subjects on the basis of their duration of untreated psychosis (DUP) ‘short’ (less or equal than 12 months) and ‘long’ DUP (longer than 12 months), assessed at baseline and after the 4-month intervention. Methods Fifty-six young subjects affected by early psychosis were assessed on psychopathology, social functioning, neurocognitive, and metacognitive measures. The primary outcome was the reduction of psychopathology. Secondary outcomes included reduction of cognitive and emotional dysfunction and improvement of social functioning. Results At the end of the 4-month MCT, both groups showed significant improvements in many variables: positive symptoms, cognitive functions, as verbal memory, attention and mental flexibility, and metacognitive functions, as cognitive insight. Significant and positive changes were found in theory of mind abilities and social perception. Conclusions The difference in DUP between the two groups of young subjects of our sample did not seem to influence the intervention outcomes, still taking into account that the average difference between the two groups in terms of DUP is 12.6 months. Practitioner points Metacognition refers to the general ability ‘to think about thinking,’ that is, the ability to think about one's mental state and the mental states of others. Persons with schizophrenia experience different metacognitive impairments. The metacognitive training for patients with schizophrenia – young version can be applied to young people affected by psychosis and seems to improve symptomatology, social functioning, cognitive, and metacognitive abilities, independently by their Duration of Untreated Psychosis over a 2-year period.

Hemoglobin (Hb) is the most abundant protein in human blood and we showed that under oxidative/nitrative stress conditions it is susceptible to cysteine oxidation, tyrosine nitration, and formation of a dimer of Hb subunits through tyrosine linkage. In the presence of hydrogen peroxide, Hb and its subunits efficiently convert nitrite into reactive nitrogen species, through reactions that are typical of perox- idases. If an exogenous phenolic substrate is present, Hb promotes its nitration with a fivefold higher efficiency with respect to the perox- idase-like phenol coupling reaction. In the absence of an exogenous substrate, the protein itself undergoes covalent modification. Trypsin treatment of Hb modified under conditions mimicking pathophysiolog

Infantile hemangiomas (IHs) with minimal or arrested growth differ from standard IHs in that they have a reduced or absent growth phase. An association between IHs with minimal or arrested growth and superimposed eczematous dermatitis has not been described in the literature. We present a case detailing this association in which an IH with minimal or arrested growth responded well to treatment with propranolol and the superimposed eczema cleared completely with topical hydrocortisone.

Aim: On 6 April 2009, at 3:32 GMT, central Italy was struck by a 6.3-magnitude earthquake with its epicentre near L'Aquila, the capital city of the Abruzzo region. Earthquakes may precipitate psychiatric symptoms. The aim of this study was to investigate cognitive functioning and positive and negative symptoms before and after the 2009 L'Aquila earthquake in patients with first-episode psychosis (FEP) and chronic schizophrenia (CS). Methods: A total of 54 FEP patients (34 males and 20 females) and 63 CS patients (39 males and 24 females) were investigated. Psychometric scores were submitted to a 2 × 2 mixed analysis of variance, with group (FEP and CS) as the between-subjects variable and time (pre- and post-earthquake) as the within-subjects variable. Results: Positive symptoms increased significantly from the pre- to the post-earthquake assessment in FEP patients but not in those with CS. There were no significant differences between the pre- and post-earthquake period in terms of negative symptoms in both groups. Compared with the pre-earthquake assessment, FEP patients scored significantly worse at the post-earthquake evaluation in terms of Wisconsin Card Sorting Test categories achieved, immediate verbal memory and delayed verbal memory. However, there were no significant differences in cognitive scores between the pre- and post-earthquake periods in patients with CS. Conclusions: Our findings suggest that a disastrous earthquake has a negative impact on cognitive functioning and positive symptoms in FEP patients, but not in those with CS. Language: en

A validation of two rating scales is presented. We first translated the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for In‐patient Evaluation (NOSIE), which cover different aspects of psychopathology, into Italian. We then tested their validity and reliability in terms of inter‐rater and internal consistency. For validity, both cases and controls were included: for the MOAS we compared patients who were aggressive (cases) to those who were presumably non‐aggressive (controls). For the NOSIE, cases were acute inpatients and controls were subjects with expected stable behaviour. The Brief Psychiatric Rating Scale (BPRS) was also administered to cases in order to test convergent validity. Either the NOSIE and/or MOAS scales were administered to 358 psychiatric inpatients. A subset of these patients (131 for the MOAS and 226 for the NOSIE) was also used to test the inter‐rater reliability. Both scales showed good psychometric properties. The correlation coefficients between raters were much higher than 0.75 (for the NOSIE) or 0.90 (for the MOAS), while the discriminant power between cases and controls was confirmed for both scales and good concordance with BPRS was observed. The NOSIE showed good internal consistency for all domains except neatness. In general the MOAS showed better results than the NOSIE for all psychometric properties, although both scales are suitable for monitoring the behaviour and aggression of acute ward inpatients. Copyright © 2005 Whurr Publishers Ltd.

The role of myoglobin (Mb) is not yet completely understood and recent evidence indicates it is involved in a variety of pseudo-enzymatic functions. Mb is also extensively used as a tool to redesign novel active-site features and introduce new activities into a protein. This review summarizes our approach to enhance the peroxidase-like activity of Mb toward phenolic compounds by combining two different strategies of protein modification, i.e. active-site engineering and cofactor replacement. The main objective of active-site engineering is to increase the rate of hydrogen peroxide activation upon reaction at the iron(III) center, while cofactor replacement facilitates substrate interaction at the protein active site, thereby increasing the efficiency of the catalytic process and stereoselective recognition of the substrate. The thermodynamic stability of the modified Mb derivatives has been evaluated through guanidinium chloride induced and thermal unfolding experiments. As expected, both protein mutation and cofactor replacement decrease the stability of the protein, the latter effect being somewhat more pronounced for the Mb derivatives studied here. For evaluating the catalytic efficiency of the protein in non-natural reactions, the chemical stability of the protein during catalysis is also important and therefore a new protocol was developed to evaluate the competitive degradation undergone by the protein upon substrate oxidation. It was found that autodegradation can occur through two different pathways involving oxidation of protein residues by the Mb active species or by a substrate-derived phenoxy radical. The peroxidase-like nitrating activity and the sulfoxidation reactions promoted by Mb, both involving the nitrite ion as a cosubstrate, have also been briefly described. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2004)

Metmyoglobin catalyzes the nitration of various phenolic compounds in the presence of nitrite and hydrogen peroxide. The reaction rate depends on the reactant concentrations and shows saturation behavior. Two competing paths are responsible for the reaction. In the first, myoglobin reacts according to a peroxidase-like cycle forming two active intermediates, which can induce one-electron oxidation of the substrates. The MbFe(IV)==O intermediate oxidizes nitrite to nitrogen dioxide, which, after reaction with the phenol or with a phenoxy radical, yields the nitrophenol. In the second mechanism, hydrogen peroxide reacts with iron-bound nitrite to produce an active nitrating species, which we assume to be a protein-bound peroxynitrite species, MbFe(III)--N(O)OO. The high nitrating power of the active species is shown by the fact that the catalytic rate constant is essentially independent of the redox properties of the phenol. The occurrence of one or other of these mechanisms depends on the nitrite concentration: at low [NO(2) (-)] the nitrating agent is nitrogen dioxide, whereas at high [NO(2) (-)] the peroxynitrite path is dominant. The myoglobin derivative that accumulates during turnover depends on the mechanism. When the path involving NO(2) (.) is dominant, the spectrum of the MbFe(IV)==O intermediate is observed. At high nitrite concentration, the Soret band appears at 416 nm, which we attribute to an iron-peroxynitrite species. The metMb/NO(2) (-)/H(2)O(2) system competitively nitrates the heme and the endogenous tyrosine at position 146 of the protein. Phenolic substrates protect Tyr146 from nitration by scavenging the active nitrating species. The exposed Tyr103 residue is not nitrated under the same conditions.

Peroxidases perform the nitration of tyrosine and tyrosyl residues in proteins, in the presence of nitrite and hydrogen peroxide. The nitrating species is still unknown but it is usually assumed to be nitrogen dioxide. In the present investigation, the nitration of phenolic compounds derived from tyrosine by lactoperoxidase and horseradish peroxidase was studied, with the aim of elucidating the mechanism of the reaction. The results indicate that nitrogen dioxide cannot be the only nitrating species and suggest the presence of two simultaneously operative pathways, one proceeding through enzyme-generated nitrogen dioxide and another through a more reactive species, assumed to be complexed peroxynitrite, which is generated by reaction of hydrogen peroxide with the enzyme-nitrite complex. The importance of the two pathways depends on peroxide and nitrite concentrations. With lactoperoxidase, nitration through the highly reactive intermediate is preferred except at very low nitrite concentration, while with horseradish peroxidase, the nitrogen dioxide driven mechanism is preferred except at very high nitrite concentration. The preferred mechanism for the two enzymes is that operative in the physiological nitrite concentration range.