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Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.

Despite the huge progress in the definition and classification of vestibular disorders within the last decade, there are still patients whose recurrent vestibular symptoms cannot be attributed to any of the recognized episodic vestibular syndromes, such as Menière's disease (MD), vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV), vestibular paroxysmia, orthostatic vertigo or transient ischemic attack (TIA). The aim of the present international, multi-center, cross-sectional study was to systematically characterize the clinical picture of recurrent vestibular symptoms not otherwise specified (RVS-NOS) and to compare it to MD and VM. Thirty-five patients with RVS-NOS, 150 patients with VM or probable VM and 119 patients with MD were included in the study. The symptoms of RVS-NOS had been present for 5.4 years on average before inclusion, similar to VM and MD in this study, suggesting that RVS-NOS is not a transitory state before converting into another diagnosis. Overall, the profile of RVS-NOS vestibular symptoms was more similar to VM than MD. In particular, the spectrum of vestibular symptom types was larger in VM and RVS-NOS than in MD, both at group comparison and the individual level. However, in contrast to VM, no female preponderance was observed for RVS-NOS. Positional, head-motion and orthostatic vertigo were reported more frequently by patients with RVS-NOS than MD, while external vertigo was more prevalent in the MD group. At group level, the spectrum of attack durations from minutes to 3 days was evenly distributed for VM, while a small peak for short and long attacks in RVS-NOS and a big single peak of hours in MD were discernible. In general, vertigo attacks and associated vegetative symptoms (nausea and vomiting) were milder in RVS-NOS than in the other two disorders. Some patients with RVS-NOS described accompanying auditory symptoms (tinnitus: 2.9%, aural fullness and hearing loss: 5.7% each), migrainous symptoms (photophobia, phonophobia or visual aura in 5.7% each) or non-migrainous headaches (14%), but did not fulfill the diagnostic criteria for MD or VM. Absence of a life time diagnosis of migraine headache and attack duration of

Augusto Pietro Casani,1 Elena Navari,1 Roberto Albera,2 Giuseppe Agus,3 Giacinto Asprella Libonati,4 Giuseppe Chiarella,5 Nicola Lombardo,6 Vincenzo Marcelli,7 Giovanni Ralli,8 Leonardo Scotto di Santillo,9 Roberto Teggi,10 Pasquale Viola,5 Luigi Califano111Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy; 2Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin School of Medicine, Turin, Italy; 3Otorhinolaryngology, Private Practice, Cagliari, Italy; 4Ear, Nose and Throat Department, Unit of Audiology, Vestibology and Phoniatry, Madonna delle Grazie Hospital, Matera, Italy; 5Department of Experimental and Clinical Medicine, Unit of Audiology and Phoniatrics, Magna Græcia University, Catanzaro, Italy; 6Otorhinolaryngology Section, Mater Domini University, Catanzaro, Italy; 7Department of Neuroscience, Vestibular and Audiology Unit, University of Naples “Federico II”, Naples, Italy; 8Department of Sense Organs, Sapienza University of Rome, Rome, Italy; 9Vestibology and Vestibular Rehabilitation Unit, Antero Micone Hospital, Genoa, Italy; 10Ear, Nose and Throat Department, San Raffaele Scientific Hospital, Milan, Italy; 11Audiovestibology Unit, G. Rummo Hospital, Benevento, ItalyPurpose: To assess if a polyphenol compound supplementation (Vertigoval®) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology.Methods: In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined.Results: A statistically significant greater decrease was established in the TG for DHI, D-VAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment.Conclusion: Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications.Keywords: residual dizziness, benign, paroxysmal positional vertigo, BPPV, Vertigoval®

Objectives: Innovative Cell Population Data (CPD) have been used as early biomarkers for diagnosing sepsis in adults. We assessed the usefulness of CPD in pediatric patients with sepsis/septic shock, in terms of early recognition and outcome prediction. We revised 54 patients (0–15 y) admitted to our Pediatric Intensive Care Unit (PICU) for sepsis/septic shock during a 4-year period. Twenty-eight patients were excluded, 26 septic patients were enrolled (G1). Forty children admitted for elective surgery served as controls (G2). Data on five selected CPD parameters, namely neutrophils fluorescence intensity (NE-SFL), monocytes cells complexity (MO-X), monocytes fluorescence intensity (MO-Y), monocytes complexity and width of dispersion of events measured (MO-WX), and monocytes cells size and width dispersion (MO-WZ), were obtained at time of PICU admission (t0) by a hematological analyzer (Sysmex XN 9000®). As the primary outcome we evaluated the relevance of CPD for diagnosing sepsis/septic shock on PICU admission. Furthermore, we investigated if CPD at t0 were correlated with C-reactive protein (CRP), patient survival, or complicated sepsis course.Results: On PICU admission (t0), NE-SFL, MO-WX, and MO-Y were higher in sepsis/septic shock patients compared to controls. NE-SFL values were correlated with CRP values in G1 patients (r = 0.83). None of the five CPD parameters was correlated with survival or complicated sepsis course.Conclusion: We found higher values of NE-SFL, MO-WX, and MO-Y in children with sepsis/septic shock upon PICU admission. These parameters may be a promising adjunct for early sepsis diagnosis in pediatric populations. Larger, prospective studies are needed to confirm our preliminary observations.

Vestibular migraine (VM) and Menière’s disease (MD) are common neurotological disorders causing episodic vertigo. Sometimes, VM is accompanied by cochlear symptoms suggestive for MD. Therefore, in those cases, the differential diagnosis between the two disorders can be difficult. Moreover, a comorbidity with migraine in MD patients is widely reported, up to the hypothesis of a possible MD-VM overlapping syndrome. In this brief case report, we consider the clinical history of a family presenting high incidence of subjects fulfilling the diagnostic criteria of VM and single case fulfilling criteria for definite MD. The relationship between VM and MD is still under debate; anyway, it can be speculated that commonly shared genetic mutations could play a role as predisposing factors in both disorders. A congenital nystagmus in the family was present too, but its correlation with the other conditions is still not clear. Future goal of our work will be to assess genetics in this family.

Benzene, a recognized occupational leukemogen in adults, has been hypothesized to also increase the risk of childhood leukemia. We carried out a population-based case-control study in a northern Italy community involving 83 cases with acute childhood leukemia diagnosed in the years 1998-2009 and 332 matched controls. We assessed residential exposure to benzene and to particulate matter ≤10 μm (PM10) from motorized traffic using geocoded residences and detailed emission and dispersion modeling. Exposure to benzene, and to a lesser extent to PM10, appeared to be independently associated with an excess leukemia risk. When we stratified the study population by age and by leukemia subtype, the relative risk associated with benzene exposure was higher among children aged less than 5 years, and despite small numbers this relation appeared to be considerably stronger for acute myeloid leukemia than for acute lymphoblastic leukemia. Overall, these findings suggest that exposure to low levels of benzene released from motorized traffic may increase the risk of childhood leukemia, and suggest a possible independent effect of PM10, although unmeasured confounding due to other pollutants cannot be ruled out.

The urban heat island (UHI) is an increasingly widespread phenomenon of concern to the wellbeing and the health of populations living in urban environments. The SUHI (Surface UHI) is directly related to UHI and influences its extension and intensity. Satellite images in the thermal infrared spectral region can be used to identify and study the SUHI. In this work, Landsat 8 TIR images were acquired to study the SUHI of a medium-sized municipality of the Po valley in the northern part of Italy. An additional Worldview 3 satellite image was used to classify the study area and retrieve the surface albedo of building roofs. Using the Local Climate Zone approach, existing roof materials were virtually replaced by solar reflective materials, and the mitigation potential of the SUHI and the UHI was quantified. This virtual scenario shows a decrease in the overheating of building roofs with respect to the ambient temperature of up to 33% compared to the current situation in the industrial areas. Focusing on UHI intensity, the air temperature decrease could be up to 0.5 °C.

Light-absorbing aerosols (LAAs) are short-lived climate forcers with a significant impact on Earth's radiative balance. LAAs include dust aerosols, black carbon (BC) and organic light-absorbing carbonaceous aerosol (collectively termed brown carbon, BrC), which have also been proven to be highly toxic. In this study, aerosol absorption at five wavelengths (ranging from ultraviolet to infrared) was monitored continuously using filter-based photometers during two winter seasons in 2020 and 2021 in the city of Modena (southern central Po Valley, northern Italy), at two regulatory air quality monitoring sites, along with other pollutants (coarse particulate matter, PM 10 ; fine particulate matter, PM 2.5 ; O 3 ; NO; NO 2 ; and C 6 H 6) and the vehicular traffic rate. The aerosol optical depth (AOD) and other column aerosol optical properties were concurrently monitored at four wavelengths by an AErosol RObotic NETwork (AERONET) sun photometer under urban background conditions within Modena. In situ absorption levels were apportioned to both sources (fossil fuel and biomass burning) and species (BC and BrC), while columnar absorption was apportioned to BC, BrC and mineral dust. The combined analysis of the atmospheric aerosol and gas measurements and of the meteorological conditions (in situ and from the ERA5 reanalysis) identified the location of potential urban sources of BC and BrC, most likely related to traffic and biomass burning. In situ data show different diurnal/weekly patterns for BrC from biomass burning and BC from traffic, with minor differences between the background and the urban traffic conditions. AERONET version 3 absorption aerosol optical depth (AAOD) retrievals at four wavelengths allowed the estimation of the absorptive direct radiative effect due to LAAs over the same period under the reasonable assumption that the AOD signal is concentrated within the mixing layer. AERONET retrievals showed a modest correlation of columnar absorption with planetary boundary layer (PBL)-scaled in situ observations, although the correlation improved significantly during a desert dust transport event that affected both in situ aerosol and columnar absorption, particularly in the blue spectrum range. A low correlation occurred between the contribution of BrC to aerosol absorption for the in situ and the columnar observations, with the BrC contribution being generally larger for in situ observations. Finally, evidence of a highly layered atmosphere during the study period, featuring significant spatial mixing and modest vertical mixing, was shown by ERA5-based atmospheric temperature profiles and by the large correlation of concurrent AERONET AOD retrievals in Modena and in Ispra (on the northwestern side of the Po Valley, ca. 225 km from Modena). [ABSTRACT FROM AUTHOR]

Abstract Background Epidemiologic studies have raised the possibility that some pesticide compounds induce the neurodegenerative disease amyotrophic lateral sclerosis (ALS), though the available evidence is not entirely consistent. Methods We conducted a population-based case-control study in two Italian populations to assess the extent to which residence in the vicinity of agricultural crops associated with the application of neurotoxic pesticides is a risk factor for ALS, using crop acreage in proximity to the residence as an index of exposure. Results Based on 703 cases and 2737 controls, we computed an ALS odds ratio of 0.92 (95% confidence interval 0.78-1.09) for those in proximity to agricultural land. Results were not substantially different when using alternative exposure categories or when analyzing specific crop types, with the exception of a higher risk related to exposure to citrus orchards and olive groves in Southern Italy, though based on few exposed subjects (N = 89 and 8, respectively). There was little evidence of any dose-response relation between crop proximity and ALS risk, and using long-term residence instead of current residence did not substantially change our estimates. Conclusions Though our index of exposure is indirect and subject to considerable misclassification, our results offer little support for the hypothesis that neurotoxic pesticide exposure increases ALS risk.

Background and goals: The estimate of the internal dose provided by physiologically based pharmacokinetic (PBPK) modelling is a big step forward in the frame of human health risk assessment (HRA) from contaminating sources. The PBPK model included in the MERLIN-Expo platform was here tested with data collected in a human biomonitoring (HBM) pilot study to check model efficacy in predicting concentrations in human blood and urine of people exposed to a modern solid waste incinerator (SWI). The aim of the study was to investigate if the use of a PBPK model integrated in a computational platform could replace more expensive and invasive pilot studies. Twenty eight subjects living and working within 4 km of the incinerator (exposed) and 21 subjects living and working outside this area (unexposed) were selected among the population recruited in the HBM study. The group of exposed (E) subjects and the group of non-exposed (NE) subjects were comparable for all relevant anthropometric characteristics and exposure parameters except for the exposure to SWI emissions. Three different scenarios were created: an “only diet-scenario” (DS), a “worst case scenario” (WCS) and a “most likely scenario” (MLS). The platform was tested for blood-lead (B-Pb), urinary-lead (U-Pb), urinary-anthracene (U-Ant) and urinary-fluoranthene (U-Flt). Average estimated U-Pb was statistically equal to the measured one (est. 0.411~0.278; meas. 0.398~0.455 µg/L) and estimated vs. measured U-Ant differ by one order of magnitude only (est. 0.018~0.010; meas. 0.537~0.444 ng/L) while for U-Flt and B-Pb, the error was respectively of two and four orders of magnitude. It is likely that the extremely high accuracy in the Pb concentration input values referring to diet led to the very accurate estimate for this chemical in urine, but the higher error in the B-Pb computed value suggests that PBPK model equations cannot entirely capture the dynamics for blood compartments. MERLIN-Expo seems a very promising tool in saving time, energy and money in the screening step of the HRA framework; however, many software validations are still required.

Recently, the severe intensification of atmospheric carbon has highlighted the importance of urban tree contributions in atmospheric carbon mitigations in city areas considering sustainable urban green planning and management systems. Explicit and timely information on urban trees and their roles in the atmospheric Carbon Stock (CS) are essential for policymakers to take immediate actions to ameliorate the effects of deforestation and their worsening outcomes. In this study, a detailed methodology for urban tree CS calibration and mapping was developed for the small urban area of Sassuolo in Italy. For dominant tree species classification, a remote sensing approach was applied, utilizing a high-resolution WV3 image. Five dominant species were identified and classified by applying the Object-Based Image Analysis (OBIA) approach with an overall accuracy of 78%. The CS calibration was done by utilizing an allometric model based on the field data of tree dendrometry—i.e., Height (H) and Diameter at Breast Height (DBH). For geometric measurements, a terrestrial photogrammetric approach known as Structure-from-Motion (SfM) was utilized. Out of 22 randomly selected sample plots of 100 square meters (10 m × 10 m) each, seven plots were utilized to validate the results of the CS calibration and mapping. In this study, CS mapping was done in an efficient and convenient way, highlighting higher CS and lower CS zones while recognizing the dominant tree species contributions. This study will help city planners initiate CS mapping and predict the possible CS for larger urban regions to ensure a sustainable urban green management system.

La vertigine e l’instabilità sono sintomi molto comuni nella popolazione la cui prevalenza è stimata tra il 20 e il 56%. L’obiettivo del nostro lavoro è stato quello di determinare la prevalenza di questi sintomi in una popolazione di 2672 soggetti. È stato somministrato loro loro un questionario; nella prima parte sono stati richiesti i dati demografici e se avessero mai sofferto di vertigine o instabilità nella loro vita. L’età media del campione è stata di 48,3 ± 15 anni, il 46,7% erano maschi. Sul totale della popolazione 1077 (40,3%) hanno riferito di aver sofferto di vertigine o instabilità nella loro vita, con un primo episodio occorso all’età di 39,2 ± 15,4 anni. Nella seconda parte del questionario sono state indagate le caratteristiche delle vertigini (età del primo episodio, il tipo di vertigine, presenza di più episodi, esacerbazione posizionale della vertigine, presenza di sintomi cocleari infine la presenza di cefalea da moderata o severa nel corso della vita e le sue caratteristiche cliniche (riferita a un emicrania, pulsante, associata a fono o fotofobia, peggiore con l’attività fisica). È stata osservata una correlazione della vertigine con l’età e con il sesso, essendo la prima 4,4 volte più frequente nelle donne e 1,8 volte nei soggetti con oltre 50 anni. Sul campione complessivo di 2672 soggetti, 13,7% hanno riferito vertigine rotatoria, 26,3% episodi recidivanti, 12,9% esacerbazione correlata alla posizione e il 4,8% presenza sintomi cocleari; il 34,8% ha lamentato cefalea nel corso della loro vita. I soggetti affetti da cefalea presentavano un’incidenza aumentata di vertigini recidivanti, di esacerbazione correlata alla posizione, di sintomi cocleari e un’età più giovane di comparsa del primo episodio di vertigine/instabilità. Nella discussione i nostri dati sono stati confrontati con quelli di precedenti studi. Gli autori sottolineano la correlazione tra vertigine/instabilità da un lato e cefalea con caratteristiche emicraniche dall’altro.