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Objective To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. Methods This is a point prevalence study nested in the “Delirium Day 2015”, which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. Results Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). Conclusions The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.

Delirium is an acute neuropsychiatric syndrome, very common in hospitalized people with medical and neurological conditions. The identification of delirium after stroke is not an easy task and validated psychometric instruments are needed to correctly identify it. We decided to verify if (1) formal training in DSM-V criteria is needed to correctly identify post-stroke delirium, (2) if the use of a brief psychometric instrument such as 4AT improves its identification, (3) the applicability of these scales in the stroke setting. In the first phase of this study we retrospectively studied 102 acute stroke patients in Stroke Units of San Martino Hospital (Genova, Italy) to evaluate delirium with clinical criteria, first by a neurologist without a formal training in DSM-V criteria and after training. Then, we enrolled 100 new acute stroke patients who underwent screening for delirium using 4AT scale and DSM-V criteria. In the first phase, DSM-V criteria training significantly increased the ability to capture delirium (5 vs. 15%). In the second phase, the 4AT was used for delirium screening revealing a 52% of cases of delirium, the same observed by the consensus diagnosis of two senior neurologists (that was 50%). In the second phase, the use of 4AT scale allowed to capture post-stroke delirium as well as the consensus diagnosis by two neurologists. The identification of post-stroke delirium is not an easy task and requires both formal training in DSM-V criteria as well as the application of brief scales, such as the 4AT.

El actual Humedal de Saldropo, de 5,7 hectáreas, es fruto de un proceso de regeneración natural e integración paisajística de una antigua turbera acometido a principios de los años 90. Tras el cese de las actividades extractivas, el área quedó convertida en un solar de terrenos removidos, sin apenas vegetación, con depresiones con agua y montículos de tierra y escombros. Siendo ya imposible la recuperación del ecosistema de turbera, se optó por acometer un proyecto de renaturalización con una mínima intervención humana, limitada a vallar el área de actuación para evitar la entrada del ganado e incrementar las láminas de agua mediante un cierre puntual del sistema de drenaje. En poco tiempo, el crecimiento vegetal disimuló la perturbación ecológica y paisajística sufrida y se desarrolló un sistema húmedo mixto, con áreas secas, estanques y un bosque pantanoso, destacando la llamativa proliferación de la sauceda (Salix atrocinerea) que se desarrolla sobre suelos más o menos encharcados, con helechos en el sotobosque y una interesante comunidad muscinal corticícola. En cada uno de estos ambientes, se constató un paulatino enriquecimiento de especies florísticas y faunísticas. En este momento, 25 años más tarde del inicio de la intervención se reconocen seis unidades de vegetación: sauceda, pastos, juncales, zarzal-helechal, cañaveral y masas de vegetación flotante. Veinte especies de mamíferos frecuentan el humedal (12 de meso y macromamíferos y 8 de micromamíferos). En el interior del recinto vallado se han inventariado 6 especies de anfibios y 6 de reptiles. Las especies de aves que visitan el humedal o han sido avistadas en su área de influencia ascienden a 52.

Introduction: So far no specific oncological strategies have been validated for locally-advanced epithelial thymic tumors (TETs). We herein report the long-term results of a large multicentric experience adopting a multimodal treatment. Methods: From 01/1990 to 12/2010, the clinical data of 108 Masaoka Stage-III TETs patients surgically treated after induction therapy (IT) were retrospectively reviewed. Different IT-regimens were administered: ADOC (32 pts); PAC (38 pts); CEE (38 pts). Radiotherapy was concurrently used in 5 patients only. The end-points of the study were the evaluation of: (1) resectability; (2) overall long-term survival (LTS) and disease-free survival (DFS); and (3) independent prognostic factors. The Mann-Whitney and Fisher's exact tests were applied to test the associations. Survival analysis was performed by the Kaplan-Meier method and log-rank test. Results: Mean age and male/female ratio were 51 ± 13 years and 61/47, respectively. World Health Organization (WHO) histotype was: A in 6 pts (5.6%), AB in 18 (16.7%), B1 in 15 (13.9%), B2 in 26 (24.1%), B3 in 23 (21.3%), and thymic carcinoma in 20 (18.5%). Thirty-day mortality was 1.8%. A total of 81 (75%) had R0-resection, 11 (10.2%) R1 and 16 (14.8%) R2-resection. Adjuvant therapy was performed in 71 patients. During the follow-up a relapse of disease was observed in 38 pts(35.2%). Five-years DFS and LTS were 69.3% and 79.3%, respectively. At univariate analysis, WHO-type B3/C ("high-risk") TETs (p = 0.001) and recurrence of disease (p = 0.02) were predictors of poor LTS while only a slight correlation was found for R-status and "CHT-regimen type" (p = 0.097 and p = 0.067, respectively). At multivariate analysis WHO "high-risk" TETs (H.R.5.73;C.I.:1.77-18.57) and ADOC-regimen (H.R.2.84;C.I.:1.37-5.86) were independent predictors of poor survival. Conclusions: A multimodal treatment for Stage-III thymic tumors may achieve a rewarding survival. WHO-Histology seems to be the most important prognos

ObjectiveThe effect of adolescent marijuana use on brain development remains unclear despite relaxing legal restrictions, decreased perceived harm, and increasing use rates among youth. The aim of this 3-year prospective study was to evaluate the long-term neurocognitive effects of adolescent marijuana use.MethodAdolescent marijuana users with concomitant alcohol use (MJ + ALC, n = 49) and control teens with limited substance use histories (CON, n = 59) were given neuropsychological and substance use assessments at project baseline, when they were ages 16-19. They were then reassessed 18 and 36 months later. Changes in neuropsychological measures were evaluated with repeated measures analysis of covariance (ANCOVA), controlling for lifetime alcohol use, and examined the effects of group, time, and group by time interactions on cognitive functioning.ResultsMJ + ALC users performed significantly worse than controls, across time points, in the domains of complex attention, memory, processing speed, and visuospatial functioning (ps <.05). Earlier age of marijuana use onset was associated with poorer processing speed and executive functioning by the 3-year follow-up (ps ≤.02).ConclusionsFrequent marijuana use throughout adolescence and into young adulthood appeared linked to worsened cognitive performance. Earlier age of onset appears to be associated with poorer neurocognitive outcomes that emerge by young adulthood, providing further support for the notion that the brain may be uniquely sensitive to frequent marijuana exposure during the adolescent phase of neurodevelopment. Continued follow-up of adolescent marijuana users will determine the extent of neural recovery that may occur if use abates.

Contains fulltext : 137733.pdf (publisher's version ) (Open Access), Single Nucleotide Polymorphisms (SNPs) in genes involved in the DNA Base Excision Repair (BER) pathway could be associated with cancer risk in carriers of mutations in the high-penetrance susceptibility genes BRCA1 and BRCA2, given the relation of synthetic lethality that exists between one of the components of the BER pathway, PARP1 (poly ADP ribose polymerase), and both BRCA1 and BRCA2. In the present study, we have performed a comprehensive analysis of 18 genes involved in BER using a tagging SNP approach in a large series of BRCA1 and BRCA2 mutation carriers. 144 SNPs were analyzed in a two stage study involving 23,463 carriers from the CIMBA consortium (the Consortium of Investigators of Modifiers of BRCA1 and BRCA2). Eleven SNPs showed evidence of association with breast and/or ovarian cancer at p<0.05 in the combined analysis. Four of the five genes for which strongest evidence of association was observed were DNA glycosylases. The strongest evidence was for rs1466785 in the NEIL2 (endonuclease VIII-like 2) gene (HR: 1.09, 95% CI (1.03-1.16), p = 2.7 x 10(-3)) for association with breast cancer risk in BRCA2 mutation carriers, and rs2304277 in the OGG1 (8-guanine DNA glycosylase) gene, with ovarian cancer risk in BRCA1 mutation carriers (HR: 1.12 95%CI: 1.03-1.21, p = 4.8 x 10(-3)). DNA glycosylases involved in the first steps of the BER pathway may be associated with cancer risk in BRCA1/2 mutation carriers and should be more comprehensively studied.

The genus Riella (Riellaceae, Sphaerocarpales) includes some 24 species of thalloid aquatic liverworts with unique morphological and ecological features among hepatics. These include the development of sporophytes enclosed within involucres and growing submerged in seasonal fresh or brackish water ponds. Riella subgenus Trabutiella includes species with winged involucres. Seven taxa have been described, however, four to five taxa have been recognized at a time depending on authors. In this study we have conducted a morphological revision of the species of this subgenus, based on 59 traits measured under light and Scanning Electron Microscopy analyses and that were the subject of statistical analyses. Taxonomically most informative traits were derived from female involucres and spores, whereas quantitative vegetative traits were of little relevance to taxonomy. Lectotypes are designated for subgenus Trabutiella and section Plicatae and for R. cossoniana. Our analyses support the recognition of six species, and support R. paulsenii as a synonym of R. cossoniana. A new species, R. mediterranea is described, and R. cossoniana var. echinata is raised to species rank. An identification key, detailed descriptions of the six accepted taxa, updated distribution maps, and full illustrations of four of the species, including the first for R. echinata are provided.