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Abstract Introduction During the COVID-19 pandemic, electroencephalography (EEG) proved to be a useful tool to demonstrate brain involvement. Many studies reported non-reactive generalized slowing as the most frequent pattern and epileptiform activity in a minority of patients. Objective To investigate the prevalence of diffuse unreactive background attenuation or suppression and its correlation with outcome in a cohort of COVID-19 patients. Methods The EEGs recorded during the first year of the COVID-19 pandemic were retrospectively evaluated to identify the main pattern and focus on the occurrence of a low-voltage background, either attenuated (10–20 μV) or suppressed ( Results Among 98 EEG performed in 50 consecutive patients, diffuse unreactive slowing was the most prevalent pattern (54%), followed by unreactive attenuation or suppression pattern (26%), being the latter significantly correlated with an unfavourable outcome (p = 0.0004). Survivors showed significantly lower interleukine-6 values compared to non-survivors. Patients with attenuated EEG and non-survivors also showed lower PaO2/FiO2 values. Neuroradiological findings were very heterogeneous with a prevalence of lesions suggestive of a microangiopathic substrate. Conclusions EEG attenuation or suppression may be more frequent than previously reported and significantly associated with a poor outcome. SARS-CoV-2 infection may result in encephalopathy and reduced EEG voltage through mechanisms that are still unknown but deserve attention given its negative impact on prognosis.

Despite the widespread use of antibiotics, deep neck infections are still a relevant clinical problem and can cause severe and potentially life-threatening complications. Imaging plays a pivotal role into the clinical management of deep neck infections, allowing identification of the source of infections, definition of the precise extension of the disease and early diagnosis of local or distant complications. The complex anatomy of deep neck spaces may hide the actual extent of disease: the knowledge of neck anatomy enables radiologists to rapidly evaluate expected routes of spread of infections and to effectively communicate crucial information to surgeons. Computed Tomography is the most used imaging modality for assessing primary site of infection, extent of disease and local complications. Magnetic resonance imaging may be used as a second level imaging modality for individuating intracranial or spinal complications. The present work aims to review the imaging of deep neck spaces infections, focusing on relevant anatomy and clinical scenarios, underlining practical teaching points for each of them. Familiarity with deep neck spaces anatomy and knowledge of most common routes of spread of infections allow the radiologist to make a prompt diagnosis and to look for early signs of potential complications.

Background Critically ill COVID-19 patients have pathophysiological lung features characterized by perfusion abnormalities. However, to date no study has evaluated whether the changes in the distribution of pulmonary gas and blood volume are associated with the severity of gas-exchange impairment and the type of respiratory support (non-invasive versus invasive) in patients with severe COVID-19 pneumonia. Methods This was a single-center, retrospective cohort study conducted in a tertiary care hospital in Northern Italy during the first pandemic wave. Pulmonary gas and blood distribution was assessed using a technique for quantitative analysis of dual-energy computed tomography. Lung aeration loss (reflected by percentage of normally aerated lung tissue) and the extent of gas:blood volume mismatch (percentage of non-aerated, perfused lung tissue—shunt; aerated, non-perfused dead space; and non-aerated/non-perfused regions) were evaluated in critically ill COVID-19 patients with different clinical severity as reflected by the need for non-invasive or invasive respiratory support. Results Thirty-five patients admitted to the intensive care unit between February 29th and May 30th, 2020 were included. Patients requiring invasive versus non-invasive mechanical ventilation had both a lower percentage of normally aerated lung tissue (median [interquartile range] 33% [24–49%] vs. 63% [44–68%], p p = 0.001), due to higher shunt (23% [15–32%] vs. 5% [2–16%], p = 0.001) and non-aerated/non perfused regions (5% [3–10%] vs. 1% [0–2%], p = 0.001). The PaO2/FiO2 ratio correlated positively with normally aerated tissue (ρ = 0.730, p ρ = − 0.633, p Conclusions In critically ill patients with severe COVID-19 pneumonia, the need for invasive mechanical ventilation and oxygenation impairment were associated with loss of aeration and the extent of gas:blood volume mismatch. Graphic abstract

Background There is a paucity of data concerning the optimal ventilator management in patients with COVID-19 pneumonia; particularly, the optimal levels of positive-end expiratory pressure (PEEP) are unknown. We aimed to investigate the effects of two levels of PEEP on alveolar recruitment in critically ill patients with severe COVID-19 pneumonia. Methods A single-center cohort study was conducted in a 39-bed intensive care unit at a university-affiliated hospital in Genoa, Italy. Chest computed tomography (CT) was performed to quantify aeration at 8 and 16 cmH2O PEEP. The primary endpoint was the amount of alveolar recruitment, defined as the change in the non-aerated compartment at the two PEEP levels on CT scan. Results Forty-two patients were included in this analysis. Alveolar recruitment was median [interquartile range] 2.7 [0.7–4.5] % of lung weight and was not associated with excess lung weight, PaO2/FiO2 ratio, respiratory system compliance, inflammatory and thrombophilia markers. Patients in the upper quartile of recruitment (recruiters), compared to non-recruiters, had comparable clinical characteristics, lung weight and gas volume. Alveolar recruitment was not different in patients with lower versus higher respiratory system compliance. In a subgroup of 20 patients with available gas exchange data, increasing PEEP decreased respiratory system compliance (median difference, MD − 9 ml/cmH2O, 95% CI from − 12 to − 6 ml/cmH2O, p p = 0.003), increased PaO2 with FiO2 = 0.5 (MD 24 mmHg, 95% CI from 12 to 51 mmHg, p 2 with FiO2 = 1.0 (MD 7 mmHg, 95% CI from − 12 to 49 mmHg, p = 0.313). Moreover, alveolar recruitment was not correlated with improvement of oxygenation or venous admixture. Conclusions In patients with severe COVID-19 pneumonia, higher PEEP resulted in limited alveolar recruitment. These findings suggest limiting PEEP strictly to the values necessary to maintain oxygenation, thus avoiding the use of higher PEEP levels.

The aim of this study was to explore the influence of perceived authentic leadership on followers’ citizenship behaviour and their intention to quit their jobs, and to examine the indirect effect of psychological ownership in the relevant relationships. The study used a cross-sectional survey design to gather data from a sample of South African service industry employees ( N = 384). It employed structural equation modelling to test the hypotheses formulated. The study found that psychological ownership indirectly affected the relationship between authentic leadership and employees’ organisational citizenship behaviour and intention to quit. This study enables organisations to gain a better understanding of how a contextual resource such as authentic leadership behaviours can influence followers’ organisational citizenship and intention to quit through increasing feelings of ownership of the organisation.

The eighth edition of the TNM classification officially introduced “depth of invasion” (DOI) as a criterion for determining the T stage in tongue squamous cell carcinoma. The DOI is a well-known independent risk factor for nodal metastases. In fact, several experts strongly suggest elective neck dissection for tongue cancer with a DOI > 4 mm due to the high risk of early and occult nodal metastases. Imaging plays a pivotal role in preoperative assessments of the DOI and, hence, in planning the surgical approach. Intraoral ultrasound (IOUS) has been proposed for early-stage SCC of the oral tongue as an alternative to magnetic resonance imaging (MRI) for local staging. The aim of this work is to investigate the accuracy of IOUS in the assessment of the DOI in early oral SCC (CIS, pT1, and pT2). A total of 41 patients with tongue SCCs (CIS-T2) underwent a preoperative high-frequency IOUS. An IOUS was performed using a small-size, high-frequency hockey-stick linear probe. The ultrasonographic DOI (usDOI) was retrospectively compared to the pathological DOI (pDOI) as the standard reference. In patients who underwent a preoperative MRI, their usDOI, magnetic resonance DOI (mriDOI), and pDOI were compared. Specificity and sensitivity for the IOUS to predict a pDOI > 4 mm and to differentiate invasive and noninvasive tumors were also evaluated. A high correlation was found between the pDOI and usDOI, pDOI and mriDOI, and usDOI and mriDOI (Spearman’s ρ = 0.84, p < 0.0001, Spearman’s ρ = 0.79, p < 0.0001, and Spearman’s ρ = 0.91, p < 0.0001, respectively). A Bland–Altman plot showed a high agreement between the usDOI and pDOI, even though a mean systematic error was found between the usDOI and pDOI (0.7 mm), mriDOI and pDOI (1.6 mm), and usDOI and mriDOI (−0.7 mm). The IOUS was accurate at determining the T stage (p < 0.0001). The sensitivity and specificity for the IOUS to predict a pDOI ≥4 mm were 92.31% and 82.14%, respectively, with an AUC of 0.87 (p < 0.0001). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) for the IOUS to predict an invasive cancer were 100%, 94.7%, 60%, and 100%, respectively. The AUC was 0.8 (95% CI 0.646–0.908, p < 0.0001). The IOUS was accurate in a preoperative assessment of a pDOI and T stage, and can be proposed as an alternative to MRI in the preoperative staging of tongue SCC.

In the last years, there has been a significant increase in the number of cesarean deliveries and, with it, of the number of complications following the procedure. They can be divided into early and late ones. We will illustrate herein the most common complications following cesarean section to help radiologists to recognize them. To familiarize with these various pathologic conditions is crucial to alert referring clinicians for a prompt and appropriate maternal and fetal management. Special attention will be given to the cesarean scar defect (CSD), the most common but also the most unknown of such conditions. Although often asymptomatic, a severe CSD represents a predisposing factor for subsequent complications especially in future pregnancies.

We present Terminus, a voting system based on blockchain technology. Terminus relies on technology solutions pioneered by Monero, a privacy-focused Blockchain, and on specifically designed operational procedures: this guarantees full anonymity of the vote and addresses several concerns of digital voting systems. Terminus was tested at an event of an Italian political movement, and will be used to carry out polls to drive some of the political decisions of this movement. We also introduce an evaluation framework for DLT voting systems, and use it to compare existing systems.

A method is described to measure the water activity (a

Freezing of gait (FoG) is among the most disabling symptoms of Parkinson’s disease (PD) patients. Recent studies showed that action observation training (AOT) with repetitive practice of the observed actions represents a strategy to induce longer-lasting effects compared with standard physiotherapy. We investigated whether AOT may improve FoG and mobility in PD, when AOT is applied in a group-based setting. Sixty-four participants with PD and FoG were assigned to the experimental (AO) or control groups and underwent a 45-minute training session, twice a week, for 5 weeks. AOT consisted in physical training combined with action observation whereas the control group executed the same physical training combined with landscape-videos observation. Outcome measures (FoG questionnaire, Timed Up and Go test, 10-meter walking test, and Berg balance scale) were evaluated before training, at the end of training, and 4 weeks later (FU-4w). Both groups showed positive changes in all outcome measures at posttraining assessment. Improvements in FoG questionnaire, Timed Up and Go test, and Berg balance scale were retained at FU-4w evaluation only in the AOT group. AOT group-based training is feasible and effective on FoG and motor performance in PD patients and may be introduced as an adjunctive option in PD rehabilitation program.

Background Treadmill training (TT) has been indicated as a potential therapeutic tool for improving balance and gait in patients with Parkinson's disease (PD). However, the lack of evidences about the best modality of intervention (e.g.: number of sessions) and the lack of reliable follow-up measures, made difficult to hand down these results into the clinical practice. Aim The aim of this study was to compare the efficacy of 3 different modalities of TT program on gait performance in PD patients. Design A randomized, single-blind pilot study. Setting Outpatients clinic, Department of Neuroscience, University of Genoa. Population Thirty patients (out of 42 screened) with PD were randomized. Methods Participants underwent the same TT program (ten sessions, 45 minute each) but with a different frequency throughout a week: 1) low-frequency (LF) group: 2-times a week; 2) intermediate-frequency (IF) group: 3-times a week; and 3) high-frequency (HF) group: 5-times a week. Patients were evaluated by Timed Up and Go (TUG) test, 10-meter walking test (10M-WT), Berg Balance Scale (BBS), Falls Efficacy Scale (FES) and falls diary before TT, immediately after the training was stopped, and 2 and 4 months later. Results At baseline, no significant differences were found among groups. Immediately after the end of the TT, TUG Test, 10 MWT, FES and falls diary scores significantly improved in the LF and IF groups, whereas they did not change in the HF group. Improvements were sustained for up 2-months in the IF and LF groups. At 4-months evaluation, outcome measures were either comparable or sometimes even better than at baseline in the LF and IF groups, whereas in the HF group, 10M-WT and FES score worsened. Conclusions According to the results of this study, we might postulate that the frequency of TT influences short and long-lasting effects on walking performance and falls. Clinical rehabilitation impact The present study confirms that TT is effective in improving gait disturbances and reducing falls risk in patients with PD. The short- and long-lasting effects induced by TT on walking performance are specifically affected by the frequency of training, possibly in relationship to learning mechanisms and fatigue.

Acute ischemic stroke, the most frequent cause of permanent disability in adults worldwide, results from transient or permanent reduction in regional cerebral blood flow and involves oxidative stress and inflammation. Despite the success of experimental animal models of stroke in identifying anti-inflammatory/neuroprotective compounds, translation of these putative neuroprotectants to human clinical trials has failed to produce a positive outcome. Tissue injury and stress activate endogenous mechanisms which function to restore homeostatic balance and prevent further damage by upregulating the synthesis of lipid signaling molecules, including N-palmitoylethanolamine (PEA or palmitoylethanolamide). PEA exerts neuroprotection and reduces inflammatory secondary events associated with brain ischemia reperfusion injury (middle cerebral artery occlusion (MCAo)). Here, we examined the neuroprotective potential of a co-ultramicronized composite containing PEA and the antioxidant flavonoid luteolin (10:1 by mass), nominated co-ultraPEALut. The study consisted of two arms. In the first, rats subjected to MCAo and treated with co-ultraPEALut post-ischemia showed reduced edema and brain infract volume, improved neurobehavioral functions, and reduced expression of pro-inflammatory markers and astrocyte markers. In the second arm, a cohort of 250 stroke patients undergoing neurorehabilitation on either an inpatient or outpatient basis were treated for 60 days with a pharmaceutical preparation of co-ultraPEALut (Glialia®). At baseline and after 30 days of treatment, all patients underwent a battery of evaluations to assess neurological status, impairment of cognitive abilities, the degree of spasticity, pain, and independence in daily living activities. All indices showed statistically significant gains at study end. Despite its observational nature, this represents the first description of co-ultraPEALut administration to human stroke patients and clinical improvement not otherwise expected from spontaneous recovery. Further, controlled trials are warranted to confirm the utility of co-ultraPEALut to improve clinical outcome in human stroke.

In previous studies investigating intracardiac electrograms (Egm) obtained from implantable cardioverter defibrillators (ICD), the presence of Diastolic Micro-Signals (DMS) preceding the initiation of ventricular tachyarrhythmias (VT) has been observed both in coronary artery disease (CAD) and in dilated cardiomyopathy (DCM). We propose a mechanism, based on a recently published computational model, to qualitatively explain the DMS for the case of ischemic cardiomyopathy. The model based on a bi-dimensional network of Beeler-Reuter cardiac cell, is able to reproduce all the erratic arrhythmias under the assumptions that the gapjunction conductance are non-linear and fluctuating, and there is a scar in the tissue. Under such hypotheses, an electrical activity may propagate within the scar and, occasionally, it may propagate outside the scar and initiate a premature cardiac beat. Our hypothesis is that, in JCD recipients with ischemic cardiomyopathy, the DMS reveal the presence of a propagating wavefront within the scar, monitored by the intracardiac electrocatheter which is assumed to be placed in the proximity of the scar lesion.

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: The quantification and monitoring of body iron burden play a pivotal role in the clinical management of patients affected by inherited hemoglobin disorders, including thalassemia, hereditary hemochromatosis and sickle cell disease. The total amount...

We present and compare two automatic methods for dimension estimation from time series. Both methods, based on conceptually different approaches, work on the derivative of the bi-logarithmic plot of the correlation integral versus the correlation length (log–log plot). The first method searches for the most probable dimension values (MPDV) and associates to each of them a possible scaling region. The second one searches for the most flat intervals (MFI) in the derivative of the log–log plot. The automatic procedures include the evaluation of the candidate scaling regions using two reliability indices. The data set used to test the methods consists of time series from known model attractors with and without the addition of noise, structured time series, and electrocardiographic signals from the MIT-BIH ECG database. Statistical analysis of results was carried out by means of paired t -test, and no statistically significant differences were found in the large majority of the trials. Consistent results are also obtained dealing with ‘difficult’ time series. In general for a more robust and reliable estimate, the use of both methods may represent a good solution when time series from complex systems are analyzed. Although we present results for the correlation dimension only, the procedures can also be used for the automatic estimation of generalized q -order dimensions and pointwise dimension. We think that the proposed methods, eliminating the need of operator intervention, allow a faster and more objective analysis, thus improving the usefulness of dimension analysis for the characterization of time series obtained from complex dynamical systems.

Mechanisms involved in the initiation of fibrillation and defibrillation are complex and still not totally understood. This paper computationally investigated the effect of monophasic, biphasic and reversed biphasic stimuli on single cardiomyocyte, with a modified Ten Tusscher model of human ventricular action potential (AP) and calcium dynamics. Three different S1-S2 protocols with variable duration were used: monophasic, biphasic and reversed biphasic. Results were expressed in terms of total response duration (TRD), defined as the interval between the S1 onset and the response generated by S2. TRD was focused both on AP (Vm-TRD) and on Calcium transient (Ca-TRD). Simulations confirmed previous results obtained with the Beeler-Reuter model pointing to the role of INa in prolonging the refractory period when using a biphasic stimulus. No differential effects of biphasic vs monophasic stimulation when CaTRDs are compared instead of Vm-TRDs were found.