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Objectives The aim of this study was to compare the effects of Animal-Assisted Therapy (AAT) with a standard treatment protocol in children and adolescents admitted to the psychiatry hospital for acute mental disorders. We used a methodology involving high quality standards for AAT research. Design A pre-post experimental design with a randomized controlled trial (RCT) in 34 hospitalized patients (17 treatment, 17 control) was carried out. Main outcome measures The study focused on improvement in clinical status including, global functioning measured by the Children Global Assessment Scale (C GAS), format of care and ordinary school attendance measured by a rating scale. Results Our results indicate a statistically significant improvement in global functioning, reduction in format of care and increased ordinary school attendance in the treatment group, but not in the control group. Conclusions Our results verify that AAT can have significant positive effects on therapeutic progress and the recovery process.

Aim To assess the predictive value of fluorine-18-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in early assessing response during neo-adjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer. Materials and methods A systematic review was performed by search of MEDLINE Library for the following terms: "rectal carcinoma OR rectal cancer", "predictive OR prediction OR response assessment OR response OR assessment", "early OR ad interim ", "therapy", "FDG OR 18 F-FDG", "PET OR PET/CT". Articles performed by the use of stand-alone PET scanners were excluded. Results 10 studies met the inclusion criteria, including 302 patients. PET/CT demonstrated a good early predictive value in the global cohort (mean sensitivity = 79%; mean specificity = 78%). SUV and its percentage decrease (response index = RI) were calculated in all studies. A higher accuracy was demonstrated for RI (mean sensitivity = 82%; pooled specificity = 85%) with a mean cut-off of 42%. The mean time point to perform PET scan during CRT resulted to be at 1.85 weeks. Some PET parameters resulted to be both predictive and not statistical predictive of response, maybe due to the small population and few studies bias. Conclusion PET showed high accuracy in early prediction response during preoperative CRT, increased with the use of RI as parameter. In the era of tailored treatment, the precocious assessment of non-responder patients allows modification of the subsequent strategy especially the timing and the type of surgical approach.

Objective To investigate whether recording from deep intracerebral (IC) electrodes can disclose laser evoked potential (LEP) components generated under the cerebral cortex. Methods LEPs were recorded to hand and/or perioral region stimulation from 7 patients suffering from Parkinson’s disease, who underwent implant of IC electrodes in the globus pallidum pars interna (GPi), in the subthalamic nucleus (STN) and in the pedunculopontine nucleus (PPN). LEPs were obtained from the IC electrode contacts and from the Cz vertex, referred to the nose. Results The scalp traces showed a triphasic response (P1-N2-P2). The IC electrodes recorded two main components (ICP2 and ICN2), showing the same latencies as the scalp N2 and P2 potentials, respectively. The ICP2-ICN2 complex was sometimes preceded by a ICP1 wave at the same latency of the scalp P1 response. Conclusions The LEP components recorded from the IC electrodes mirrored the ones picked up from the Cz lead, thus suggesting that they are probably generated by the opposite pole of the same cortical sources producing the scalp responses. Significance In the IC traces, there was no evidence of earlier potentials possibly generated within the thalamus or of subcortical far-field responses. This means that the nociceptive signal amplification occurring within the cerebral cortex is necessary to produce identifiable LEP components.

In this study we investigate whether the cutaneous silent period (CSP)-an inhibitory response evoked in hand muscles by painful digital nerve stimulation-is useful for assessing nociceptive pathway function in patients with neuropathic pain. In 40 patients with peripheral neuropathy (21 without and 19 with neuropathic pain) we recorded the CSP in the abductor digiti minimi after fifth digit stimulation and also recorded laser evoked potentials (LEPs) after stimulation applied to the ulnar territory of the hand. Although the LEP amplitude was significantly lower in patients with pain than in those without (P 0.50). Pain intensity correlated significantly with LEP amplitudes (P 0.5). Our findings indicate that the CSP is not useful for assessing nociceptive pathway function in patients with neuropathic pain.

The topodiagnostic implications of hemiataxia following lesions of the human brainstem are only incompletely understood. We performed a voxel-based statistical analysis of lesions documented on standardised MRI in 49 prospectively recruited patients with acute hemiataxia due to isolated unilateral brainstem infarction. For statistical analysis individual MRI lesions were normalised and imported in a three-dimensional voxel-based anatomical model of the human brainstem. Statistical analysis revealed hemiataxia to be associated with lesions of three distinct brainstem areas. The strongest correlation referred to ipsilateral rostral and dorsolateral medullary infarcts affecting the inferior cerebellar peduncle, and the dorsal and ventral spinocerebellar tracts. Secondly, lesions of the ventral pontine base resulted in contralateral limb ataxia, especially when ataxia was accompanied by motor hemiparesis. In patients with bilateral hemiataxia, lesions were located in a paramedian region between the upper pons and lower midbrain, involving the decussation of dentato-rubro-thalamic tracts. We conclude that ataxia following brainstem infarction may reflect three different pathophysiological mechanisms. (1) Ipsilateral hemiataxia following dorsolateral medullary infarctions results from a lesion of the dorsal spinocerebellar tract and the inferior cerebellar peduncle conveying afferent information from the ipsilateral arm and leg. (2) Pontine lesions cause contralateral and not bilateral ataxia presumably due to major damage to the descending corticopontine projections and pontine base nuclei, while already crossed pontocerebellar fibres are not completely interrupted. (3) Finally, bilateral ataxia probably reflects a lesion of cerebellar outflow on a central, rostral pontomesencephalic level.

Polymer-polymer blends provide a cost-effective solution process fabrication method to generate a variety of self-assembled structures. Previously, we have demonstrated that blending poly(3-hexylthiophene-2,5-diyl) (P3HT) with polystyrene (PS) leads to the fabrication of nanoporous structures with variable pore diameters ranging from 150 to 600 nm.[1] In the present study, we demonstrate that by adding polymethylmetacrylate (PMMA) to the mixture, the pore dimensions increase while maintaining their honeycomb-like ordered structure. The formation of self-assembled polymer nanostructures can be theoretically predicted in binary blends but this becomes more complicated for ternary blends. Here, we use confocal microscopy to characterize our ternary blends by replacing the commercial (non-emissive) PS with a boron-dipyrromethene functionalized PS (PS-bodipy). In the ternary blends with high PMMA contents, we can distinctively locate the green-emitting PS phase, which acts as a compatibilizing agent at the interface between the red-emitting P3HT and PMMA. After selective removal of the PS and PMMA phases, we demonstrate that structured P3HT thin films exhibit angle dependent reflectivity (iridescence) in a similar manner to morpho-butterfly wings. This effect is further emphasized when covered with a thin metal layer and the metal covered nanostructured P3HT films display structural coloration properties with blue and red emission at low and high reflection angles, respectively. The angular dependence of the reflectivity peak is well reproduced by the Bragg formula that describes the iridescence of opal-like systems and is often used to characterize the parameters of colloidal crystals. The large inter-pore distance of the film and the presence of a long-wavelength reflection tail suggests that the observed visible iridescence originates from higher order Brillouin zone reflectance wavelengths, as in the case of the blue feathers coloration of some bird wings.

Le sorgenti luminose a stato solido che utilizzano emettitori organici (Organic Light-Emitting Diodes o OLEDs [1]) sono già presenti sul mercato, ma la loro produzione si basa su complessi processi di evaporazione in alto vuoto che richiedono tempi lunghi e ne innalzano i costi di produzione. Al fine di utilizzare appieno le possibilità offerte dai materiali organici occorre passare ad un processo di fabbricazione, più semplice e sostenibile, basato su tecniche da soluzione. Allo stesso modo, le celle solari organiche (OPV) hanno un notevole vantaggio, rispetto a quelle basate sul silicio: sono leggere, trasparenti, adatte ad un mercato "off-grid" e possono essere fabbricate con tecniche da soluzione come "ink-jet printing" e "roll-to-roll". Il "gap" di efficienza, ma soprattutto la durata, rispetto alla controparte inorganica è però ancora tale da limitarne l'applicazione commerciale. Entrambe le tipologie di dispositivi organici si sviluppano con architetture multistrato, per cui le loro prestazioni sono fortemente dipendenti dalle proprietà delle interfacce tra i diversi strati che li compongono. L'ingegnerizzazione delle interfacce tra strato organico ed elettrodo gioca quindi un ruolo fondamentale nell'ottimizzazione del dispositivo [2]. I polimeri coniugati polari (PCP) sono stati recentemente proposti per svolgere questo ruolo. Si tratta di una classe di materiali semiconduttori che presenta catene laterali alchiliche con gruppi terminali polari o ionici (cationici, anionici o in forma zwitterionica) innestate su un backbone coniugato. Grazie alla natura delle catene laterali, i PCP sono generalmente solubili in solventi polari come metanolo, etanolo e acqua, diversamente dai semiconduttori polimerici tradizionali solubili in solventi organici. Questa solubilità in solventi "green" ortogonali a quelli in cui viene processato lo strato attivo del dispositivo, consente la fabbricazione di architetture multistrato con tecniche da soluzione ecosostenibili, rapide ed economiche, che mimano ciò che fino ad ora era una prerogativa dei processi di termo-sublimazione in alto vuoto. L'estrema facilità di processo di deposizione unita alle funzionalità ioniche hanno spinto la ricerca a sviluppare PCP per ottimizzare i dispositivi elettronici ed optoelettronici organici. Grazie alla formazione di dipoli elettrici all'interfaccia tra elettrodo e materiale organico, l'inserimento di PCP come "interlayer" può infatti portare a migliorare le efficienze sia degli OLED che delle OPV modificando le barriere di potenziale per l'iniezione/estrazione e trasporto delle cariche elettriche. Un ulteriore beneficio offerto dall'utilizzo dei PCP è quello di poter evitare l'impiego, come catodo, di metalli altamente reattivi (come bario o calcio) normalmente necessari per ridurre la barriera di potenziale per l'iniezione di elettroni nel livello di LUMO ("lowest unoccupied molecular orbital" [1]) dello strato organico attivo. Il PCP infatti, grazie alla formazione del dipolo all'interfaccia col metallo, è in grado di ridurre l'elevata barriera tra alluminio (tipico metallo utilizzato come catodo) ed il LUMO stesso. Eliminando metalli reattivi, il dispositivo risulta più stabile e durevole anche in aria. In questa ottica, abbiamo sintetizzato una serie di PCP basati su backbone di polifluorene e catene laterali terminate con diversi gruppi polari o ionici, e li abbiamo testati come "interlayer" in OLED e OPV. I risultati ottenuti hanno mostrato come i materiali testati siano effettivamente in grado di aumentare in maniera rilevante le prestazioni delle diverse tipologie di dispositivi optelecttronici.

Objective Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a rare primary headache whose origins are unclear. To seek information on its pathophysiology, we studied the trigeminal Aβ and Aδ pathways by recording trigeminal reflexes and laser evoked potentials (LEPs) in patients with SUNCT. Methods Trigeminal reflexes and LEPs were recorded in 11 consecutive patients. Ten patients had neuroimaging evidence documenting idiopathic SUNCT and one had a posterior fossa tumour that compressed the trigeminal nerve thus causing symptomatic SUNCT. Results Whereas the patients with idiopathic SUNCT had normal trigeminal reflex and LEP responses, the patient with symptomatic SUNCT had abnormal responses. Conclusions Our neurophysiological findings show that idiopathic SUNCT spares the trigeminal sensory pathways whereas symptomatic SUNCT does not. Significance Neurophysiological testing can easily differentiate the idiopathic and symptomatic forms of SUNCT. It also suggests that the two forms are pathophysiologically distinct entities.

This review deals with the diagnostic usefulness of neurophysiological testing in patients with craniofacial pain. Neurophysiological testing of trigeminal nerve function relies on trigeminal reflexes and laser-evoked potentials (LEPs). This review briefly describes the physiology of trigeminal reflexes and LEPs, reports normal values and highlights the neurophysiological abnormalities in the main clinical conditions.

Aims of the study. - Nerve conduction studies have demonstrated that carbamazepine (CBZ), as well as other antiepileptic drugs (AEDs), can affect peripheral nerve conduction; reports on conventional somatosensory evoked potentials and CBZ are controversial. In a previous study, assessing laser-evoked potentials (LEPs) in CBZ-treated patients with idiopathic trigeminal neuralgia, we found that LEPs were dampened even after stimutation of the non-painful side, with a strong correlation between LEP latency and daily CBZ dose. No other study investigated the influence of AEDs on LEPs. In order to clarify the effect of CBZ on LEPs we sought possible LEP changes in epileptic patients taking CBZ.Materials and methods. - We studied LEPs after trigeminal and hand CO2-laser stimutation in 20 patients with epilepsy taking CBZ and 20 age-matched controls.Results. - Although the trigeminal LEP mean latency was slightly longer in epileptic patients (P = 0.11), we did not find significant differences between epileptic patients and controls for any LEP data. LEP data did not correlate with the daily CBZ dose, CBZ blood concentration, or duration of therapy (P > 0.3).Conclusion. - The tack of a CBZ-induced dampening of LEPs suggests that small-fibre pathways, compared to large-fibre, might be less susceptible to AED's toxic effect. Although the TN patients in our previous study were older than the epileptic patients in the present study, a possible combined effect induced by drug and age in patients with TN is unlikely because LEP latency is reportedly unaffected by age. The CBZ-induced effect in patients with trigeminal neuralgia is possibly related to pathophysiological changes specific to this disease. (c) 2005 Elsevier SAS. All rights reserved.

Our current understanding of brainstem reflex physiology comes chiefly from the classic anatomical-functional correlation studies that traced the central circuits underlying brainstem reflexes and establishing reflex abnormalities as markers for specific areas of lesion. These studies nevertheless had the disadvantage of deriving from post-mortem findings in only a few patients. We developed a voxel-based model of the human brainstem designed to import and normalize MRIs, select groups of patients with or without a given dysfunction, compare their MRIs statistically, and construct three-plane maps showing the statistical probability of lesion. Using this method, we studied 180 patients with focal brainstem infarction. All subjects underwent a dedicated MRI study of the brainstem and the whole series of brainstem tests currently used in clinical neurophysiology: early (R1) and late (R2) blink reflex, early (SP1) and late (SP2) masseter inhibitory reflex, and the jaw jerk to chin tapping. Significance levels were highest for R1, SP1 and R2 afferent abnormalities. Patients with abnormalities in all three reflexes had lesions involving the primary sensory neurons in the ventral pons, before the afferents directed to the respective reflex circuits diverge. Patients with an isolated abnormality of R1 and SP1 responses had lesions that involved the ipsilateral dorsal pons, near the fourth ventricle floor, and lay close to each other. The area with the highest probabilities of lesion for the R2-afferent abnormality was in the ipsilateral dorsal-lateral medulla at the inferior olive level. SP2 abnormalities reached a low level of significance, in the same region as R2. Only few patients had a crossed-type abnormality of SP1, SP2 or R2; that of SP1 reached significance in the median pontine tegmentum rostral to the main trigeminal nucleus. Although abnormal in 38 patients, the jaw jerk appeared to have no cluster location. Because our voxel-based model quantitatively compares lesions in patients with or without a given reflex abnormality, it minimizes the risk that the significant areas depict vascular territories rather than common spots within the territory housing the reflex circuit. By analysing statistical data for a large cohort of patients, it also identifies the most frequent lesion location for each response. The finding of multireflex abnormalities reflects damage of the primary afferent neurons; hence it provides no evidence of an intra-axial lesion. The jaw jerk, perhaps the brainstem reflex most widely used in clinical neurophysiology, had no apparent topodiagnostic value, probably because it depends strongly on peripheral variables, including dental occlusion.

Sensory neuropathy usually impairs tactile sensations related to large myelinated afferents (Abeta) as well as thermal-pain sense related to small myelinated (Adelta) and unmyelinated (C) afferents. By selectively affecting large or small fibres, some sensory neuropathies may also provoke a dissociated sensory loss. Standard nerve conduction studies and somatosensory evoked potentials assess Abeta-fibre function only. Laser pulses selectively excite free nerve endings in the superficial skin layers and evoke Adelta-related brain potentials (LEPs). From earlier studies and new cases we collected data on 270 patients with sensory neuropathy. LEPs often disclosed subclinical dysfunction of Adelta fibres and proved a sensitive and reliable diagnostic tool for assessing small-fibre function in sensory neuropathy.

Il testo affronta la tematica della malattia di Alzheimer, l'impatto sui familiari che curano e fornisce strumenti concetttuali e pratici per gestire i disturbi cognitivi e comportamentali determinati dalla malattia.

The GISTs are rare tumours but even rarer is the localization in some districts. We reported two GISTs of the duodenum, two of the omentum and peritoneum, one of the rectum and one of a Meckel’s diverticulum. These exceptional locations are confirmed by the relative difficult diagnosis, obtained in some cases only by the surgical treatment despite the CT and MR. The endoscopy is useful in hemorrhagic and duodenum forms, only for the diagnosis and for the control of blood loss. Surgical treatment in all cases was decisive without the need to make use of adjuvant therapy, with positive long-term results, which excluded the disappearance of relapses or secondary lesions.

To assess the predictive value of fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in early assessing response during neo-adjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer.A systematic review was performed by search of MEDLINE Library for the following terms: "rectal carcinoma OR rectal cancer", "predictive OR prediction OR response assessment OR response OR assessment", "early OR ad interim", "therapy", "FDG OR (18)F-FDG", "PET OR PET/CT". Articles performed by the use of stand-alone PET scanners were excluded.10 studies met the inclusion criteria, including 302 patients. PET/CT demonstrated a good early predictive value in the global cohort (mean sensitivity = 79%; mean specificity = 78%). SUV and its percentage decrease (response index = RI) were calculated in all studies. A higher accuracy was demonstrated for RI (mean sensitivity = 82%; pooled specificity = 85%) with a mean cut-off of 42%. The mean time point to perform PET scan during CRT resulted to be at 1.85 weeks. Some PET parameters resulted to be both predictive and not statistical predictive of response, maybe due to the small population and few studies bias.PET showed high accuracy in early prediction response during preoperative CRT, increased with the use of RI as parameter. In the era of tailored treatment, the precocious assessment of non-responder patients allows modification of the subsequent strategy especially the timing and the type of surgical approach.

The GISTs are rare tumours but even rarer is the localization in some districts. We reported two GISTs of the duodenum, two of the omentum and peritoneum, one of the rectum and one of a Meckel's diverticulum. These exceptional locations are confirmed by the relative difficult diagnosis, obtained in some cases only by the surgical treatment despite the CT and MR. The endoscopy is useful in hemorrhagic and duodenum forms, only for the diagnosis and for the control of blood loss. Surgical treatment in all cases was decisive without the need to make use of adjuvant therapy, with positive long-term results, which excluded the disappearance of relapses or secondary lesions.

Polydimethylsiloxane (PDMS) nano-structured layers were investigated as possible candidates for inexpensive and hydrophobic coatings to be used on glass substrates. A mature manufacturing process, developed for moulding a single layer of micro-hemispheres on a PDMS film, was used to create a single layer of nano-hemispheres that can act like a nano-structured coating. The nano-hemispheres on the PDMS film were created by using a self-assembly process [1]. The index of refraction of the PDMS is very similar to the one of glass so it can be conveniently used for coating glass surfaces. In principle it could also be used for coating other SiO2 surfaces such as those deposited on PV cells or LEDs, thus improving the performances of those devices. The nano-hemispheres on the PDMS film have a size of about 300nm. The nano-structured coating was characterized by comparing the transmission of a glass substrate with and without the nano-coating. The transmission measurements were performed at different angles of incidence and over a wide range of wavelengths, ranging from about 400nm to about 900nm. The results show an improvement in the transmission of the glass. The best improvement was obtained at normal incidence, with an increase of more than 1% in the transmission of a single surface. Such value has to be compared with the typical loss of about 4% introduced by a single uncoated glass surface. Future research will focus on reducing the size and changing the shape of the nano-structure in order to improve the coating performances, and testing the coating on different substrates.

The last few decades have seen a huge growth in research on silk chemistry. Many modern applications in medicine utilize biological active biomolecules and benefit from having them localized on a surface. An ideal surface for medical application can be made up of biopolymers, in our research silk protein was used.1 Films prepared from natural silk fibroin -from Bombyx mori worm- are biocompatible, biodegradable and exhibit implant ability.2 Silk fibroin is suitable for being chemically altered through hydroxyl, amino and carboxyl acid side groups, whereby attaining specific, new material properties. The present study demonstrates a convenient approach to provide efficient, bioactive molecules to silk film by Click reaction. This reaction is often applied in medicinal chemistry and 1,2,3-triazole moiety is used as pharmacophore.3 The free standing films were covalently coupled with azide derivative through cyanuric chloride as a spacer. The copper (I)-catalyzed 1,2,3-triazole forming reaction between silk-azides and terminal alkynes can be employed for connection of bioactive molecules on silk film . The technology has the potential to be used in medical diagnostics, biosensors, and implantable prosthetics.

Pain is a subjective condition that cannot be objectively measured; for this reason, self patient-perspective is crucial. Recently, several screening tools to discriminate between nociceptive and neuropathic pain have been developed. We aimed at assessing the consistence and discrepancy of two widely used screening tools, The Douleur Neuropathique 4 (DN4) and the 6-item questionnaire (ID-Pain), by comparing their ability in discriminating neuropathic from nociceptive pain. DN4 and ID-Pain were administered to 392 Italian patients attending 16 outpatient services for peripheral nerve diseases. Based on medical history, clinical findings and diagnostic tools, patients were divided into two groups (neuropathic and nociceptive). Globally, ID-Pain identified neuropathic pain in 60 % of patients (38 % probable, 22 % likely). Interestingly also DN4 diagnosed neuropathic pain in 60 % of cases. A discrepancy was observed in 16 % of cases. DN4 and ID-Pain resulted to be highly interrelated in the identification of neuropathic pain. Sensitivity of DN4 was 82 % and specificity was 81 %, while ID-Pain (considering both probable and likely groups) showed sensitivity 78 % and specificity 74 %. Reliable screening tools for neuropathic pain are well related between them; hence, they are available for researchers and clinicians who may choose the most appropriate for their activity. Since the gold standard for the diagnosis and treatment of neuropathic pain cannot do without a neurological evaluation, perhaps DN4, that includes physician objective measures, may help reducing the percentage of dubious cases. Conversely, when needing a more agile tool (not needing a physician) ID-Pain may be adopted.

In patients with distal symmetric polyneuropathy we assessed non-nociceptive Abeta- and nociceptive Adelta-afferents to investigate their role in the development of neuropathic pain. We screened 2240 consecutive patients with sensory disturbances and collected 150 patients with distal symmetric polyneuropathy (68 with pain and 82 without). All patients underwent the Neuropathic Pain Symptom Inventory to rate ongoing, paroxysmal and provoked pains, a standard nerve conduction study (NCS) to assess Abeta-fibre function, and laser-evoked potentials (LEPs) to assess Adelta-fibre function. Patients with pain had the same age (P0.50), but a longer delay since symptom onset than those without (P0.01). Whereas the LEP amplitude was significantly lower in patients with pain than in those without (P0.0001), NCS data did not differ between groups (P0.50). LEPs were more severely affected in patients with ongoing pain than in those with provoked pain (P0.0001). Our findings indicate that the impairment of Abeta-fibres has no role in the development of ongoing or provoked pain. In patients with ongoing pain the severe LEP suppression and the correlation between pain intensity and LEP attenuation may indicate that this type of pain reflects damage to nociceptive axons. The partially preserved LEPs in patients with provoked pain suggest that this type of pain is related to the abnormal activity arising from partially spared and sensitised nociceptive terminals. Because clinical and neurophysiological abnormalities followed similar patterns regardless of aetiology, pain should be classified and treated on mechanism-based grounds.

Thin polymeric films bearing on their surface a hexagonally ordered array of micrometric holes are produced by means of the straightforward and cost-effective method based on the breath figure formation phenomenon. Through the combination of breath figures and soft lithographic techniques we are able to create microporous and micropatterned thin films from different materials, that are potentially attractive for the realization of advanced optoelectronic devices.

Multiple sclerosis (MS) is an inflammatory, demyelinating, central nervous system disease that frequently causes pain.This article reviews the current literature and describes the therapeutic options for treating MS-related pain. The reader will be provided with current, evidence-based knowledge about the treatment of MS-related pain, and the review will take a practical approach to the various drugs for treating pain, including starting dose, titration and side effects.Only cannabinoids have been assessed in randomized, controlled trials. Because of the concern regarding the risk of abuse and psychiatric adverse events, published guidelines as well as expert recommendations suggest using them as second-line therapy only. Hence, current treatment should be based on the general principles for treating peripheral neuropathic pain, taking into account drug-induced adverse effects.

Stimulation of the dorsal skin with brief laser impulses easily evokes brain potentials (laser evoked potentials, LEPs). Dorsal LEPs were first used to study the conduction velocity in the human spinothalamic tract. In this study the diagnostic usefulness of this technique was assessed by recording dorsal LEPs in two patients with focal spinal cord lesions (one intrinsic and the other extrinsic) and spared lemniscal sensitivities. In both cases, the brain evoked potentials were normal after stimulation of the metamers above the lesion but absent after stimulation of those below. Dorsal LEP recordings may prove a useful tool in localising lesions and in the neurophysiological assessment of focal spinal cord lesions involving the anterolateral quadrants of the spinal cord.

BACKGROUND: There is good evidence that radiotherapy is beneficial in advanced rectal cancer, but its application in Italy has not been investigated. METHODS: We conducted a nationwide survey among members of the Italian Society of Colo-Rectal Surgery (SICCR) on the use of radiation therapy for rectal cancer in the year 2005. Demographic, clinical and pathologic data were retrospectively collected with an online database. Italy was geographically divided into 3 regions: north, center and south which included the islands. Hospitals performing 30 or more surgeries per year were considered high volume. Factors related to radiotherapy delivery were identified with multivariate analysis. RESULTS: Of 108 centers, 44 (41%) responded to the audit. We collected data on 682 rectal cancer patients corresponding to 58% of rectal cancers operated by SICCR members in 2005. Radiotherapy was used in 307/682 (45.0%) patients. Preoperative radiotherapy was used in 236/682 (34.6%), postoperative radiotherapy in 71/682 (10.4%) cases and no radiotherapy in 375 (55.0%) cases. Of the 236 patients who underwent preoperative radiotherapy, only 24 (10.2%) received short-course radiotherapy, while 212 (89.8%) received long-course radiotherapy. Of the 339 stage II-III patients, 159 (47%) did not receive any radiotherapy. Radiotherapy was more frequently used in younger patients (P < 0.0001), in patients undergoing abdominoperineal resection (APR) (P < 0.01) and in the north and center of Italy (P < 0.001). Preoperative radiotherapy was more frequently used in younger patients (P < 0.001), in large volume centers (P < 0.05), in patients undergoing APR (P < 0.005) and in the north-center of Italy (P < 0.05). CONCLUSION: Our study first identified a treatment disparity among different geographic Italian regions. A more systematic audit is needed to confirm these results and plan adequate interventions.

Laser-evoked potentials (LEPs) are brain responses to laser radiant heat pulses and reflect the activation of Adelta nociceptors. LEPs are to date the reference standard technique for studying nociceptive pathway function in patients with neuropathic pain. To find out whether LEPs also provide a useful neurophysiological tool for assessing antinociceptive drug efficacy, in this double-blind placebo-controlled study we measured changes induced by the analgesic tramadol on LEPs in 12 healthy subjects. We found that tramadol decreased the amplitude of LEPs, whereas placebo left LEPs unchanged. The opioid antagonist naloxone partially reversed the tramadol-induced LEP amplitude decrease. We conclude that LEPs may be reliably used in clinical practice and research for assessing the efficacy of antinociceptive drugs.

The aim of this study was to validate the Italian version of the Neuropathic Pain Symptom Inventory (NPSI) in patients with neuropathic pain due to peripheral nerve diseases, and also to evaluate the validity of a new NPSI score: a frequency weighted NPSI score (NPSI-FW). First, the original version of the NPSI was translated into Italian. Then the validity and reliability of the Italian NPSI (I-NPSI) were tested in 392 Italian patients consecutively referred to 16 Italian outpatient services for peripheral nerve diseases, by correlating the I-NPSI scores with other pain scales. The repeatability and responsiveness were assessed. A significant correlation between the I-NPSI scores and all the other pain measures was seen. Reproducibility and responsiveness were good. Our study shows the validity of the I-NPSI and demonstrates its reliability for assessing neuropathic pain in patients with peripheral nerve diseases. The I-NPSI scores represent reliable measurements to assess neuropathic symptoms and effectiveness of treatment on them.

Although many patients with multiple sclerosis (MS) complain of trigeminal neuralgia (TN), its cause and mechanisms are still debatable. In a multicentre controlled study, we collected 130 patients with MS: 50 patients with TN, 30 patients with trigeminal sensory disturbances other than TN (ongoing pain, dysaesthesia, or hypoesthesia), and 50 control patients. All patients underwent pain assessment, trigeminal reflex testing, and dedicated MRI scans. The MRI scans were imported and normalised into a voxel-based, 3D brainstem model that allows spatial statistical analysis. The onset ages of MS and trigeminal symptoms were significantly older in the TN group. The frequency histogram of onset age for the TN group showed that many patients fell in the age range of classic TN. Most patients in TN and non-TN groups had abnormal trigeminal reflexes. In the TN group, 3D brainstem analysis showed an area of strong probability of lesion (P

Carpal tunnel syndrome (CTS), a common entrapment neuropathy involving the median nerve at the wrist, frequently manifests with neuropathic pain. We sought information on pain mechanisms in CTS. We studied 70 patients with a diagnosis of CTS (117 CTS hands). We used the DN4 questionnaire to select patients with neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to assess the intensity of the various qualities of neuropathic pain. All patients underwent a standard nerve conduction study (NCS) to assess the function of non-nociceptive Abeta-fibres, and the cutaneous silent period (CSP) after stimulation of the IIIrd and Vth digits, to assess the function of nociceptive Adelta-fibres. In 40 patients (75 CTS hands) we also recorded laser-evoked potentials (LEPs) in response to stimuli delivered to the median nerve territory and mediated by nociceptive Adelta-fibres. We sought possible correlations between neurophysiological data and the various qualities of neuropathic pain as assessed by the NPSI. We found that the median nerve sensory conduction velocity correlated with paroxysmal pain and abnormal sensations, whereas LEP amplitude correlated with spontaneous constant pain. Our findings suggest that whereas paroxysmal pain and abnormal sensations reflect demyelination of non-nociceptive Abeta-fibres, spontaneous constant pain arises from damage to nociceptive Adelta-fibres.

In this study we investigate whether the cutaneous silent period (CSP)-an inhibitory response evoked in hand muscles by painful digital nerve stimulation-is useful for assessing nociceptive pathway function in patients with neuropathic pain. In 40 patients with peripheral neuropathy (21 without and 19 with neuropathic pain) we recorded the CSP in the abductor digiti minimi after fifth digit stimulation and also recorded laser evoked potentials (LEPs) after stimulation applied to the ulnar territory of the hand. Although the LEP amplitude was significantly lower in patients with pain than in those without (P0.005), the CSP duration did not differ between groups (P0.50). Pain intensity correlated significantly with LEP amplitudes (P0.005) but not with CSP duration (P0.5). Our findings indicate that the CSP is not useful for assessing nociceptive pathway function in patients with neuropathic pain.

Postherpetic neuralgia is an exceptionally drug-resistant neuropathic pain. To investigate the pathophysiological mechanisms underlying postherpetic neuralgia we clinically investigated sensory disturbances, pains and itching, with an 11-point numerical rating scale in 41 patients with ophthalmic postherpetic neuralgia. In all the patients we recorded the blink reflex, mediated by non-nociceptive myelinated A beta-fibers, and trigeminal laser evoked potentials (LEPs) related to nociceptive myelinated A delta- and unmyelinated C-fiber activation. We also Sought possible correlations between clinical sensory disturbances and neurophysiological data. Neurophysiological testing yielded significantly abnormal responses on the affected side compared with the normal side (P < 0.001). The blink reflex delay correlated with the intensity of paroxysmal pain, whereas the A delta and C-LEP amplitude reduction correlated with the intensity of constant pain (P < 0.01). Allodynia correlated with none of the neurophysiological data. Our study shows that postherpetic neuralgia impairs all sensory fiber groups. The neurophysiological-clinical correlations suggest that constant pain arises from a marked loss of nociceptive afferents, whereas paroxysmal pain is related to A beta-fiber demyelination. These findings might be useful for a better understanding of pain mechanisms in postherpetic neuralgia. (C) 2008 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

The involution of crown odontoblasts after primary dentinogenesis in teeth of limited eruption is discussed. The odontoblasts of rat first lower molars were analyzed morphometrically from the tenth day to the 40th day of age, i.e., from the late phase of primary dentinogenesis to complete eruption. All the organelles underwent atrophy, but at different rates. In particular, the membranes of the endoplasmic reticulum decreased progressively in surface area from day 10 to day 40, whereas those of the Golgi apparatus decreased significantly between day 10 and day 14, and then remained practically unchanged in size. The volume of the lysosome compartment never increased beyond that during primary dentinogenesis. The profile length of the endoplasmic reticulum in each observed cell section was taken as an estimate of secretory activity. At day 40, this organelle was smaller in ~95% of the cells than it had been in any cell at day 10. These results suggest that cell atrophy may occur without any increase in the degradation processes of the cytoplasmic components and that the organelles along the secretory pathway may have independent regulatory systems. In the odontoblasts, as in several types of secretory epithelial cells, only a small fraction of the cells is engaged in appreciable secretory activity. This occurs, however, when the overall activity of the same cell population is relatively low.

Despite intensive neurophysiological research, evidence is lacking to show whether abnormal cortical excitability in migraine reflects a primary cortical disturbance or reduced control by thalamo-cortical loops. One way to contribute to the scientific discussion on this topic is to deliver transcranial magnetic stimulation (TMS) and test the cortical silent period (SP) recorded in facial muscles. The facial-muscle SP is a purely cortical phenomenon that reflects the excitability of inhibitory interneurons, and can disclose changes in cortical inhibition even in patients without documented primary lesions of the motor cortices. To test the interictal excitability of cortical motor inhibitory interneurons in migraine, we investigated the facial-SP in patients with migraine with and without aura between attacks. In 26 patients and 15 age-matched controls, high-intensity magnetic stimuli were delivered with a round coil centered at the vertex during a maximal muscle contraction. Electromyographic responses were recorded from surface electrodes placed over the subjects' perioral muscles. Facial SPs were significantly shorter in patients than in controls. The SP shortening provides neurophysiological evidence showing hypoexcitability of cortical inhibitory neurons in patients with migraine between attacks. Despite a possible primary deficit of cortical inhibitory interneurons in migraine, we favor the interpretation of a secondary disfacilitation by hypoactive thalamo-cortical loops. Based on this interpretation, the interictal reduced cortical inhibition documented by the shortened SP could be considered the motor counterpart of the reduced preactivation excitability level in the sensory cortices purported to explain why cortical evoked responses habituate poorly in patients with migraine.