P374 MANAGEMENT OF A HOSPITAL NURSING OFFICE FOR AF AND CONTROL OF DIRECT ORAL ANTICOAGULANT THERAPY IN THE COVID EMERGENCY PHASE

Anticoagulant therapy is the gold standard treatment in thromboembolic prevention in AF patients. Starting from the indications from the regional indications that give the therapeutic diagnostic path, a divisional clinic dedicated to the diagnosis and treatment of AF was born in our territory. The aim of the team (Cardiologists, Nurses, GPs, administrative secretariat) was to monitor the number of patients treated with DOACs through AIFA therapeutic plans; Verify adherence to regional guidelines, analysis of therapy adherence; Prepare a protocol for the management of complications and emergencies; Ensure that the departments and services authorized to prescribe NOA take charge, in collaboration with general practitioners who since June 2020 have become active prescribers and also actors in the follow–up of patients; Taking care of the training of the prescribers themselves and the education of patients through hospital meetings dedicated to guided counseling and, finally, monitoring the pharmaceutical expenditure of the NOA on the total prescription of the local health unit of competence in compliance with the regional indicators. In our hospital the pilot project started in 2017 (3726 currently in FU). In the three–year period 2017–19, an average of 700 therapeutic plans were collected for renewal / first prescription per year (58.3 plans / month) to be monitored in subsequent years. In the two–year period 2020–2021, which saw the difficulty of organizing activities due to the pandemic emergency, 903 and 790 PTs were analyzed with an average of 70 plans / month, keeping almost 75% of face to face visits compared to telemedicals set up in the pandemic context.

According to the data, therefore, there is a strong need for diagnostic and health assistance paths. Despite the emergency period and despite a framework in which territorial medicine could have helped the clinical and bureaucratic effort, no resistance to the care burden has occurred and on the contrary the constant increase in patients makes the complexity and difficulty of a correct clinical classification and management support for patients with AOC needs

Understanding the role and function of maternal touch in children with neurodevelopmental disabilities

During the first years of life, maternal touch can serve different functions including facilitation of child's gaze orientation to faces which is a key precursor for social attention. Although children with neurodevelopmental disability (ND) may have reduced social skills, the role of maternal touch in contributing to gaze orientation to maternal face has not been explored in previous research. In the present study, we investigate the functions of maternal touch in dyads of mothers and children with ND, compared to dyads of children with typical development (TD). Micro-analytic 2-s coding of maternal touch (i.e., affectionate, playful, facilitating, holding, no touch) and children's gaze orientation (i.e., mother-oriented, object-oriented, non-oriented) occurred during 5-minute interactions between mothers and their 12-to-24-month-old ND and TD children. Dyads were paired for children chronological age and sex. Mothers of children with ND used more touch - especially facilitating and holding types -, compared to mothers of TD peers. Children with ND exhibited more non-orientated gaze compared to TD counterparts. Playful touch associated with increased mother-oriented gaze in children with ND, whereas affectionate and holding touch associated with greater mother-oriented gaze in TD children. Findings suggest that specific types of touch support children's attention to social partners.

Altered dynamics of brain connectivity in major depressive disorder at-rest and during task performance

Major depressive disorder (MDD) has been associated with alterations in several functional brain networks. Previous studies investigating brain networks in MDD during the performance of a task have yielded inconsistent results with the function of the brain at rest. In this study, we used functional magnetic resonance imaging at rest and during a goal-directed task to investigate dynamics of functional connectivity in 19 unmedicated patients with MDD and 19 healthy controls across both experimental paradigms. Patients had spatial differences in the default mode network (DMN), in the executive network (EN), and in the dorsal attention network (DAN) compared to controls at rest and during task performance. In patients the amplitude of the low frequency (LFO) oscillations was reduced in the motor and in the DAN networks during both paradigms. There was a diagnosis by paradigm interaction on the LFOs amplitude of the salience network, with increased amplitude change between task and rest in patients relative to controls. Our findings suggest that the function of several networks could be intrinsically affected in MDD and this could be viable phenotype for the investigation on the neurobiological mechanisms of this disorder and its treatment.

Mapping the brain correlates of borderline personality disorder: A functional neuroimaging meta-analysis of resting state studies

BACKGROUND

Altered intrinsic function of the brain has been implicated in Borderline Personality Disorder (BPD). Nonetheless, imaging studies have yielded inconsistent alterations of brain function. To investigate the neural activity at rest in BPD, we conducted a set of meta-analyses of brain imaging studies performed at rest.

METHODS

A total of seven functional imaging studies (152 patients with BPD and 147 control subjects) were combined using whole-brain Signed Differential Mapping meta-analyses. Furthermore, two conjunction meta-analyses of neural activity at rest were also performed: with neural activity changes during emotional processing, and with structural differences, respectively.

RESULTS

We found altered neural activity in the regions of the default mode network (DMN) in BPD. Within the regions of the midline core DMN, patients with BPD showed greater activity in the anterior as well as in the posterior midline hubs relative to controls. Conversely, in the regions of the dorsal DMN they showed reduced activity compared to controls in the right lateral temporal complex and bilaterally in the orbitofrontal cortex. Increased activity in the precuneus was observed both at rest and during emotional processing. Reduced neural activity at rest in lateral temporal complex was associated with smaller volume of this area.

LIMITATIONS

Heterogeneity across imaging studies.

CONCLUSIONS

Altered activity in the regions of the midline core as well as of the dorsal subsystem of the DMN may reflect difficulties with interpersonal and affective regulation in BPD. These findings suggest that changes in spontaneous neural activity could underlie core symptoms in BPD.

In medication-overuse headache, fMRI shows long-lasting dysfunction in midbrain areas

OBJECTIVE

The primary aim of our study was to evaluate if a group of medication-overuse headache (MOH) patients present dysfunctions in the mesocorticolimbic dopamine circuit. The secondary aim was to disentangle the role of the medication overuse and of the acute/chronic headache in determining these alterations and to investigate their persistence.

BACKGROUND

Several researches have suggested that MOH may belong to the spectrum of addictive behavior. Preclinical models and neuroimaging studies have consistently demonstrated that in addiction, critical long-lasting alterations occur in the mesocorticolimbic dopamine circuit. If MOH shares some neurophysiological features with addiction, long-lasting functional alterations of the mesocorticolimbic dopamine system related to medication overuse should be present.

METHODS

We collected functional magnetic resonance imaging data during the execution of a decision-making under risk paradigm in 8 MOH patients immediately after beginning medication withdrawal, in 8 detoxified MOH patients at 6 months after beginning medication withdrawal, in 8 chronic migraine patients, and in 8 control subjects.

RESULTS

Our results revealed that MOH patients present: (1) reduced task-related activity in the substantia nigra/ventral tegmental area complex and increased activity in the ventromedial prefrontal cortex, when compared with controls; (2) reduced activity in the substantia nigra/ventral tegmental area complex, when compared with chronic migraine patients; (3) increased activity in the ventromedial prefrontal cortex, when compared with detoxified MOH patients.

CONCLUSION

Our study showed that MOH patients present dysfunctions in the mesocorticolimbic dopamine circuit, in particular in the ventromedial prefrontal cortex and in the substantia nigra/ventral tegmental area complex. The ventromedial prefrontal cortex dysfunctions seem to be reversible and attributable to the acute/chronic headache, whereas the substantia nigra/ventral tegmental area complex dysfunctions are persistent and possibly related to medication overuse. These dysfunctions might be the expression of long-lasting neuroadaptations related to the overuse of medications and/or a pre-existing neurophysiological condition leading to vulnerability to medication overuse. The observed persistent dysfunctions in the midbrain dopamine suggest that MOH may share some neurophysiological features with addiction.

[The subclavian-carotid bypass as a method for treating obstruction of the common carotid]

Common carotid artery occlusion is a relatively uncommon lesion (0.5-5% of patients with cerebral ischaemia). Cerebral revascularization is possible only in case of patent carotid bifurcation, three patients, all of them symptomatic (2 TIA's and 1 amaurosis fugax) with a complete common carotid artery occlusion have been treated with a subclavian-carotid artery by-pass (2 PTFE, 1 reversed saphenous vein). Among the patients one death occurred in the fourth postoperative day by bronchopneumonia, no stroke was detected, in the remaining two, the by-pass was patent one year and respectively three years post-operatively. In case of common carotid artery occlusion, visualization of bifurcation is usually better obtained through a color-duplex than arteriography. Several operations have been proposed in these patients (retrograde thrombectomy, carotid to carotid by-pass, carotid-subclavian reimplantation), but subclavian to carotid by-pass is the most safe and common used procedure.

Arterial injury of the axilla: an unusual case after blunt trauma of the shoulder

The lesion of an axillary artery after a shoulder dislocation without bone fractures is very rare. The most common lesion is the subtotal transection of the vessel. Vascular injuries may be associated with nervous lesions whose incidence ranges from 27 to 44%. The nervous lesions are highly invalidating. The symptoms which recur most frequently are motor and sensitive deficiencies and a distal ischemia which, in some cases, may not be noted owing to the extensive collateral network. Whenever these symptoms are covered or absent, as in this case report, an angiography of the upper limb becomes essential for correct diagnosis and treatment.