Clinical criteria and diagnostic assessment of fibromyalgia: position statement of the Italian Society of Neurology-Neuropathic Pain Study Group

BACKGROUND

The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.

AIM

The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies.

METHODS

Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016).

RESULTS

ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up.

CONCLUSIONS

The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.

Characterization of a kg-scale archaeological lead-based PbWO4 cryogenic detector for the RES-NOVA experiment

Core-collapse Supernovae (SNe) are one of the most energetic events in the Universe, during which almost all the star's binding energy is released in the form of neutrinos. These particles are direct probes of the processes occurring in the stellar core and provide unique insights into the gravitational collapse. RES-NOVA will revolutionize how we detect neutrinos from astrophysical sources, by deploying the first ton-scale array of cryogenic detectors made from archaeological lead. Pb offers the highest neutrino interaction cross-section via coherent elastic neutrino-nucleus scattering (CEνNS). Such process will enable RES-NOVA to be equally sensitive to all neutrino flavours. For the first time, we propose the use archaeological Pb as sensitive target material in order to achieve an ultra-low background level in the region of interest (O(1 keV)). All these features make possible the deployment of the first cm-scale neutrino telescope for the investigation of astrophysical sources. In this contribution, we will characterize the radiopurity level and the performance of a small-scale proof-of-principle detector of RES-NOVA, consisting in a PbWO₄ crystal made from archaeological-Pb operated as cryogenic detector.

Development of ultralow-background cryogenic calorimeters for the measurement of surface α contamination

Next-generation experiments searching for rare events must satisfy increasingly stringent requirements on the bulk and surface radioactive contamination of their active and structural materials. The measurement of surface contamination is particularly challenging, as no existing technology is capable of separately measuring parts of the ²³²Th and ²³⁸U decay chains that are commonly found to be out of secular equilibrium. We will present the results obtained with a detector prototype consisting of 8 silicon wafers of 150 mm diameter instrumented as bolometers and operated in a low-background dilution refrigerator at the Gran Sasso Underground Laboratory of INFN, Italy. The prototype was characterized by a baseline energy resolution of few keV and a background <100 nBq/cm² in the full range of  α energies, obtained with simple procedures for cleaning of all employed materials and no specific measures to prevent recontamination. Such performance, together with the modularity of the detector design, demonstrate the possibility to realize an alpha detector capable of separately measuring all alpha emitters of the ²³²Th and ²³⁸U chains, possibly reaching a sensitivity of few nBq/cm².

New Direct Limit on Neutrinoless Double Beta Decay Half-Life of ^{128}Te with CUORE

The Cryogenic Underground Observatory for Rare Events (CUORE) at Laboratori Nazionali del Gran Sasso of INFN in Italy is an experiment searching for neutrinoless double beta (0νββ) decay. Its main goal is to investigate this decay in ^{130}Te, but its ton-scale mass and low background make CUORE sensitive to other rare processes as well. In this Letter, we present our first results on the search for 0νββ decay of ^{128}Te, the Te isotope with the second highest natural isotopic abundance. We find no evidence for this decay, and using a Bayesian analysis we set a lower limit on the ^{128}Te 0νββ decay half-life of T_{1/2}>3.6×10^{24}  yr (90% CI). This represents the most stringent limit on the half-life of this isotope, improving by over a factor of 30 the previous direct search results, and exceeding those from geochemical experiments for the first time.

[The treatment of thoracic empyema by video-assisted thoracic surgery (VATS)]

Despite various treatment options, empyema thoracis remains associated with important morbility and mortality. Diffused or loculated empyema developed through exudative, purulent and organized phases. Clinically, these phases corresponding to the evolution of the disease: acute and chronic one. The treatment of empyema thoracis is also correlated with the general condition of the patient and even if the drainage is satisfactory in the exudative form, these surgical procedure may be not curative in the purulent and chronic phase. In these cases empyemectomy and pleural decortication are treatment of choice. Recently, Video Assisted Thoracic Surgery has assumed greater importance in the management of this pathology. In our Department of General and Thoracic Surgery, on 178 patients with chronic empyema thoracis, 26 were underwent VATS. During the follow-up there was no mortality or recurrence of empyema. The results indicate VATS because of higher efficacy, shorter hospital stay and less cost, is the primary surgical treatment of chronic empyema thoracis.

[Diagnosis of thoraco-pulmonary disorders: role of videothoracoscopy]

Videothoracoscopy can be used for diagnostic purposes when the other non-invasive methods are not satisfactory for an accurate histological diagnosis in lung and pleural pathology. The role of VTS was confirmed in the cases, observed from 1993 and surgically treated, which are herein discussed.

[The bronchogenic carcinoma-laryngeal cancer association: the experience of our school]

In a 20 year period (1974-1995), 3451 patients with bronchogenic carcinoma were observed. Retrospective analysis of these cases allowed to study the relationship between primary pulmonary malignancies and laryngeal tumours. In 32 patients synchronous or metachronous carcinoma of the larynx and lung were found. All laryngeal tumours were curable but only fifteen of these second primary lung tumours were successfully treated. None of unresected patients survived beyond 2 years.

[Rubber band ligation of hemorrhoids. A four-year experience]

The non-surgical approach to hemorrhoidal disease was considered, particularly in relation to the rubber band ligation technique. On the basis of a four-year experience collected on 60 treated patients among 75 observed, cases, indications, results and advantages of the method were outlined. Besides the classic method's applications, two cases were presented in which the technique was applied on the grounds of non typical indications. From the final results the rubber band method represents a good therapeutic option for early degrees of hemorrhoidal disease. Moreover, on the basis of the author's experience, this method is also suitable in appropriately selected cases of advanced hemorrhoidal disease intra-anal mucosal prolapse.