A Personalized Mediterranean Diet Improves Pain and Quality of Life in Patients with Fibromyalgia

INTRODUCTION

Fibromyalgia is a form of chronic pain that affects a large number of women. It can start at any age and last a lifetime, with no cure. The Mediterranean diet is said to have an anti-inflammatory effect. Therefore, this study was conducted to investigate possible beneficial effects of a personalized Mediterranean diet in patients with fibromyalgia.

METHODS

Outpatients with fibromyalgia were recruited and invited to participate in the study, including clinical, nutritional, and dietary assessments. Patients received a personalized Mediterranean diet (DIET group) or a general balanced diet (NODIET group) to be followed for 8 weeks. All tests were carried out at baseline and repeated after 4 and 8 weeks.

RESULTS

In total, 100 subjects were included, 84 of whom completed the study. Most of the patients showed incorrect habits in terms of food choices, timing of meals and composition of nutrients. The DIET group showed an improvement in most of the fibromyalgia parameters, including the disability scores, fatigue, and anxiety.

CONCLUSIONS

The habit of eating inflammatory foods and/or eating meals with the wrong nutritional content would increase the negative status of patients with fibromyalgia. With this study, we confirm that proper attention to feeding habits would improve the quality of life of such patients.

Exploring Aesthetic Perception in Impaired Aging: A Multimodal Brain-Computer Interface Study

In the field of neuroscience, brain-computer interfaces (BCIs) are used to connect the human brain with external devices, providing insights into the neural mechanisms underlying cognitive processes, including aesthetic perception. Non-invasive BCIs, such as EEG and fNIRS, are critical for studying central nervous system activity and understanding how individuals with cognitive deficits process and respond to aesthetic stimuli. This study assessed twenty participants who were divided into control and impaired aging (AI) groups based on MMSE scores. EEG and fNIRS were used to measure their neurophysiological responses to aesthetic stimuli that varied in pleasantness and dynamism. Significant differences were identified between the groups in P300 amplitude and late positive potential (LPP), with controls showing greater reactivity. AI subjects showed an increase in oxyhemoglobin in response to pleasurable stimuli, suggesting hemodynamic compensation. This study highlights the effectiveness of multimodal BCIs in identifying the neural basis of aesthetic appreciation and impaired aging. Despite its limitations, such as sample size and the subjective nature of aesthetic appreciation, this research lays the groundwork for cognitive rehabilitation tailored to aesthetic perception, improving the comprehension of cognitive disorders through integrated BCI methodologies.

A multicomponent physical activity home-based intervention for fibromyalgia patients: effects on clinical and skin biopsy features

OBJECTIVES

Adapted physical activity (APA) has been recommended for fibromyalgia (FM) treatment as an essential component of a biopsychosocial therapeutic approach for patients. Previous studies report that aerobic and resistance training are the most effective programs in improving the quality of life and psycho-physical well-being. Patients with FM are frequently affected by an impairment of small fibers innervation, which is evident in the proximal somatic districts. Therefore, this pilot randomised controlled not pharmacological trial aimed to investigate if a 12-week home-based multicomponent (aerobic and resistance training and mobility) physical activity (PA) intervention was effective in improving pain perception, FM-related disability, and IntraEpidermal Nerve Fibers Density (IENFD) in adult FM patients.

METHODS

Thirty-four female subjects with a fibromyalgia diagnosis (51.5±11.88 years) were randomly assigned to an experimental group (n=17) that received a supervised home-based multicomponent PA intervention twice a week and a control group (n=17) that received a generic program of aerobic exercise. Skin biopsy was performed before the physical program and after 18 months with constant execution of the supervised PA intervention or generic aerobic exercise. Both groups assumed pharmacological treatment with duloxetine and/or pregabalin.

RESULTS

We found that the group performing physical activity in a supervised and regular way showed a significant improvement in the Fibromyalgia-linked invalidity questionnaire (FIQ) as well as epidermal fibers density at proximal and distal sites.

CONCLUSIONS

Physical activity could improve FM outcomes, with a possible beneficial impact on peripheral factors contributing to pain-related disability.

Current Challenges in the Diagnosis of Progressive Neurocognitive Disorders: A Critical Review of the Literature and Recommendations for Primary and Secondary Care

Screening for early symptoms of cognitive impairment enables timely interventions for patients and their families. Despite the advances in dementia diagnosis, the current nosography of neurocognitive disorders (NCDs) seems to overlook some clinical manifestations and predictors that could contribute to understanding the conversion from an asymptomatic stage to a very mild one, eventually leading to obvious disease. The present review examines different diagnostic approaches in view of neurophysiological and neuropsychological evidence of NCD progression, which may be subdivided into: (1) preclinical stage; (2) transitional stage; (3) prodromal or mild stage; (4) major NCD. The absence of univocal criteria and the adoption of ambiguous or narrow labels might complicate the diagnostic process. In particular, it should be noted that: (1) only neuropathological hallmarks characterize preclinical NCD; (2) transitional NCD must be assessed through proactive neuropsychological protocols; (3) prodromal/mild NCDs are based on cognitive functional indicators; (4) major NCD requires well-established tools to evaluate its severity stage; (5) insight should be accounted for by both patient and informants. Therefore, the examination of evolving epidemiological and clinical features occurring at each NCD stage may orient primary and secondary care, allowing for more targeted prevention, diagnosis, and/or treatment of both cognitive and functional impairment.

Prefrontal dysfunction in post-COVID-19 hyposmia: an EEG/fNIRS study

Introduction

Subtle cognitive dysfunction and mental fatigue are frequent after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, characterizing the so-called long COVID-19 syndrome. This study aimed to correlate cognitive, neurophysiological, and olfactory function in a group of subjects who experienced acute SARS-CoV-2 infection with persistent hyposmia at least 12 weeks before the observation.

Methods

For each participant (32 post-COVID-19 patients and 16 controls), electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) data were acquired using an integrated EEG-fNIRS system during the execution of a P300 odd-ball task and a Stroop test. The Sniffin' Sticks test was conducted to assess subjects' olfactory performance. The Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB) were also administered.

Results

The post-COVID-19 group consisted of 32 individuals (20 women and 12 men) with an average education level of 12.9 ± 3.12 years, while the control group consisted of 16 individuals (10 women and 6 men) with an average education level of 14.9 ± 3.2 years. There were no significant differences in gender (X2 = 0, p = 1) or age between the two groups (age 44.81 ± 13.9 vs. 36.62 ± 11.4, p = 0.058). We identified a lower concentration of oxyhemoglobin (p < 0.05) at the prefrontal cortical level in post-COVID-19 subjects during the execution of the Stroop task, as well as a reduction in the amplitude of the P3a response. Moreover, we found that post-COVID-19 subjects performed worst at the MoCA screening test (p = 0.001), Sniffin's Sticks test (p < 0.001), and Stroop task response latency test (p < 0.001).

Conclusions

This study showed that post-COVID-19 patients with persistent hyposmia present mild deficits in prefrontal function, even 4 months after the end of the infection. These deficits, although subtle, could have long-term implications for quality of life and cognitive wellbeing. It is essential to continue monitoring and evaluating these patients to better understand the extent and duration of cognitive impairments associated with long COVID-19.

Theory of Mind and Executive Functions in Individuals with Mild Cognitive Impairment or Healthy Aging

Social cognition involves skills for maintaining harmonious personal and social relationships throughout life. Social cognition issues, including Theory of Mind (ToM), can significantly impact the well-being of older individuals and intensify with the onset of neurological conditions. Mild Cognitive Impairment (MCI) is a state between healthy and pathological neurocognitive aging, where monitoring social functions is crucial. Despite numerous studies on ToM challenges in older adults and cognitive disorders, the underlying mechanisms remain debated. Uncertainty exists regarding whether ToM deficits are related to other cognitive functions, such as Executive Functions (EFs). Our study examined the correlation between EF and ToM performance in 32 MCI patients and 36 healthy elderly controls. The findings revealed a link between EF and ToM performance among healthy elderly individuals. Specifically, within the assessed EFs, the role of the working memory (WM) emerged. The study also highlighted distinctions between the MCI group and the healthy elderly group, showing that despite a general reduction in cognitive performance, the condition could impact these abilities in different ways. The study contributes to the literature, fostering comprehension of the mechanisms underlying ToM difficulties, while also paving the way for targeted interventions and enhanced clinical or preventative care.

Galcanezumab treatment changes visual related EEG connectivity patterns in migraine patients

BACKGROUND

Monoclonal antibodies against calcitonin gene-related peptides (CGRP) are innovative therapies for migraine treatment. Although they are clinically effective, how anti-CGRP treatment reduces migraine attacks still remains unclear.

OBJECTIVE

In this observational case-control study, we aimed to apply graph theory to EEG data from 20 migraine patients and 10 controls to investigate the effects of 3 months of galcanezumab on brain connectivity.

METHODS

We analyzed EEG rhythms during black-white pattern reversal stimulation with 0.5 cycle per degree spatial frequency before (T0) galcanezumab injection, as well as after 3 months (T2). EEG recordings made 1 hour after galcanezumab administration served as the control session (T1). Patients' connectivity patterns obtained at T0, T1 and T2 were compared with normal controls.

RESULTS

We found that galcanezumab increased network integration (with a 5% significance level corrected with the false discovery rate), changing the intensity of connections between the occipital through the frontal areas. At 3 months follow up, patients with persistent high headache intensity had a minor effect on the strength of connections (evaluated using Kendall's rank correlation test and p < 0.05).

CONCLUSIONS

The potent anti-nociceptive action that galcanezumab exerts at a peripheral level could restore cortical connections and possibly factors predisposing to attack onset.

Clinical Correlates of Osmophobia in Primary Headaches: An Observational Study in Child Cohorts

Primary headaches, especially migraines, have a significant impact on physical and mental health, as well as on the scholarly performance and quality of life of children and adolescents. Osmophobia could be a potential diagnostic marker of migraine diagnosis and disability. This multicenter observational cross-sectional study included 645 children, aged 8-15, with a diagnosis of primary headaches. We took into consideration the duration, intensity and frequency of headaches, pericranial tenderness, allodynia and osmophobia. In a subgroup of migraine children, we evaluated the migraine-related disability, Psychiatric Self-Administration Scales for Youths and Adolescents, and the Child Version of the Pain Catastrophizing Scale. Osmophobia was found to be present in 28.8% of individuals with primary headaches, with children suffering from migraines having the highest prevalence (35%). Migraine patients with osmophobia also showed a more severe clinical picture, with enhanced disability, anxiety, depression, pain catastrophizing, and allodynia symptoms (F Roy square 10.47 p < 0.001). The presence of osmophobia could help in identifying a clinical migraine phenotype coherent with an abnormal bio-behavioral allostatic model that is worthy of prospective observations and careful therapeutic management.

Lower Prevalence of Chronic Pain in Manifest Huntington's Disease: A Pilot Observational Study

Pain is a minor problem compared with other Huntington Disease (HD) symptoms. Nevertheless, in HD it is poorly recognized and underestimated. So far, no study evaluated the presence of chronic pain in HD. The aim of this pilot study was to evaluate the presence and features of chronic pain in a cohort of HD gene carriers. An observational cross-sectional study was conducted in a cohort of HD gene carriers compared to not gene carriers (n.134 HD subjects, n.74 not gene mutation carriers). A specific pain interview, alongside a neurological, cognitive and behavioural examination, was performed in order to classify the type of pain, subjective intensity. A significant prevalence of "no Pain" in HD was found, which tended to increase with HD progression and a reduced frequency of pain in the last 3 months. A clear difference was found between manifest and premanifest HD in terms of intensity of pain, which did not change significantly with HD progression; however, a tendency emerges to a progressive reduction. No significant group difference was present in analgesic use, type and the site of pain. These findings could support a lower prevalence of chronic pain in manifest HD. Prevalence and intensity of chronic pain seem directly influenced by the process of neurodegeneration rather than by an incorrect cognitive and emotional functioning.

Central effects of galcanezumab in migraine: a pilot study on Steady State Visual Evoked Potentials and occipital hemodynamic response in migraine patients

BACKGROUND

The discovery of the prominent action of Calcitonin Gene Related Peptide -CGRP- on trigeminal afferents and meningeal vessels, opened a new era in migraine treatment. However, how the block of nociceptive afferents could act on central mechanisms of migraine is still not clear. In this pilot study we aimed to test the effect of 3 months Galcanezumab (CGA) therapy on occipital visual reactivity in migraine patients, using the Steady State Visual Evoked Potentials-SSVEPs and Functional Near Infrared Spectroscopy -fNIRS.

METHOD

Thirteen migraine patients underwent clinical and neurophysiological examination in basal condition (T0), 1 h after GCA injection (T1) and after 3 months of GCA treatment (T2). Ten healthy volunteers were also evaluated.

RESULTS

At T2, there was a reduction of headache frequency and disability. At T2, the EEG power significantly diminished as compared to T0 and T1 at occipital sites, and the topographical analysis confirmed a restoration of SSVEPs within normal values. The Oxyhemoglobin levels in occipital cortex, which were basically increased during visual stimulation in migraine patients, reverted to normal values at T2.

CONCLUSIONS

The present pilot study indicates that Galcanezumab could act on cortical targets located beyond the pain network, restoring the abnormal occipital reactivity. This effect could indicate the possible disease modifying properties of CGRP related monoclonal antibodies.

Quantum magnetomechanics with levitating superconducting microspheres

We show that by magnetically trapping a superconducting microsphere close to a quantum circuit, it is possible to perform ground-state cooling and prepare quantum superpositions of the center-of-mass motion of the microsphere. Due to the absence of clamping losses and time-dependent electromagnetic fields, the mechanical motion of micrometer-sized metallic spheres in the Meissner state is predicted to be very well isolated from the environment. Hence, we propose to combine the technology of magnetic microtraps and superconducting qubits to bring relatively large objects to the quantum regime.

Is manual dexterity essential in the selection of dental students?

OBJECTIVE

The purpose of this study was to determine whether basic manual dexterity (BMD) could be an important parameter in selecting students for the Degree in Dentistry (CLOPD) and to assess whether initial manual dexterity in students admitted to the CLOPD can improve with training in pre-clinical and clinical practice.

DESIGN

Observational study.

SETTING

The study was carried out at the Catholic University of Rome, in five consecutive academic years.

SUBJECTS AND METHODS

Four hundred and thirty-three subjects (262 males and 171 females) were tested (10 different exercises) in five consecutive years. Two retests were performed after three and five years respectively from the beginning of the experimentation.

MAIN OUTCOME MEASURES

The scores of individual exercises were averaged for each candidate, assessing the mean value of basic manual dexterity score (BMDS).

RESULTS

It was possible to observe some differences among candidates coming from different types of high schools, since those having a prior university degree or a scientific high school degree proved better than those with classical or vocational high school qualifications (p < 0.05). A statistically significant improvement of BMDS has been observed in students who attended the CLOPD for at least 32 months.

CONCLUSIONS

Data obtained revealed that basic manual dexterity is not essential in the selection of dental students. Students who could follow training significantly improved in their manual ability.

Distribution and inventories of fallout radionuclides (239+240Pu, 137Cs) and 210Pb to study the filling velocity of salt marshes in Doñana National Park (Spain)

Within an extensive multinational and multidisciplinary project carried out in Doñana National Park (Spain) to investigate its preservation and regeneration, the filling velocity of the salt marshes has been evaluated through the calculation of their average sediment accumulation rates. (239+240)Pu and (137)Cs from weapons testing fallout and total (210)Pb distribution profiles and inventories have been determined in some of the most characteristic zones of the park, namely, the ponds (or "lucios") and the waterjets (or "caños"). Plutonium inventories range from 16 to 101 Bq m(-2), (137)Cs values fluctuate between 514 and 3,758 Bq m(-2) and unsupported (210)Pb values comprise between 124 and 9398 Bq m(-2). Average sedimentation rates range from 3 to 5 mm y(-1) (1952-2002). These data are higher than those obtained by carbon dating for the period 6,500 AD-present, estimated as 1.5-2 mm y(-1), suggesting an increase in the accumulation of sediments and the alteration of the park's hydrodynamics caused by the re-channeling of the major rivers feeding the salt marshes.

Neuroblastoma with symptomatic spinal cord compression at diagnosis: treatment and results with 76 cases

PURPOSE

To report on the treatment of patients with newly diagnosed neuroblastoma presenting with spinal cord compression (SCC).

PATIENTS AND METHODS

Of 1,462 children with neuroblastoma registered between 1979 and 1998, 76 (5.2%) presented with signs/symptoms of SCC, including motor deficit in 75 patients (mild in 43, moderate in 22, severe [ie, paraplegia] in 10), pain in 47, sphincteric deficit in 30, and sensory loss in 11. Treatment of SCC consisted of radiotherapy in 11 patients, laminectomy in 32, and chemotherapy in 33. Laminectomy was more frequently performed in cases with favorable disease stages and in those with severe motor deficit, whereas chemotherapy was preferred in patients with advanced disease.

RESULTS

Thirty-three patients achieved full neurologic recovery, 14 improved, 22 remained stable, and eight worsened, including three who become paraplegic. None of the 10 patients with grade 3 motor deficit, eight of whom were treated by laminectomy, recovered or improved. In the other 66 patients, the neurologic response to treatment was comparable for the three therapeutic modalities. All 11 patients treated by radiotherapy and 26 of 32 patients treated by laminectomy, but only two of 33 treated by chemotherapy, received additional therapy for SCC. Fifty-four of 76 patients are alive at time of the analysis, with follow-up of 4 to 209 months (median, 139 months). Twenty-six (44%) of 54 survivors have late sequelae, mainly scoliosis and sphincteric deficit.

CONCLUSION

Radiotherapy, laminectomy, and chemotherapy showed comparable ability to relieve or improve SCC. However, patients treated with chemotherapy usually did not require additional therapy, whereas patients treated either with radiotherapy or laminectomy commonly did. No patient presenting with (or developing) severe motor deficit recovered or improved. Sequelae were documented in 44% of surviving patients.

Patterns of sulfadiazine acute nephrotoxicity

Sulfadiazine acute nephrotoxicity is reviving specially because of its use in toxoplasmosis in HIV-positive patients. We report 4 cases, one of them in a previously healthy person. Under treatment with sulfadiazine they developed oliguria, abdominal pain, renal failure and showed multiple radiolucent renal calculi in echography. All patients recovered their previous normal renal function after adequate hydration and alcalinization. A nephrostomy tube had to be placed in one of the patients for ureteral lithiasis in a single functional kidney. None of them needed dialysis or a renal biopsy because of a typical benign course. Treatment with sulfadiazine requires exquisite control of renal function, an increase in water ingestion and possibly the alcalinization of the urine. We communicate a case in a previously healthy person, a fact not found in the recent literature. Probably many more cases are not detected. We think that a prospective study would be useful.

Heavy metal pollution of soils affected by the Guadiamar toxic flood

Total heavy metal concentrations were determined in soil samples of seven selected areas along the Guadiamar river valley affected by the toxic flood, after removal of the deposited sludge. Mean total concentrations of nine elements (As, Au, Bi, Cd, Cu, Pb, Sb, Tl and Zn) out of the 23 (As, Au, Ba, Be, Bi, Cd, Co, Cr, Cu, In, Mn, Mo, Ni, Pb, Sb, Sc, Sn, Th, Tl, U, V, Y and Zn) analysed were higher in sludge-covered soils than in unaffected soils. Mean values of total As, Au, Pb, Sb, Tl and Zn in sludge-affected soils were higher than the upper limits for normal soils world-wide. Mean concentrations of Bi, Cd and Cu were within these ranges, although some individual values exceeded the upper limits. In all sampling areas, severe heavy metal pollution was observed in the superficial layers (0-20 cm) of most of the affected soils, which decreased downward in the soil profile. Generally, in soils with more than 25% of clay, concentration of heavy metals below the 20-cm depth decreased to values close to those of the background level of the Guadiamar valley soils, while in coarser soils, heavy metal pollution penetrated below this depth, being noticeable down to a depth of at least 50-80 cm.

Electromyographic activity of gastrointestinal tract of patient with short-bowel syndrome

Electromyographic recordings were obtained from a patient with short-bowel syndrome. Eight recording sessions were performed in almost 3 mo, during both fasting and fed states. Slow waves were always present, and their frequencies were similar during both states. Phase III of the migrating motor complex (MMC) was not identified in any of the four recordings performed in the 1st mo after the operation. Afterward, phase III was observed in three of four recordings. Ingestion of milk caused substitution of the MMC by the fed pattern in all eight recordings. We conclude that extensive small-bowel resection causes temporary disappearance of phase III of the MMC. A change from a fasting to a fed pattern after food ingestion is normal.

Nutritional status and efficiency of dialysis in CAPD and CCPD patients

Renal patients are prone to malnutrition. This is of particular concern in patients undergoing peritoneal dialysis because of the loss of protein in the dialysate. Data comparing the adequacy of continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD) are few. To compare nutritional status and dialysis adequacy, 32 patients were studied (19 CAPD, 13 CCPD). Weight change, dietary intake, degree of edema, and laboratory parameters (hemoglobin, albumin, urea, creatinine) were assessed. Dialysis efficiency was compared using urea and creatinine kinetics [KT/V(urea), normalized protein catabolic rate (PCRN), efficacy number, weekly creatinine clearance]. Age was similar in each group [CAPD 56.5 years (34-75 years); CCPD 53.5 years (14-76 years)]. There were no significant differences in hemoglobin, albumin [29 +/- 1.3 g/L CAPD; 32 +/- 1.5 g/L CCPD (mean +/- SEM)], urea, or creatinine between groups, nor in KT/V (1.72 +/- 0.15 CAPD; 1.93 +/- 0.17 CCPD) and PCRN (0.79 +/- 0.05 CAPD; 0.97 +/- 0.08 CCPD). The efficacy number was significantly higher in the CCPD patients (6.95 +/- 0.66 CAPD; 9.93 +/- 1.3 CCPD; p = 0.03). This study indicates that the nutritional status of CCPD patients at our center was similar to that of CAPD patients. Adequacy of dialysis was also similar in CCPD patients as compared with CAPD patients.

Gastrointestinal motility of patients with Roux-en-Y reconstruction

The electromyographic activity of the gastrointestinal tract was studied in 28 patients undergoing gastric, biliary, and pancreatic operations with reconstruction of the gastrointestinal tract with a Roux-en-Y limb. The Roux-en-Y limb was constructed 1 to 5 years before the study in 8 patients (chronic Roux-en-Y) and at the operation in which the electrodes were implanted in 20 patients (recent Roux-en-Y). All four phases of the migrating motor complex (MMC) were identified in the gastrointestinal tract, including in the Roux-en-Y limb. The duration of the MMC was 82.4 +/- 22.3 min in the patients with chronic Roux-en-Y and 89.0 +/- 25.1 min in the patients with recent Roux-en-Y. Food ingestion converted the MMC to the fed pattern in the entire gastrointestinal tract, including the Roux-en-Y limb in 16 (76.2%) of 21 recordings of the patients with chronic Roux-en-Y and in 27 (84.4%) of 32 recordings of the patients with recent Roux-en-Y. The duration of the fed pattern was 170 +/- 34 min in the patients with chronic Roux-en-Y and 154 +/- 26 min in the patients with recent Roux-en-Y. The findings of this study indicate that the electromyographic activity of the Roux-en-Y limb is normal during both fasting and fed states, even many years after the construction of the Roux-en-Y.