Due to a flaw in the International Classification of Diseases, Ninth Revision, Clinical Modification coding system, epidemiology of skin and soft-tissue infections (SSTIs) has conflated abscess with ...other SSTIs. We analyzed emergency department visits during 1997—2007, finding that the odds of abscess relative to any other diagnosis increased 11% per year, or 3.1-fold, whereas other SSTIs increased minimally.
Background: There is a need for an easily administered instrument which can be applied to all patients with restless legs syndrome (RLS) to measure disease severity for clinical assessment, research, ...or therapeutic trials. The pathophysiology of RLS is not clear and no objective measure so far devised can apply to all patients or accurately reflect severity. Moreover, RLS is primarily a subjective disorder. Therefore, a subjective scale is at present the optimal instrument to meet this need.
Methods: Twenty centers from six countries participated in an initial reliability and validation study of a rating scale for the severity of RLS designed by the International RLS study group (IRLSSG). A ten-question scale was developed on the basis of repeated expert evaluation of potential items. This scale, the IRLSSG rating scale (IRLS), was administered to 196 RLS patients, most on some medication, and 209 control subjects.
Results: The IRLS was found to have high levels of internal consistency, inter-examiner reliability, test–retest reliability over a 2–4 week period, and convergent validity. It also demonstrated criterion validity when tested against the current criterion of a clinical global impression and readily discriminated patient from control groups. The scale was dominated by a single severity factor that explained at least 59% of the pooled item variance.
Conclusions: This scale meets performance criteria for a brief, patient completed instrument that can be used to assess RLS severity for purposes of clinical assessment, research, or therapeutic trials. It supports a finding that RLS is a relatively uniform disorder in which the severity of the basic symptoms is strongly related to their impact on the patient's life. In future studies, the IRLS should be tested against objective measures of RLS severity and its sensitivity should be studied as RLS severity is systematically manipulated by therapeutic interventions.
Idiopathic Hypersomnia (IH) is a rare sleep disorder characterised by excessive daytime sleepiness (EDS) that leads to invalidating daytime consequences. Till now the treatment of IH has mirrored ...that of sleepiness in narcolepsy, and it is mainly focused on symptoms' management. We employed an anodal transcranic Direct Current Stimulation (tDCS) treatment in order to induce a shift toward arousal in IH patients' cortex during the day. Every patients underwent a 4 weeks treatment (3 stimulations per week, for a total of 12 stimulations over a period of 28 days) with an assessment at the baseline and after treatment aimed to the evaluation of subjective daytime sleepiness, neurocognitive functions, and attentional domain tested by means of the Attentional Network Task (ANT). The dependent variables of the ANT are accuracy and reaction times, which represent the objective outcome of our study. A significant effect of tDCS' treatment in reducing EDS was found. Besides the amelioration in subjective EDS, an objective improvement in RTs in all conditions of the ANT, in particular in the more difficult component, was observed. Our results indicate that tDCS may foster the management of EDS in IH, improving also the attentional domain.
The possibility to treat Duchenne dystrophy (DMD) through cell therapy has been widely investigated but before starting clinical trials in humans many questions still need to be addressed in ...pre-clinical studies. In addition to clarifying the role of the exogenous cells in dystrophic muscle, one important concern is whether there is an increased risk of tumors or any other long-term side effects following stem-cells injections. Since murine models have a short life span, the best animal model to address these questions is the Golden Retriever Muscular Dystrophy (GRMD) dog, which reproduces the full spectrum of human DMD. They present clinical signs within the first weeks of life and most of them do not survive beyond age two. However, due to their phenotype variability each dog must be compared separately before and after any experiment. We have injected human adipose-derived mesenchymal stromal cells (hAMSCs), from two different donors, in three GRMD dogs, without immunosuppression. They were injected in the cephalic vein with 5 × 107 cells/kg within their first year of life: weekly in the first month of injections and then monthly. Dolar and Yuan were born in September of 2008 and Rum in July of 2011. In Dolar and Yuan, who received cells from donor 1, we observed that hAMSCs injected systemically were able to reach and express human dystrophin in the host GRMD dystrophic muscle up to 6 months after transplantation. When cells from donor 2 were injected in Rum, no human dystrophin was found in the host muscle. However, the three dogs showed clinical improvement following hAMSCS injections with an apparent stabilization afterwards, suggesting a beneficial effect from factors released by the injected cells. Most importantly, after almost four years of follow-up for Dolar and Yuan there was no tumor or other side effect suggesting that hAMSCS transplantation is a safe procedure, which may have important applications for future therapy in muscular dystrophy patients.
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