The Luigi Sacco Hospital VAS-COG stroke care pathway: A five-year experience.

Background: Psycho-cognitive consequences are a frequent cause of disability in stroke survivors but are often underdiagnosed also because of lack of services dedicated to these aspects. We started assessing systematically cognitive and behavioral functions in acute stroke patients and to follow them up. Here, we report a retrospective analysis of the organization of the Sacco VAS-COG stroke care pathway and the refinements implemented during 5 years of activity. Methods: The protocol includes baseline collection of clinical history, general and neurologic examinations, functional, neuropsychological, and neuroimaging assessment. At follow-up, a diagnosis of cognitive decline was made based on best clinical judgment in the first period (January 2018 to May 2019, namely VAS-COG protocol 1.0) and then based on an extensive neuropsychological battery (May 2019 to January 2023, namely VASCOG protocol 2.0); psychiatric and behavioral disturbances are investigated through suitable scales. Results: From January 2018 to December 2022, 834 patients (mean age 76±13.6 years; 46.6 % females) with acute cerebrovascular events were admitted to the stroke unit, mostly (80 %) for ischemic strokes. Pre-event cognitive impairment was not assessable in 78 patients (9.3 %) because no reliable informant was present and was reported in 327/756 (43 %) patients. During follow-up, post-stroke cognitive impairment was detected in 124/217 (57.1 %) patients in VAS-COG protocol 1.0 and in 137/201(68.2 %) patients in VAS-COG protocol 2.0, while 95/218 (43.2 %) patients were found to be depressed and patients presented on average 2.5 neuropsychiatric symptoms on Neuropsychiatric Inventory-questionnaire. Conclusions: The VAS-COG stroke care pathway represents a model for patients and for their families.

Rhabdomyolysis with Acute Renal Failure and Deep Vein Thrombosis Induced by Antipsychotic Drugs: A Case Report.

Atypical antipsychotics, the first line therapy for schizophrenia, have already been reported as causing rhabdomyolysis or isolated elevation in serum creatine kinase (SCK). This case report dealing with rhabdomyolysis in a 25-year-old man treated with antipsychotics is particularly unusual, due to the extremely high elevation in SCK and the ensuing acute renal failure. He was treated with loxapine 400 mg/day and risperidone 4 mg/day for 4 days and then loxapine was replaced by levomepromazine 300 mg/day. A series of laboratory examinations showed: SCK 43 650 UI/L, creatinine 392 µmol/L. An acute renal failure (acute tubular necrosis) after iatrogenic rhabdomyolysis was diagnosed, requiring hemodialysis. Furthermore, the patient also developed a deep vein thrombosis (DVT) attributed to his antipsychotic treatment. This case underlines the importance of taking rhabdomyolysis and DVT risk factors into account in patients treated with antipsychotics. Indeed, in this case we note that rhabdomyolysis was probably promoted by the interruption and the reintroduction of the treatment more than by possible dehydration, because no other risk factor could be identified.

Electrophilic activation of allenenes and allenynes: analogies and differences between Brønsted and Lewis acid activation.

This Tutorial Review summarizes recent examples of electrophilic activation of allenes with particular focus on analogies and differences between Lewis and Brønsted acid activation of these versatile substrates. The aim of this article is to present a general overview of the possibilities offered to chemists using complementary modes of catalysis and to emphasize advantages and limitations of each approach, thereby providing a means to expand the scope of this powerful synthetic methodology.

Rapid screening of DOM's metal-binding ability using a fluorescence-based microplate assay.

This note describes the development of a method to rapidly quantify the metal-binding ability of low-volume DOM samples based on their fluorescence properties. The method uses 96-well microplates to screen the fluorescence quenching observed when increasing concentrations of various metals are added to the pH-buffered DOM sample. Only 1.6 mL of DOM sample is required to quantify the binding affinity for each metal and the result is obtained in a few minutes. This study presents results for a surface soil DOM sample for which binding was assessed for Cu2+, Fe2+, Ni2+ at pH 5 and 9.

On the deposition of unipolarly charged particles in the human respiratory tract.

The effect of unipolar electrostatic charges on the total deposition efficiency in the human respiratory tract has been investigated. Monodisperse carnauba wax particles of diameter between 0.3 and 1.1 micron were charged, in a corona discharge apparatus, with a number of elementary charges ranging from about 30 to 110 per particle, with a narrow distribution. The experiments were performed with volunteers breathing through the mouth at 12 resp/min at constant flow rate, without pauses. The increase in deposition was of the order of 15 to 30% relative to neutral but otherwise unchanged monodisperse aerosol. The increase depended on the charges carried by each particle, but was independent of the concentration. Therefore it may be concluded that the variation can be ascribed to the effect of electrostatic attraction between the particle charge and the image charge on the airway wall.