Ring-Opening Polymerisation of rac

cone-25,27-Dipropyloxy-26,28-dioxo-calix[4]arene titanium (IV) dichloride (1) has been assessed in the ring-opening polymerisation of rac-lactide (L,D-LA). The polymers formed (PLDA) turned out to display an isotactic stereoblock microstructure (determined by NMR) despite the fact that the catalyst has C2v symmetry. Two techniques were applied for initiating the polymerisation reaction, microwave irradiation, and conventional thermal treatment. The polymers obtained were all characterised by NMR, IR, HPLC-SEC, DSC, and MALDI-TOF analysis. The use of microwave irradiation, applied for the first time to calixarene-based catalysts in the presence of the rac-lactide monomer, increased the polymerisation rate compared with that obtained by the other method. On the other hand, standard thermal treatment enabled a slightly better control than microwave irradiation over the molecular weight and molecular weight distribution of the polylactides formed

Ultrasound description of cortical-entheseal bone remodeling in peripheral entheses of patients with psoriasis and nonspecific musculoskeletal symptoms

Aims: ultrasound (US) diagnosis of enthesitis is burdened of low specificity, especially when it is performed in patients with psoriasis (PsO) but without clinical psoriatic arthritis (PsA), because of mechanical, dysmetabolic and age-related concurrent enthesopatic changes. We propose a novel US score to quantify the cortical-entheseal bone remodeling burden of several peripheral entheses, aiming to improve the specificity of US for PsA-related enthesitis, and to evaluate its diagnostic value in PsO patients with subsequent diagnosis of psoriatic arthritis (PsO/PsA). Methods: clinical and US data of 119 consecutive patients with moderate/severe PsO and nonspecific musculoskeletal symptoms, were included in this retrospective study. PsO patients underwent a multi-joint US examination and a subsequent rheumatologic visit to evaluate concurrent PsA clinical diagnosis, in a scenario of real clinical practice. The cortical-entheseal bone remodeling has been evaluated with a morphologic gray-scale US score named “CERTUS” (Cortical-Entheseal Remodeling Tuscany Ultrasonographic Score, range 0-36), grading the combination of both enthesophytes and erosions in a semiquantitative scale. A variant of CERTUS, with Power Doppler (PD), was calculated too (CERTUS-PD, range 0-48), scoring PD signals into erosions. The sum of the scores obtained for 12 peripheral entheses was used as global score for statistic aims. The new bone formation at extensor tendon entheses at distal inter-phalangeal (DIP) joints were also recorded. Results: a clinical diagnosis of PsO/PsA was made in 48/119 PsO patients (40.3%), showing older age (p<0.001), higher BMI (p=0.015), prevalence of metabolic syndrome (p=0.014) and smoking habit (p<0.001). CERTUS (AUROC 0.814) showed a highest specificity cut-off=11 (sensitivity 41.4%, specificity 100%), whereas CERTUS-PD (AUROC 0.828) showed a highest specificity cut-off=13 (sensitivity 37.9%, specificity 100%). CERTUS and CERTUS-PD correlated with both other validated US scores as Belgrade Ultrasound Enthesitis Score (BUSES) (p<0.001), DACTylitis glObal Sonographic (DACTOS) score (p=0.05 and p=0.031 respectively), amount of synovitis (p=0.036 and p=0.04 respectively), enthesitis (p<0.001) and entheseal new bone formation on DIP joints (p=0.029 and p=0.031 respectively). Conclusions: the scoring system named CERTUS (and its variant with PD) is a quick tool to quantify cortico-entheseal bone remodeling burden in PsO patients, improving the specificity of US to diagnose patients with subclinical PsA-related enthesitis

Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

Headaches are among the most prevalent and disabling neurologic disorders and there are several unmet needs as current pharmacological options are inadequate in treating patients with chronic headache, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. Among these, the largest body of evidence supports the use of the ketogenic diet (KD). Exactly 100 years ago, KD was first used to treat drug-resistant epilepsy, but subsequent applications of this diet also involved other neurological disorders. Evidence of KD effectiveness in migraine emerged in 1928, but in the last several year's different groups of researchers and clinicians began utilizing this therapeutic option to treat patients with drug-resistant migraine, cluster headache, and/or headache comorbid with metabolic syndrome. Here we describe the existing evidence supporting the potential benefits of KDs in the management of headaches, explore the potential mechanisms of action involved in the efficacy in-depth, and synthesize results of working meetings of an Italian panel of experts on this topic. The aim of the working group was to create a clinical recommendation on indications and optimal clinical practice to treat patients with headaches using KDs. The results we present here are designed to advance the knowledge and application of KDs in the treatment of headaches

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ABSTRACT. Objective. To investigate by high frequency grey-scale ultrasonography (US) and power Doppler sonography (PDS) the modality and frequency of involvement of the Achilles tendon and plantar fascia in chondrocalcinosis (CC), and to correlate these findings with clinical complaints and radiographic evidence. Methods. The heels of 57 consecutive patients with CC were evaluated by US, PDS, and radiography. One control group of 50 consecutive patients with osteoarthritis (OA) without signs of CC was studied in the same way. A second control group of 50 healthy subjects underwent only US/PDS examination. All subjects also underwent clinical assessment. Results. US revealed Achilles tendon calcifications in 57.9% of those with CC, but none in the control groups. Plantar fascia calcifications were observed in 15.8% of CC and in 2% of OA cases, but not in healthy controls. US showed no significant difference in postero-inferior and inferior calcaneal enthesophytosis between subjects with CC (59.6% and 61.4%, respectively) and those with OA (46% and 44%, respectively). Such alterations were also present, in lower percentages, in the healthy controls. Posterior and inferior calcaneal erosions were absent in all groups. Achilles enthesopathy was found in 22.8% of patients with CC (14.9% of heels, with vascular signals in 11.4% of heels on PDS). Deep retrocalcaneal bursitis was found in 10.5% of patients with CC (7% of heels, with vascular signals in 5.2% of heels on PDS). Plantar fasciitis was found in 40.3% of patients with CC (36% of heels, with vascular signals in 2.6% of heels on PDS) and in 14% of OA patients, but not in healthy controls. No significant correlation was found between talalgia or sex of patients and presence of calcifications. A significant correlation was observed between talalgia and Achilles enthesopathy (r = 0.78, p < 0.0001), deep retrocalcaneal bursitis (r = 0.7, p < 0.0001), and plantar fasciitis (r = 0.31, p < 0.001). A significant correlation between talalgia and vascular signals on PDS was observed in Achilles enthesopathy (r = 0.91, p < 0.0001) and deep retrocalcaneal bursitis (r = 0.65, p < 0.0001). The presence of vascular signals on PDS was significantly associated with the presence of tendinous and bursal grey-scale US alterations. Achilles tendon calcifications were 39% sensitive, 100% specific, and 77% accurate for the presence of CC, whereas plantar fascia calcifications were 15% sensitive, 98% specific, and 54% accurate. Excellent agreement was found between US and radiography in detecting Achilles tendon calcifications (k = 0.86), plantar fascia calcifications (k = 0.77), postero-inferior enthesophytosis (k = 0.90), and inferior enthesophytosis (k = 0.83). Chondrocalcinosis (CC) is an arthropathy generally caused by deposit of calcium pyrophosphate-dihydrate (CPPD) microcrystals in the joints and in the tendons 1,2 . In CPPD crystal deposition disease typical linear calcifications can be found in fibrocartilage, especially in the knee menisci, carpus triangular ligament, symphysis pubis, and in hyaline articular cartilage, especially in the knee 1,2 . Calcifications in tendons have been described in previous radiological reports 3-9 : Achilles tendon, gastrocnemius tendon, hip adductors, and quadriceps tendon were the sites primarily involved. Conclusio

Analysis of Usual Consumption of Vitamin D Among Adult Individuals in Italy

Abstract: Background: The condition of vitamin D (25OHD) deficiency represents an important public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent paper, reporting data collected by a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary consumption of vitamin D, both in females and males, was far below the average. Methods: With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the amount and type of intake of foods containing ergocalciferol and cholecalciferol. It was submitted to 870 subjects, 627 females and 243 males, with an age range from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Results: The present data confirm previous observations: the global quantity of vitamin D intake in 14 days was 70.8 μg (±1.8 SE, ±54.4 SD) in females and 87.5 μg (±1.9 SE, ±57.1 SD) in males; the mean daily intake of vitamin D in females and males was 5.05 μg (±0.5 SE, ±3.8 SD) and 6.25 μg (±0.21 SE, ±4.1 SD), respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to an increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40–50 age group to 54.5 μg and 87.8 μg in the 71–80 age group, respectively Conclusions: In conclusion, the present data, collected in a large Italian cohort, underscore that the daily intake of vitamin D is far below the recommended daily average, thereby contributing to the development of potential hypovitaminosis

Improvement in diagnostic-therapeutic care pathways for women with migraine: an Italian Delphi panel

BackgroundMigraine is a highly underestimated and burdensome disease. Real-world studies evidence that migraine is more frequent and severe in women than men. However, to this day, no diagnostic-therapeutic pathways exist to satisfy the specific needs of female patients.MethodsIn this study, migraine experts, specialists in women’s health, patient, and decision makers, analyzed the diagnostic and therapeutic options for women with migraine across various ages and health conditions within the Italian healthcare system. A Delphi approach was used to formulate statements and achieve a consensus.ResultsGaps in clinical practice were identified, and strategies to accommodate women’s needs were proposed. The experts agreed that a socio-behavioral intervention should be planned before any pharmacological treatment in pediatric/adolescent female patients and that the assessment of migraine with aura is considered crucial for adult women requiring contraceptive therapy. Acupuncture emerged as an effective treatment for pregnant and breastfeeding women, and hormone-replacement therapy selection in menopausal patients requires careful consideration to mitigate safety risks. The experts highlighted the absence of literature and guidelines for the management of migraine in women undergoing assisted reproductive procedures or oncological treatment. In light of these observations, the experts advocated the establishment of multidisciplinary collaborations between neurologists/headache specialists and other healthcare professionals, including general practitioners, pediatricians, gynecologists, and oncologists. Comprehensive migraine education for all healthcare professionals potentially involved in managing the disease, including pharmacists, was emphasized. Efforts to increase migraine awareness among women should be prioritized.ConclusionThe insights gained from this Italian consensus study should serve to develop an improved, female-specific pathway to diagnose and treat migraine