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Introduction: The MonCOVID study aimed to assess the feasibility of early home management and monitoring of patients with suspected or confirmed CoViD-19, and to evaluate if this would ensure a rapid and adequate transfer to hospital care., Methods: This pilot, open-label, single-arm study included adult symptomatic patients with suspected or confirmed CoViD-19 for whom the general practitioner or other carer had decided not to proceed to hospitalization. Participants were monitored daily at home, by measuring the pulse oximetry (SpO2) at rest and after a rapid walking test. The study assessed feasibility outcomes (at least 80% of patients recommended to be sent to the competent emergency room actually transferred within 24 hours from reporting) and efficacy (SpO2 at emergency room admission). Patients with SpO2 values below 90% (86% if affected by chronic pulmonary diseases) at rest or with a decrease in SpO2 of five percentage points after a rapid walking test were recommended for hospital care., Results: Thirty-seven participants reported by the local health unit of Alessandria and the Metropolitan City of Turin were included in the study. Enrollment, initially planned for two months to reach a target of 340, was interrupted early due to the drastic reduction in the number of cases. On average, each participant was monitored for 8.2 (median 6.0) days, for a total of 302 visits. The participants showed milder symptoms than those observed in the first phase of the epidemic, at least in terms of pulmonary impairment. No patient had a decrease in SpO2 of 5 percentage points or greater and only one patient required hospitalization due to a worsening of the disease., Discussion: The cases collected were not sufficient to demonstrate or refute the hypothesis of the monitoring test effectiveness. However, the study showed the feasibility of such a program, and raised some elements of interest regarding hospital territory integration, the need to develop tools to support home care and the variability of the clinical manifestations of the CoViD-19 disease.

We examined if the aetiology of heart failure could influence the favourable autonomic response to cardiovascular rehabilitation. We used the autoregressive spectral analysis of RR intervals variability, obtained from 10 minutes of ECG recording: within each autospectrum, we calculated the power of the low (LH) and high frequency (HF) oscillations: their ratio LF/HF is a useful, well accepted index of the sympathovagal balance. In 43 patients with heart failure we evaluated the autonomic tone at rest, during regular breathing (= stimulation of cardiopulmonary receptors, i.e. a parasympathetic challenge) and during active standing (= sympathetic stimulation). The shift in such autonomic response to 3 months of cardiovascular rehabilitation was analyzed separately for patients with ischemic (n = 19) and non-ischemic (n = 24) cardiomyopathy. Before rehabilitation, patients with ischemic cardiomyopathy had a higher sympathetic activity at rest, and a preserved response to parasympathetic stimulation. After rehabilitation, both groups of patients showed an improvement in exercise tolerance and performance, no deterioration in ventricular pump function, and a change in the autonomic profile. Thus, the aetiology of heart failure, despite a different baseline sympathovagal balance, does not influence the favourable clinical and autonomic modulation induced by rehabilitation. Independently from the underlying disease, all clinically stable patients with heart failure can benefit from rehabilitation.

We investigated the reliability of some US signs in the diagnosis of the carpal tunnel syndrome. We carried out a single-blind study with 13-MHz high resolution probes and electromyography on 132 patients with clinical evidence of the carpal tunnel syndrome; a control group of 20 asymptomatic patients was also submitted to US. Eighty-six of 107 patients with US signs of the carpal tunnel syndrome were then submitted to surgical decompression (resection of the transverse carpal ligament), while the extant 21 patients underwent conservative treatment and clinical follow-up. To diagnose the carpal tunnel syndrome, we considered the following US patterns: median nerve changes (swelling before its entrance into the carpal tunnel and flattening in the tunnel itself), palmar bowing of the flexor retinaculum, thickening of the transverse carpal ligament and increased depth of the carpal tunnel, as measured from the apex of the transverse carpal ligament convexity to the underlying carpal bone. Median nerve changes were unreliable signs and were missing in many cases: only 45 of 107 patients exhibited median nerve swelling before and/or its flattening in the carpal tunnel (42%). Such indirect signs as the thickening of the transverse carpal ligament in chronic cases were demonstrated in 94 of 107 patients with the carpal tunnel syndrome (88%) and canal deepening in all unilateral carpal tunnel syndromes was shown in 92 of 107 patients (87%); both these signs proved to be much more reliable. The palmar bowing of the flexor retinaculum was also difficult to demonstrate in surgical patients or in those with connective tissue fibrosis within the tunnel: this sign was demonstrated in 80 of 107 patients with the carpal tunnel syndrome confirmed with electromyography (75%). Tanzer and Rietze reported median nerve changes observed at surgery in 43% and 66% of their patients, respectively. Recent MR findings in asymptomatic wrists have demonstrated that the normal median nerve has an elliptical shape inside the carpal tunnel. To conclude, high resolution US exhibited 96% sensitivity, 95% specificity and 93% diagnostic accuracy and proved to play a major role in the diagnosis of the carpal tunnel syndrome.

The diagnosis of enlarged lymph nodes is of the utmost importance especially in the treatment planning of cancer patients. US yields such morphological findings as node size, longitudinal/transverse diameter ratio, hilum visibility and cortical thickness, which however do not permit the differential diagnosis of benign from malignant forms. Some authors tried to distinguish inflammatory enlargement from metastatic forms on the basis of color Doppler findings, with conflicting and questionable results. We investigated the potentials of color Doppler US in the differential diagnosis of benign and malignant lymph node enlargement using morphological data and flow measurements in lymphatic hilum vessels. The palpable superficial lymph nodes of 70 patients were studied with color Doppler with a linear probe (7.5-10 MHz) equipped for Doppler flow measurements. The largest lymph node was studied in multiple enlargement. The final diagnosis was made with US-guided cytology and/or excisional biopsy. The venous hilar vessels were depicted with color Doppler US in 44/45 patients with lymphadenitis and only in 1/17 patients with metastatic enlargement. Spectral Doppler exams of the hilar arteries showed flows with a wide telediastolic component in lymphadenitis (relative RI:0.58), while flow was rapid and with poor telediastolic component (relative RI:0.84) in metastatic enlargement. Average RI was 0.62 in Hodgkin's lymphomas and 0.71 in all the other lesions. We conclude that the distortion and compression of the main hilar vessels in metastatic lymph node enlargement often prevents color Doppler depiction of venous vessels. Moreover, the compression and distortion of the intranodal capillary network (the "mass" effect) often results in increased RI, as detected with power Doppler in the lymphatic hilum. Even though color Doppler US studies of the hemodynamic changes in the hilar vessels need further validation in larger series of cases, our preliminary results suggest interesting potentials in distinguishing inflammatory from metastatic enlargement, which differentiation remains nevertheless difficult especially in Hodgkin's lymphoma.

The NRC (National Research Council) task force on head and neck cancer issued this document to help clinicians involved in diagnosing and treating precancerous oral diseases. Chapter 1 includes definition, epidemiology, risk factors (alcohol, smoking, poor oral hygiene), WHO classification, clinical picture of leukoplakias, erythroplasia, lichen planus, as well as their natural history. Chapter 2 points out the clinical signs to be looked for in order to make a proper diagnosis and discusses biopsy techniques. Chapter 3 deals with therapeutic procedures (surgical technique and medical treatment), while Chapter 4 concerns follow-up according to the clinical and histological diagnosis. Finally, some statistical forms are enclosed: Form 1 consists of information regarding educational qualifications, occupation, alcohol consumption, smoking and dietary habits; Form 2 consists of information about previous diseases and the history of the present disease; Form 3 records the signs and symptoms observed for the precancerous lesion; Form 4 records treatment modalities; Form 5 records patient follow-up.