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Introduction: Knowledge about the neurobiology of psychiatric disorders is increasing in the last decades and evidence from literature suggests a central role for immuno-inflammatory mechanisms in these illnesses. The antipsychotic quetiapine acts on dopamine and serotonin signalling and well-established evidence demonstrates that these neurotransmitters can modulate immune functions in healthy and diseased conditions. Starting from this perspective, in the last few decades, a number of studies attempted to identify quetiapine effects on immune functions in order to highlight a possible additional effect of this drug in psychotic diseases, although no conclusive results were obtained., Methods: We critically reviewed preclinical and clinical studies evaluating quetiapine effects on immune systems, suggesting strategies for future work in this field., Results: Computerised search, in PubMed and Embase databases, was performed in March 2020: 120 studies were identified but only 29 relevant papers were selected for detailed review., Conclusion: Despite some interesting preliminary findings about anti-inflammatory effects of quetiapine, mainly supported by preclinical studies, it is possible to conclude further studies are needed to investigate the immunomodulatory effects of this drug and achieve a better understanding of its relevance on clinical outcomes to finally identify new therapeutic approaches in psychiatric treatment. KeypointsMounting evidence points to a role for immuno-inflammatory mechanisms in psychiatric disorders.Quetiapine (QUE) acts on catecholamine (dopamine and norepinephrine) and serotonin signalling.The immunomodulatory effects of catecholamines are well established.Treatment with QUE in psychiatric disorders could leverage immunomodulatory effects.QUE unclear role in immune function modulation suggests future work.

Objectives: Recent studies proposed the existence of a correlation between patients' inflammatory status and therapy response in bipolar disorder (BD). Here we investigated the correlation between levels of inflammatory markers and quetiapine (QUE) effects in BD patients., Methods: In 15 hospitalised BD patients, we investigated changes in inflammatory markers such as C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR) and cytokines after a 6-week treatment with QUE monotherapy., Results: We found QUE treatment to significantly reduce CRP and IL-6 plasma levels. Moreover, we found higher CRP and IL-6 plasma levels at baseline correlated with better improvement of patients' clinical symptoms., Conclusion: The reported results, although preliminary, could be useful in clinical practice, providing not only markers for QUE response, but also allowing for identification of new targets and new therapies for the treatment of this condition., (© 2022 John Wiley & Sons Ltd.)

Background: Obstructive sleep apnea affects a consistent percentage of the population, and only a minority of patients have been diagnosed and treated because of a discrepancy between resources available for diagnosis and the epidemiology of a disorder possibly affecting nearly one billion people in the world., Aim: We conducted a study to compare a standard home respiratory monitoring system (Nox T3) with a novel device (Airgo™) consisting of an elastic band and a small recorder, light, comfortable for the patient, and low-cost complete with automatic analysis of the data that produces a screening report indicating the type and severity of sleep respiratory disorder., Patients and Results: We examined 120 patients, reduced to 118 for technical problems. The mean ( SD ) age of the patients is 55.7 ± 13 years, their BMI is 27.8 ± 4.3 kg/m 2 , and their AHI is 22 ± 22 events/h. Patients belong to all the different severity rates of OSA, with a percentage of them classified as free of respiratory disorders. The Airgo™ showed excellent agreement with the results of the gold standard, reporting high levels of sensitivity, specificity, positive and negative predicted value, and accuracy., Conclusion: Airgo™ is a reliable tool to screen patients with suspected sleep respiratory disorders, well tolerated by the patient based on totally automatic analysis and reporting system, leading to more efficient use of doctor's and clinician's time and resources and extending the opportunity to diagnose more possible candidates for treatment., Competing Interests: ICS Maugeri holds stocks of Myair Inc. DK, CEO of both Myair Inc. and its subsidiary Myairgo Italy Srl, has a clear conflict of interest in this study. DK is a major shareholder in Myair Inc. as well as the inventor and principal developer of the Airgo technology platform and the author of all related patents. DK has provided much of the know-how and developed many of the algorithms used to produce the Airgo Sleep Reports being tested in this clinical trial. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Braghiroli, Kuller, Godio, Rossato, Sacco and Morrone.)

Bipolar Disorder (BD) is a mental disorder characterized by periods of depression and abnormally elevated moods. Recent studies proposed the existence of a correlation between inflammation, disease severity and response to antipsychotic therapy. The present study is aimed to investigate if treatment with second-generation antipsychotic, in monotherapy, influences the inflammatory process in BD patients. In 50 hospitalized BD patients who started monotherapy with second-generation antipsychotic, we investigated, after six-week of treatment, both clinical outcomes and change in inflammatory markers such as C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR). We observed a significant improvement of clinical symptoms (measured through MADRAS, YMRS, CGI and BPRS scales) in all treated patients. Moreover, we found that at the time of enrolment BD patients showed higher CRP levels compared to reference value, and that after 6 weeks of antipsychotic treatment CRP (but not ERS) plasma levels were significantly reduced returning to reference levels. The present exploratory study indicates that monotherapy with antipsychotic drugs reduces, not only BD symptoms, but also an inflammatory marker such as PCR. The evaluation of relationship between antipsychotic treatment and patients inflammatory conditions could be usefulness in clinical practice, both providing a marker to drug response, and permitting the identification of new targets in BD therapy., (Copyright © 1964–2022 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.)

Background: The rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and coronavirus disease 2019 (COVID-19), has caused more than 3.9 million cases worldwide. Currently, there is great interest to assess venous thrombosis prevalence, diagnosis, prevention, and management in patients with COVID-19., Objectives: To determine the prevalence of venous thromboembolism (VTE) in critically ill patients with COVID-19, using lower limbs venous ultrasonography screening., Methods: Beginning March 8, we enrolled 25 patients who were admitted to the intensive care unit (ICU) with confirmed SARS-CoV-2 infections. The presence of lower extremity deep vein thrombosis (DVT) was systematically assessed by ultrasonography between day 5 and 10 after admission. The data reported here are those available up to May 9, 2020., Results: The mean (± standard deviation) age of the patients was 68 ± 11 years, and 64% were men. No patients had a history of VTE. During the ICU stay, 8 patients (32%) had a VTE; 6 (24%) a proximal DVT, and 5 (20%) a pulmonary embolism. The rate of symptomatic VTE was 24%, while 8% of patients had screen-detected DVT. Only those patients with a documented VTE received a therapeutic anticoagulant regimen. As of May 9, 2020, 5 patients had died (20%), 2 remained in the ICU (8%), and 18 were discharged (72%)., Conclusions: In critically ill patients with SARS-CoV-2 infections, DVT screening at days 5-10 of admission yielded a 32% prevalence of VTE. Seventy-five percent of events occurred before screening. Earlier screening might be effective in optimizing care in ICU patients with COVID-19., (© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.)

When designing unreinforced masonry buildings, the wall stiffness and, consequently, the masonry elastic and shear modulus E and G are essential parameters. Current codes provide empirical estimates of the masonry elastic modulus and a ratio between the shear and elastic modulus, G / E . This ratio, commonly taken as 0.4, is not based on scientific evidence and there appears to be no consensus concerning its value and influencing parameters, meaning that current code standards might not accurately portray the shear deformations of masonry elements. To give the choice of the G/E ratio a theoretical foundation, this paper presents closed-form expressions for the G/E ratio of running-bond masonry that capture the effects of finite joint thickness, finite wall thickness and orthotropic block properties. Based on the geometry of blocks and joints as well as their elastic parameters, a validation of the developed expression using 3D finite element analyses shows good performance. For modern masonry typologies with hollow clay bricks, a G / E ratio of 0.20-0.25 is obtained. For historical masonry typologies, such as dry stacked or mortared stone masonry, as well as solid clay brick masonry, ratios between 0.30 and 0.40 are computed., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s) 2020, corrected publication 2021.)

The refeeding syndrome (RS) is a consequence of passing from a catabolic state to an anabolic state triggered by renutrition that is followed by a prolonged period of fasting. Often under-diagnosed in the context of malnutrition or multimorbid patients, RS presents itself through nonspecific symptoms (oedema and tachycardia) that can rapidly progress in the first 72 hours into life threatening states. The internationally recognized NICE guidelines estimate the risk of RS and are based on BMI, weight loss and electrolyte levels. Several recent studies have addressed hypophosphatemia as a predominant marker allowing to better estimate refeeding syndrome gravity and risk. Patients who present a risk should have a progressive renutrition with an electrolyte substitution if required., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Purpose: To describe visual and vestibular functioning and the effects of age and surgery effects on postural control in healthy children with vertical strabismus., Design: This is a comparative case series., Methods: We evaluated participants at the Scientific Institute Eugenio Medea during routine clinical activities. We enrolled 30 consecutive children/adolescents (age range 4-13 years) with isolated vertical strabismus, with and without corrective surgery. Participants were split into four subgroups according to age (4-8 years versus 9-13 years) and ocular surgery (surgery versus no surgery). The clinical protocol included ophthalmological, orthoptic, neurological, physiatrical, otolaryngological, and vestibular evaluations, and the instrumental protocol included ocular cyclotorsions assessment, posturography, and vestibular myogenic-evoked potentials. Main outcome measures of the study were the prevalence of study-relevant orthopedic, ocular, vestibular, and posturographic abnormalities., Results: Among the overall largely variable findings across patients' groups, we found some interesting trends: larger binocular vision and convergence disorders in younger children, smaller prevalence of asymmetric vestibular-evoked potentials in operated children, less posturographic abnormalities in younger children. No clear-cut beneficial effect of surgery was found on all clinical and instrumental parameters considered, despite good re-alignment of the eyes., Conclusion: The pathophysiology of postural control in vertical strabismus is extremely complex and above the potential of this study design and should be specifically addressed in deeper experimental studies., Competing Interests: Conflict of interest statement: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Available antipsychotics show different efficacy on manic symptoms of bipolar patients, but few studies have investigated the speed of action of the various compounds. For this reason, purpose of the present paper was to compare antipsychotic mono-therapies in terms of speed of action in a sample of manic bipolar patients. In total, 155 bipolar patients, treated with antipsychotic mono-therapy and followed-up in Inpatient Psychiatry Clinic of University of Milan, were included in this single-blind comparative study. Clinical response was defined as a reduction of Young Mania Rating Scale (YMRS) scores ⩾50%, while remission as a YMRS score <10. After 4 days patients who had been treated with asenapine, were more likely to have achieved a clinical response than those in treatment with haloperidol ( p = 0.001). After 7 days, a more frequent clinical response was achieved by patients treated with asenapine than those who had been treated with haloperidol ( p < 0.001) or olanzapine ( p = 0.047). Asenapine appears to be faster in determining treatment response in manic patients compared with haloperidol and less markedly with olanzapine.

Obstructive Sleep Apnea syndrome (OSAS) is largely prevalent among the general adult population, particularly among obese subjects. Diurnal somnolence is a characteristic feature of OSAS, one that can interfere on daily life of the patients and also on his/her work-related activities. Aim of this study was to evaluate the impact of OSAS, its symptoms and its therapy with Continuous Positive Airway Pressure (CPAP) may have on work-related activities. Fourty-eight subjects were studied, all > 18 years old and in a work-related age (< 65 years for men, < 60 years for women). There were 34 males and 14 females, 38 actively working, 3 unemployed, 7 not actively working. Before diagnosis the Epworth Sleepiness Scale (ESS) was 12 +/- 4, after the use of CPAP it was 4 +/- 4 (p< 0.001), the Apnea Hypopnea Index (AHI) before CPAP use was 44 +/- 24, after CPAP use 4 +/- 4 (p< 0.001). CPAP compliance was very good (mean hours of CPAP/night 5 +/- 2). At yearly follow-up, work activity was confirmed in all patients, as all employed patients were still working. Our data seem to indicate that not only OSAS interferes with working performance, mainly due to OSAS-related diurnal somnolence, but also that appropriate CPAP therapy, reinforced with educational activities and followed after one year, is able to ameliorate OSAS-related symptoms, potential cause of inefficiency an occupational risk at work.

Disease related malnutrition has numerous financial and medical consequences and requires to be treated by a nutritional team. Sick patients will frequently need an artificial oral or enteral nutritional support. Prescribing oral nutritional supplements (ONS) with a real indication has to be associated to a bundle of measures to enhance compliance. The efficacy of ONS is supported by various publications. Enteral nutrition (EN) through a nasogastric tube is indicated when oral support has failed or when it is not feasible. The standard formulae are polymeric, have a normal energy density et contain fibres. The macro and micronutrients supply is easily controlled but the the need for free water also has to be managed. EN treatment is paid by the Swiss basic medical coverage insurance while ONS reimbursement is dependant on complementary private insurances.