University of Siena

About: University of Siena is a education organization based out in Siena, Italy. It is known for research contribution in the topics: Population & Cancer. The organization has 12179 authors who have published 33334 publications receiving 1008287 citations. The organization is also known as: Università degli studi di Siena & Universita degli studi di Siena.

Treatment for ulnar neuropathy at the elbow.

Abstract: Background Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical, but optimal management remains controversial. This is an update of a review first published in 2010 and previously updated in 2012. Objectives To determine the effectiveness and safety of conservative and surgical treatment in ulnar neuropathy at the elbow (UNE). We intended to test whether: - surgical treatment is effective in reducing symptoms and signs and in increasing nerve function; - conservative treatment is effective in reducing symptoms and signs and in increasing nerve function; - it is possible to identify the best treatment on the basis of clinical, neurophysiological, or nerve imaging assessment. Search methods On 31 May 2016 we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, AMED, CINAHL Plus, and LILACS. We also searched PEDro (14 October 2016), and the papers cited in relevant reviews. On 4 July 2016 we searched trials registries for ongoing or unpublished trials. Selection criteria The review included only randomised controlled clinical trials (RCTs) or quasi-RCTs evaluating people with clinical symptoms suggesting the presence of UNE. We included trials evaluating all forms of surgical and conservative treatments. We considered studies regarding therapy of UNE with or without neurophysiological evidence of entrapment. Data collection and analysis Two review authors independently reviewed titles and abstracts of references retrieved from the searches and selected all potentially relevant studies. The review authors independently extracted data from included trials and assessed trial quality. We contacted trial investigators for any missing information. Main results We identified nine RCTs (587 participants) for inclusion in the review, of which three studies were found at this update. The sequence generation was inadequate in one study and not described in three studies. We performed two meta-analyses to evaluate the clinical (3 trials, 261 participants) and neurophysiological (2 trials, 101 participants) outcomes of simple decompression versus decompression with submuscular or subcutaneous transposition; four trials in total examined this comparison. We found no difference between simple decompression and transposition of the ulnar nerve for both clinical improvement (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08; moderate-quality evidence) and neurophysiological improvement (mean difference (in m/s) 1.47, 95% CI -0.94 to 3.87). The number of participants to clinically improve was 91 out of 131 in the simple decompression group and 97 out of 130 in the transposition group. Transposition showed a higher number of wound infections (RR 0.32, 95% CI 0.12 to 0.85; moderate-quality evidence). In one trial (47 participants), the authors compared medial epicondylectomy with anterior transposition and found no difference in clinical and neurophysiological outcomes. In one trial (48 participants), the investigators compared subcutaneous transposition with submuscular transposition and found no difference in clinical outcomes. In one trial (54 participants for 56 nerves treated), the authors found no difference between endoscopic and open decompression in improving clinical function. One trial (51 participants) assessed conservative treatment in clinically mild or moderate UNE. Based on low-quality evidence, the trial authors found that information on avoiding prolonged movements or positions was effective in improving subjective discomfort. Night splinting and nerve gliding exercises in addition to information provision did not result in further improvement. One trial (55 participants) assessed the effectiveness of corticosteroid injection and found no difference versus placebo in improving symptoms at three months' follow-up. Authors' conclusions We found only two studies of treatment of ulnar neuropathy using conservative treatment as the comparator. The available comparative treatment evidence is not sufficient to support a multiple treatment meta-analysis to identify the best treatment for idiopathic UNE on the basis of clinical, neurophysiological, and imaging characteristics. We do not know when to treat a person with this condition conservatively or surgically. Moderate-quality evidence indicates that simple decompression and decompression with transposition are equally effective in idiopathic UNE, including when the nerve impairment is severe. Decompression with transposition is associated with more deep and superficial wound infections than simple decompression, also based on moderate-quality evidence. People undergoing endoscopic surgery were more likely to have a haematoma. Evidence from one small RCT of conservative treatment showed that in mild cases, information on movements or positions to avoid may reduce subjective discomfort.

Prey selection and predation by wolves in białowieża primeval forest, poland

Abstract: Relationships of wolves (Canis lupus) and ungulates were studied in the Polish part of Biaowieza Primeval Forest with high densities of prey. The number of wolves ranged from 7 to 19, and the number of packs ranged from 2 to 4. Average densities were 2.3 wolves/ 100 km 2 . Red deer (Cervus elaphus) was the main prey of wolves. Roe deer (Capreolus capreolus), wild boar (Sus scrofa), moose (Alces alces), and European bison (Bison bon- asus) were hunted less than expected based on their abundance. Mean mass of ungulates killed by wolves was 55 kg. Prey were consumed quickly, with 57% of kills completely eaten on the 1st day after killing. Average killing rate by wolves was 0.78 ungulate per wolf pack per day (0.14 prey item per wolf per day). Results of this study combined with the data obtained in the Belarussian part of Biaowieza Primeval Forest in 1946-1985 allowed for analysis of dietary response of wolves to changes in densities of ungulates. Wolves showed a response to abundance of red deer. The amount of other ungulates in their diet depended on the densities of red deer. From 1991 to 1996, wolves annually removed 57-105 red deer, 19-38 wild boar, 19-25 roe deer, and 0-2 moose per 100 km 2 . Those amounts were equivalent to 9-13% of spring-summer densities of red deer, 4-8% of wild boar, 3-4% of roe deer, and 0-29% of moose. Additionally, hunters annually harvested 131-140 red deer, 44-114 roe deer, 1-7 moose, and 45-142 wild boar per 100 km 2 . Effects of predation and harvest by hunters on ungulate mortality were likely additive and caused declines in ungulate populations during our study.

Relevance of cognitive deterioration in early relapsing-remitting MS: a 3-year follow-up study.

Abstract: Objective: To assess longitudinally cognitive functioning in relapsing—remitting multiple sclerosis (RRMS) patients and its relationship with clinical and MRI variables.Methods: Early RRMS patients and matched healthy controls were assessed in parallel in three testing sessions over 3 years, using the Rao’s Brief Repeatable Battery of Neuropsychological Tests. Patients also underwent an MRI analysis of T2-weighted lesion volume (T2LV), number of gadolinium-enhanced lesions and whole brain atrophy. Forty-nine RRMS patients (mean age 36.9 ± 8.9 years; mean disease duration 2.9 ± 1.7 years, mean Expanded Disability Status Scale, 1.7 ± 0.7) and 56 healthy controls were recruited.Results: At baseline, cognitive impairment was detected in 15 patients (30.6%). After 3 years, cognitive functioning worsened in the 29.3% of patients, whereas Expanded Disability Status Scale progression was observed in only three patients. The most sensitive test to detect cognitive deterioration over time was the Symbol Digit Modal...