The aggregation of α-synuclein (αS), a protein abundant at presynaptic terminals, is associated with a range of highly debilitating neurodegenerative conditions, including Parkinson’s disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Emerging evidence indicates that the interaction of αS with lipid membranes defines both its physiological function and pathological effects. The characterisation of the modes of membrane binding by αS is therefore crucial to clarify the balance between normal and aberrant behaviour of this protein. Here we used solid-state nuclear magnetic resonance (ssNMR) spectroscopy to probe the nature of the N-terminally acetylated form of αS (NTAc-αS) bound to synaptic-like lipid vesicles. This post-translational modification is prevalent for the physiological form of αS and modulates the binding to lipid bilayers. By probing the structure, dynamics and membrane topology of NTAc-αS, we found that N-terminal acetylation does not alter significantly the conformational and topological properties of the membrane-bound state of αS, despite increasing its propensity for binding. Taken together, our data and previous characterisations of the cytosolic state of NTAc-αS clarify that the role of the N-terminal acetylation is to regulate the binding affinity of αS for synaptic vesicles without altering the structural properties of the bound state.
This pilot clinical trial suggests potential activity of botulinum toxin A for the manipulation of appetite.
Summary Since 1980, botulinum toxin has been employed for the treatment of various voluntary muscle spastic disorders in the fields of neurology and ophthalmology. More recently, botulinum toxin has been proved to be effective in the therapy of dyskinetic smooth muscle disorders of the gastrointestinal tract. Achalasia and anal fissure are the gastrointestinal disorders in which botulinum toxin therapy has been most extensively investigated. Botulinum toxin is the best treatment option for achalasia in patients whose condition makes them unfit for pneumatic dilation or surgery. In anal fissure, botulinum toxin is highly effective and may become the treatment of choice. In the future, botulinum toxin application in the gastrointestinal tract will be extended to many other gastrointestinal disorders, such as non‐achalasic motor disorders of the oesophagus, dysfunction of Oddi's sphincter, achalasia of the internal anal sphincter and others. This article describes the mechanism of action, rationale of employment, indications and side‐effects of botulinum toxin application in smooth muscle disorders of the gastrointestinal tract, and compares the results of different techniques of botulinum toxin therapeutic application.
Background SARS-CoV2 outbreak has challenged NHS of many countries. Generalized restriction of movement, together with unprecedented pressure on Health System, disrupted routine care for non-COVID-19 patients. Telemedicine has been promoted to reduce the risk of infections and to offer medical assistance to the restricted population. This paper is aimed to evaluate the impact of tele-consulting technology in a single bariatric center. Materials and Methods Our outpatient clinic reorganized the service from on-site to long-distance video consultations. All patients received a satisfaction questionnaire. The main goals were to evaluate patient compliance and to assess patient satisfaction. Results Of the 33 booked patients who were offered a teleconsultation, 19 (57.6%) participated in the video-call. No significant differences were found between participants and non-participants in terms of age and gender ratio. Urban area residents were 57.9% of the participants versus 42.8% of the non-participants group. Of the participants, 52.6% completed the survey reporting levels of satisfaction ranging from high to very high. Conclusion Telemedicine has been advocated as a useful tool to relieve pressure on the overwhelmed Health Systems during the COVID-19 pandemic. However, e-health technologies are not yet widely adopted. Our initial experience, also compared with national data relating to the digital divide, suggests that the absence of basic computer skills and the lack of confidence with video-call systems may be patient-specific barriers for the implementation of telemedicine. In this context, telemedicine implementation can run up against various patient-related barriers, and several challenges remain for e-health to be integrated into outpatient practice.
Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.
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