Ultrasound-guided percutaneous antegrade pyelography for suspected ureteral obstruction in 6 pet guinea pigs (Cavia porcellus)

Objectives

To describe the feasibility and safety of ultrasound-guided percutaneous antegrade pyelography (US-PAP) in pet guinea pigs (Cavia porcellus) with suspected ureteral obstruction.

Materials and methods

Six adult pet guinea pigs (4 females and 2 males, all intact) were evaluated for suspected ureteral obstruction. The mean weight of the guinea pigs was 0.8 ± 0.25 kg (range 0.4–1.1 kg), and mean age was 4.07 ± 1.63 years (range 2–7 years). All animals were free from comorbid diseases, had clinical signs of urologic disease and were referred based on either strong clinical suspicion of, or diagnostic imaging of ureteral obstruction. Data on signalment and clinical examination findings, response to anaesthesia and imaging findings were recorded.

Results

Partial ureteral obstruction was confirmed in all guinea pigs but one, in which a complete ureteral obstruction occurred. Uroliths were in both ureters of 5 cases and in both the left renal pelvis and ureters in 1 case. All guinea pigs showed a normal appetite and regular defaecation within 2 h following the procedure. No intraoperative or immediate postoperative complications were encountered after the procedure. The only complication was contrast medium leakages in the subcapsular perinephric, retroperitoneal and, in one case, peritoneal space, which caused no overt clinical consequences afterwards. In one male patient, mobilisation of the ureteral calculus occurred and the urolith was found in the urinary bladder on the radiograph taken after contrast medium injection.

Clinical significance

The US-PAP technique is a useful, safe and easy-to-perform diagnostic tool in guinea pigs with hydronephrosis and hydroureter.

Ultrasonographic measurement of kidney-to-aorta parameters in Whippets

In a previous study, an ultrasonographic method to assess kidney size in dogs as a ratio of kidney length to aortic luminal diameter (KL/AoD ratio) was proposed. The main limitation of this method was the wide range of normal values (5.5-9.1), which resulted in poor sensitivity and specificity. The aim of this prospective, observational, reference interval study was to determine whether the KL/AoD normal cut-off values in a single breed (Whippets) would have a narrower range than the previously reported normal reference ranges. The influence of sex, age, weight, and side on kidney length (KL) and of sex, age, weight, and scanning plane (longitudinal vs transversal) on aortic luminal diameter (AoD) were also investigated. Thirty-six clinically healthy Whippets (16 males, 20 females) without ultrasonographic renal lesions were included in this study. The 95% confidence interval of mean KL/AoD was found to be narrower than the previously reported range (ie, 6.3-6.9 versus 5.5-9.1). This was considered to be especially notable in that the KL in this breed exhibits marked sexual dimorphism. The KL/AoD ratio did not differ between right versus left sides or male versus female sexes in Whippets (P > .05). Findings from the current study provided KL/AoD ratio normal reference range cut-off values for future use in Whippets and supported the use of breed-specific KL/AoD ratio values for characterizing abnormal renal size in other canine breeds.

Qualitative mucin disorders in patients with primary Sjögren's syndrome: a literature review

Background

It is a common opinion that Primary Sjögren Syndrome (pSS) damages the exocrine glands and determines the reduction of secreted saliva, some studies show that there are qualitative anomalies of the mucins produced in saliva, including MUC7, MUC5B, MUC1. The purpose of this study is to trace all the information useful to establish whether there is a qualitative or quantitative defect of the mucins in the pSS.

Material and Methods

We reviewed the literature by looking for publications relevant to the topic in electronic databases. Sixteen articles met the search criteria. The studies were divided into two categories, those that studied the rheological characteristics of the saliva and those that studied the structural and / or metabolism modifications of the muciparous cells in the salivary glands.

Results

in Patients with pSS, xerostomia and the reduction of salivary spinnbarkeit are only partially related to the reduction of the unstimulated salivary flow. In pSS, pathological alterations of mucins’ chemical-physical properties prevail as a cause of the clinical characteristics. Moreover, in pSS there are structural and metabolism changes in salivary glands’ muciparous cells.

Conclusions

There is much evidence that supports the presence of qualitative alterations in the saliva’s rheological properties in Patients with pSS, and these are the main cause, more than the reduction of the unstimulated salivary flow, of the disease clinical characteristics - dry mouth and complications in the oral cavity. Therefore we propose to add to the classification criteria of pSS also a qualitative test of salivary glycoproteins.

Key words:Primary Sjögren's syndrome, mucin, MUC7, MUC5B, MUC1, sulphate oligosaccharides.

Challenges for Midwives' Healthcare Practice in the Next Decade: COVID-19 - Global Climate Changes - Aging and Pregnancy - Gestational Alcohol Abuse

Midwives are multifaceted healthcare professionals whose competence spectrum includes a large variety of knowledge and skills going from antenatal care to education and research. The aim of this review is to suggest the future challenges midwives are going to face in the upcoming decade of this Century. COVID-19 and other infections will reasonably impact healthcare workers all over the world. Midwives are frontline healthcare professionals who are constantly at risk of contagion as their job implies close contact with women, physical support and hand touch. Also, menstruation waste plays a large role in the pollution of waters, severely impacting hygiene in the developing countries and fueling climate change. Appropriate disposal of used menstrual material is still insufficient in many countries of the world especially because of lack of sanitary education on girls. As educators, midwives will be more involved into preventing inappropriate disposal of menstrual hygiene devices by educating girls around the world about the green alternatives to the commercial ones. Despite the evidences about the fertility decrement that occurs with aging, women keep postponing reproduction and increasing their chance being childless or suffering complications related to the advanced maternal age. Teen pregnancies are as well an important issue for midwives who will be called to face more age-related issues and use a tailored case to case approach, enhancing their family planning skills. Another crucial role of midwifery regards the information about the risk of drinking alcohol during gestation. Alcohol assumption during pregnancy is responsible for serious damage to the fetus causing a wide range of pathological conditions related to Fetal Alcoholic Spectrum Disorder, leading cause of mental retardation in children of western countries. On the whole, midwives have demonstrated their willingness to expand their practice through continuing professional development, and through specialist and advanced roles especially in preventive and educational positions.

The employment of an earth-to-air heat exchanger as pre-treating unit of an air conditioning system for energy saving: A comparison among different worldwide climatic zones

A great fraction (20-40%) of primary energy is required for building air conditioning, so the use of renewable energy sources is increasing. The geothermal energy for Heating, Ventilating and Air Conditioning (HVAC) systems can be used considering an Earth-to-Air Heat eXchanger (EAHX). This work analyses the performance of an EAHX through a mathematical model (2D), as a function of diameter and length of the air ducts. The problem is solved with finite element method. A case study office building is analyzed. The air conditioning plant is characterized by fan-coil units and primary air; the EAHX is positioned upstream the Air Handling Unit (AHU) to pre-cool/pre-heat the air. The building is virtually placed initially in six Italian cities (different climatic zones according to Italian regulation DPR 412/93) and subsequently in eight worldwide cities according to Köppen climate classification. The following parameters are calculated: air temperature variation and thermal efficiency of the EAHX; the decreasing of cooling and heating capacity of the coils into the AHU. The best results refer to a duct length of 100 m for Ottawa (warm-summer humid continental climate, 65% capacity reduction), the worst ones for Rio de Janeiro (tropical wet and dry climate, maximum 24% reduction).

Joint laxity in canine hip dysplasia assessed using the hip flexed not distracted ventrodorsal view

OBJECTIVES

The ventrodorsal hip extended standard view is conventionally used for radiographic screening of canine hip dysplasia. However, because the ventrodorsal hip extended standard view minimises hip joint laxity, several alternative views have been proposed. Our aim was to evaluate a new ventrodorsal hip flexed and not distracted view to assess joint laxity, by comparing it with the ventrodorsal hip extended standard and ventrodorsal hip flexed and distracted views.

MATERIALS AND METHODS

Between April 2013 and March 2017, all dogs referred to the University of Naples "Federico II" for the diagnosis of canine hip dysplasia were studied using the ventrodorsal hip extended standard, ventrodorsal hip flexed and not distracted and ventrodorsal hip flexed and distracted views. The Norberg angle and the laxity index were measured for each view.

RESULTS

Overall, 102 dogs, 67 males and 35 females, mean age 15 months, were included. The mean (±standard deviation) Norberg angles were 99.77° (±10.42°), 89.29° (±14.32°) and 91.80° (±13.50°) for the ventrodorsal hip extended standard, ventrodorsal hip flexed and not distracted and ventrodorsal hip flexed and distracted views, respectively. The mean (± standard deviation) laxity indices were 0.19 (± 0.14), 0.39 (± 0.25) and 0.36 (± 0.21), respectively. The ventrodorsal hip flexed and distracted and ventrodorsal hip flexed and not distracted views had lower Norberg angle and higher laxity index values compared with the ventrodorsal hip extended standard view. The ventrodorsal hip flexed and distracted and ventrodorsal hip extended standard views are in strong agreement for the measurement of both Norberg angle and laxity index, as confirmed by Bland-Altman analysis and the intraclass correlation coefficient.

CLINICAL SIGNIFICANCE

The ventrodorsal hip flexed and distracted and ventrodorsal hip flexed and not distracted views obtained with the hip in a neutral position reveal joint laxity better than the ventrodorsal hip extended standard view. Unlike the ventrodorsal hip flexed and distracted view, the ventrodorsal hip flexed and not distracted view does not require human operators or special devices for positioning the dog. The wide age range of the dogs enrolled might have influenced the laxity index measurements, since capsular fibrosis in older dogs reduces laxity.

Determinants of pulmonary vascular resistance reduction with upfront oral therapy in idiopathic pulmonary arterial hypertension: relevance in risk assessment

Background

In pulmonary arterial hypertension (PAH) upfront oral therapy represents the standard of care for naive patients at low and intermediate risk. However little is known about associated changes in risk assessment and prediction of low risk status achievement.

Purpose

To evaluate determinants of PVR reduction in patients treated with upfront oral therapy and to create a score to predict PVR reduction after upfront oral treatment and compared its additive value on top of the European and REVEAL scoring system in predicting treatment response.

Methods

One-hundred-eighty-one consecutive naive PAH patients treated with upfront therapy at 11 italian centers were retrospectively evaluated. Evaluation included clinical, hemodynamic and simple echocardiographic parameters, together with European and REVEAL 2.0 risk scores.

Results

At the time of diagnosis, the majority of the patients was idiopathic PAH (80.6%), female (66.3%), at intermediate risk, 71.8% and 55.2%, respectively, according to the European (average method) and the REVEAL 2.0 risk scores. Ambrisentan-Tadalafil was the most frequent combination used (62%). The median PVR reduction obtained after 180 days (IQR 79–394) was −40.4% (IQR −25.8; −45.3).

Age ≥60 years, male-sex, baseline mPAP 48 mmHg associated with low CI (<2.5 l/min/m2), and RV/LV ratio >1 associated with low TAPSE (<18 mm) emerged as independent predictors of poor PVR reduction, defined as the lower tertile of PVR changes (−25.8%). A treatment response score was created deriving weighted integers from the beta coefficient.

At second evaluation 78 (43.1%) patients achieved or remained at European-derived low risk status, while 63 (34.8%) considering the REVEAL 2.0 score.

Multivariate analysis for the prediction of treatment failure, defined as the absence of low-risk status at follow-up, demonstrated the incremental prognostic power of the models incorporating the treatment response score (≥3) on top of the European and REVEAL 2.0 scores, improving risk discrimination by 63.2% (IDI index 0.056) and 36.8% (IDI index 0.080), respectively.

Conclusions

A significant proportion of PAH patients treated with upfront oral combination are not able to achieve a low-risk status. The treatment response score helps clinicians in predicting treatment failure at the time of diagnosis.

Funding Acknowledgement

Type of funding source: None

Neuroprotective role of phosphoserine in primary open-angle glaucoma patients

OBJECTIVE

To evaluate the neuroprotective role of phosphoserine (P-Ser) in primary open-angle glaucoma (POAG) patients and to compare its therapeutic effectiveness to placebo treatment.

PATIENTS AND METHODS

Fifty-one patients (24 males and 27 females) between 35 and 61 years (average 46 years ± 3.8 SD) affected by POAG were enrolled in this study. Patients were divided in two groups: group A included 28 subjects that received an oral P-Ser treatment for 12 months; and group B included 23 subjects that received an oral placebo treatment for 12 months. Complete ophthalmological examination, standard automated perimetric examination, analysis of ON fibers via scanning laser polarimetry and glaucoma staging was performed in all patients at enrolment and 1, 3, 6, and 12 months after. Statistical analysis was performed using STATA 14.0 (Collage Station, TX, USA).

RESULTS

Mean deviation (MD) and pattern standard deviation (PSD) analysis by means of 30-2 full threshold of the visual fields (VFs), retinal nerve fiber layer (RNFL) thickness by means of GDx, and IOP were considered to evaluate P-Ser therapy effectiveness in both groups. A statistically significant improvement (p<0.05) in VF, RNFL thickness and IOP compared to pre-treatment was found in patients in group A.

CONCLUSIONS

Our study shows a significant improvement in several variables in patients with glaucoma treated with P-Ser compared to placebo and suggests a potential neuroprotective effect of P-Ser in treating glaucoma patients in association with the traditional hypotonic topical therapy.

Impact of COVID-19 pandemic on otolaryngology, ophthalmology and dental clinical activity and future perspectives

OBJECTIVE

Since the COVID-19 outbreak, otolaryngologists, ophthalmologists and dentists have been severely affected, both for the transmission routes and for the diagnostical and therapeutic procedures typical of these disciplines.

MATERIALS AND METHODS

In this article, we discuss the transmission routes, the potential risk of contagion for patients and healthcare providers during procedures, and comment on the changes that will affect head and neck clinical practice in the future of outpatient and surgical activities.

RESULTS

Otolaryngologists, ophthalmologists and dentists are at high risk for infection contagion and spread because they perform diagnostic and therapeutic procedures that generate aerosol and droplets thus facilitating virus transmission. Furthermore, examination involves close doctor-patient contact and otolaryngologists and dentists have to remove patient's protective devices during the visit.

CONCLUSIONS

Special attention to prevention protocols for diagnostic and therapeutic procedures and the use of protective equipment is of utmost importance to limit contagion and prevent a new virus spread in the near future.

Gaussian Processes with Physiologically-Inspired Priors for Physical Arousal Recognition

While machine learning algorithms are able to detect subtle patterns of interest in data, expert knowledge may contain crucial information that is not easily extracted from a given dataset, especially when the latter is small or noisy. In this paper we investigate the suitability of Gaussian Process Classification (GPC) as an effective model to implement the domain knowledge in an algorithm's training phase. Building on their Bayesian nature, we proceed by injecting problem- specific domain knowledge in the form of an a-priori distribution on the GPC latent function. We do this by extracting handcrafted features from the input data, and correlating them to the logits of the classification problem through fitting a prior function informed by the physiology of the problem. The physiologically-informed prior of the GPC is then updated through the Bayes formula using the available dataset. We apply the methods discussed here to a two-class classification problem associated to a dataset comprising Heart Rate Variability (HRV) and Electrodermal Activity (EDA) signals collected from 26 subjects who were exposed to a physical stressor aimed at altering their autonomic nervous systems dynamics. We provide comparative computational experiments on the selection of appropriate physiologically-inspired GPC prior functions. We find that the recognition of the presence of the physical stressor is significantly enhanced when the physiologically-inspired prior knowledge is injected into the GPC model.

Awake fiberoptic intubation in patients with stenosis of the upper airways: Utility of the laryngeal nerve block

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P <0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p <0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB.

Relationship between physical/sedentary activities and overweight/obesity in Modena primary schools

Background

Childhood overweight/obesity can be influenced by food habits, but also by poor physical activity and excessive use of screens. The aim of this study was to investigate physical exercise and sedentary behaviours of children attending the first year of primary schools in Modena, and their association with weight status of children and characteristics of family.

Methods

We involved 890 children attending the first classes of 15 primary schools in Modena. The physical and sedentary activities of child were examined through an anonymous questionnaire administered to the parents. Sociodemographic characteristics of family, weight and height of child and parents were also collected. Univariate logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyse data.

Results

Filled questionnaires were 660 out of 890 families (74.2%), of which 72 without anthropometric data were excluded. The prevalence of overweight/obesity was 25.2% without difference of gender. Less than 25% of children did physical activity per ≥7 hours per week; most children (about 40%) did 2 to 4 hours per week. There was no association between time spent in physical activity and overweight/obesity of children. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets, PCs, mobile phones, videogames (OR = 2.2, CI 95%: 1.4-3.6). Children screen time ≥2 hours daily (63.9%) was associated with parents' low education level and father's weight status.

Conclusions

Our results suggest the need of educational interventions aimed to increase time spent in physical activity, and to promote a responsible use of digital media, by actively involving both children and parents.

Key messages

Children screen time ≥2 hours daily is strongly associated with childhood overweight/obesity. High education level of parents can positively affect lifestyles of their children.

The role of cytokines in head and neck squamous cell carcinoma: A review

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide, accounting for approximately 6% of all cancer cases and responsible for an estimated 1-2% of all cancer deaths. Much research evidence has accumulated in the recent years on the changes in the expression of pro-inflammatory and, to a lesser extent, anti-inflammatory cytokines, that (i) may have a role in the malignant transformation of HNSCC, (ii) may be used as diagnostic markers in the sera of patients because of their excessive production by the tumor cells and (iii) may act as possible immunotherapeutic targets. Among pro-inflammatory cytokines, interleukin-8 (IL--8) has been reported to have an important role in cancer invasion, angiogenesis and metastasis. Recent studies have shown an increased concentration of IL--8 in patients with HNSCC and a positive association with lymph node metastasis and tumor classification, although IL--8 was not significantly associated with shorter overall survival and cancer progression-free survival. Additional evidence on the pathological mechanism of origin, invasion, and metastasis of HNSCC, as well as a better understanding of the implications of cytokines, chemokines and growth factors, are of paramount importance for the advancement of research in head and neck oncology.

An overview on upper respiratory tract infections and bacteriotherapy as innovative therapeutic strategy

OBJECTIVE

The aim of this review is to describe the most common recurring and chronic upper respiratory tract infections (URTI) in children and discuss the role of bacterial interference and bacteriotherapy in their prevention and treatment.

MATERIALS AND METHODS

A literature review has been performed on the following topics: acute otitis media, adenoiditis, tonsillitis, rhinosinusitis, microbiotics and the role of bacterial interference, and bacteriotherapy in the prevention and treatment of URTI.

RESULTS

Research studies into the characteristics of the microbiological flora and its role in the pathogenesis of URTI have focused on a single pathogen, on resistance to and ineffectiveness of antibiotic therapies, or on the persistence of bacterial biofilm. Recent evidence supports a central role of the existing microbial ecosystem in the pathogenesis of respiratory disease. In light of this, new therapeutic approaches include the implantation and persistence within the normal microflora of relatively innocuous "effector" bacteria that can competitively exclude or prevent the outgrowth of potentially disease-causing bacteria. Recently, a retrospective and observational study demonstrated that S. salivarius 24SMB and S. oralis 89a nasal spray could be effective in the prevention of recurrent otitis media in a real-life setting. Other studies have focused on the role of bacteriotherapy in children with beneficial effects in the prevention of URTI.

CONCLUSIONS

The results of previous studies on the role of bacteriotherapy in paediatric URTI suggest that the use of bacterial interference phenomena through bacteriotherapy is a feasible, safe approach and deserves proper consideration as a promising therapeutic strategy against URTI.

Obstructive sleep apnea syndrome in the pediatric age: the role of the anesthesiologist

OBJECTIVE

Childhood obstructive sleep disordered breathing (SDB) is a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation; obstructive sleep apnea syndrome (OSAS) is one of the most common causes of SDB in children. The aim of this review is to evaluate the role of the anesthesiologist in pediatric OSAS.

MATERIALS AND METHODS

A literature review has been performed on the following topics: clinical aspects of pediatric OSAS, preoperative investigations including questionnaires, clinical parameters, laboratory polysomnography and home sleep apnea testing, anesthesiologic preoperative management, anesthesiologic perioperative management, anesthesiologic postoperative management including postoperative analgesia, postoperative nausea and vomiting (PONV), and post-tonsillectomy bleeding.

RESULTS

OSAS in children is a distinct disorder from the condition that occurs in adults; adenoidectomy and tonsillectomy are the first line of therapy in these patients. Even if these surgical procedures are frequently performed, they represent a great challenge for surgeons and anesthesiologists and are associated with a substantially increased risk of morbidity and mortality.

CONCLUSIONS

The role of the anesthesiologist is pediatric OSAS is crucial before, during and after surgery, as pediatric patients are at higher risk of preoperative, perioperative and postoperative adverse events including airway obstruction, PONV, and bleeding.

P569Efficacy and safety of direct Xa oral inhibitors versus warfarin in patients with atrial fibrillation and cancer: a meta-analysis of randomized controlled trials

Background

Patients with cancer are at higher risk of atrial fibrillation (AF) compared with the general population. Furthermore, cancer per se and anti-cancer treatments have been associated with thromboembolic complications and increased bleeding risk. Considering that only 12% of cancer patients can achieve a stable International Normalized Ratio target and the frequent need for invasive procedures, warfarin is not an ideal option. Direct oral anticoagulants may theoretically represent a valid alternative although their use in this population has been scarcely investigated.

Purpose

To compare efficacy and safety of direct oral Xa inhibitors (DOXaI) versus warfarin in patients with atrial fibrillation and cancer.

Methods

We searched electronic databases for randomized controlled trials (RCTs) that analyzed the use of DOXaI versus warfarin in patients with AF and cancer. The primary efficacy outcome was stroke or systemic embolism (SE). The secondary efficacy outcomes were ischemic stroke, myocardial infarction and all-cause death. The primary safety outcome was major bleeding; secondary safety outcomes were major or clinically relevant non-major bleeding, intracranial bleeding and any bleeding. The net clinical benefit was estimated as the composite of the two primary outcomes. A sensitivity analysis was performed to better define the incidence of these outcomes in patients with active cancer. The statistical software ProMeta 3 was used to estimate the risk ratio with a random-effect model.

Results

3 RCTs counting a total of 3029 cancer patients (1682 on DOXaI and 1347 on warfarin), 1354  of whom with active cancer (856 on DOXaI and 502 on warfarin), were included in the analysis. Mean age was 75.6 ± 1.2 years, and 32% were female. Mean follow-up period was 2.2 ± 0.6 years. The most common cancer sites were prostate (23%), gastrointestinal tract (22.2%), breast (12.1%) and genitourinary tract (10.6%). The mean CHADS2 score was 2.9 ± 0.6 and the mean HAS-BLED score was 2.6 ± 0.4.

There were no significant differences in the risk of stroke or SE (RR 0.76; 95% CI 0.52-1.10) as well as for all the other secondary efficacy outcomes. DOXaI significantly reduced the incidence of major bleeding in the overall cancer population (RR 0.79; 95% CI 0.63-0.99; p = 0.039); this finding was consistent also in patients with active cancer (RR 0.79; 95% CI 0.59-1.05) although the effect was not statistically significant.  DOXaI also significantly reduced intracranial bleeding in overall cancer population (RR 0.12; 95% CI 0.02-0.63; p = 0.013) and any bleeding in active cancer patients (RR 0.87; 95% CI 0.77-0.98; p = 0.026). Furthermore, DOXaI significantly reduced the composite endpoints of major bleeding and stroke or SE in overall cancer population (RR 0.78; 95% CI 0.64-0.94; p = 0.008).

Conclusions

Our metanalysis shows that, in patients with atrial fibrillation and cancer, DOXaI are safer and have a similar efficacy compared with warfarin.

Abstract Figure. Primary efficacy and safety outcomes

Pleomorphic Adenoma of the Parotid Gland and Ipsilateral Thyroid Incidentaloma: Report of A Rare Case With Review of Literature

BACKGROUND

Pleomorphic adenomas are benign tumors of the salivary glands that mainly affect the lower pole of the superficial lobe of the parotid gland. The term "pleomorphic" refers to the epithelial and connective origin of the mass. The clinical presentation is typically that of asymptomatic swelling which increases in volume. Therapy consists in surgical removal of the tumor mass by parotidectomy with nerve preservation.

CASE DETAILS

This clinical case describes an interesting case of pleomorphic adenoma of the parotid gland in a 62-year-old patient. The patient presented with a long history of an asymptomatic mildly worsening swelling of the left parotid region. The peculiarity of the clinical case is the dimension of the adenoma (9x5x9 cm) and the presence of a thyroid incidentaloma (TI), consisting of a thyroid multinodular goiter composed of nodules, the largest of which measured 8 cm in diameter. This mass dislocated the laryngotracheal axis, compressed the larynx and caused the reduction of the respiratory space, making orotracheal intubation difficult and determining the need to perform a tracheotomy.

CONCLUSION

Benign pleomorphic adenomas can potentially reach large sizes if untreated. Socio-economic problems may be the reason for late diagnosis.

Transoral laser microsurgery for Tis, T1, and T2 glottic carcinoma: 5-year follow-up

The aim of this retrospective study is to evaluate the results obtained with CO₂ TOLMS in patients with Tis, T1, and T2 glottic tumors at our Department from 2004 to 2016 treated with CO₂ TOLMS. One hundred eighty-five patients having a median age of 67 years (range 42-88) were included in the present analysis. The tumor stages of the patients included 134 pTis-T1a, 12 pT1b, and 39 pT2 cases. Median duration of follow-up for the whole study cohort was 55 months (range 24-108 months). At 5-year follow-up, local control was 91%, 83%, and 79.4% for T1a, T1b, and T2 respectively. Disease-specific survival was 95.5%, 91.6%, and 92.3%. Overall survival was 73.8%, 91.6%, and 82%, and larynx preservation was 96.2%, 83%, and 84.6%. This study confirms that CO₂ TOLMS is a safe and standard therapy for selected T1 and T2 glottic carcinoma, and our review on T2 glottic cancer suggests that CO₂ TOLMS represents a reliable option in terms of overall survival, disease-specific survival, and laryngeal preservation. However, patients with anterior commissure involvement and T2 cancer should be evaluated with a preoperative MRI in order to exclude the infiltration of the laryngeal framework and to quantify the neoplastic involvement of para-glottic space.

In vivo imaging of CNS microglial activation/macrophage infiltration with combined [18F]DPA-714-PET and SPIO-MRI in a mouse model of relapsing remitting experimental autoimmune encephalomyelitis

Purpose

To evaluate the feasibility and sensitivity of multimodality PET/CT and MRI imaging for non-invasive characterization of brain microglial/macrophage activation occurring during the acute phase in a mouse model of relapsing remitting multiple sclerosis (RR-MS) using [¹⁸F]DPA-714, a selective radioligand for the 18-kDa translocator protein (TSPO), superparamagnetic iron oxide particles (SPIO), and ex vivo immunohistochemistry.

Methods

Experimental autoimmune encephalomyelitis (EAE) was induced in female SJL/J mice by immunization with PLP_139–151. Seven symptomatic EAE mice and five controls underwent both PET/CT and MRI studies between 11 and 14 days post-immunization. SPIO was injected i.v. in the same animals immediately after [¹⁸F]DPA-714 and MRI acquisition was performed after 24 h. Regional brain volumes were defined according to a mouse brain atlas on co-registered PET and SPIO-MRI images. [¹⁸F]DPA-714 standardized uptake value (SUV) ratios (SUVR), with unaffected neocortex as reference, and SPIO fractional volumes (SPIO-Vol) were generated. Both SUVR and SPIO-Vol values were correlated with the clinical score (CS) and among them. Five EAE and four control mice underwent immunohistochemical analysis with the aim of identifying activated microglia/macrophage and TSPO expressions.

Results

SUVR and SPIO-Vol values were significantly increased in EAE compared with controls in the hippocampus (p < 0.01; p < 0.02, respectively), thalamus (p < 0.02; p < 0.05, respectively), and cerebellum and brainstem (p < 0.02), while only SPIO-Vol was significantly increased in the caudate/putamen (p < 0.05). Both SUVR and SPIO-Vol values were positively significantly correlated with CS and among them in the same regions. TSPO/Iba1 and F4/80/Prussian blue staining immunohistochemistry suggests that increased activated microglia/macrophages underlay TSPO expression and SPIO uptake in symptomatic EAE mice.

Conclusions

These preliminary results suggest that both activated microglia and infiltrated macrophages are present in vulnerable brain regions during the acute phase of PLP-EAE and contribute to disease severity. Both [¹⁸F]DPA-714-PET and SPIO-MRI appear suitable modalities for preclinical study of neuroinflammation in MS mice models.

Quantifying the lagged Poincaré plot geometry of ultrashort heart rate variability series: automatic recognition of odor hedonic tone

The application of Poincaré plot analysis to characterize inter-beat interval dynamics has been successfully proposed in the scientific literature for the assessment of humans' physiological states and related aberrations. In this study, we proposed novel descriptors to trace the evolution of Poincaré plot shape over the lags. Their reliability in ultra-short cardiovascular series analysis was validated on synthetic inter-beat series generated through a physiologically plausible integral pulse frequency modulation model. Furthermore, we used the proposed approach for the investigation of the direct relationship between autonomic nervous system (ANS) dynamics and hedonic olfactory elicitation, in a group of 30 healthy subjects. Participants with a similar olfactory threshold were selected, and were asked to score 5-s stimuli in terms of arousal and valence levels according to the Russell's circumflex model of affect. Their ANS response was investigated in 35-s windows after the elicitation. Experimental results showed a gender-specific, high discriminant power of the proposed approach, discerning between pleasant and unpleasant odorants with an accuracy of 83.33% and 73.33% for men and for women, respectively. Graphical Abstract Olfaction plays a crucial role in our life and is strictly related to the Autonomic Nervous System (ANS) activity, which can be monitored studying Heart Rate Variability. We used the Lagged Poincare Plot approach to recognize gender-specific ANS response in 35-second windows after the elicitation through pleasant/unpleasant odorants.

Arthrogenic human synovial cysts: immunohistochemical profile of interleukin-1beta, interleukin-6, tumour necrosis factor-alpha

BACKGROUND

Synovial cysts are currently classified as degenerative lesions affecting the joint capsule or adjacent structures.

MATERIALS AND METHODS

In our study we describe the results obtained in an immunohistochemical study comprising 18 patients with synovial cysts, performed to evaluate the pathophysiological role of some inflammatory cytokines such as: interleukin (IL)-1β, IL-6 and tumour necrosis factor-alpha (TNF-α).

RESULTS

Results showed an over-expression of TNF-α, IL-1β and IL-6 which appears to be involved in the onset and progression of the disease. At the present time it is not possible to affirm that these molecules play a direct role also due to the absence of further and more specific investigations. The authors therefore hypothesize that inhibition of inflammation may have a significant role in the pathogenesis and regression of synovial cysts.

CONCLUSIONS

Hence, these inflammatory cytokines may be considered potential therapeutic targets. The development of synthetic inhibitors of these inflammatory factors could lead to a reduction in the intensity of inflammation, thus inhibiting the onset and development of the disease.

Physiological Responses to Induced Stress in Individuals Affected by Alcohol Use Disorder with Dual Diagnosis and Alexithymia

Alcohol use disorders (AUD) are among the most common and undertreated mental disorders in developed countries. The co-occurrence of psychiatric comorbidity and AUD has already been well documented. Moreover, alexithymia was found associated with heavy drinking and alcohol dependence. A large part of AUD individuals, between 45 and 67%, have been identified as alexithymics. Both psychiatric comorbidity and alexithymia can negatively impact the course of recovery from alcohol. Alcohol consumption has also been shown to significantly influence autonomic responses. Chronic use of alcohol may induce significant changes in heart rate variability, respiratory frequency, electrodermal activity and skin temperature. To date, only a few studies have comprehensively investigated the comorbidity of alexithymia in AUD individuals with dual diagnosis. Thus, the aim and also the novelty of the present investigation were to disclose in individuals with AUD the emotional and cognitive stress responses to selected physiological parameters measured by ProComp5 Infiniti™ encoder in AUD patients suffering alexithymia with or without concomitant dual diagnosis. Quite interestingly, in AUD subjects with concomitant dual diagnosis we found that the alexithymia elevated skin temperature, heart rate variability and decreased respiratory frequency. Alexithymia, if associated with the dual diagnosis condition in AUD individuals, can be considered as a further vulnerability factor to stressing factors, impacting psychosomatic processing and inducing alterations in physiological parameters. In this paper, we discuss the implications of these findings in the early treatment of alexithymic AUD individuals.

Sudden hearing loss as an early detector of multiple sclerosis: a systematic review

OBJECTIVE

To evaluate whether Sudden Sensorineural Hearing Loss (S-SNHL) may be an early symptom of Multiple Sclerosis (MS).

MATERIALS AND METHODS

A systematic review was conducted using the following keywords: "Multiple sclerosis, hearing loss, sudden hearing loss, vertigo, tinnitus, magnetic resonance imaging, otoacoustic emission, auditory brainstem responses, white matter lesions, sensorineural hearing loss, symptoms of MS and otolaryngology, nerve disease and MS". Only the articles that included results of at least one auditory test and MRI were considered. We evaluated the prevalence of SNHL in patients with MS, the presence of different forms of SNHL (S-SNHL and Progressive SNHL (P-SNHL)) and their correlation with the stage of MS, the results of electrophysiological tests, and the location (if any) of MS lesions as detected by white matter hyperintensities in the MRI.

RESULTS

We reviewed a total of 47 articles, which included 29 case reports, 6 prospective studies, 6 cohort studies, 4 case-control studies, and 2 retrospective studies. 25% of patients suffered from SNHL. S-SNHL typically occurred in the early stage of the disease (92% of patients) and was the only presenting symptom in 43% of female subjects. Instead, P-SNHL occurred in the late stage of MS (88% of patients). Auditory Brainstem Responses (ABR) were abnormal in all MS patients with S-SNHL. When S-SNHL appeared during the early stage of the disease, MS lesions were found in the brain in 60% of patients and in the Internal Auditory Canal in 40% of patients. ABR remained abnormal after recovery.

CONCLUSIONS

S-SNHL can be an early manifestation of MS and should always be considered in the differential diagnosis of this condition, especially in women. The pathophysiology can be explained by the involvement of microglia attacking the central and/or peripheral auditory pathways as indicated by WMHs.

Brain gliomas and growth factors: immunohistochemical, immunofluorescence, flow cytometry and RT-PCR profile in pediatric age

Gliomas represent over 50% of tumors occurring in children. Evidence suggests that glioma stem cells (GSCs), maintained by the transforming growth factor-beta (TGF-β1) pathway, and vascularization substantially contribute to tumor aggressiveness. The identification of important angiogenic factors such as vascular endothelial growth factor (VEGF) may represent a crucial step in the therapeutic approach against tumor growth and metastatic diffusion. The aim of this study was to identify the expression of TGF-β1, VEGF and VEGF-receptors in brain gliomas. Specimens of 16 gliomas and 4 controls from children aged 0.2-14 years were used in the study. Immunohistochemical analysis and gene expression study from specimens was performed. Flow cytometry analysis on GSCs was performed to ascertain the expression of VEGF and VEGF-R2 in the tumor stem cell compartment. Newly diagnosed gliomas mainly showed moderate to strong VEGF immunostaining and increased expression of pro-inflammatory molecules in glioma cells. The proportion of TGF-β1 positive endothelial cells was markedly lower in normal brain vessels compared to tumor vessels. These findings demonstrate that the glioma mass is constituted by a phenotypically immature anoxic central area with a proliferating hypoxic layer; the peripheral area is characterized by cell types with a higher degree of differentiation expressing pro-angiogenic factors. Our data have proven that GSCs play a central role in promoting glioma neovascularization. These findings are useful to understand glioma vascularization, have relevant implications in the therapeutic options and may favor new insights into stem cells biology and suggest therapeutic opportunities for the anti-vascular treatment strategy.

Quantification of Different Regulatory Pathways Contributing to Heartbeat Dynamics during Multiple Stimuli: a Proof of the Concept

The dynamical interplay between brain and heart is mediated by several feedback mechanisms including the central autonomic network and baroreflex loop at a peripheral level, also for a short-term regulation. State of the art focused on the characterization of each regulatory pathway through a single stressor elicitation. However, no studies targeted the actual quantification of different mediating routes leading to the generation of heartbeat dynamics, particularly in case of combined exogenous stimuli. In this study, we propose a new approach based on computational modeling to quantify the contribution of multiple concurrent stimuli in modulating cardiovascular dynamics. In this preliminary attempt, the model estimates the high-frequency power of heartbeat dynamics, and derives disentangling coefficients quantifying the effect of multiple elicitations. Model evaluation is performed on healthy rate variability (HRV) series from fourteen healthy subjects undergoing physical (tilt-table) and mental stressors (aritmetics), as well as their combined administration. Results indicate that, at a group-wise level, in base of concurrent physical and mental elicitations, the physical stressor contributes for the 85% of the resulting heartbeat dynamics. These findings are in agreement with the current knowledge on heartbeat regulatory systems, providing valuable perspectives on the quantification of underlying generative mechanisms of HRV.

Liquid chromatography-tandem mass spectrometry for the simultaneous quantitation of enmetazobactam and cefepime in human plasma

A simple ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the simultaneous analysis enmetazobactam (also known as AAI101) and cefepime in human plasma. Sample preparation was based on protein precipitation with acetonitrile. Separation was performed on Acquity BEH HILIC column (50 mm × 2.1 mm, 1.7 μm) with a mobile phase containing ammonium formate in water and acetonitrile. The analytes were analyzed with the corresponding isotopically labeled internal standards and were detected in multiple reactions monitoring (MRM) using API 5000 triple-quadrupole mass spectrometer with electrospray (ESI) source operating in positive ion mode. The calibration curves were linear over the selected ranges (r > 0.9970 for both analytes). The intra and inter-assay precision of the Quality Control samples showed CV ≤ 15% and the accuracy was within 85 and 115% in all cases for both compounds. The lower limit of quantification was 0.05 μg/mL for enmetazobactam and 0.5 μg/mL for cefepime.

[The Involvement of Cardiomyocyte-Specific Transcription Factors Meis in Adipocyte Differentiation]

Homeodomain transcription factors play a significant role in adipocyte differentiation. The role of Pbx1 and Prep1, proteins of the TALE family (the three amino acid loop extension), was previously established in adipocyte differentiation of mesenchymal stromal cells and 3T3-L1 cell line. In this study, with the use of RNA interference technology we show that another transcription factor from the same family, Meis1, which is a core protein of mature cardiomyocytes, represses adipogenesis to a greater degree than its paralog Meis2. A number of Meis target genes, markers of adipocytes, are identified. This may indicate the transcriptional mechanism of the effect of Meis1 on the adipocyte differentiation of mouse preadipocytes.

Prediction of hearing recovery in sudden deafness treated with intratympanic steroids

The present study aims to obtain a probability model allowing prediction of auditory recovery in patients affected by sudden sensorineural hearing loss treated exclusively with intratympanic steroids. A monocentric retrospective chart review of 381 patients has been performed. A Probit model was used to investigate the correlation between the success of treatment (marked or total recovery according to Furuashi’s criteria) and the delay between onset of disease and beginning of therapy. The age of patients and audiometric curve shapes were included in the analysis. The results show that delay is negatively correlated with variable success. Considering the entire sample, each day of delay decreases the probability of success by 3%. The prediction model shows that for each day that passes from the onset of the disease the probability of success declines in absence of the medical treatment, hence we conclude that early treatment is strongly recommended.

Correlation between otitis media with effusion and cranial deformation in children

OBJECTIVE

Otitis media with effusion (OME), defined as the presence of fluid in the ear without signs of an acute infection, usually occurs after acute otitis media and could result in reduced sound transmission with hearing loss. Several risk factors have been suggested to be associated with OME, as well as the relationships between morphology anomalies of cranial bones and ear infections. The aim of this study is to investigate the correlation between OME and cranial deformation in a pediatric population.

PATIENTS AND METHODS

Eighteen children (13 males and 5 females) with a diagnosis of unilateral OME based on otolaryngologic examination, conductive hearing loss and an asymmetric tympanogram type were enrolled in the study. Patients underwent osteopathic and physical examinations to evaluate the presence of cranial deformations.

RESULTS

Our study showed a high percentage of skull asymmetry (94%) in the study sample; children were mainly dolichocephalic and with atypical swallowing (72%). Particularly, we observed an occipital flattening, mainly ipsilateral to the ear affected by OME.

CONCLUSIONS

The results of the present study indicated that a high percentage of children with OME present a skull asymmetry with concomitant dolichocephaly, known to be associated with high arched palate which is also related to a higher incidence of OME.

Junctional adhesion molecule-A is down-regulated in anaplastic thyroid carcinomas and reduces cancer cell aggressiveness by modulating p53 and GSK3 α/β pathways

Junctional adhesion molecule A (JAM-A) is a transmembrane protein that contributes to different biological process, including the epithelial to mesenchymal transition (EMT). Through an EMT profiler array, we explored the molecular players associated with human thyroid cancer progression and identified JAM-A as one of the genes mostly deregulated. The quantitative real-time polymerase chain reaction and immunohistochemistry analyses showed that downregulation of JAM-A occurred in anaplastic thyroid carcinoma (ATC) compared with normal thyroid (NT) and papillary thyroid carcinoma (PTC) tissues and correlated with extrathyroid infiltration, tumor size, and ATC histotype. In ATC cell lines, JAM-A restoration suppressed malignant hallmarks of transformation including cell proliferation, motility, and transendothelial migration. Accordingly, knockdown of JAM-A enhanced thyroid cancer cell proliferation and motility in PTC cells. Through the proteome profiler human phospho-kinase array, we demonstrated that higher expression of JAM-A was associated with a significant increased level of phosphorylation of p53 and GSK3 α/β proteins. In conclusion, our findings highlight a novel role of JAM-A in thyroid cancer progression and suggest that JAM-A restoration could have potential clinical relevance in thyroid cancer treatment.

Clinical and immunological effects of a treatment with desentizating low-dose multicomponents in IgE mediated and non IgE mediated food allergies: observational retrospective pilot study

BACKGROUND

Alimentary allergy has high impact on the quality of life (Qol) of patients and their families: it represents an economic burden for individuals and National Health System. The disease, particularly frequent in pediatric age, recognizes different pathogenetic mechanisms and expresses itself through the production of IgE (IgE mediated form) antibodies or through cell-mediated immunune responses (non IgE mediated forms). The aim of this clinical observational retrospective study is to evaluate the effect of a long-term treatment with Low Dose Medicine (LDM) drugs in pediatric patients affected by IgE and non IgE mediated food allergy.

OBJECTIVE

The purpose of the study is to determine the efficacy of the treatment with Allergy Plex (Guna Laboratory, Milan, Italy) to induce clinical and/or immunological tolerance both to IgE mediated and non IgE mediated food allergy; the secondary endpoint is to investigate the treatment tolerability, the reduction of positivity to Skin Prick test and Patch test to food allergens and the decrease on the peripheral blood of the specific IgE to food allergens. The treatment efficacy was measured through a clinical score.

METHODS

In this study the immunomodulant activity of Allergy Plex 13, Allergy Plex 7 and Allergy Plex 10 (Guna S.p.A., Milano, Italy) was evaluated. In every patient the state of allergical clinical responses and the immuno-allergological state were evaluated by means of specific parameters letting know the regulatory response to the allergical Th fenotype.

RESULTS

Data about Clinical tolerance to food, Symptomatological clinical score, ECP, ACTH, Cortisol; IL-4, IL-10 was collected. There was evidence of improvement of clinical score, reduction of the diameter of cutaneous pomphus obtained through the Prick test and a decrease of IgE specifics values.

CONCLUSIONS

The data issued from this study seem to confirm the efficacy of treatment with Allergy Plex in allowing the restoration of immune tolerance and the definite reduction of the clinical score.

A Multiclass Arousal Recognition using HRV Nonlinear Analysis and Affective Images

This paper reports on a multiclass arousal recognition system based on autonomic nervous system linear and nonlinear dynamics during affective visual elicitation. We propose a new hybrid method based on Lagged Poincaré Plot (LPP) and symbolic analysis, hereinafter called LPP_symb. This tool uses symbolic analysis to evaluate the irregularity of the trends of Lagged Poincaré Plot (LPP) quantifiers over the lags, and is here applied to investigate complex Heart Rate Variability (HRV) changes during emotion stimuli. In the experimental protocol 22 healthy subjects were elicited through a passive visualization of affective images gathered from the international affective picture system. LPP_symb and standard HRV analysis (defined in time and frequency domains) were applied to HRV series of one minute length. Then, an ad-hoc pattern recognition algorithm based on quadratic discriminant classifier was implemented and validated through a leave-onesubject-out procedure. The best performance of the proposed classification algorithm for recognizing the four classes of arousal was obtained using nine features comprising heartbeat complex dynamics, achieving an accuracy of 71.59%.

A new Modelling Framework to Study Time-Varying Directional Brain-Heart Interactions: Preliminary Evaluations and Perspectives

We propose a novel modelling framework to study non-stationary, directional brain-heart interplay in a time varying fashion. Considering electroencephalographic (EEG) signals and Heart Rate Variability (HRV) series as inputs, a new multivariate formulation is derived from proper coupling functions linking cortical electrical activity and heartbeat dynamics generation models. These neural-autonomic coupling rules are formalised according to the current knowledge on the central autonomic network and fully parametrised in adaptive coefficients quantifying the information outflow from-brain-to- heart as well as from-heart-to-brain. Such coefficients can be effectively estimated by solving the model inverse problem, and profitably exploited for a novel assessment of brain-heart interactions. Here we show preliminary experimental results gathered from 27 healthy volunteers undergoing significant sympatho-vagal perturbations through cold-pressor test and discuss prospective uses of this novel methodological frame- work. Specifically, we highlight how the directional brain-heart coupling significantly increases during prolonged baroreflex elicitation with specific time delays and throughout specific brain areas, especially including fronto-parietal regions and lateralisation mechanisms in the temporal cortices.

Multidisciplinary team in head and neck cancer: a management model

Nowadays, the multidisciplinary team (MDT) is an essential component for oncologic disease management. Its benefit is also extensively recognized in head and neck cancer (HNC) community, due to tumor rarity and complex treatment. A well-defined MDT management serves as a stable point to define the better strategy and offers a chance to optimize HNC clinical outcomes and patient's quality of life. We explored both mandatory and additional requirements for establishing a high-quality MDT. Then we proposed an example of HNC MDT organization. The aim is to contribute to the best way to systematize HNC care.

Does focal mechanical stimulation of the lower limb muscles improve postural control and sit to stand movement in elderly?

BACKGROUNDS

Imbalance in elderly is a common problem strictly related to fall.

AIMS

This study investigates the possibility that a new protocol based on the focal mechanical muscle vibration may improve balance and stability in elderly.

METHODS

Pre-post non-randomized clinical trial has been used. Patients referring postural disequilibrium with negative vestibular bed-side examinations have been treated with focal muscle vibration applied to quadriceps muscles and evaluated before and immediately after therapy and after 1 week and after 1 month with postural stabilometric examination and with an inertial measurement units during the time up and go test.

RESULTS

Stabilometric analysis showed statistically significant differences in both the area (p = 0.01) and sway (p < 0.01) of the center of pressure during the close eyes tests. Moreover, the global time of the time up and go test was reduced (p < 0.05) and the rotation velocity was increased (p < 0.01).

CONCLUSIONS

The findings confirm the beneficial role of focal muscle vibration in elderly patients improve postural stability and mobility.

Investigation of Lagged Poincaré Plot reliability in ultra-short synthetic and experimental Heart Rate Variability series

This study reports on the reliability of Lagged Poincaré Plot (LPP) parameters calculated from ultra-short cardiovascular time series (from 30 to 180 seconds). ity (HRV) signals, whereas a few studies have studied nonlinear approaches. Particularly, methods derived from the phase-space theory, especially the ones employing multi-lag analyses, are usually considered to be inaccurate with a low number of samples. Here we propose a comprehensive study about LPP, using both synthetic and real RR series. Specifically, we considered 109 5-minutes HRV series: 60 synthetic series generated through the Integral Pulse Frequency Modulation (IPFM) model and 49 experimental series acquired from healthy subjects during resting-state. Three parameters have been extracted through the ellipse-fitting method, SD1, SD2 and S, using ten values of lag. All LPP parameters were estimated by averaging estimates gathered from segments of 30, 120 and 180 seconds, and compared with the once from 5-minute series. Results showed Spearman's correlation coefficients higher than 0.9 in both synthetic and real series. In conclusion, SD1 gave promising results in terms of percentage absolute error, when it was extracted from series with a duration less than three minutes.

Sialendoscopic management of autoimmune sialadenitis: a review of literature

Autoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy.

Results of primary repair of distal triceps tendon ruptures in a general population: a multicentre study

Aims

The aim of the study was to analyze the results of primary tendon reinsertion in acute and chronic distal triceps tendon ruptures (DTTRs) in the general population.

Patients and Methods

A total of 28 patients were operated on for primary DTTR reinsertions, including 21 male patients and seven female patients with a mean age of 45 years (14 to 76). Of these patients, 23 sustained an acute DTTR and five had a chronic injury. One patient had a non-simultaneous bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture or dislocation. Comorbidities were present in four patients. Surgical treatment included transosseous and suture-anchors reinsertion in 22 and seven DTTRs, respectively. The clinical evaluation was performed using Mayo Elbow Performance Score (MEPS), the modified American Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), and the Medical Research Council (MRC) Scale.

Results

A total of 27 patients (28 DTTRs) were available for review at a mean of 47.5 months (12 to 204). The mean MEPS, QuickDASH, and m-ASES scores were 94 (60 to 100), 10 (0 to 52), and 94 (58 to 100), respectively. Satisfactory results were observed in 26 cases (93%). Muscle strength was 5/5 and 4/5 in 18 and ten DTTRs, respectively. One patient with chronic renal failure experienced a traumatic rerupture of distal triceps. One patient (1 DTTR) experienced mild elbow stiffness.

Conclusion

Primary repair of acute and chronic DTTRs in a general population yields satisfactory results in the majority of patients with a low rerupture rate. Cite this article: Bone Joint J 2018;100-B:610-16.

Neuroendocrine Differentiation in Prostatic Malignancy

Neuroendocrine differentiation in prostatic malignancy is receiving considerable attention; this occurs commonly as a “focal” histological variant and, most rarely, in the form of small cell carcinoma (“oat cell carcinoma”) and carcinoid tumor. In prostate cancer, neuroendocrine differentiation may be the response to androgen deprivation and neuroendocrine products, either biogenic amines or peptides, have been shown to stimulate proliferation of androgen-ablation refractory cancer cells. Serum chromogranins, neuron-specific enolase and other neuroendocrine products as well as 111-In-chromogranin A “three step” immunoscintigraphy and somatostatin-receptor scintigraphy may be useful for predicting tumor behaviour and patient prognosis.

Several of the neuroendocrine products, particularly somatostatin analogues, are candidates for new therapeutic approaches. The paper aims to outline the advances in this field on the basis of the review of the literature.