IncobotulinumtoxinA versus OnabotulinumtoxinA intradetrusor injections in patients with neurogenic detrusor overactivity incontinence: a double-blind, randomized, non-inferiority trial

BACKGROUND

A randomized, double-blind, non-inferiority clinical study was performed on the efficacy and tolerability of IncobotulinumtoxinA vs OnabotulinumtoxinA intradetrusor injections in patients with refractory neurogenic detrusor overactivity incontinence performing intermittent catheterization.

METHODS

Sixty-four patients with Spinal Cord Injury or Multiple Sclerosis were randomized to receive 30 intradetrusor injections of IncobotulinumtoxinA or OnabotulinumtoxinA 200 U; 28 patients in IncobotulinumtoxinA group and 29 in OnabotulinumtoxinA group completed the study. Primary outcome measure was the noninferior variation from baseline in daily urinary incontinence episodes (week 12), with a non-inferiority margin of one episode/day. Secondary outcomes measures were changes in Incontinence- Quality of Life questionnaire, Visual Analog Scale score (bother of symptoms on Quality of Life), urodynamic parameters, occurrence of adverse effects and related costs (week 12).

RESULTS

At week 12, mean value of difference in urinary incontinence episodes/day between the two groups was -0.2 (95% two-sided CI: -1; 0.7); the difference in incontinence episodes/day between the two groups was -0.4 with a higher limit of one-sided 95% CI of 0.2 episodes/day which was much lower than the non-inferiority margin of one episode/day. Total score and subscores of Incontinence- Quality of Life questionnaire, Visual Analog Scale Scores and urodynamics did not show differences between the two groups. Adverse effects were similar for both treatments, with urinary tract infection being the most frequent, localised effect. Minor costs were observed following IncobotulinumtoxinA.

CONCLUSIONS

In patients with refractory neurogenic incontinence due to Spinal Cord Injury or Multiple Sclerosis, IncobotulinumtoxinA was not inferior to OnabotulinumtoxinA in improving clinical and urodynamic findings in the short-term follow-up, with comparable adverse effects but minor costs.

How to improve CPAP failure prediction in preterm infants with RDS: a pilot study

We aimed to test the diagnostic accuracy in predicting continuous positive airway pressure (CPAP) failure in premature infants with respiratory distress syndrome (RDS) by integrating oxygen saturation (SpO₂)/fraction of inspired oxygen (FiO₂) (SF ratio) with the measurement of peak velocity of the right diaphragmatic excursions (RD-PV), during the inspiration (I-Peak) and expiratory (E-Peak) phases, performed by pulsed-wave Tissue Doppler imaging. This is a prospective, observational pilot study conducted over a 2-year period. Neonates at ≤ 32 weeks gestation supported by early CPAP were eligible. Natural surfactant was delivered via a minimally invasive technique. We performed serial measurements of SF ratio and RD-PV during the early post-natal hours to test the accuracy in predicting surfactant administration as well as invasive ventilation support within 72 h from birth because of the RDS worsening. Of 56 preterm infants enrolled, 34 (61%) failed CPAP support. SF ratio showed a significant inverse relationship with both Silverman-Andersen score at birth (rho = - 0.417; P = .001) and RD-PV [E-Peak] (rho = - 0.361; P = .007). We achieved a high accuracy in predicting CPAP failure (AUC = 95%; 95% CI, 89-100%) by integrating gender, SF ratio, and RD-PV [E-Peak] at the restricted, multivariate analysis.Conclusions: SF ratio and RD-PV, as measured by pulsed-wave Tissue Doppler, may help physicians to improve their confidence in optimizing therapeutic options in preterm infants with RDS. What is Known: • Continuous positive airway pressure is the recommended first-line treatment for respiratory distress syndrome in preterm infants, but failure rates remain unacceptably high. • Choosing the optimal treatment in terms of non-invasive ventilation effectiveness and timeliness of surfactant administration for these patients is often challenging, also due to our inability to identify a worsening respiratory failure. What is New: • The integration of oxygen saturation, as measured by SpO₂/FiO₂, with right diaphragm peak motion velocities, as measured by pulsed-wave tissue Doppler, allows for high prediction accuracy of non-invasive ventilation support failure in premature infants at risk of respiratory distress syndrome. • These measurements may help physicians in providing optimal supportive therapy for these patients.

Are three months multidisciplinary lifestyle intervention enough to get benefits on blood pressure in overweight/obese adults ?

The aim of the study is to determine the effects of a multidisciplinary lifestyle intervention (including a short period of physical exercise) on some health-related variables, particularly on blood pressure, in an overweight/obese adult group. The main outcome was blood pressure lowering. The study involved 378 subjects affected by obesity or type 2 diabetes. The intervention included exercise, nutrition and psychological aspects. Before and after the intervention, several anthropometrics, cardiovascular risk related measures (height, body weight, body mass index, waist circumference, body composition and WHTR index) and physical exercise measures (aerobic capacity, flexibility and dynamic muscle strength) were evaluated through fitness tests. We observed a significant reduction in: blood pressure values, body weight, BMI, waist circumference, WHTR, fat mass and an improvement of fat free mass and physical exercise measures. The C.U.R.I.A.Mo. multidisciplinary approach is effective for reducing blood pressure, after relatively few exercise sessions (three weeks), particularly in patients with hypertension. The intervention can ameliorate the health status and physical performance in the short term, in normotensive and hypertensive adult subjects with overweight/obesity.

Gestational diabetes: A link between OGTT, maternal-fetal outcomes and maternal glucose tolerance after childbirth

BACKGROUND AND AIM

The relationship among distribution of pathological values at the Oral Glucose Tolerance Test (OGTT), metabolic risk factors and pregnancy outcomes in women with Gestational Diabetes (GDM), has not been clearly identified. We retrospectively compared metabolic and therapeutic parameters, maternal-fetal outcomes and post-partum OGTTs, with respect to the number and distribution of altered values of diagnostic OGTT in pregnancy. Secondly, we assessed whether insulin therapy predictive factors were identifiable.

METHODS AND RESULTS

This analysis included 602 pregnant women with GDM, followed in Diabetes and Pregnancy Unit of Perugia Hospital from diagnosis to childbirth. All women were diagnosed diabetic upon 75g OGTT, according IADPSG criteria. Women were divided into 3 groups, respect to distribution of diagnostic blood glucose (BG) values at OGTT: Group 1: only fasting BG (OGTT0h); Group 2: 1 and/or 2h (OGTT1-2h); Group 3: both fasting and 1 h and/or 2h (OGTT0+1-2h) BG. Pregnant women with fasting hyperglycemia at OGTT (Groups 1 and 3) had similar metabolic characteristics (weight, prevalence of obesity, gestational weight gain, HbA1c), a greater need for insulin therapy, and a higher risk of impaired glucose tolerance persistence after childbirth, as compared to Group 2. No significant differences were observed in terms of maternal and neonatal outcomes (p > 0.05), except for a greater prevalence of caesarean sections in Group 3.

CONCLUSION

The metabolic characteristics of GDM women are mirrored by OGTT values at diagnosis, but are not associated with adverse pregnancy outcomes. Intensive management and a tailored treatment of GDM improve maternal-neonatal outcomes, regardless of diagnostic values distribution and pre-gestational metabolic characteristics.

Clinical characterization of glioblastoma patients living longer than 2 years: A retrospective analysis of two Italian institutions

AIM

Despite the advances in surgery and radio-chemotherapy, the prognosis of glioblastoma (GBM) remains poor with about 13% of patients alive at 24 months.

METHODS

A total of 75 long-term survivors (LTS), defined as alive at least 24 months from diagnosis, were retrospectively analyzed. Overall survival (OS) and recurrence-free-survival (RFS) were calculated and related to patient characteristics and treatment received.

RESULTS

Median age and Karnofsky performance status (KPS) were 56 years and 100%, respectively. After surgery (gross tumor resection-GTR in 62, 83% patients), all LTS received concomitant temozolomide (TMZ) with radiotherapy and 70 (93%) adjuvant TMZ. Of these, 10 (13%) discontinued TMZ prior the completion of 6 cycles, 37 (49%) received 6 cycles and 23 (31%) >6 cycles. Sixty-nine (92%) patients experienced a first tumor recurrence at a median time of 21 months. Of these, 32 (46%) were submitted to a second surgery, 34 (49%) to other no-surgical treatments and 3 (5%) only supportive care. At multivariate analysis, OS was significantly improved by second surgery after first recurrence (P = 0.0032) and by cycles of adjuvant TMZ > 6 versus ≤6 (P = 0.05). More than six cycles of TMZ significantly conditioned also first RFS (P = 0.011) and second RFS (P = 0.033).

CONCLUSION

The large majority of LTS had <65 years, had a high KPS and received GTR. OS and RFS resulted significantly related to an extended administration of adjuvant TMZ (>6 cycles) and a second surgery in case of recurrence.

The ST segment depression pattern in asymptomatic peri-menopausal female athletes

Background

ST segment has not been well investigated in asymptomatic peri-menopausal female athletes, when the CV risk is higher.

Aims

The aims of the study is to investigate the prevalence of ST segment depression in peri-menopausal female athletes, divided in four age groups.

Methods

in a cohort of 6010 female athletes aged 45–65 years old, 161 subjects were selected for the presence of ST segment depression, revealed by maximal ergometric test. All athletes were also evaluated by physical examination and echocardiography. Inclusion criteria for ST segment depression were ST depression >0.5 mm respect to baseline and its depth was divided in 0.5 mm, 0.5–1 mm, 1–2 mm categories. Its behavior was classified in ascending, horizontal and descending and it was studied in relation to the age range (<51; 51–55; 56–60; >60).

Results

ST segment depression was mainly evident in inferolateral leads in all groups (63%, 70,3%, 71%, 63,6%, for <51; 51–55, 56–60 and 61–65 respectively) with horizontal pattern (52,2%, 59,5%, 57,8%, 63,6%) and 1–2 mm depth (43,5%, 46,7%, 60,6%), with the exception of the range 51–55, mainly showing a depth of 0,5-1 mm (45,9%). The older group showed increased SBP (137.5 mmHg, p = 0.007) and BMI (24.3, p = 0.093) values. Mitral prolapse was shown in 11,8% while 36,6% showed systolic flattening of mitral leaflets.

Conclusions

ST depression in asymptomatic menopausal female athletes is frequent and it is characterized by a specific presentation pattern. This is particularly important in the menopausal age when CV risk factors are more prevalent.

Significance of anti-La/SSB antibodies in primary Sjögren's syndrome patients with combined positivity for anti-Ro/SSA and salivary gland biopsy

OBJECTIVES

Immunological parameters exert a relevant diagnostic and prognostic role in primary Sjögren's syndrome (pSS) and may identify specific disease phenotypes. Among disease-associated immunological features, anti-La/SSB are rarely found without concomitant anti-Ro/SSA and their clinical significance in patients with pSS has been poorly investigated. Thus, we aimed to characterise the value of anti-La/SSB analysing clinical and serologic features of a wide cohort of pSS patients with both circulating anti-Ro/SSA and positive salivary gland biopsy (SGB).

METHODS

Clinical and serological data of 600 pSS patients with both anti-Ro/SSA and SGB positivity and categorised according to anti-La/SSB status were retrospectively analysed. Comparisons between patients with and without circulating anti-La/SSB were performed.

RESULTS

Among the whole cohort, 319 (53%) of patients were anti-La/SSB negative and 281 (47%) were anti-La/SSB positive. Anti-La/SSB positive patients were younger at disease diagnosis and had a longer disease duration. Moreover, anti-La/SSB positive patients had a higher prevalence of hypergammaglobulinaemia and circulating rheumatoid factor and of lymphoproliferative disorders in comparison to seronegative group. At multivariate analysis, hypergammaglobulinaemia (OR=1,7; 95% CI 1.17, 2.43), rheumatoid factor (OR=2.3; 95% CI 1.6, 3.3) and lymphoma (OR=2.6; 95% CI 1.12, 5.96) were identified as independent variables significantly associated with anti-La/SSB positivity.

CONCLUSIONS

In patients with pSS and concomitant anti-Ro/SSA and SGB positivity, the presence of anti-La/SSB may help in identifying a disease subset with distinct prognostic features, especially in terms of higher risk of lymphoproliferative complications.

Levels of physical activity, nutrition and body composition in the workplace: reports from a distribution company

INTRODUCTION

Lifestyle factors, as eating habits and physical activity, are associated with health and productivity of workers. The aim of this study is an assessment of lifestyle of the employees of an international company of household items.

METHODS

291 (170 female, 121 male) employees underwent body composition assessment and completed two questionnaires (International Physical Activity Questionnaire and National Institute for Research of the Food and Nutrition).

RESULTS

The weight status of the sample is at the upper limits of normal weight. Products based on cereals are consumed about once a day, fresh meat 3.0 (0.0-12.0) per week, fresh fruit (5.0, 0.0-25.0) and vegetables (6.0, 0.0-14.0) less than one serving a day. No vigorous physical activity is performed (0.0, 0.0-240.0 min/week), moderate is performed 30.0 (0.0-450.0) min/week and only 106 subjects were aware of the number of daily steps.

CONCLUSIONS

Job duties can have an influence on the daily habits. Workplaces have great potential to change personal lifestyle choices and a preliminary assessment should be performed in order to propose a tailored intervention.

Fractionated Stereotactic Sequential Boost in a Selected Cohort of Glioblastoma Patients: A Mono-institutional Analysis

AIM

To retrospectively assess toxicity and survival in 15 selected Glioblastoma patients treated with a sequential fractionated stereotactic radiotherapy (FSRT) boost after chemo-radiotherapy (CHT-RT) and compare their survival outcomes with a control group.

PATIENTS AND METHODS

Toxicity was assessed with the CTCAE 3.0 scale. The Kaplan-Meier method was used to design survival curves, log-rank test for bivariate analysis and Cox proportional hazard regression model for multivariate analysis.

RESULTS

The median follow-up was 16 months (range=5-60). One case of headache and one of radionecrosis (RN) occurred. Median overall survival (OS) was 25 months in the boost group vs. 14 in the no-boost group (p=0.004). Median progression-free survival (PFS) was 15 months in the boost group versus 8 in the no-boost group (p=0.046). At multivariate analysis FSRT boost resulted significantly associated with OS and PFS.

CONCLUSION

In our series a sequential FSRT boost resulted in safe outcomes and significantly associated with survival.

Micronutrients in support to the one carbon cycle for the modulation of blood fasting homocysteine in PCOS women

PURPOSE

Fasting blood homocysteine is increased in PCOS women and is involved in several of its co-morbidities including cardiovascular disease and infertility. Corrective interventions based on the administration of supra-physiologic doses of folic acid work to a low extent. We aimed to test an alternative approach.

METHODS

This was a prospective, randomized, parallel group, open label, controlled versus no treatment clinical study. PCOS women aged > 18, free from systemic diseases and from pharmacological treatments were randomized with a 2:1 ratio for treatment with activated micronutrients in support to the carbon cycle (Impryl, Parthenogen, Switzerland-n = 22) or no treatment (n = 10) and followed-up for 3 months. Fasting blood homocysteine, AMH, testosterone, SHBGs, and the resulting FTI were tested before and at the end of the follow-up.

RESULTS

The mean baseline fasting blood homocysteine was above the normal limit of 12 μMol/L and inversely correlated with SHBG. AMH was also increased, whereas testosterone, SHBG, and FTI were within the normal limit. The treatment achieved a significant reduction of homocysteine, that did not change in the control group, independently of the starting value. The treatment also caused an increase of AMH and a decrease of SHBGs only in the subgroup with a normal homocysteine at baseline.

CONCLUSIONS

In PCOS ladies, blood homocysteine is increased and inversely correlated with the SHBGs. Physiologic amounts of activated micronutrients in support to the carbon cycle achieve a reduction virtually in all exposed patients. Whether this is of clinical benefit remains to be established.

Pulmonary function in stereotactic body radiotherapy with helical tomotherapy for primary and metastatic lung lesions

AIMS

This retrospective study reports outcomes after stereotactic body radiation therapy (SBRT) as delivered by helical tomotherapy (HT) for lung lesions. It promotes a dose escalation program.

METHODS

Histological and/or radiological findings and/or case histories identified 41 primary and 15 metastatic lesions. Thirty patients received 40 Gy in 5 fractions (BED 72 Gy_10Gy) and 26 50 Gy in 5 fractions (BED 100Gy_10Gy). Primary end point was lung toxicity. Secondary end points were respiratory function, local control and local progression-free survival.

RESULTS

Acute toxicity developed in 18/56 patients and late toxicity in 8/54. Median FEV-1 variations versus baseline were - 0.5% (range - 16 to + 43%) at 6 months and - 4.00% (range - 42 to + 18%) at 24 months. Median DLCO variations versus baseline were - 1% (range - 38 to + 36%) at 6 months and - 12.2% (range - 48 to + 11%) at 24 months. At 6 months, a significant positive correlation emerged between FEV-1 change and KPS (p = 0.047). At 24 months, a significant negative correlation emerged between FEV-1 change and the ipsilateral lung V5 (p = 0.006). A low baseline DLCO correlated with more marked DLCO worsening at 6 months (p = 0.012). At 24 months, DLCO worsening correlated significantly with the median contralateral lung dose (p = 0.003). At the last checkup, 23 patients were in complete remission, 16 were in partial remission, 5 had stable disease, and 7 were in relapse. Median follow-up was 12 months (range 5-56).

CONCLUSIONS

In patients with lung disease, SBRT, as delivered by HT, was well tolerated and provided good local control.

Does epidural analgesia influence labor progress in women aged 35 or more?

Background: During the last decades, the age of pregnant women significantly increased. The incidence of maternal and labor complications is higher among older women, but conclusive data have not been delivered whether labor epidural analgesia (EA) may affect the duration of labor and delivery outcomes in this population of patients. The aim of this study is to evaluate the effect of EA among women aged over 35 years.Methods: We retrospectively reviewed medical records of all, singleton, at term deliveries, laboring with EA, between December 2011 and October 2017. Women aged ≥35 years (study group) were compared with women aged <35 years (control group) to evaluate EA effects on the duration of labor and neonatal outcome.Results: The study enrolled 459 women with EA: 122 women were included in the study group and 337 in the control group. The multiple regression analysis showed that parity was an independent variable for a shorter dilation period (p = .002), second stage length (p = .0001) and for the total labor duration (p = .0001); neonatal weight was significant for a shorter dilation period (p = .005) and for the total labor duration (p = .002); maternal age and cervical dilatation at the beginning of EA did not influence neither the period of the labor stages nor the total labor duration (p > .05).Conclusions: Results of this study indicate that women aged ≥35 with EA may have labor duration and neonatal short-term outcomes similar to younger women with EA.

Helical tomotherapy re-irradiation for patients affected by local radiorecurrent prostate cancer

Background

Salvage re-irradiation in patients affected by radiorecurrent prostate cancer might be a valid as well as challenging treatment option. The aim of this study was to evaluate feasibility and toxicity of salvage external beam radiotherapy (EBRT) re-treatment in patients affected by radiorecurrent prostate cancer within the prostate gland or the prostate bed.

Materials and Methods

15 patients underwent EBRT re-treatment using helical tomotherapy (HT), with daily Megavolt computed tomography image-guidance. We registered toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Biochemical relapse was defined as a PSA increase > 20% compared with the pre-EBRT re-treatment value. Survival curves were calculated using the Kaplan-Meier method.

Results

All patients received a total dose of 50 Gy (25 × 2 Gy), and 7 (46.6%) had concomitant androgen deprivation therapy (median duration of 12 months). With a median follow-up of 40.9 months, the 2-year and 4-year biochemical relapse-free survival were 55% and 35%, respectively. Acute and late genito-urinary (GU) toxicity ≥2 were recorded in 4 (26.6%) and 5 (33.3%) patients, respectively, and the 4-year late GU toxicity was 30%. Acute gastrointestinal toxicity ≥2 was recorded in 2 (13.3%) cases, whereas no patient experienced late toxicity.

Conclusions

Despite the inherent bias of a retrospective analysis, our long-term results showed a low toxicity profile with a relatively low rate of biochemical control for HT re-treatment in patients affected by local radiorecurrent prostate cancer. Prospective trials are needed to investigate the role of EBRT in this setting.

Likelihood of Accomplishing an In-Patient Hysteroscopic Myomectomy in a One-Step Procedure: A Systematic Review and Meta-Analysis

PURPOSE

To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted.

METHODS

In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups.

RESULTS

One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (p < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (.

CONCLUSION

In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.

Overweight in Young Athletes: New Predictive Model of Overfat Condition

The aim of the study is to establish a simple and low-cost method that, associated with Body Mass Index (BMI), differentiates overweight conditions due to a prevalence of lean mass compared to an excess of fat mass during the evaluation of young athletes. 1046 young athletes (620 male, 426 female) aged between eight and 18 were enrolled. Body composition assessments were performed with anthropometry, circumferences, skinfold, and bioimpedance. Overweight was established with BMI, while overfat was established with the percentage of fat mass: 3.5% were underweight, 72.8% were normal weight, 20.1% were overweight, and 3.5% were obese according to BMI; according to the fat mass, 9.5% were under fat, 63.6% were normal fat, 16.2% were overfat, and 10.8% were obese. Differences in overfat prediction were found using BMI alone or with the addition of the triceps fold (area under the receiver operating characteristics curve (AUC) for BMI = 0.867 vs. AUC for BMI + TRICEPS = 0.955, p < 0.001). These results allowed the creation of a model factoring in age, sex, BMI, and triceps fold that could provide the probability that a young overweight athlete is also in an overfat condition. The calculated probability could reduce the risk of error in establishing the correct weight status of young athletes.

Diagnostic Pathway and Clinical Significance of Premature Ventricular Beats (PVBs) in Trained Bicuspid Aortic Valve (BAV) Athletes

PURPOSE

Bicuspid aortic valve (BAV) represents a common congenital cardiac disease (1-2%) normally compatible with sports activity. In the case of competitive sports, eligibility can be barred by the presence of symptoms, aortic valve dysfunction, or arrhythmias. This investigation of a large cohort of BAV athletes aims to verify the prevalence of premature ventricular beats (PVBs) found in the exercise test (ET) at the first sports medicine clinical evaluation.

METHODS

A sample of 356 BAV athletes, regularly examined over a period of 10 years at the Sports Medicine Center of the University of Florence, was retrospectively evaluated for arrhythmic events found in the first sports medicine check-up carried out. The athletes (321 M and 79 F), aged between 8-50 years (mean age 21.8 ± 11.6), practised sports at high dynamic cardiovascular intensity (mainly soccer, basketball, and athletics). Criteria for participation included a 2D echocardiography and ET conducted at 85% of maximal effort. Ventricular arrhythmic events were reported if found to be ≥3 at rest and/or during the exercise test and for subjects with any other cardiac or systemic structural diseases. Individuals aged >50 were excluded from the study. The selected participants were matched with a control group of 400 athletes with similar levels of training (age 20.0 ± 9.9) without BAV.

RESULTS

Only 25 (7.02%) of BAV athletes showed PVBs at the ET. A total of 403 single PVBs and four monomorphic couples were observed; a polymorphic pattern was present in only three athletes, and only five had exercise-induced PVBs at peak. None had acute events or major arrhythmias. The difference in PVBs prevalence in BAV athletes vs. controls (PVBs 6.25%) was not significant (p > 0.05).

CONCLUSIONS

The prevalence of PVBs is low in BAV athletes and appears not to differ from athletes without BAV. Despite this, the behaviour of PVBs at the ET should be considered for the major suspicion for arrhythmic events. More data in this field could optimize the cost/effectiveness ratio for eventual ECG Holter indications.

Right Diaphragmatic Peak Motion Velocities on Pulsed Wave Tissue Doppler Imaging in Neonates: Method, Reproducibility, and Reference Values

OBJECTIVES

To test the reproducibility and report the reference ranges of the right diaphragmatic excursion's peak velocities recorded by pulsed wave tissue Doppler imaging in healthy term neonates.

METHODS

We formerly assessed intraobserver and interobserver variability of the method for the right hemidiaphragm in a small group of neonates, including ventilated neonates. We did not attempt to test the approach for the left hemidiaphragm because of the recognized high failure rate of visualization. Next, we recorded the peak velocities of both hemidiaphragms throughout inspiration and expiration in 229 healthy term neonates near birth to establish weight-dependent reference ranges for the measurements.

RESULTS

The study population included 116 male and 113 female neonates. The reproducibility of the technique was excellent even in neonates supported by ventilation. We always recorded the right diaphragmatic peak velocities in the normative study group, whereas the left ones were only recorded in 110 of 229 (48%) and 148 of 229 (65%) neonates from the anterior and lateral views, respectively. The modality of delivery and sex showed no influence on diaphragmatic kinetics. The mean inspiratory peak velocities ± SD were 1.4 ± 0.2 cm/s for the right hemidiaphragm and 1.5 ± 0.3 cm/s for the left hemidiaphragm. The mean expiratory peak velocities were 1.3 ± 0.2 cm/s for the right hemidiaphragm and 1.4 ± 0.3 cm/s for the left hemidiaphragm.

CONCLUSIONS

Measurement of right diaphragmatic kinetics as assessed by pulsed wave tissue Doppler imaging was found to be a reliable technique. Its clinical applicability for the prompt diagnosis and effective management of neonatal respiratory failure deserves further investigation.

The effect of prenatal exposure to music on fetal movements and fetal heart rate: a pilot study

OBJECTIVE

To assess and compare fetal cardiac parameters of fetuses listening to music before and during nonstress test, only during the test or never.

STUDY DESIGN

Thirty healthy mother-fetus dyads were randomized in a 1:1:1 ratio to one of three groups: group A in which fetuses were submitted to prelistening phase (33rd + 0 to 36th + 3 week) and listening sessions during 4 nonstress tests, group B in which fetuses were submitted to listening sessions during 4 nonstress tests, and group C receiving 4 nonstress tests without any listening. We assessed mean fetal heart rate, fetal heart rate accelerations, fetal heart rate decelerations, fetal movements and uterine contractility.

RESULTS

Fetuses of the group A, who had already listened to a particular piece of music during previous sessions, had significantly increased their heart rate accelerations and movements during the music listening session of the last nonstress test. No significant changes were observed in the number of uterine contractions.

CONCLUSIONS

Our findings show that fetuses slightly respond to that music they know, but they do not significantly respond to unknown music.