Longitudinal changes in bifidobacterial population during the first two years of life

Early life microbiota encompasses of a large percentage of Bifidobacterium, while it is not sufficiently understood how the Bifidobacterium population develops after infant's birth. Current study investigated the longitudinal changes in Bifidobacterium population during the first two years of life in 196 term born infants (1,654 samples) using 16S rRNA-23S rRNA internal transcribed spacer (ITS) sequence analysis. Throughout the first two years of life, Bifidobacterium breve, Bifidobacterium longum subsp. longum and Bifidobacterium adolescentis were most dominant and prevalent in the Bifidobacterium population, while B. breve had the highest relative abundance and prevalence during the first week of life and it was taken over by B. longum subsp. longum around two years after birth. Sampling time points, early antibiotic(s) exposure (effect only measurable within a month after birth), delivery mode (effect still detectable two-months after birth) and feeding mode (effect lasted until six months after birth), significantly contributed to the overall variation in the bifidobacterial population. From six months onwards, introducing of solid food and cessation of breastfeeding were accompanied with drastic changes in the composition in bifidobacterial population. Altogether, current study confirmed the effect of potential contributors to the longitudinal changes within the bifidobacterial population during the first two years of life. Registered at https://clinicaltrials.gov: NCT02536560.

Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study

BACKGROUND

Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia.

METHODS

We conducted a population-based retrospective cohort study of patients with dementia admitted to the ICU in Ontario, Canada from 2016 to 2019. We described the characteristics and outcomes of these patients alongside those with dementia admitted to non-ICU hospital settings. The primary outcome was hospital mortality but we also assessed length of stay (LOS), discharge disposition, and costs.

RESULTS

Among 114,844 patients with dementia, 11,341 (9.9%) were admitted to the ICU. ICU patients were younger, more comorbid, and had less cognitive impairment (81.8 years, 22.8% had ≥ 3 comorbidities, 47.5% with moderate-severe dementia), compared to those in non-ICU settings (84.2 years, 15.0% had ≥ 3 comorbidities, 54.1% with moderate-severe dementia). Total mean LOS for patients in the ICU group was nearly 20 days, compared to nearly 14 days for the acute care group. Mortality in hospital was nearly three-fold greater in the ICU group compared to non-ICU group (22.2% vs. 8.8%). Total healthcare costs were increased for patients admitted to ICU vs. those in the non-ICU group ($67,201 vs. $54,080).

CONCLUSIONS

We find that patients with dementia admitted to the ICU have longer length of stay, higher in-hospital mortality, and higher total healthcare costs. As our study is primarily descriptive, future studies should investigate comprehensive goals of care planning, severity of illness, preventable costs, and optimizing quality of life in this high risk and vulnerable population.

Bioarchaeological and paleogenomic profiling of the unusual Neolithic burial from Grotta di Pietra Sant'Angelo (Calabria, Italy)

The Neolithic burial of Grotta di Pietra Sant'Angelo (CS) represents a unique archaeological finding for the prehistory of Southern Italy. The unusual placement of the inhumation at a rather high altitude and far from inhabited areas, the lack of funerary equipment and the prone deposition of the body find limited similarities in coeval Italian sites. These elements have prompted wider questions on mortuary customs during the prehistory of Southern Italy. This atypical case requires an interdisciplinary approach aimed to build an integrated bioarchaeological profile of the individual. The paleopathological investigation of the skeletal remains revealed the presence of numerous markers that could be associated with craft activities, suggesting possible interpretations of the individual's lifestyle. CT analyses, carried out on the maxillary bones, showed the presence of a peculiar type of dental wear, but also a good density of the bone matrix. Biomolecular and micromorphological analyses of dental calculus highlight the presence of a rich Neolithic-like oral microbiome, the composition of which is consistent with the presence pathologies. Finally, paleogenomic data obtained from the individual were compared with ancient and modern Mediterranean populations, including unpublished high-resolution genome-wide data for 20 modern inhabitants of the nearby village of San Lorenzo Bellizzi, which provided interesting insights into the biodemographic landscape of the Neolithic in Southern Italy.

Impact of Built Environment and Neighborhood on Promoting Mental Health, Well-being, and Social Participation in Older People: an Umbrella Review

Background

The built environment, especially in the context of the neighborhood, affects older people's health. This umbrella review aims to summarize the associations between factors and interventions in the built environment as regards modifying or improving mental health, well-being, social inclusion and participation in the elderly.

Methods

We searched articles in the following databases: PubMed, Embase, Cochrane Library, Scopus, Avery Index, Sage, Web of Science, Health Evidence, and Google Scholar, without any time limits. The factors and interventions examined have been classified into three categories (urban infrastructure, green infrastructure, built environment), and we have assessed their relationships with each of the health outcomes.

Results

Eight reviews have been included. The results show a positive association between factors and interventions and health outcomes, even though this tends to differ with respect to some of the elements (study design, sample size, built environment and health outcome measurements, and the quality of the primary studies included in the reviews) in the selected studies.

Conclusions

In conclusion, the present study suggests and confirms that acting on the built environment has a positive impact on mental health and social inclusion.

USCA service utilization in the city of Florence (Italy) during the COVID-19 pandemic

Background

In order to support primary care during the first pandemic wave (March 2020), the Italian Government instituted multiprofessional health teams called “USCA” (Special Continuity Care Units), which ensured continuity of care for COVID-19 patients who do not need hospitalization. The aim of our study was to compare the volumes of USCA service utilization in Florence (Tuscany, Italy) during the peak of home visits of three pandemic waves.

Methods

This single-center study followed a retrospective cross-sectional design. The USCA of the Heath District of Florence served a population of 366,190 people. The following data were collected: home medical visits, nursing home (NH) visits, visits in health-care hotels. The peak periods of three epidemic waves were considered in the analyses: the second wave (23 October - 20 November 2020), the third wave (25 March - 22 April 2021), and the Omicron period (27 December 2021 - 6 February 2022). The maximum 7-day moving averages of the daily number of visits during the three periods were calculated. Relative percent differences for visits comparing the considered periods were computed.

Results

Home visits during the third pandemic wave increased by 14% compared to the second wave (second wave: N = 1370, third wave: N = 1562), while a decrease was observed during the Omicron period (Omicron vs third wave: -21%; peak value: 41 vs 60). Visits in health-care hotels during the third wave doubled compared to the second wave. After the start of the COVID-19 vaccination campaign, NH visits steeply declined (third wave vs second wave: -95%; N = 323 vs 15; peak value= 14 vs 2 visits per day). During the Omicron period, NH visits increased by almost four times compared to the third wave period.

Conclusions

The USCA service utilization was significant in all the analyzed periods. In a pandemic context, it is necessary to strengthen primary care services such as USCA, which have proved to respond to rapidly changing health needs.

Key messages

• The USCA service is an innovative model of integrated home care that has proved to respond to rapidly changing health needs during all phases of the COVID-19 pandemic.

• The USCA service utilization was significant during all phases of the pandemic. The USCA service has introduced new ways of working and new relationships between services in primary care.

Serum concentration of mineralocorticoids, glucocorticoids, and sex steroids in peripartum bitches

The aim of the work was to describe the profile of steroid hormones in the peripartum period of the bitch. Twenty-five healthy pregnant bitches presented for pregnancy monitoring and parturition assistance were included in the study. A blood sample was collected for routine progesterone assay, and serum was stored at -20°C. The day of parturition and the number of delivered puppies were registered. Concentrations of corticosteroids, androgens, progestogens, estrogens, for a total number of 17 different hormones, were measured using ultra-performance supercritical fluid chromatography-tandem mass spectrometry. Data were analyzed using a repeated measure, mixed-model approach, taking into account day (from day -4 to day +2 from parturition), age, parity (primiparous vs pluriparous), number of delivered puppies (<4 vs 4-8 vs > 8), and interactions between factors. Day related to parturition significantly affected the concentration of progesterone (P < 0.001), testosterone (P < 0.001), 17α-hydroxyprogesterone (P = 0.0002), and cortisone (P = 0.006). Estrogen concentration did not show any significant variation over time. Testosterone and androstenedione showed an abrupt decline on the day of parturition. The concentration of all glucocorticoids increased the day before parturition. Age or parity was not significantly associated with any of the steroids. Litter size significantly affected concentrations of aldosterone (P = 0.02) and etiocholanolone (P = 0.01). Aldosterone concentrations were higher in litters with 4 to 8 pups than in litters with more than 8 pups (P = 0.02). None of the steroids measured in our study, with the already known exception of progesterone, shows potential to be clinically useful in predicting the onset of parturition in the bitch.

Health needs, community and network in primary care: an action research program

Issue

According to the Alma Ata Declaration, Comprehensive Primary Health Care (C-PHC) addresses the main health problems in the community, promotes participation and involves all health related sectors. In Italy the so called Case della Salute model aims at realizing these principles. The purpose of the project is to understand how this model should be implemented in order to better answer the community needs. In the outskirts of Florence there is an area mostly made of public housing, devoted to people with housing and economic problems. There it is Casa della Salute (a health center where a PHC multidisciplinary team works), which could represent the key to cope with health inequalities and to create a network with the multiple associations rooted in the community. The implementation of an experimental model of C-PHC needs to involve local population, community actors, health professionals and researchers in a process of action-research.

Results

• An epidemiological study described a heavily deprived population compared with the rest of the city, with a burden of mortality especially affecting those most deprived and women. Mental health and addictions showed a deep need of care. A map of the neighbourhood was created in order to analyse formal and informal resources.The health needs of the community were deepened using social and ethnographic methodologies (semi-structured interviews, participant observation and focus groups with health workers, associations' representatives and individuals).Standing multi professional briefings were launched in order to facilitate the process of taking care of complex situations as a team.

Lessons

Preliminary results show the need for stronger collaborations with the actors in the community; further exploration of health related topics; community participation in the process of informing and transforming health practices; involvement of health workers in interprofessional practices to create a shared knowledge.

Key messages

Local health networks need a methodology to expand knowledge of peoples’ needs. Complexity in health and inequalities require a paradigm based on social determinants of health such as PHC.

Renewing primary care: the bottom-up experience of an Italian health professional movement

Sustainability of the National Health Systems (NHS) has been facing different challenges. A community-oriented Comprehensive Primary Health Care (CommOr C-PHC) could help its survival. Such a framework, focused on health promotion, primary prevention, not communicable disease management, requires new capabilities among health professionals. Considering teamwork and interprofessional collaboration (IPC) as PHC core elements, there is growing recognition of the need of interprofessional education (IPE). Nevertheless, italian medical education is distant from other disciplines and mainly based on hospital care settings. Since this situation represents an obstacle to implement a CommOr C-PHC model of health service, new ways of training students and retraining actual health workers should be developed.

The aim of the project is to design IPE programs and to improve IPC within the C-PHC framework, shared learning environments placed in the community were developed.

At the end of 2017 a group of young italian health professionals (public health resident, young general practitioner, social assistant, nurse, medical anthropologist, etc) founded the Campaign “2018 Primary Health care: Now or never”, a cultural movement of public health advocacy. Its goals are: The creation of a common cultural background through the study of PHC evidence and best italian and international practices. Organization of workshops all over Italy: peer education training session, site-visits, lectures with Italian and foreigner health professionals, based on need assessment methods.

Individuation of learning environments placed in the community and in a primary care setting where students can apprehend social determinants of health, exercise critical thinking and develop transprofessional knowledge.

Key messages

Young health professionals from Italy, starting from the need for a different educational framework, based on IPE, created a movement to defend the NHS and promote PHC principles. The success and large participation of a national campaign sustaining PHC and aimed at promoting interprofessional education shows the need for a change in the medical education field.

A public health Italian ethical movement to sustain the beveridge model: health promotion and equity

Worldwide sustainability of the National Health Systems (NHS) has been facing different challenges, such as population ageing, epidemiologic transition and deep social transformations. All these changes are struggling Italian welfare state and its public NHS. Following the principle of the Right to Health of the Declaration of Human Right and the Italian Constitution, a group of young health professionals from all over Italy founded a campaign called “2018 Primary Health care: Now or Never”(PHC Campaign) reminding WHO report of 2008 “primary Health Care: Now more than never”. This movement promotes a reform of the NHS focusing on comprehensive-PHC (C-PHC) and health promotion to guarantee sustainability of the Beveridge model italian system, fight health inequalities and answer the complexity of population needs in a period of spending cuts.

Since the beginning, the movement started an educational program through the study of the literature and the research of the Italian and international best practices of C-PHC and community health promotion. As a result, to achieve the goal of this project, PHC campaign organized peer education training sessions, educational site-visit of some Italian best practices, lectures and workshops with Italian and foreigner health professionals experts on the field. Several national and regional events had been organized all over Italy. Members of “PHC” Campaign have been invited to write books, news on web-based newspapers on this topic and participate in congresses. To date, PHC campaign might be considered one of the strongest not-institutional voices in Italy in supporting the public beveridge-model NHS

Moved from a strong ethical health policy view underlined the importance of the Right-to-Health and of a C-PHC based NHS, since the beginning, “2018 Primary Health care: Now or Never” Movement identified three asset of action: advocacy, education/knowledge and diffusion.

Key messages

The experience showed the importance of health professionals engagement in public health topics such as sustainability of public NHS in order to promote a reform towards health promotion and equity. PHC Campaign is an example of how a bottom-up ethical movement on public health from different Health professionals could actively contribute to promoting cultural and health policy change.

CT examination and 3D analysis of Egyptian animal mummies

AIM

To report our experience on CT investigation of animal mummies, focusing on the practical and radiological aspects of the study, the acquisition parameters and the different reconstruction techniques.

MATERIALS AND METHODS

Thirteen mummies underwent CT examination on the same CT scanner (Siemens sensation) with the following acquisition parameters: 120 kV; 140 mAs; slice thickness: 1 mm; reconstruction interval: 0.7 mm; and rotation time: 0.75 s. All datasets were reconstructed with both bone and soft tissue algorithms and archived on our picture archiving and communication system using their catalogue number as an identifier. Images were then transferred on IntelliSpace Portal (Philips Healthcare) for post-processing multiplanar and 3D reconstructions. The acquired data were submitted to anthropological analysis.

RESULTS

CT enabled the identification of the bundles content: four cats with complete skeleton, one upper part of a cat mummy, one lower part of a cat mummy, one cat head with four cervical vertebrae, two crocodiles, two raptors, skeletons from one or more snakes and one mummy with dog appearance, containing long bones. All cats and hawks showed cervical fractures; in one cat, the skull was collapsed inwards, and in another cat, the head was turned backwards; one cat presented a skeleton more radiopaque than normal with evidence of cracks related to the use of the resins for mummification that were poured directly over the corpse.

CONCLUSIONS

CT is a valuable noninvasive technique to study Egyptian mummies, enabling in-depth analysis while preserving the integrity of the mummy bundles, ensuring protection of a valuable archaeological resource.

Migrants and access to healthcare: the Italian public health residents action plan

Background

Fighting health inequalities have been included in the WHO Sustainable Development Goals as a priority. Migrants are between the most vulnerable individuals and healthcare interventions, also during the post-migration period, should be oriented, context-specific and aimed at identifying reasons underlying inequalities, as suggested by the recent WHO report ’No public health without migrant health’. The “Inequality Working Group” of the Italian network of public health (PH) residents of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) aims at identifying an interdisciplinary approach suitable to detect barriers to healthcare access for migrants in different Italian regions. Secondly, we aspire to develop some strategies to overcome unequal healthcare access.

Methods

Focus group methodology was applied to set working group educational needs, priorities of action and working plan. Moreover, we implemented a network between various professionals involved in migrant healthcare, particularly with the Regional Groups of the Italian Society of Migration Medicine (SIMM).

Results

After a period of peer-to-peer education about social determinants of health and migration, we reviewed Italian policies about migrants’ healthcare and considered potential discrepancies from WHO recommendations. Furthermore, we mapped practices regarding access to care for migrant population and we focused on causes underlying unequal healthcare access.

Conclusions

Although with regional differences, migrants have limited access to healthcare services and therefore represent a vulnerable subpopulation.

Key messages

Fighting against the barriers that limit access to care for migrants is a priority for health systems. PH residents have a relevant role in identifying and defining critical issues, designing enforcement measures and implementing advocacy actions.

Asylum seekers’ healthcare in Italy: policies and practices among different regions

Background

The Italian law provides for international protection and universal health-care coverage for asylum seekers (AS). Indeed, they are entitled to be regularly registered at the National Healthcare Service. Before submitting the application for refugee status, medical assistance to migrants is up to local administration. Our aim was to describe and compare policies and protocols regulating AS healthcare from their arrival to their application for refugee status, at national and regional level. Moreover, we investigated the daily healthcare practice addressing potential gaps between policies and practice.

Methods

The research team is a subgroup of the Inequality working group of the Italian hygiene society and it is composed of public health residents. The research involved also local health workers and other professionals belonging to regional groups of Italian migrant medicine society (SIMM). We collected national, regional and local policies and protocols and we compared them using a specific framework. Furthermore, we achieved a mapping of daily practice implementation at local health organization (LHO) level using a checklist.

Results

The most relevant findings were that regional policies themselves vary notably from each other and, as regard practices, LHO implement differently the same regional legislation. Furthermore, we found some critical issues: the delayed inclusion in primary care assistance and lack of continuity of care and of a computerized system of recording information.

Conclusions

The lack of uniformity concerning policies and practices of AS healthcare might also result in unawareness and uncertainty about how to access to healthcare services by migrants. An enhanced cooperation between groups dealing with migrants’ issues may lead to avoid variability at the implementation. Finally, a computerized system for data collection might facilitate the continuity of care and the assessment of the real health needs of the AS population.

Key messages

It is a priority challenge for health systems to strengthen the interventions aimed at overcoming the linguistic, economic, cultural and administrative barriers to the health services access. It is crucial to improve the recording information system to detect the real health needs of AS, their change and the inequalities in access and to improve collaboration between groups and university.

Analysis of Frontal Sinuses for Personal Identification in a Chinese Sample Using a New Code Number

The study of frontal sinuses for personal identification is a considered approach in the forensic field. In Yoshino's system, the frontal sinus patterns of a given person were formulated as a code number (codY) obtained by arranging the class numbers in each classification item. The aim of this work was to use a new code number (codC) with eight digits that includes other two continuous variables obtained as ratios SOR₁ (left frontal sinus area/left orbit area) and SOR₂ (right frontal sinus area/right orbit area), comparing the results with that of Yoshino. Digital radiographic images of the skulls of 150 Chinese people were analyzed. Spearman's partial correlation coefficients were evaluated between variables characterizing frontal sinus patterns. We used a maximum-weight dependence tree for statistical analysis. Results demonstrated that codC significantly reduced the probability of having the same personal code number compared with codY. Our scientific approach results valid for personal identification purposes.

Expression of Heterochromatin Protein 1 in the Primary Tumor of Breast Cancer Patients in the Presence or Absence of Occult Metastatic Cells in the Bone Marrow

Gene silencing may occur in breast cancer samples from patients presenting with occult metastatic cells in the bone marrow and one mechanism regulating gene suppression is heterochromatin formation. We have studied whether members of the heterochromatin protein 1 family (HP1Hsα, HP1Hsβ and HP1Hsγ), which take part in chromatin packaging and gene expression regulation, were differentially expressed in tumors from patients with and without occult metastatic cells in their bone marrow. Tumor samples and bone marrow aspirates were obtained from 37 breast cancer patients. Median age was 63 years and 68% of the patients presented with clinical stage I/II disease. Presence of occult metastatic cells in bone marrow was detected through keratin-19 expression by nested RT-PCR in samples from 20 patients (54.1%). The presence of occult metastatic cells in bone marrow was not associated with node involvement, histological grade, estrogen receptor and ERBB2 immunoexpression. Relative gene expression of HP1Hsα, HP1Hsβ and HP1Hsγ was determined by real-time RT-PCR and did not vary according to the presence of occult metastatic cells in bone marrow. In addition, the combined expression of these three transcripts could not be used to classify samples according to the presence of bone marrow micrometastasis. Our work indicates that regulation of heterochromatin formation through HP1 family members may not be the sole mechanism implicated in the metastatic process to the bone marrow.

Estimation of fetal lung development using quantitative analysis of ultrasonographic images in normal canine pregnancy

We investigated the quantitative analysis of sonographic images to predict fetal lung maturity of the canine foetus in normal pregnancy. Twelve bitches were recruited in the present study. Serial ultrasonographic exams were performed at three pre-determined time periods corresponding to the pseudoglandular (40-48 days of pregnancy), canalicular (49-56 days of pregnancy) and saccular phase (57-63 days of pregnancy) of lung development. Mean grey level (MGL) and the standard deviation of the histogram (SDH) of fetal lung and liver sonographic images were measured with dedicated software. The lung-to-liver ratio (LLR) for both parameters was also calculated. Measurements were taken on the two caudal-most foetuses and then averaged. SDH did not show any statistically significant difference between the three time periods in the lungs or in the liver. MGL measured in the lungs significantly increased in the first period and reached a plateau during the last two periods. Liver echogenicity was constant during the first two periods and significantly increased during the last week of gestation. The LLR of MGL significantly decreased during the last week of pregnancy. The LLR was a very good test to detect fetal lung maturity (area under the receiver operator curve (AUROC) = 0.875); using a cut-off value of LLR < 1.541, sensitivity was 83.33% and specificity was 83.33%, positive likelihood ratio = 5. LLR of MGL is an accurate test to estimate lung development in normal canine pregnancies.

Stature estimation based on vertebral morphometry by dual energy X-rays absorptiometry imaging in Italian females

Anthropological profile in forensic context includes the assessment of parameters as ancestry, sex, age and stature of an individual by the analysis of skeletal remains. Stature can be estimated from decomposed and fully or partially skeletonized remains by means of anatomical or mathematical methods applied on the whole skeleton or single bones. Many authors calculated regression formulae for the living stature estimation by these methods, in particular based on a population similar to the remains recovered. Long bones are commonly used for stature estimation, but, when they are missing, methods involving different parts of the skeleton are needed. In this preliminary study we measured heights of the vertebral bodies in a female Caucasian Italian population, evaluated by images of morphometric X-ray absorptiometry based on dual-energy X-ray absorptiometry in living subjects investigated for routine diagnostic purposes. Thoracic and lumbar segments of the spine were measured and statistical analysis was performed, thus obtaining regression formulae for estimated living stature from thoraco-lumbar spine segments (T₆-T₁₂, L₁-L₄ and T₆-L₄). We propose this method for stature evaluation in physical or forensic anthropology when the spine is available and long bones are missing.

Use of the gonadotropin-releasing hormone (GnRH) stimulation test to monitor gonadal function in intact adult male cats

The gonadotropin-releasing hormone (GnRH) stimulation test is a common procedure used to investigate normality of the pituitary-gonadal axis in mammals. There is very little information on the technique, its efficacy and side effects in small animals and in particular no information for male cats. In dogs, such test is performed by intravenous (IV) administration. With cats, the number of times the animal needs to be restrained for blood sampling should be the least possible. The purpose of this study was to assess efficacy and side effects of the GnRH stimulation test in tomcats comparing the IV with the intramuscular (IM) route of administration. A GnRH stimulation test was performed in eight adult tomcats through IM or IV administration of 50 μg gonadorelin. The response of the pituitary-gonadal axis was assessed by measuring serum testosterone on blood samples collected prior to and 1 hr following treatment. When considering each single group of cats, the post-stimulation serum testosterone values were significantly higher than the pre-treatment ones (p < .05). When comparing the two groups of cats, basal testosterone concentrations did not differ, and also post-GnRH testosterone concentrations did not differ. In conclusion, in the cats of our study, the GnRH stimulation test produced the same results following the IM or the IV route of administration. Therefore, in tomcats, the IM route can be considered as effective as the IV one and should be preferred when doing a GnRH test.

The human gut microbiota and its interactive connections to diet

The microbiota of the gastrointestinal tract plays an important role in human health. In addition to their metabolic interactions with dietary constituents, gut bacteria may also be involved in more complex host interactions, such as modulation of the immune system. Furthermore, the composition of the gut microbiota may be important in reducing the risk of contracting particular gut infections. Changes in the microbiota during an individual's lifespan are accompanied by modifications in multiple health parameters, and such observations have prompted intense scientific efforts aiming to understand the complex interactions between the microbiota and its human host, as well as how this may be influenced by diet.

Efficacy of a workplace relaxation exercise program on muscle tenderness in a working community with headache and neck pain: a longitudinal, controlled study

BACKGROUND

Pericranial muscle tenderness shows a remarkable prevalence not only in tension-type headache, but also in migraine, both episodic and chronic. Neck pain is a common disorder and leads to a high rate of work disability; its prevalence increases for headache.

AIM

This study aimed at examining the effects of a relaxation exercise programme on pericranial/cervical muscle tenderness in a working community with headache and neck pain.

DESIGN

This was a controlled, non-randomized trial.

SETTING

The study was carried out in a working community, on the employees of the City of Turin's central and peripheral registry and tax offices.

POPULATION

A total of 384 workers were enrolled and divided into two groups: a study group (group 1; 192 subjects) and a control group (group 2; 192 subjects).

METHODS

A programme, with relaxation/posture exercises and a visual feedback, was carried out for Group 1 for 6 months and, afterwards, also for group 2 for the same follow-up period throughout. Data on head/neck pain were collected. Standard palpation of pericranial and cervical muscles was done, scoring each patient for Pericranial Muscle Tenderness (PTS) (0-3), Cervical Muscle Tenderness (CTS) (0-3) and a Cumulative Muscle Tenderness (CUM) (0-6).

RESULTS

After 6 months from baseline, a significant difference was observed between the groups: i.e. group 1 had an average change from baseline of -0.19 for PTS, -0.2 for CTS and -0.36 for the CUM score - in association with a reduction in headache, neck and shoulder pain. The difference between the groups in PTS, CTS and CUM scores was no longer detectable at the end of the study, after also group 2 performed the programme.

CONCLUSIONS

The administration of a workplace relaxation exercise intervention significantly decreased pericranial/cervical muscle tenderness in the working community, in association with head-neck pain benefit.

CLINICAL REHABILITATION IMPACT

This relaxation exercise programme was remarkably cost-effective, yielding a relevant benefit on pericranial/cervical muscle tenderness in a working community, at a relatively low cost.

Misuse of antimicrobials and selection of methicillin-resistant Staphylococcus pseudintermedius strains in breeding kennels: genetic characterization of bacteria after a two-year interval

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) strains have been isolated from dogs with increasing frequency; prolonged or excessive use of antimicrobials is associated with the selection of MRSP, and misuse of antimicrobials is frequent in breeding kennels. This study was carried out in two breeding kennels (A and B) in which we had isolated MRSP in 2008: the aim was to assess colonization of previously positive bitches and of other bitches sharing the same environment and to assess the genetic profile of both the old and the new strains [spa typing, staphylococcal cassette chromosome mec (SCCmec) typing and Pulsed-field Gel Electrophoresis (PFGE)]. Six animals from Kennel A (two from 2008) and eight from Kennel B (one from 2008) were tested: 16 MRSP strains were isolated only from bitches housed in Kennel B. Old and new isolates were mecA positive, resulted spa type t02 and carried SSCmec II-III. PGFE showed that all isolates were related and belonged to the main clone lineage dominating in Europe, ST71-J-t02-II-III. Kennels A and B differ in the use of antimicrobials, which has been reduced over time in Kennel A, while has remained excessive in Kennel B, where many agents belonging to different classes (third-generation cephalosporins, fluoroquinolones, macrolids) are administered to dogs, without veterinary supervision, especially around parturition. Misuse of antimicrobials is the key factor for the selection of MRSP strains in healthy dogs and for their persistence over time. Dog breeders should be aware that infections caused by multiresistant bacteria have very limited therapeutical options and represent a huge challenge for animal health.

An educational and physical program to reduce headache, neck/shoulder pain in a working community: a cluster-randomized controlled trial

BACKGROUND

Noninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain.

METHODOLOGY/PRINCIPAL FINDINGS

Cluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (-1.72; -2.40 to -1.04) and with neck/shoulder pain (-2.51; -3.56 to -1.47).

CONCLUSIONS

The program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00551980.

Early onset of primary hypogonadism revealed by serum anti-Müllerian hormone determination during infancy and childhood in trisomy 21

Male patients with an extra sex chromosome or autosome are expected to present primary hypogonadism at puberty owing to meiotic germ-cell failure. Scarce information is available on trisomy 21, a frequent autosomal aneuploidy. Our objective was to assess whether trisomy 21 presents with pubertal-onset, germ-cell specific, primary hypogonadism in males, or whether the hypogonadism is established earlier and affects other testicular cell populations. We assessed the functional status of the pituitary-testicular axis, especially Sertoli cell function, in 117 boys with trisomy 21 (ages: 2months-20year). To compare with an adequate control population, we established reference levels for serum anti-Müllerian hormone (AMH) in 421 normal males, from birth to adulthood, using a recently developed ultrasensitive assay. In trisomy 21, AMH was lower than normal, indicating Sertoli cell dysfunction, from early infancy, independently of the existence of cryptorchidism. The overall prevalence rate of AMH below the 3rd percentile was 64.3% in infants with trisomy 21. Follicle-stimulating hormone was elevated in patients <6months and after pubertal onset. Testosterone was within the normal range, but luteinizing hormone was elevated in most patients <6months and after pubertal onset, indicating a mild Leydig cell dysfunction. We conclude that in trisomy 21, primary hypogonadism involves a combined dysfunction of Sertoli and Leydig cells, which can be observed independently of cryptorchidism soon after birth, thus prompting the search for new hypotheses to explain the pathophysiology of gonadal dysfunction in autosomal trisomy.

Human breast tumor slices: a model for identification of vitamin D regulated genes in the tumor microenvironment

While many studies have addressed the direct effects of 1alpha,25(OH)2D3 on breast cancer (BC) cells, stromal-epithelial interactions, which are important for the tumor development, have been largely ignored. In addition, high concentrations of the hormone, which cannot be attained in vivo, have been used. Our aim was to establish a more physiological breast cancer model, represented by BC tissue slices, which maintain epithelial-mesenchymal interactions, cultured with a relatively low 1alpha,25(OH)2D3 concentration, in order to evaluate the vitamin D pathway. Freshly excised human BC samples were sliced and cultured in complete culture media containing vehicle, 0.5 nM or 100 nM 1alpha,25(OH)2D3 for 24 h. BC slices remained viable for at least 24 h, as evaluated by preserved tissue morphology in hematoxylin and eosin (HE) stained sections and bromodeoxyuridine (BrdU) incorporation by 10% of tumor cells. VDR mRNA expression was detected in all samples and CYP24A1 mRNA expression was induced by 1alpha,25(OH)2D3 in both concentrations (but mainly with 100 nM). Our results indicate that the vitamin D signaling pathway is functional in BC slices, a model which preserves stromal-epithelial interactions and mimics in vivo conditions.

Further evidence of the positive effects of an educational and physical program on headache, neck and shoulder pain in a working community

In a controlled trial to evaluate the effectiveness of a simple educational and physical program administered to a large cohort of public servants, we previously found that 6 months following treatment the monthly frequency of headache and neck and shoulder pain and drug intake was reduced by 40% in the experimental compared with controls. These results were stable at a 12-month follow up. The program consists of brief shoulder and neck exercises to be performed several times a day, a relaxation exercise, and instructions on how to reduce parafunction and hyperfunction of the craniofacial and neck muscles during the day. The purpose of this work was to investigate whether the data previously obtained could be confirmed also in the group of 192 subjects that served as controls in first phase of the study and received the intervention in the second phase of the study. The primary endpoint was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a ≥50% reduction of frequency (responder rate) at the last 2 months of the 6-month intervention period compared to the 2 months preceding the intervention (baseline). The number of days of analgesic drug consumption was also recorded. Days per month with headache at the baseline and at the end of intervention period were 6.40 and 4.58 (mean change −1.81, p < 0.0001), respectively; days with neck and shoulder pain were 7.48 and 6.18 (mean change −1.30, p = 0.0179); days of analgesic consumption were 1.67 and 1.17 (mean change −0.50, p = 0.0222). The responder rate was 42.3% for headache, 42% for neck and shoulder pain and 58.3% for drug consumption. In conclusion, this study adds further evidence on the efficacy of our program and its high acceptability in a large, unselected, working population.

Effect of an injectable cabergoline formulation on serum prolactin (PRL) and milk secretion in early postpartum Beagle bitches

This study was conducted in order to evaluate effects on prolactin (PRL) concentration and mammary milk secretion of an injectable cabergoline formulation administered to five lactating Beagle bitches during early postpartum (PP). Bitches were bled twice daily (from PP day 3 to PP day 12) and then daily (from PP day 13 to PP day 16) to assay serum PRL. On PP day 6, a subcutaneous (SC) injection of 0.1 ml/kg of placebo was administered. On PP day 9, a SC 0.1 ml/kg dose of injectable cabergoline was administered. All bitches were checked for milk production, using a clinical scoring in order to quantify milk expression from each teat. A circadian variation of serum PRL was evident during the 6 days of pre-treatment monitoring. The day after cabergoline injection, an 80% decrease of PRL serum concentration was observed (p < 0.05). The circadian oscillatory pattern of PRL secretion disappeared after administration of cabergoline, and PRL values remained significantly lower than in the previous days for the first 60 h following treatment (p < 0.001). Milk production was drastically reduced when comparing pre-treatment to post-treatment scores (p < 0.001). A single dose of injectable cabergoline caused a significant reduction in serum PRL concentration and a significant reduction in milk flow. The injectable formulation of cabergoline appeared to be safe and well tolerated.

Breast Cancer Gene Expression Profile in Post-Menopausal Patients Supplemented with Vitamin D

Vitamin D supplementation is indicated for post-menopausal women to prevent osteoporosis and lower 25(OH)2D3 or 1,25(OH)2D3 serum levels have been associated with breast cancer incidence or prognosis (metastasis). The antiproliferative effects of vitamin D are observed in breast cancer cell lines exposed to phamacological doses of calcitriol (1,25(OH)2D3, 100nM) but whether physiological doses are sufficient to produce growth inhibition in vivo is not known. The aim of our study was to investigate gene expression profile changes of breast cancer samples from patients supplemented with calcitriol, presenting an anti-proliferative effect on the tumor. Post-menopausal women diagnosed with breast cancer were instructed to take one (0.25ug/day, n=8) or two (0.50ug/day, n=8) tablets of calcitriol after tumor biopsy. Median time of supplementation was 30 days. Sixteen tumor samples were collected during biopsy (before supplementation) and breast surgery (after supplementation). Proliferation index was evaluated by tumor Ki-67 immunohistochemistry (IHC) expression in breast cancer samples before and after calcitirol supplementation and 1000 cells were counted by three observers (p &lt; 0,001, Pearson's correlation). After establishing a counting error between observers, the cut-off value was fixed in 26.53% (percentile 60%) to define response. Patients were then categorized as responsive (a reduction of more than 26.53% on positive Ki-67 positive cells) and non-responsive (difference between samples before and after supplementation not exceeding 26.53%). Among our sixteen patients, all were categorized as responsive to calcitriol supplementation except for two. So far, gene expression profile of two patients (both categorized as responsive) has been analyzed using the U133 Plus 2.0 Affymetrix Gene Chips from 100ng of total RNA. To verify signalling pathways possibly involved in response to vitamin D exposure, additional five samples from a parallel study, in which breast cancer samples from post menopausal patients were collected at surgery and treated in vitro with a low concentration of calcitriol, 0.5nM (that can be attained with subcutaneous administration of doses of 8ug calcitriol, without hypercalcemia) for 24h, were included in the analysis. All samples had RNA hybridized to the same gene chips. Results were normalized and analyzed using RMA and Mev.TM4 softwares. CYP24A1, a target gene of vitamin D, presented a positive regulation after calcitriol supplementation in all samples analyzed. Differentially expressed genes were involved in the regulation of cell cycle [SMAD2, cyclin E, YWHAQ (14-3-3 family] and calcium signalling (HTR7, PTGER1 and PTGER2). Our results indicate that the tumor proliferation index is reduced upon calcitriol supplementation. Moreover, potentially regulated pathways in breast cancer specimens after administration of low doses of calcitriol are regulation of cell cycle and calcium signaling.Supported by FAPESP 2007/01111-0 – 2007/04799-2

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6128.

HIV-associated anaplastic large cell lymphoma

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Background: Anaplastic large cell lymphoma (ALCL) is a CD30+ T-cell lymphoma that is generally unrelated to EBV in the non-HIV setting. Based upon anaplastic lymphoma kinase (ALK) expression, the new WHO classification provisionally distinguishes between ALK+ (favorable) and ALK- (unfavorable) ALCL. The characteristics of ALCL, such as ALK expression and EBV coinfection, in individuals with HIV infection have not been adequately evaluated. The aim of this study was to investigate these features in HIV-associated ALCL cases. Methods: A MEDLINE search for all cases of HIV-associated non-cutaneous ALCL was undertaken. Data regarding patient age, gender, HIV status (CD4 count, viral load, opportunistic infections), HAART, lymphoma features (B symptoms, stage, sites of involvement, immunophenotype, ALK expression, molecular studies), EBV coinfection, therapy and outcome (survival, cause of death) were extracted and analyzed. Results: A total of 23 cases were included. Patients were of median age 39 years with a male:female ratio of 7:1. Median CD4+ count was 76 cells/mm3 and HIV viral load 416,500 copies/ml. Most (67%) patients had an opportunistic infection, although only 3 (17%) were on HAART. ALCL was extranodal in 22 cases (96%) affecting most commonly lung, soft tissue and liver. Many (78%) patients had stage IV disease and B symptoms were reported in 9 cases (50%). T-cell receptor gene rearrangement was present in all cases, CD30 was positive in 22 (96%), and the vast majority (90%) were ALK-negative. EBV was identified in 8 (35%) cases. Therapy for ALCL was documented in 15 (67%) cases; 64% received CHOP. In 2 of the 3 patients who were on HAART, long-term survival was achieved. Many (68%) patients died, with a median survival of 9 months. Death was caused by either lymphoma progression (42%) or infection (58%). Conclusions: HIV-associated non-cutaneous ALCL appears to affect younger individuals and is associated with EBV infection in a subset of cases. Apart from marked immunosuppression, the poor prognosis of HIV-associated ALCL appears to be related to the absence of ALK expression, advanced stage at presentation with prominent extranodal disease, inadequate therapy including HAART, and poor response to CHOP. Further research is needed to better understand and treat this unique HIV-associated lymphoma.

No significant financial relationships to disclose.

HIV-associated peripheral T-cell lymphoma

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Background: T-cell lymphomas (TCL) constitute 3% of all AIDS-related lymphomas. Over the past 2 decades numerous case reports have documented the emergence of TCL among HIV-infected individuals. These lymphomas comprise a diverse group of disease entities, including peripheral T-cell lymphomas (PTCL), which represent the most common subtype. The aim of this study was to investigate the clinical and pathological features of HIV-associated PTCL. Methods: A MEDLINE search for cases of HIV-associated PTCL was conducted through December 2008. Data regarding patient age, gender, HIV status (CD4 count, viral load, opportunistic infections), use of HAART, lymphoma features (B symptoms, stage, sites of involvement, immunophenotype, molecular studies), EBV coinfection, therapy, and outcome (survival, cause of death) were analyzed and reported descriptively. Results: A total of 34 cases were included. Patients had a median age of 36 years with a male:female ratio of 4:1. Median CD4+ count was 126 cells/mm3. Seventeen patients (50%) had an opportunistic infection, but only 7 patients (26%) were on HAART treatment; 4 patients on HAART (57%) were alive at time of publication. PTCL was extranodal in 75% of cases, affecting predominantly the oral cavity, lung, and GI tract. B symptoms were present in 60% of cases. Stage III and IV disease was found in 17 and 5 cases, respectively, accounting for 76% of the total cases. T-cell receptor gene rearrangement was positive in 10 out of 10 (100%) analyzed cases. EBV was identified in 6 of 12 cases (50%). Median LDH level was 269 IU/L. Therapy for PTCL was administered in 23 cases (68%), while 10 cases (30%) did not receive therapy; 9 of the treated patients (39%) received CHOP with a 33% remission rate. Twenty-two patients (69%) died complicated by infections in 57% and lymphoma progression in 36% of cases. The reported median survival was 12 months. Conclusions: HIV-associated PTCL tends to affect young male individuals with low CD4 counts. Apart from marked immunosuppression, the poor prognosis of HIV-associated PTCL appears to be related to advanced stage at presentation, presence of B symptoms, elevated LDH levels, prominent extranodal disease, and poor response to CHOP chemotherapy. The role of HAART and EBV in the development of PTCL needs further clarification.

No significant financial relationships to disclose.

Personality profiles and subjective perception of pain in head pain patients

Little or no information is available regarding the effect of the personality characteristics of headache sufferers on the quality of pain perception. The aim of this study is to investigate, in head pain sufferers, the relationship between the personality profile, assessed by the MMPI, and the different dimensions of pain (sensory, affective and evaluative), as assessed by the MPQ. Three hundred and seventeen patients with Migraine and/or tension-type headache (episodic or chronic) and myogenic facial pain were included. The Italian versions of the MMPI-2 and MPQ were administered, and the pain level was measured by the VAS. Cluster analysis based on the clinical scales of MMPI identified four personality profiles closely corresponding to the MMPI profiles obtained by the previous researchers: "depressive" (Dep.), "emotionally overwhelmed" (Emot.), "conversive" (Conv.) and "Coper". Differences in MPQ scales between personality profiles were investigated by means of a general linear model (GLM), adjusting for sex, age and pain level and type. Results of GLM analysis showed that the affective dimension was significantly higher in cluster Emot. than in Dep. (p=0.027), Conv. (p=0.002) and Coper (p=0.003). Total PRI was significantly higher in Emot. than in Conv. (p=0.010). The findings of the present study suggest that a specific personality profile (Emot.), characterized by a heavy emotional burden, may increase the affective dimension of pain with respect to a depressive profile (Dep.), a conversive profile (Conv.) or a normal profile (Coper), independent of sex, age and pain level and type.

A Four-Year Experience with Holmium-YAG Laser: Parameters of use

In the last years, laser has gained increasingly high popularity in Endourology The newer generation Ho-YAG lasers represent the most updated laser used in Urology, being able to successfully treat both urinary stones and soft tissue lesions. The aim of this work was to report a multicentre 4-year experience using the Ho-YAG laser in the treatment of stones and soft tissue lesions, in order to offer parameters and modalities of use in several different situations.

Materials and Methods

Two urological Centers were asked between 2002 and 2005 to use Coherent Versa Pulse 20 Ho-YAG laser source in the treatment of urinary stones in 212 patients, and urinary soft tissue lesions (urethra, ureter or bladder neck strictures or urinary tract tumors) in 56 patients. According to the various situations (either stone fragmentation or treatment of soft tissue lesions), pulse frequency and energy per impulse were differently dosed and set.

Results

The following parameters were identified as the starting points for the correct use of the Ho-YAG laser: a) lithotripsy with rigid endoscope: 365 μm fiber, 0.8 - 1.2 Joule (J) energy and 6–8 Hz frequency; 365 μm fiber, 0.8–1.2 J energy and 10–12 Hz frequency; 550 μm fiber, 1.0–1.5 J energy and 10–12 Hz frequency. b) lithotripsy with flexible endoscope: 270 μm fiber, 0.6–1.0 J energy and 6–10 Hz frequency. c) soft tissue resection in case of: c1) ureteral stricture, 365 μm fiber, 0.6 J energy and 14–16 Hz frequency; c2) urethral stricture, 365 μm fiber, 0.7 J energy and 16–18 Hz frequency; c3) upper urinary tract tumors, 365 μm fiber, 0.7 J energy and 16 Hz frequency; c4) bladder tumors 365 μm fiber, 0.8 J energy and 16–20 Hz frequency; c5) bladder neck strictures, 365 μm fiber, 1.0 J energy and 16–18 Hz frequency.

Conclusions

In the light of these parameters, Ho-YAG laser is a very handy instrument for the treatment of both urinary stones and soft tissue lesions, which allows to put aside the current tools used for the same purposes.