Development of a self-report screening instrument for emotional dysregulation: the Reactivity, Intensity, Polarity and Stability questionnaire, screening version (RIPoSt-SV)

BACKGROUND

Emotional dysregulation (ED) refers to the inability to manage emotional experiences or expressions hindering goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples exists. We aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40).

METHODS

150 adult outpatients with non-psychotic conditions were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Clinically significant ED (CSED) was defined based on the previously suggested approach for ADHD. Differences between patients with and without CSED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30.

RESULTS

75 subjects met criteria for CSED (50 %). CSED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected CSED, with accuracy, sensitivity, specificity, positive and negative predictive values of 80 % or higher in both the training and testing sets.

LIMITATIONS

Tertiary-level; no consensus on criteria; sample size.

CONCLUSION

The screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.

Type 2 diabetes mellitus is associated with manic morbidity in elderly patients with mood disorders

The association between mood disorders, especially bipolar disorder (BD), and metabolic disorders, is long known. However, to which extent metabolic disorders affect the course of mood disorders in late life is still open to inquiring. To assess the impact of type 2 diabetes mellitus (T2DM) on late-life mood disorders a retrospective chart review was performed. Elderly depressive patients (≥ 65 years) diagnosed with Major Depressive Disorder (N = 57) or BD (N = 43) and followed up for at least 18 months were included and subdivided according to the presence of T2DM comorbidity. Vascular encephalopathy (39.1% vs. 15.6%, P  = 0.021) and neurocognitive disorders (21.7% vs. 5.2%, P  = 0.028), were more frequently reported in patients with T2DM than in those without. Patients with T2DM showed a greater percentage of follow-up time in manic episodes (r = -0.23, P  = 0.020) and a higher rate of manic episode(s) during follow-up (21.7% vs. 5.2%, P  = 0.028) than those without. When restricting longitudinal analyses to patients with bipolar spectrum disorders, results were confirmed. In line with the well-known connection between BD and metabolic disorders, our data support an association between T2DM and unfavorable course of illness in the elderly with BD.

History of Childhood/Adolescence Referral to Speciality Care or Treatment in Adult Patients with Attention-Deficit/Hyperactivity Disorder: Mutual Relations with Clinical Presentation, Psychiatric Comorbidity and Emotional Dysregulation

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that only rarely remits in adulthood. While several studies underlined differences between child and adult ADHD, the relationship between adult clinical presentation and early referral/treatment has been rarely investigated. In our study, 100 adults with ADHD were recruited and subdivided according to a history of referral to speciality care or treatment with methylphenidate (MPH) during childhood/adolescence. The early referral was associated with a history of disruptive behaviors during childhood/adolescence. Current ADHD symptoms were more pronounced in patients first referred during childhood/adolescence but never treated with MPH. Early MPH treatment was associated with lower rates of mood disorders and lower severity of emotional dysregulation at the time of assessment. Negative emotionality mediated the relationship between MPH treatment and mood disorders comorbidity. ADHD patients first referred during childhood/adolescence are characterized by more externalizing features than those first referred in adulthood. MPH treatment during the developmental age may have a role in preventing mood disorders in patients with ADHD, possibly by reducing emotional dysregulation.

Poor sleep quality may contribute to dysfunctional illness perception, physical and emotional distress in hospitalised patients: results of a national survey of the Italian Society of Consultation-Liaison Psychiatry

Distress associated with physical illness is a well-known risk factor for adverse illness course in general hospitals. Understanding the factors contributing to it should be a priority and among them dysfunctional illness perception and poor sleep quality may contribute to it. As poor sleep quality is recognised as a major risk factor for health problems, we aimed to study its association with illness perception and levels of distress during hospitalisation. This cross-sectional study included a consecutive series of 409 individuals who were hospitalised in medical and surgical units of different hospitals located throughout the Italian national territory and required an assessment for psychopathological conditions. Sleep quality was assessed with the Pittsburgh (Sleep Quality Index), emotional and physical distress with the Edmonton Symptom Assessment System (ESAS), and illness perception with the Brief Illness Perception Questionnaire (BIPQ). Differences between groups, correlations and mediations analyses were computed. Patients with poor sleep quality were more frequently females, with psychiatric comorbidity, with higher scores in the ESAS and BIPQ. Poor sleep quality was related to dysfunctional illness perception, and to both emotional and physical distress. In particular, by affecting cognitive components of illness perception, poor sleep quality may, directly and indirectly, predict high levels of distress during hospitalisation. Poor sleep quality may affect >70% of hospitalised patients and may favour dysfunctional illness perception and emotional/physical distress.Assessing and treating sleep problems in hospitalised patients should be included in the routine of hospitalised patients.

Long-term treatment of adult ADHD in a naturalistic setting: clinical predictors of attrition, medication choice, improvement, and response

Objectives: The aim of this study was to identify clinical predictors of treatment attrition, medication choice, improvement and response to pharmacotherapy in adult attention-deficit/hyperactivity disorder (ADHD). Methods: 150 ADHD patients were enrolled and naturalistically followed-up for at least 4 months. Conners' Adult ADHD Rating Scales-Observer: Screening Version (CAARS-O:SV) were used to measure ADHD severity. Results: 58 subjects (38.7%) were lost at follow-up, while 75 (50%) completed follow-up assessment, on average after 26.05 ± 11.99 weeks; 35 were treated with atomoxetine (ATX) and 40 with methylphenidate (MPH). Treatments were moderately effective (d = 0.72) and 37 patients (49.3%) were responders (≥30% CAARS-O:SV decrease). Patients lost at follow-up had lower inattentive symptoms, less generalized anxiety and family history of bipolar disorder, more amphetamine use disorder than follow-up completers. Compared to ATX-treated subjects, MPH-treated patients had greater severity of hyperactivity/impulsivity and were more frequently diagnosed with alcohol use disorder. While MPH and ATX showed similar efficacy, more pronounced improvements were observed in patients with combined ADHD, anxiety and substance use disorders. ADHD severity and comorbid substance use positively predicted response. Conclusions: Consensus-based hierarchical treatment of ADHD comorbidity is not consistently supported. Comorbid anxiety, mood and substance use disorders should not discourage the treatment of adult ADHD.

Treatment adherence and tolerability of immediate- and prolonged-release lithium formulations in a sample of bipolar patients: a prospective naturalistic study

The aim of this study was to compare treatment adherence and tolerability of different lithium formulations in 70 bipolar patients receiving lithium therapy for the first time. During the 1-year follow-up, information was collected regarding patient's clinical course, therapeutic adherence, side effects of the treatment and serum levels of lithium, creatinine and thyroid-stimulating hormone. At baseline, 30 patients (43%) were on prolonged-release lithium formulations and 40 (57%) on immediate-release formulations. At the final evaluation, 37 patients (53%) were considered lost to follow-up. Both prolonged- and immediate-release patients showed significant improvement in the Functioning Assessment Short Test and in the Clinical Global Impressions for Bipolar Disorder scores during the follow-up. At the first follow-up visit, the mean plasma lithium level of prolonged-release patients was higher than immediate-release patients (0.61 vs. 0.47, respectively; P = 0.063), as well as the therapeutic adherence (85 vs. 64%, respectively; P = 0.089). Fine tremor and gastrointestinal symptoms were more frequent in immediate-release patients than in prolonged-release patients at each follow-up visit, with the sole exception of gastrointestinal symptoms at the last evaluation. Prolonged-release lithium therapy could provide potential advantages over immediate-release formulations. Future naturalistic studies and clinical trials with a longer follow-up duration are needed.

Predictors of Suicidal Ideation and Preparatory Behaviors in Individuals With Bipolar Disorder: The Contribution of Chronobiological Dysrhythmicity and Its Association With Hopelessness

OBJECTIVE

To examine the role of chronobiological dysrhythmicity in suicidal ideation and behaviors and its relation with hopelessness.

METHODS

One hundred twenty-seven patients (77 females, mean age of 47.4 ± 12.5 years) with a major depressive episode and bipolar disorder (BD) type I or II (according to Structured Clinical Interview for DSM-5 assessment) were recruited in 2019 and assessed for depressive and manic symptoms (Beck Depression Inventory-II, Young Mania Rating Scale) and with the Biological Rhythms Interview of Assessment in Neuropsychiatry, Beck Hopelessness Scale, and Scale for Suicide Ideation. Univariate regression and mediation analyses were performed.

RESULTS

Forty-one patients (32.3%) showed clinically significant suicidal ideation and were more frequently affected by BD type I (P = .029) with mixed features (P = .022). Compared to nonsuicidal individuals, they had significantly more depressive symptoms (P = .019), higher emotional component of hopelessness (P = .037), and higher dysrhythmicity of sleep (P = .009), activities (P = .048), and social life (P = .019). Passive and active suicidal ideation and suicidal plans were best predicted by dysrhythmicity of sleep and social life. Dysrhythmicity of sleep and social life mediated the direct effect of depressive symptoms on passive and active suicidal ideation and also of active ideation on suicidal plans. The emotional component of hopelessness was related to dysrhythmicity of social life and mediated its effect on suicidal plans (P = .010).

CONCLUSIONS

Chronobiological alterations directly contributed to passive and active suicidal ideation and to suicidal preparation, with a key role of dysrhythmicity of sleep, activities, and social life. Chronobiological alterations also impacted the emotional component of hopelessness, hence indirectly contributing to suicidal ideations and plans. These findings call for the systematic screening of these dysrhythmicity dimensions when considering suicidal risk in individuals with BD.

A pilot study on secondary anemia in "frailty" patients treated with Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine: safety of treatment explored by HRV non-linear analysis as predictive factor of cardiovascular tolerability

OBJECTIVE

Iron deficiency anemia (IDA) in patients with heart disease is correlated with decreased exercise capacity and poor health-related quality of life, and predicts worse cardiovascular outcomes, especially for elderly patients. IDA can worsen cardiac function that can be monitored with Heart Rate Variability (HRV) analysis, providing important information about cardiac health. In a recent study we explored the effect and the tolerability of the administration of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) in "frailty" patients with secondary anemia and low kidney failure, by analysing the HRV frequency domain. The aim of the present study is the further confirmation of the safety of the already evaluated intervention, by analysing non-linear domain of HRV.

PATIENTS AND METHODS

In this pilot study we enrolled 52 "frailty" elderly patients, with a recent diagnosis of secondary anemia due to iron deficiency, with Class II New York Heart Association (NYHA) hypertensive heart disease, low kidney failure, and atherosclerosis. The patients were divided in 2 groups: Group A (N=23 patients) received oral administration of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) 2 tabs/day, containing 60 mg of Fe3+, for 24 days; Group B (N=29 patients) received intravenous administration of ferrous gluconate 63 mg/day added to saline solution, while they were hospitalized (15±5 days). We evaluated laboratory values of hemoglobin (Hb) and sideremia levels. Furthermore, we measured ECG signals before and after treatment, using non-linear analysis techniques.

RESULTS

Both intravenous and oral treatments evaluated in this study, were effective and safe about the cardiovascular risk in "frailty" elderly patients, as resulted from non-linear HRV analysis. Efficacy results showed that hemoglobin and sideremia levels after treatments are significantly increased. The HRV non-linear analysis showed that all parameters evaluated, except for the SD1 values in the Group A, were not affected by treatments, confirming the absence of cardiovascular risk of the therapy.

CONCLUSIONS

Non-linear HRV evaluation confirmed that oral administration of Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) did not impact the cardiovascular risk, without causing adverse events typically reported with other iron supplementation therapies, both oral and intravenous.

Assessing the readability, quality and accuracy of online health information for patients with low anterior resection syndrome following surgery for rectal cancer

AIM

Management of low anterior resection syndrome (LARS) requires a high degree of patient engagement. This process may be facilitated by online health-related information and education. The aim of this study was to systematically review current online health information on LARS.

METHOD

An online search of Google, Yahoo and Bing was performed using the search terms 'low anterior/anterior resection syndrome' and 'bowel function/movements after rectal cancer surgery'. Websites were assessed for readability (eight standardized tests), suitability (using the Suitability Assessment of Materials instrument), quality (the DISCERN instrument), accuracy and content (using a LARS-specific content checklist). Websites were categorized as academic, governmental, nonprofit or private.

RESULTS

Of 117 unique websites, 25 met the inclusion criteria. The median readability level was 10.4 (9.2-11.7) and 11 (44.0%) websites were highly suitable. Using the DISCERN instrument, seven (28.0%) websites had clear aims, two (8.0%) divulged the sources used and four (16.0%) had high overall quality. Only eight (32.0%) websites defined LARS and ten (40.0%) listed all five major symptoms associated with the LARS score. There was variation in the number of websites that discussed dietary modifications (80.0%), self-help strategies (72.0%), medication (68.0%), pelvic floor rehabilitation (60.0%) and neuromodulation (8.0%). The median accuracy of websites was 93.8% (88.2-96.7%). Governmental websites scored highest for overall suitability (P = 0.0079) and quality (P < 0.001).

CONCLUSIONS

Current online information on LARS is suboptimal. Websites are highly variable, important content is often lacking and material is too complex for patients.

Longitudinal neurophysiological assessment of intramuscular type-A botulin toxin in healthy humans

The aim of this study is to assess the neurophysiological abnormalities of type A botulin toxin-infiltrated human muscle, and their evolution over time. Seried cMAP measurements, 3 and 20 Hz repetitive nerve stimulation, EMG, SFEMG over 3 months from toxin injection. Our findings consist in lack of decrement with 3 Hz repetitive nerve stimulation and facilitation with 20 Hz repetitive nerve stimulation; progressive increasing of jitter; early appearance of fibrillations; small and short motor unit action potential in the first 3 weeks, followed by increasing of MUAP amplitude and duration, with polyphasic morphology. Although claimed as highly specific and sensible, neuromuscular junction facilitation is an inconstant finding in human botulism. Therefore, lack of neuromuscular junction facilitation cannot exclude a diagnosis of botulism. Our findings are compatible with a process of acute denervation followed by distal reinnervation, favored by terminal nerve sprouting.

Practical implementation of ISO 11929: 2010

The determination of characteristic limits in the measurement of radioactive materials is an important aspect of low-level measurements and the underlying principles are well understood by scientists working on such measurements. ISO 11929:2010 provides a rigorous basis for the systematic calculation of detection limits, but may be difficult to interpret for the routine user. This paper attempts to simplify some of the more arcane aspects of this standard.

MYH7-related myopathies: clinical, histopathological and imaging findings in a cohort of Italian patients

BACKGROUND

Myosin heavy chain 7 (MYH7)-related myopathies are emerging as an important group of muscle diseases of childhood and adulthood, with variable clinical and histopathological expression depending on the type and location of the mutation. Mutations in the head and neck domains are a well-established cause of hypertrophic cardiomyopathy whereas mutation in the distal regions have been associated with a range of skeletal myopathies with or without cardiac involvement, including Laing distal myopathy and Myosin storage myopathy. Recently the spectrum of clinical phenotypes associated with mutations in MYH7 has increased, blurring this scheme and adding further phenotypes to the list. A broader disease spectrum could lead to misdiagnosis of different congenital myopathies, neurogenic atrophy and other neuromuscular conditions.

RESULTS

As a result of a multicenter Italian study we collected clinical, histopathological and imaging data from a population of 21 cases from 15 families, carrying reported or novel mutations in MYH7. Patients displayed a variable phenotype including atypical pictures, as dropped head and bent spine, which cannot be classified in previously described groups. Half of the patients showed congenital or early infantile weakness with predominant distal weakness. Conversely, patients with later onset present prevalent proximal weakness. Seven patients were also affected by cardiomyopathy mostly in the form of non-compacted left ventricle. Muscle biopsy was consistent with minicores myopathy in numerous cases. Muscle MRI was meaningful in delineating a shared pattern of selective involvement of tibialis anterior muscles, with relative sparing of quadriceps.

CONCLUSION

This work adds to the genotype-phenotype correlation of MYH7-relatedmyopathies confirming the complexity of the disorder.

Periodontitis, implant loss and peri-implantitis. A meta-analysis

OBJECTIVE

The aim of the present systematic review and meta-analysis was to assess the role of periodontal disease as a risk factor for implant loss, peri-implantitis and implant-bone loss.

MATERIALS AND METHODS

Six electronic database and a manual search resulted in 7391 unique publications; after selection only 16 studies were included in systematic review. Dichotomous data were expressed as risk ratio (RR) and 95% confidence interval (CI), while continuous data were expressed as standardized mean difference (SMD). Due to the expected inter-study heterogeneity, a random effect model was used for both type of data. The pooled effect was considered significant for a P < 0.05.

RESULTS

Meta-analysis revealed that an higher and significant risk for implant loss was present in patients affected by PD (RR: 1.69, 95% CI: 1.31-2.17, P < 0.0001). A higher and significant IBL was present in patients with periodontal disease, when compared with patients periodontally healthy (SMD: 0.38, 95% CI: 0.18-0.58, P = 0.0002). Patients periodontally compromised showed an increased risk of PI, when compared with patients without periodontitis (RR: 2.17, 95% CI: 1.51-3.12, P < 0.0001) No evidence of significant heterogeneity was detected for the three outcomes.

CONCLUSION

Strong evidence suggests that periodontitis is a risk factor for implant loss; moderate evidence revealed that periodontitis is a risk factor for peri-implantitis and that patients with periodontitis have higher implant-bone loss.

Effects of correction of Class II malocclusion on the kinesiographic pattern of young adolescents: a case- control study

AIM

The aim of this study was to assess the dynamic activity of the mandible by means of a computerised kinesiograph in Class II patients treated with orthodontic therapy and to compare the results of this group with those of a sample of untreated Class II patients.

METHODS

Twenty young adolescents who had undergone orthodontic treatment for correction of Class II malocclusion and twenty age and sex-matched adolescents exhibiting Class II malocclusion, whose parents refused the orthodontic treatment, were enrolled. Maximum vertical opening (MVO), maximum anterior-posterior movement (MAPM), maximum right deviation (MRD), maximum left deviation (MLD), MVO/ MAPM ratio, maximum velocity in opening (MVIO), maximum velocity in closure (MVIC), verticality (ID-V), anterior-posteriority (ID-AP) and laterality (ID-L) were recorded during the kinesiographic evaluations. Differences in the kinesiographic data were analysed using the Wilcoxon sum rank test; data are expressed as means and standard deviations (SD). Differences between groups in age were analysed using unpaired t-test, while differences in gender distribution were assessed using the Fisher's exact test. The level of significance was set at p < 0.05.

RESULTS

No differences were detected in the distribution of sex and age between the two groups. Significant differences between the two groups were observed for MVO, MAPM, that were higher in the control group, and MLD, which was higher in the case group; no other significant differences were detected for MRD, MVO/ MAPM, MVIO, MVIC, ID-V, ID-AP, ID-L.

CONCLUSION

Orthodontic treatment of young patients with Class II malocclusion may reduce the maximum vertical opening as well as the maximum anterior-posterior movement and enhance the lateral displacement; however, further studies are needed to assess the relationship between impaired mandible kinetics of orthodontic treatment in patients with Class II malocclusion and craniomandibular disorders.

Lasers for the Treatment of Dentin Hypersensitivity

This systematic review and meta-analysis assessed the efficacy of lasers in reducing dentin hypersensitivity (DH) as compared with placebo or no treatment. Seven electronic databases and a manual search resulted in 2,538 unique publications. After selection, 13 studies were included in the meta-analysis. A CONSORT-based quality assessment revealed that 3 and 10 studies were at low and high risk of bias, respectively. A random-effects model with the generic inverse variance standardized mean difference (SMD) was used because of expected heterogeneity. Meta-analyses of the baseline-end of follow-up changes in pain revealed no differences for Er,Cr:YSSG vs. placebo (SMD = 2.49; 95% CI, -0.25 to 5.22; p = .07) but did reveal differences in favor of lasers for Er:YAG vs. placebo (SMD, 2.65; 95% CI, 1.25 to 4.05; p = .0002), Nd:YAG vs. placebo (SMD, 3.59; 95% CI, 0.49 to 6.69; p = .02), and GaAlAs vs. placebo (SMD, 3.40; 95% CI, 1.93 to 4.87; p < .00001). High and significant heterogeneity was found for all comparisons. In conclusion, Er:YAG, Nd:YAG, and GaAlAs lasers appear to be efficacious in reducing DH. However, given the high heterogeneity of the included studies, future randomized controlled clinical trials are needed to confirm these results.

Prevalence of myopia in a population with malocclusions

AIM

The purpose of this study was to investigate the prevalence of myopia among a paediatric population with malocclusions.

MATERIALS AND METHODS

A total of 322 consecutive patients of the department of Orthodontics and Gnathology, Dental Clinic, University of L'Aquila, were enlisted for the study and 292 were selected according to the exclusion criteria. Pretreatment diagnostic data, which included radiographic cephalometric and dental cast evaluation, were recorded and presence of myopia was assessed through an ophthalmological examination. Differences in the prevalence of myopia by sex and malocclusion were analysed by using Pearson's chi-square and Fisher's exact tests.

RESULTS

According to the sagittal malocclusion, patients were classified as Class I (N=162), Class II division 1 (N=75), Class II division 2 (N=38), or Class III (N=12). No gender influence was found for myopia or malocclusion. No differences were recorded when analysing the influence of sex on the prevalence of myopia in classes of malocclusion. A statistical significant higher prevalence was found for subjects showing myopia in Class II division 1 malocclusion, while no other significant differences were found for prevalence in the other classes of malocclusions.

DISCUSSION

Few studies investigated a possible relationship between the ocular and stomatognathic system, and no data are available in the scientific literature. A higher prevalence of myopia was found in patients with Class II division 1: as expected no other significant association was found.

CONCLUSION

The findings of the present study suggest a possible association between myopia and Class II, but further studies are needed to confirm and explain this observation.

Prevalence of hyperopia and strabismus in a paediatric population with malocclusions

AIM

The purpose of this study was to investigate the prevalence of hyperopia and strabismus among a paediatric population with malocclusions.

MATERIALS AND METHODS

From a total of 322 consecutive patients observed at the department of Orthodontics and Gnathology, Dental Clinic, University of L'Aquila, 176 were selected for the study according to the exclusion criteria. Pretreatment diagnostic data, which included radiographic, cephalometric and dental cast evaluation, were recorded and presence of hyperopia or strabismus was assessed through an ophthalmological examination. Differences in incidence rates of strabismus or hyperopia by sex and malocclusion were analysed by using the chi-square (Pearson's chi-square test) and Fisher's exact tests.

RESULTS

According to the sagittal malocclusion, patients were classified as Class I (122), Class II division 1 (26), Class II Division 2 (9), or Class III (19); after ophthalmological examination, hyperopia was detected in 8.6% of patients, while strabismus was present in 3.6% of them. No gender influence was found for hyperopia, strabismus or malocclusion.

DISCUSSION

Few studies investigated a possible relationship between the ocular and stomatognathic system, and no data are available in the scientific literature; the present study did not highlight differences in the prevalence of hyperopia or strabismus in the three Angle classes malocclusion.

CONCLUSION

The findings of the present study did not suggest a possible association between hyperopia or strabismus and sagittal malocclusion, but future studies are needed to confirm and explain this observation.

Prevalence of astigmatism in a paediatric population with malocclusions

AIM

The purpose of this study was to investigate the prevalence of astigmatism among a paediatric population.

MATERIALS AND METHODS

A total of 322 consecutive patients of the department of Orthodontics and Gnathology, Dental Clinic, University of L'Aquila, were enlisted for the study and 176 were selected according to the exclusion criteria. Pre- treatment diagnostic data, which included radiographic cephalometric and dental cast evaluation, were recorded and presence of astigmatism was assessed through an ophthalmological examination. Differences in the prevalence of astigmatism by sex and malocclusion were analysed by using the chi-square (Pearson's chi-square test) and Fisher's exact tests.

RESULTS

According to the sagittal malocclusion, patients were classified as Class I (N=122), Class II Division 1 (N=26), Class II Division 2 (N=9), or Class III (N=19); according to the transverse malocclusion patients were classified into cross-bite (N=39) and no cross-bite (N=137) groups; after ophthalmological examination astigmatism was detected in 32 patients (18.18%). Statistically significant correlations were found between astigmatism and cross-bite (p < 0.0001), while no associations were found with other malocclusions. No gender influence was found for astigmatism or malocclusion.

DISCUSSION

Few study investigated a possible relationship between the ocular and stomatognathic system, and no data are available in the scientific literature. A higher prevalence of astigmatism was found in patients with cross-bite: as expected no other significant association was found. The relationship between astigmatism and cross-bite could be either related to a specific skeletal pattern, which could induce visual alterations, or to the effect of abnormal visual input on the postural system, which could induce stomatognathic alterations.

CONCLUSION

The findings of the present study suggest a possible association between astigmatism and cross-bite, but future studies are needed to confirm and explain this observation.

An interdisciplinary approach to a survey on dental caries in a group of 3-year-olds in Ascoli Piceno (Italy)

AIM

The purpose of this study was to investigate the dental caries experience in a group of 3-year-old children, through an interdisciplinary protocol, both paediatric and paedodontic, in the district of Ascoli Piceno (Marche, Italy).

MATERIALS AND METHODS

A sample of 82 children, 38 males and 44 females, was recruited by four paediatricians during a preliminary study phase, which consisted of the epidemiological survey explanation to the involved children's parents and informed consents collection; the survey was first planned and then performed by one calibrated examiner, (Cohen k test was 0.85) in two days on May 2008. The examinations were performed in the nurseries of the schools attended by the children. The collected data were analysed by descriptive and association statistics: the chi² test was used to investigate the association between caries and gender, assuming as statistical significance level the p < 0.05 value.

RESULTS

The study revealed that caries prevalence in the observed population was 38%, while caries free group accounted for 61%; the mean dmft was 1.06, with a standard deviation of 1.64. No statistical significance was observed in the association between caries and gender (chi²=0.65, p > 0.05). discussion: Dental caries prevalence of the surveyed population, according to the WHO 2010 objectives, was judged quite high, focusing the low caries free group (61% instead of 90% or over) and the children's preschool age; nonetheless the sample situation was not considered as critical, because the WHO 2000 goals were achieved (caries free > 50%).

CONCLUSION

The interdisciplinary paedodontic paediatric protocol, used in the present study, was a useful and powerful instrument for preparing the epidemiological survey and could be the basis of future preventive programs.

The impact of young age on breast cancer outcome

AIMS

We conducted a retrospective analysis in order to evaluate the impact of age on women aged less than 35 years affected by breast cancer.

MATERIALS AND METHODS

Between January 1972 and December 2006, 346 patients aged less than 35 years underwent adjuvant treatment at Florence University. The mean age of the patient population was 32 years (range 22-35): 76 patients were under 30 years old, the remaining were above 30 years old.

RESULTS

In our series, 215 patients received adjuvant radiotherapy to whole breast after conservative surgery, 131 patients underwent mastectomy without subsequent radiation therapy and 323 patients had lymphadenectomy; 191 patients received adjuvant chemotherapy, 73 with anthracycline-containing regimen. With a median time of 2.5 years (range 6 months to 27.6 years) local relapses were observed in 67 cases (19.4%). At the multivariate analysis of local disease-free survival, ductal and ductal plus lobular histotypes, having more than 3 positive nodes, and age emerged as independent significant relapse predictors (p = 0.018, p = 0.0005, p = 0.003 and p = 0.024, respectively). For the DSS analysis, the median follow-up was 6.8 years (range 0.6-36.7 years). At the multivariate analysis, age (p = 0.0038), positive nodes (p = 0.0035) and distant metastases (p < 0.0001) resulted to be independent death predictors. Patients younger than 30 had a worse prognosis. At the univariate analysis also local relapse resulted to be statistically significant (p = 0.0004).

CONCLUSIONS

Anthracycline-based chemotherapy seems to improve the outcome of these patients. However, there is an urgent need for tailored treatment investigations within the framework of randomized, controlled clinical trials.

The impact of young age on breast cancer outcome

AIMS: We conducted a retrospective analysis in order to evaluate the impact of age on women aged less than 35 years affected by breast cancer. MATERIALS AND METHODS: Between January 1972 and December 2006, 346 patients aged less than 35 years underwent adjuvant treatment at Florence University. The mean age of the patient population was 32 years (range 22-35): 76 patients were under 30 years old, the remaining were above 30 years old. RESULTS: In our series, 215 patients received adjuvant radiotherapy to whole breast after conservative surgery, 131 patients underwent mastectomy without subsequent radiation therapy and 323 patients had lymphadenectomy; 191 patients received adjuvant chemotherapy, 73 with anthracycline-containing regimen. With a median time of 2.5 years (range 6 months to 27.6 years) local relapses were observed in 67 cases (19.4%). At the multivariate analysis of local disease-free survival, ductal and ductal plus lobular histotypes, having more than 3 positive nodes, and age emerged as independent significant relapse predictors (p=0.018, p=0.0005, p=0.003 and p=0.024, respectively). For the DSS analysis, the median follow-up was 6.8 years (range 0.6-36.7 years). At the multivariate analysis, age (p=0.0038), positive nodes (p=0.0035) and distant metastases (p<0.0001) resulted to be independent death predictors. Patients younger than 30 had a worse prognosis. At the univariate analysis also local relapse resulted to be statistically significant (p=0.0004). CONCLUSIONS: Anthracycline-based chemotherapy seems to improve the outcome of these patients. However, there is an urgent need for tailored treatment investigations within the framework of randomized, controlled clinical trials.

Antibiotic regimen including linezolid for treating prosthetic valve endocarditis with cerebral embolism due to methicillin-susceptible Staphylococcus aureus after failure with oxacillin and teicoplanin

A case of prosthetic valve endocarditis due to methicillin susceptible Staphylococcus aureus (MSSA) with cerebral metastatic seeding is described. The patient is a 61 year old man with diabetes mellitus, chronic renal failure and previous bacterial endocarditis. Despite appropriate MSSA therapy, the patient was eventually cured with the introduction of linezolid, without needing surgical intervention.

Loco-regional recurrence in 2064 patients with breast cancer treated with mastectomy without adjuvant radiotherapy

INTRODUCTION

We investigated the incidence of loco-regional recurrence in a sub-group of patients who underwent mastectomy without adjuvant radiotherapy to evaluate the effect of each specific clinical or pathological parameter that could be associated with a higher local relapse rate.

PATIENTS AND METHODS

Two thousand and sixty-four patients were treated from January 1971 to December 2003 at the University of Florence.

RESULTS

At the time of analysis 18.3% of patients (378/2064) had isolated loco-regional failures. Univariate analysis showed an association of borderline statistical significance with pathological tumour size. Elderly age at diagnosis had a low incidence of local recurrence but the results did not reach statistical significant. The number of positive axillary lymph node did not show any influence for local recurrence.

CONCLUSION

In our series we noted a higher relapse rate only related to the pathological tumour size without any correlation with number of positive axillary nodes. Radiotherapy after mastectomy still remains controversial, but in our series the number of positive axillary lymph node did not seem enough to justify adjuvant treatment.

Charge collection efficiency in ionization chambers exposed to electron beams with high dose per pulse

The correction for charge recombination was determined for different plane-parallel ionization chambers exposed to clinical electron beams with low and high dose per pulse, respectively. The electron energy was nearly the same (about 7 and 9 MeV) for any of the beams used. Boag's two-voltage analysis (TVA) was used to determine the correction for ion losses, k(s), relevant to each chamber considered. The presence of free electrons in the air of the chamber cavity was accounted for in determining k(s) by TVA. The determination of k(s) was made on the basis of the models for ion recombination proposed in past years by Boag, Hochhäuser and Balk to account for the presence of free electrons. The absorbed dose measurements in both low-dose-per-pulse (less than 0.3 mGy per pulse) and high-dose-per-pulse (20-120 mGy per pulse range) electron beams were compared with ferrous sulphate chemical dosimetry, a method independent of the dose per pulse. The results of the comparison support the conclusion that one of the models is more adequate to correct for ion recombination, even in high-dose-per-pulse conditions, provided that the fraction of free electrons is properly assessed. In this respect the drift velocity and the time constant for attachment of electrons in the air of the chamber cavity are rather critical parameters because of their dependence on chamber dimensions and operational conditions. Finally, a determination of the factor k(s) was also made by zero extrapolation of the 1/Q versus 1/V saturation curves, leading to the conclusion that this method does not provide consistent results in high-dose-per-pulse beams.