Heterogeneity in regional changes in body composition induced by androgen deprivation therapy in prostate cancer patients: potential impact on bone health-the BLADE study

BACKGROUND

It is not clear whether changes in body composition induced by androgen deprivation therapy (ADT) in prostate cancer (PC) patients are uniform or vary in the different body districts and whether regional lean body mass (LBM) and fat body mass (FBM) could have an impact on bone health.

OBJECTIVE

To prospectively evaluate the regional changes in LBM and FBM in PC patients submitted to degarelix; to explore the relationship of regional body composition and bone mineral density (BMD) and bone turnover markers.

DESIGN, SETTING, AND PARTICIPANTS

29 consecutive non metastatic PC patients enrolled from 2017 to 2019. FBM, LBM and bone mineral density (BMD) evaluated by dual-energy x-ray absorptiometry (DXA) at baseline and after 12-month of ADT. Alkaline phosphate (ALP) and C-terminal telopeptide of type I collagen (CTX) assessed at baseline, 6 and 12 months.

INTERVENTION

All patients underwent degarelix administration.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

T-test or sign test and Pearson or Spearman test for continuous variables were used when indicated.

RESULTS AND LIMITATIONS

Median percent increase in FBM ranged from + 14.5% in trunk to + 25.4% in the left leg after degarelix. LBM changes varied from + 2% in the trunk to - 4.9% in the right arm. LBM in both arms and legs and their variations after degarelix directly correlated with ALP and inversely correlated with CTX. Lean mass of limbs, trunk and legs significantly correlated with BMD of the hip, lean mass of the trunk significantly correlated with spine BMD. These are post-hoc analysis of a prospective study and this is the main limitation.

CONCLUSIONS

an heterogeneous change in body composition among body district is observed after ADT and bone turnover is influenced by lean mass and its variation. A supervised physical activity is crucial to maintain general physical performance and preserving bone health.

Knowledge and behaviour of nursing students on the prevention of healthcare associated infections

INTRODUCTION

Hospital infections, or "healthcare associated infections" (HAI) represent the most common and serious complications of healthcare. Adoption of safe care practices able to prevent or control the transmission of infections, both in hospitals and in other healthcare settings is crucial. The aim of the study is to assess the awareness about the risk factors and the most effective measures of prevention of HAI in the University of Ferrara nursing school students, giving particular attention to the hand hygiene practices and the use of standard precautions.

METHODS

339 students attending all the three years of course of the same academic year were enrolled. An anonymous questionnaire was administered in order to investigate the knowledge about three specific areas: infections associated with healthcare practices (HAI), standard precautions (SP) and hand hygiene (HH).

RESULTS

A sufficient level of knowledge by all the three groups of students was observed only in the SP area. A barely sufficient score was reached only by the third year students with regard to the proper HH. The level of knowledge about HAI was inadequate.

CONCLUSIONS

A periodically check of nursing students' knowledge would be advisable in order to fill any gaps, improve training, reduce HAI and increase prevention measures compliance.

Knowledge of preventive measures against occupational risks and spread of healthcare-associated infections among nursing students. An epidemiological prevalence study from Ferrara, Italy

INTRODUCTION

Exposure to biological agents is the most common occupational risk for nursing staff. This study verified changes in attitudes and knowledge occurred in the nursing students after the first year of degree.

METHODS

The survey was conducted in academic year 2006/07 among the students of the Professional Nursing Course at University of Ferrara (Italy) using a structured questionnaire. Students were 85 at the beginning and 80 at the end of the courses.

RESULTS

The rate of subjects using gloves for intramuscular injections and fingertip puncture was unsatisfactory. A high percentage of students performed recap of needles. The use of gloves in case of washing of surgical instruments was high. The compliance in the use of gloves in handling test tubes remained low. Only 2/3 of the students washes their hands coming in ward. Incorrect attitudes have been observed in changing or wearing gloves. The students considered vaccination against hepatitis-B necessary, vaccination against flu unnecessary. A high percentage of students had not performed any prophylaxis for tuberculosis.

DISCUSSION

Students intend the use of gloves mainly to perform self-protection. The concept of self-protection is contradicted by the large percentage of students that recap used needles. A significant percentage of students have not yet gained the critical thinking necessary to consider the importance of universal precautions as a means not only of self-protection but also of prevention of hospital infections.

CONCLUSIONS

Students consider the basic standard measures for the control of infectious diseases only like self-protection and not to prevent hospital infections.

Assessment of humoral and cell-mediated immunity against Bordetella pertussis in adolescent, adult, and senior subjects in Italy

Humoral and cell-mediated immunity (CMI) against B. pertussis was assessed in a sample of adolescent, adult and senior subjects distributed in five different geographical areas in Italy. Most (99.1%) subjects had IgG anti-pertussis toxin (PT) antibodies exceeding the minimum detection level [> or = 2 ELISA units (EU)/ml]. There were no significant differences between the genders; 6.2% samples recorded titres > or = 100 EU/ml. CMI was positive [stimulation index (SI) > or = 5] against PT in 39.0% of all samples. This study suggests that B. pertussis continues to circulate in age groups that have been previously considered to be uninvolved in the circulation of this pathogen and that adolescent and adult pertussis boosters may be of value in these populations. Nevertheless, over the last 10 years, large increases in vaccination coverage rates have contributed to reduce the spread of the aetiological agent, especially in the immunized population.

Cervical cancer screening in the Ferrara Local Health Authority catchment area

Since 1996, the Emilia-Romagna Region has been promoting screening programmes for cervical cancer, selecting resident women aged 25-64 as a target population. This analysis concerns a second round of screening performed in the city of Ferrara and its province. A total of 103,971 women were invited to be screened, but only 55.51% of them arrived on the day of the scheduled screening. We therefore decided to investigate the reasons for this lack of participation using preliminary findings from the local screening program registry. These indicated that non-attendance was related to variables such as area of residence and age, and significant differences were observed between localities, with a consistently greater participation in industrial neighbourhoods and their surroundings than in rural areas. In order to elucidate these observations further, a cross-sectional survey, placing special emphasis on setting, area of residence, age and level of education, was performed by structured telephone questionnaire, in order to identify the reasons behind non-attendance. Approximately 94% of the contacted women agreed to be interviewed, thereby demonstrating that a telephone interview is a valid means of collecting data in such cases. It should be noted that, among the women unwilling to respond to the questionnaire, a marked increase in percentage was observed for those resident in rural areas, of whom approximately 50% fell into the under-40 age group. The results of the survey indicated, as demonstrated by several previous studies, that age and the area of residence are both determining factors in the decision or not to participate in a screening programme. It was also observed that women who had completed the lower and upper secondary school education were shown to pay greater attention to health matters than those who had not.

[Persistence of circulation of Corynebacterium diphtheriae non-toxigenic strains and low prevalence of carriers in a sample of children vaccinated against diphtheria]

This study was carried out with the aim to investigate the presence of carriers of diphtheria bacillus in a sample of 1970 healthy children, 6-14 years aged, residing in eight Italian towns. Three non-toxigenic strains of Corynebacterium diphtheriae biotype mitis were isolated from as many healthy children. Molecular characterization by ribotyping showed close genetic relation of two of the wild strains with the C7(b) reference strain whereas one of the wild strains showed close genetic relation with two collection strains isolated in the same geographic area (Emilia-Romagna) from diphtheria patients in the seventy years. This supports the hypothesis of the persistence of some non toxigenic C. diphtheriae strains derived from ancient endemic strains under the selective pressure of mass immunization against diphtheria. The persistence of carriers of diphtheria bacilli, although non toxigenic, suggests that high levels of immunity must be maintained, not only in children, but also in adults by booster vaccination.

Ultrastructural abnormalities of muscle spindles in the rat masseter muscle with malocclusion-induced damage

Human temporomandibular disorders due to disturbed occlusal mechanics are characterized by sensory, motor and autonomic symptoms, possibly related to muscle overwork and fatigue. Our previous study in rats with experimentally-induced malocclusion due to unilateral molar cusp amputation showed that the ipsilateral masseter muscles undergo morphological and biochemical changes consistent with muscle hypercontraction and ischemia. In the present study, the masseter muscle spindles of the same malocclusion-bearing rats were examined by electron microscopy. Sham-operated rats were used as controls. In the treated rats, clear-cut alterations of the muscle spindles were observed 26 days after surgery, when the extrafusal muscle showed the more severe damage. The fusal alterations affected predominantly capsular cells, intrafusal muscle fibers and sensory nerve endings. These results suggest that in the malocclusion-bearing rats, an abnormal reflex regulation of the motor activity of the masticatory muscles may take place. They also allow us to hypothesize that muscle spindle alterations might be involved in the pathogenesis of human temporomandibular disorders.

Dantrolene counteracts the masseter muscle damage induced by artificial occlusal wear: studies in a rat model

In previous studies, we showed that the introduction of occlusal alterations to rats results in masseter muscle abnormalities. Here, we investigate whether administration of the muscle relaxant dantrolene to rats with occlusal alteration could counteract the occurrence of such abnormalities. Rats underwent unilateral amputation of molar cusps to cause malocclusion. Some rats received dantrolene (10 mg/kg/day subcutaneously). The masseter muscles ipsilateral to the amputated molars were excised 26 days later. Sham-operated rats were used as controls. The tissue samples were studied by light and electron microscopy and morphometry. Moreover, tissue Ca2+ content, an index of muscle injury, was determined. In the absence of dantrolene, occlusal alteration leads to microvessel constriction, morphologic damage of masseter muscle fibers and blood capillaries, and elevation of tissue Ca2+ content. These changes were nearly abrogated by dantrolene, thus supporting it as a possible new therapeutic tool for the treatment of malocclusion-induced muscle diseases.

Factors influencing vaccine uptake in Italy

In Italy, vaccination of children is regulated by a dual system, that is a certain number of compulsory immunisations, and a number of other facultative vaccinations. This has resulted in a different coverage against infections under the two regimens. While the percentage of immunised children against polio, diphtheria, tetanus and hepatitis B is around 95%, until recently the average coverage with facultative vaccinations was no >50%. Coverage against pertussis has dramatically increased in recent times thanks to the advent of acellular and combined vaccines. Regional programmes that aim to increase coverage against measles, mumps and rubella are presently underway. In order to verify the attitude of mothers towards vaccination, a questionnaire-based study was proposed to women taking their children to vaccination services for mandatory immunisation. The preliminary results on 300 questionnaires show a generally favourable attitude towards vaccines of 80% of mothers. Only 7% of them would not immunise at all their children if vaccinations were not mandatory. Measles and mumps vaccines are considered important by 92% of mothers. However, a high number of both parents and paediatricians still give disproportionate importance to mild intercurrent diseases as a reason to differ immunisation. In the middle-long term, it is likely that Italy will shift to a system of recommended immunisations without compulsion. Before this happens, wide and in-depth campaigns on the benefits of vaccination need to be planned and implemented by central and local health authorities, in order to avoid the risk of a dramatic drop of coverage.

Evidence of increased carriage of Corynebacterium spp. in healthy individuals with low antibody titres against diphtheria toxoid

This study evaluated whether a correlation exists between carriage of corynebacteria and the lack of immunity to diphtheria toxoid. Samples of both nasal and pharyngeal secretions were taken from 500 apparently healthy subjects of both sexes and of all ages and inoculated onto Tinsdale's medium. A serum sample was also taken for ELISA test to determine the titre of diphtheria toxin antibodies. None of the subjects carried Corynebacterium diphtheriae. Ninety-three strains of Corynebacterium spp. were isolated from 93 subjects and 86 of these were classified to species or group level by biochemical tests. C. xerosis was the most common (25.8%) followed by C. pseudodiphthericum (16.1%), C. jeikeium and C. striatum (both 10.8%), and C. urealyticum (9.7%). Three other species accounted for approximately 20% of strains and seven were unclassified as biochemically atypical corynebacteria. Non-protective antibodies to diphtheria toxin were found in 80 of the 93 subjects and a strong statistical association was demonstrated between carriage of corynebacteria and non-protective levels of anti-toxin antibodies. The remaining 13 subjects had protective levels of antitoxin antibodies. In contrast, only 45 of the 407 non-colonized subjects had non-protective antitoxin titres. The prevalence of carriage increased with age among males as did the percentage of non-protected subjects. The prevalence of female carriers of corynebacteria was significantly lower. Serum samples from 12 subjects with different antibody titres to diphtheria toxoid reacted to varying degrees with whole-cell lysates of a number of species of corynebacteria. The results suggest that a causal relationship may exist between nasopharyngeal carriage of corynebacteria and a low anti-diphtheria toxin immune response.

Morphologic and biochemical changes of the masseter muscles induced by occlusal wear: studies in a rat model

Occlusal alterations may result in changes in the functional performance of masticatory muscles. In this study, we set up an experimental model in rats to examine whether masticatory muscle abnormalities occur after a malocclusion is induced. Rats underwent unilateral amputation of the molar cusps to simulate an occlusal wear situation. The masseter muscles ipsilateral and contralateral to the amputated molars were excised at different experimental times. Sham-operated rats were used as controls. The tissue samples were studied by light and electron microscopy and morphometry. Tissue calcium content, a biochemical index of muscle injury, was also determined. The results show that occlusal dysfunction leads to microvessel constriction and clear-cut morphologic damage of muscular fibers and blood capillary endothelium, as well as to elevation of tissue calcium content, in the ipsilateral masseter muscle. These changes are likely related to muscle fatigue and ischemia. The early signs of injury do not involve the entire muscle but are mostly restricted to tissue areas rich in type I (slow) muscle fibers, which are characterized by a predominantly aerobic metabolism. The muscle damage becomes more extended and severe with time. On the other hand, the contralateral muscles show only slight alterations which are reversible with time, possibly due to an adaptive response.

Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population

A polycentric study was carried out between 1993 and 1995 in order to evaluate diphtheria immunity on a representative sample of population from different areas of Italy. To determine diphtheria antitoxin, sera from 5187 apparently healthy subjects, divided according to sex and age groups, were titrated using an ELISA indirect method. A basic protective titre of diphtheria antitoxin (> 0.01 IU ml-1) was found in 4080 (78.6%) subjects. No statistically significant differences between males and females were observed. Our findings show that the proportion of susceptibles increases with age and a high proportion of adults no longer has diphtheria antitoxin at protective levels since toxigenic C. diphtheriae circulation is presently lacking in Italy.

Immunity to diphtheria in Siena

The aim of this study, carried out in 1993, was to evaluate diphtheria immunity in Siena. Diphtheria antitoxin levels were measured by means of the immunoenzymatic test (ELISA) in serum samples of 602 apparently healthy subjects (239 males and 363 females) of all ages residing in Siena. According to widely used criteria, 6% of the total population were susceptible to diphtheria (antibody levels < 0.01 IU/ml), 71% had basic protection (0.01-0.09 IU/ml) and 23% were fully protected (> or = 0.1 IU/ml). The results suggested that a high proportion of young population had a protective level of immunity against diphtheria, that susceptibility increased with age and a smaller proportion of males (2.9%) than females (8.3%) were unprotected; this difference was statistically significant. Our results suggest that it may be useful to revaccinate adults with low levels of diphtheria toxoid so that the percentage that remains unprotected does not put the community at risk of an outbreak of diphtheria.

Submicroscopic mathematical evaluation of spermatozoa in assisted reproduction. 4. The bovine fertilization (Notulae seminologicae 10)

In this paper we apply a modification of the formula of Baccetti et al. (1995) in the evaluation of submicroscopical characteristics of bull spermatozoa used in assisted reproduction. In the present experiment sperm quality is proposed as a useful parameter in predicting the success of fertilization. Our results demonstrate that the percentage of spermatozoa devoid of submicroscopic defects, according to the particular Bayesan formula proposed by us, is clearly correlated with the result of artificial insemination. In fact, the parameter concerning sperm quality obtained in variously successful donors shows a large correlation with fertility power. The synthetic parameters observed are therefore a good tool in the prediction of sperm power in artificial fertilization. The evaluation is mainly concerned with the quality of the acrosomal characters, the status of the chromatin, the shape of mitochondria, the position of the postacrosomal sheath, the perinuclear space and the axonemal pattern. All these characters are expressed with different means in ejaculates. All these data confirm that submicroscopic-mathematical evaluation offers a convincing and reliable diagnosis based upon sperm structure and functions such as acrosomal reaction and cell motility. It has been also demonstrated that sperm quality is a major factor in the success of artificial insemination and it is clearly revealed in the integrity of most of sperm organelles.

Radicular cysts are involved in the recruitment of osteoclast precursors

In consideration of the close relationship between radicular cysts and alveolar bone, it is important to evaluate the potential involvement of the neighbouring bone tissue in such lesions. In the present study, using cytochemical, immunocytochemical and morphological analyses, presumptive osteoclast precursors were revealed in the connective tissue of radicular cyst capsules. The osteoclastic nature of these cells was postulated by their positive staining for the enzyme tartrate-resistant acid phosphatase (TRAP) and by the expression of vitronectin receptor (VnR) on their cell surface. However, these cells did not express the vacuolar-type proton pump, suggesting that they may represent early osteoclast precursors infiltrating the cyst capsule. Cysts also contained activated small blood vessels whose endothelial cells expressed the VnR. This integrin receptor is important in the adhesion of preosteoclasts to the endothelial lining, a necessary step for their emigration out of the vasculature. Therefore, the intracystic vessels could represent a substrate for preosteoclast recruitment. These precursor cells may then reach the perialveolar bone surface and contribute to bone demolition together with those recruited by the resorbing surfaces. The bone-destroying potential of radicular cysts was confirmed by the presence of numerous osteoclasts with large resorption areas on the perialveolar bone surfaces exposed to the cyst capsules. The resorbed surfaces were usually located around the vascular canals of the Haversian systems.

Odontogenic jaw cysts: light and electron microscopical investigations

Light and electron microscopy were used to analyze the epithelial lining of odontogenic cysts excised from edentulous regions of the jaws. Clinically, three cases were identified as keratocysts, and 21 cases as cysts other than keratocysts ("non-keratocysts"). The epithelium of the former was found to achieve keratinization over most of the surface and to never contain mucus secreting cells. The epithelium of the latter appeared to be in part stratified squamous, with cells loosely connected to each other, and in part stratified columnar, with superficial cells connected to each other by tight junctions and secreting mucus. The results suggest that cysts arising from edentulous regions of the jaws may be either keratocysts or cysts with heterogeneous, non-keratinizing epithelium; the content of keratocysts can be formed mainly by shedding of cornified epithelial layers, and that of non-keratocysts by mucus secretion from columnar epithelium associated to fluid filtration through non-keratinizing squamous epithelium.

[Highlights in the subject of low frequency-high intensity TENS (review)]

Transcutaneous electrical neural stimulation (l.f.-h.i. TENS), employed in dentistry, allows masticatory muscles relaxation, temporary clearance of muscular and periodontal proprioceptive input and even oro-facial pain relief. The mechanisms involved in this type of stimulation are not entirely clarified. According to the most recent neurophysiological researches, the authors describe several l.f.-h.i. TENS. action modalities. Some of them are well known such as the gate control theory, the endogenous antinociceptive system activation, the metabolic recovery of the muscular tissue and the unloading reflex. Other mechanisms, instead, are less known such as hypnosis and stress analgesia, exteroceptive suppression and counterirritation (DNIC). Some hypothetical mechanisms are also considered such as endogenous inhibition and sympathetic activity reduction.

Osteolytic processes in human radicular cysts: morphological and biochemical results

In an attempt to verify the nature of bone resorption processes on the bone surrounding radicular cysts, fragments of cysts with the adjacent bone tissue were studied by morphological, cytochemical and ultrastructural methods. Cyst fluid was analysed for its content of cytokines with osteolytic activity. The cyst wall exhibited several connective tissue extensions which penetrated the adjacent bone. Numerous multinucleated tartrate-resistant acid phosphatase (TRAP)-positive cells were seen at the tip of the intraosseous extensions of the cyst capsule and in direct contact with the bone tissue. Typical resorption lacunae were identified on the bone surface by scanning electron microscopy. Moreover, mononuclear TRAP-positive cells were seen within the cyst capsule. High levels of prostaglandin E2 (PGE2) and interleukin-6 (IL-6) were detected in the cyst fluids. In conclusion, active bone resorption may contribute significantly to the growth of these lesions within the jaws.

[Ultrastructural relief of unaffected mucosa in recurrent oral ulcer patients. 2]

Electron microscopy was performed on clinically normal vestibular mucosa biopsies of two patients affected with recurrent oral ulcers. Apoptotic cells were absent from vestibular mucosa; this is in contrast with the pathogenetic theory proposed by Honma et al., 1985 (1). Only a few modifications in the keratinization process (intracytoplasmic desmosomes, electrondense granules in basal keratinocytes) and an unusually high number of dendritic cells were found; dendritic cells could be involved in local immunological iperreactivity, responsible for the ulcers of these subjects.

[Surgical treatment of oroantral fistula. Experience with the use of fibrin glue]

Personal surgical experience in the treatment of oro-antral fistulas is reported. Fifteen patients underwent plastic surgery (palatal strip) and fibrin glue was used to guarantee a better take of the strip.

[Red lesions of the oral mucosa as early manifestations of squamous cell carcinoma]

Red lesions of oral mucous membranes may have various aetiology, but we must never forget, that among them, there is also the so-called erythroplachia, the oral variation of the better known and mainly genital form of Queyrat, which is one of the most typical examples of cancer in situ (c.i.s.).