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Tissue-Tracking Mitral Annular Displacement in Neonates: A Novel Index of Left Ventricular Systolic Function. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:729-739. [PMID: 38140738 DOI: 10.1002/jum.16399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To assess the feasibility, accuracy, and reproducibility of tissue-tracking mitral annular displacement (TMAD) compared with other measures of left ventricular systolic function in healthy preterm and term neonates in the transitional period. METHODS This was a prospective observational study. Two echocardiograms were performed at 24 and 48 hours of life. TMAD, shortening fraction (SF), ejection fraction (EF), s', and global longitudinal strain (GLS) were measured offline. Accuracy to detect impaired GLS was tested by ROC curve analysis. DeLong test was used to compare AUCs. Intra and interobserver reproducibility of the off-line analysis was calculated. RESULTS Mean ± SD gestational age and weight were 34.2 ± 3.8 weeks and 2162 ± 833 g, respectively. TMAD was feasible in 168/180 scans (93%). At 24 hours the AUC (95% CI) of SF, EF, s', and TMAD (%) was 0.51 (0.36-0.67), 0.68 (0.54-0.82), 0.63 (0.49-0.77), and 0.89 (0.79-0.99) respectively. At 48 hours the AUC (95% CI) of SF, EF, s', and TMAD (%) was 0.64 (0.51-0.77), 0.59 (0.37-0.80), 0.70 (0.54-0.86), and 0.96 (0.91-1.00), respectively. The AUC of TMAD was superior to the AUC of SF, EF, s', at both timepoints (P < .02). Intraclass correlation coefficients (95% CI) of intra and interobserver reproducibility of TMAD were 0.97 (0.95-0.99) and 0.94 (0.88-0.97), respectively. CONCLUSION TMAD showed improved accuracy and optimal reproducibility in neonates in the first 48 hours of life.
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Hormonal control during infancy and testicular adrenal rest tumor development in males with congenital adrenal hyperplasia: a retrospective multicenter cohort study. Eur J Endocrinol 2023; 189:460-468. [PMID: 37837609 DOI: 10.1093/ejendo/lvad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/28/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Abstract
IMPORTANCE Testicular adrenal rest tumors (TARTs), often found in male patients with congenital adrenal hyperplasia (CAH), are benign lesions causing testicular damage and infertility. We hypothesize that chronically elevated adrenocorticotropic hormone exposure during early life may promote TART development. OBJECTIVE This study aimed to examine the association between commencing adequate glucocorticoid treatment early after birth and TART development. DESIGN AND PARTICIPANTS This retrospective multicenter (n = 22) open cohort study collected longitudinal clinical and biochemical data of the first 4 years of life using the I-CAH registry and included 188 male patients (median age 13 years; interquartile range: 10-17) with 21-hydroxylase deficiency (n = 181) or 11-hydroxylase deficiency (n = 7). All patients underwent at least 1 testicular ultrasound. RESULTS TART was detected in 72 (38%) of the patients. Prevalence varied between centers. When adjusted for CAH phenotype, a delayed CAH diagnosis of >1 year, compared with a diagnosis within 1 month of life, was associated with a 2.6 times higher risk of TART diagnosis. TART onset was not predicted by biochemical disease control or bone age advancement in the first 4 years of life, but increased height standard deviation scores at the end of the 4-year study period were associated with a 27% higher risk of TART diagnosis. CONCLUSIONS AND RELEVANCE A delayed CAH diagnosis of >1 year vs CAH diagnosis within 1 month after birth was associated with a higher risk of TART development, which may be attributed to poor disease control in early life.
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How much does a liter of donor human milk cost? Cost analysis of operating a human milk bank in Italy. Int Breastfeed J 2022; 17:90. [PMID: 36539788 PMCID: PMC9764658 DOI: 10.1186/s13006-022-00530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To date, 40 Human Milk Banks (HMB) have been established in Italy; however, recent cost analysis data for operating an HMB in Italy are not available in the literature. METHODS This study was a cross-sectional study performed at "Bambino Gesù" Children's Hospital in Rome, Italy in 2019. We assessed the one-year operational costs and, the per liter unit costs at our HMB. RESULTS During the 2019 year we collected 771 l of human milk supplied by 128 donors. The total cost was € 178,287.00 and the average cost was € 231.00 per liter. € 188,716.00 would have been spent had the maximum capacity for 904 l been reached. We found a significant difference (€ 231.00 vs € 209.00 per liter, p = 0.016) comparing the cost for collected liters in the year 2019 and the cost for the maximum capacity of the bank for that year of activity. Analyzing each cost item that determines the charge of donor human milk (DHM), the highest costs are the salaries of medical and paramedical staff, and then the costs related to transporting. If the HMB works at maximum capacity and manages a greater number of liters of milk, this can represent an important saving. Conversely, the price of consumables is modest (i.e., the price of a single-use kit for breast pumps was € 0.22 per unit). CONCLUSION The costs for a liter of DHM are quite high, but they must be related to the benefits, especially for preterm infants. Comparing the cost for collected liters in 2019 and the costs for the 2019 maximum capacity of the HMB, we calculated how much fixed costs of collection and distribution of DHM can be reduced, by increasing the volume of milk collected. To the best of our knowledge, this is the first complete cost analysis for an Italian Milk Bank. A thorough analysis could help to abate fixed costs and reduce the cost of a liter of DHM. The centralization of DHM can allow savings, rather than creating small HMBs scattered throughout the territory that would operate with lower milk volumes.
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Lung ultrasound in Italian neonatal intensive care units: A national survey. Pediatr Pulmonol 2022; 57:2199-2206. [PMID: 35637553 DOI: 10.1002/ppul.26025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Lung ultrasound (LU) is a noninvasive, bedside imaging technique that is attracting growing interest in the evaluation of neonatal respiratory diseases. We conducted a nationwide survey of LU usage in Italian neonatal intensive care units (NICUs). METHODS A structured questionnaire was developed and sent online to 114 Italian NICUs from June to September 2021. RESULTS The response rate was 79%. In the past 4 years (range: 2-6), LU has been adopted in 82% of Italian NICUs. It is the first-choice diagnostic test in 23% of the centers surveyed. The main LU diagnostic applications reported were: pneumothorax (95%), respiratory distress syndrome (89%), transient tachypnea of the newborn (89%), plural effusion (88%), atelectasis (66%), pneumonia (64%), bronchopulmonary dysplasia (43%), congenital pulmonary airway malformation (41%), and congenital diaphragmatic hernia (34%). Thirty percent of participating centers calculated LU score routinely, but only seven units used it to predict the need for surfactant replacement. Sixty-six percent of respondents learned the LU technique via a self-training process, while 34% of them visited an expert in the field for one-to-one tuition. CONCLUSIONS LU has a widespread use in Italian NICUs. However, the use of LU is extremely heterogeneous among centers. There is an urgent need to ensure standardization of clinical practice guidelines and to design and implement a formalized and accredited training program.
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Cell adhesion molecules E-cadherin and CADM1 are differently expressed in canine inflammatory mammary cancer. Res Vet Sci 2022; 152:307-313. [DOI: 10.1016/j.rvsc.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/27/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
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A retrospective analysis of endocrine disease in sphingosine-1-phosphate lyase insufficiency: case series and literature review. Endocr Connect 2022; 11:e220250. [PMID: 35904228 PMCID: PMC9346324 DOI: 10.1530/ec-22-0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022]
Abstract
Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional mineralocorticoid deficiency. While most individuals also have nephrotic syndrome, SGPL1 variants also account for isolated adrenal insufficiency at presentation. Primary gonadal insufficiency, manifesting with microphallus and cryptorchidism, is reported in less than one-third of affected boys, all with concomitant adrenal disease. Mild primary hypothyroidism affects approximately a third of patients. There is paucity of data on the impact of SGPL1 deficiency on growth, and pubertal development, limited by the early and high mortality rate (approximately 50%). There is no clear genotype-phenotype correlation overall in the syndrome, with variable disease penetrance within individual kindreds. However, with regards to endocrine phenotype, the most prevalent disease variant p.R222Q (affecting 22%) is most consistently associated with isolated glucocorticoid deficiency. To conclude, SPLIS is associated with significant multiple endocrine disorders. While endocrinopathy in the syndrome generally presents in infancy, late-onset disease also occurs. Screening for these is therefore warranted both at diagnosis and through follow-up.
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Congenital Heart Disease: Growth Evaluation and Sport Activity in a Paediatric Population. CHILDREN 2022; 9:children9060884. [PMID: 35740821 PMCID: PMC9221605 DOI: 10.3390/children9060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
(1) Objective: To evaluate: (i) the associations of age and disease severity with anthropometric indices and weight status, (ii) the difference in the frequency of sports activity among different levels of disease severity in paediatric patients with congenital heart disease (CHD). (2) Methods: Clinical data of Caucasian children (aged 2–18 years) diagnosed with CHD (2005–2018) were retrospectively collected from the electronic register of outpatient visits. Of the 475 children with CHD, 368 children and their 1690 complete anthropometric measurements were eligible for inclusion in our analysis. (3) Results: Significant increase with age was observed for weight z-score [beta (95%CI): 0.03 (0.02, 0.05) for one-unit of age] and BMI z-score [0.06 (0.03, 0.08)] but not for height z-score. The probability of being underweight and overweight/obese increased and decreased with disease severity, respectively. The obesity probability of patients with mild CHD (0.06 [95%CI: 0.03, 0.08]) was not statistically distinguishable from that of patients with moderate CHD (0.03 [95%CI: 0.02, 0.05]), whereas it was lower in patients with severe CHD (0.004 [95%CI: 0.0, 0.009]). No obese patients with a univentricular heart defect were observed. Days spent in sport activities were equal to 1.9 [95%CI: 1.6, 2.2] days/week, 1.9 [1.5, 2.2], 1.4 [1.1, 1.7] and 0.7 [0.1, 1.3] in patients with mild, moderate, severe and univentricular CHD, respectively. (4) Conclusions: The risk of being overweight and obese should not be underestimated in paediatric patients diagnosed with CHD, especially in children with mild or moderate heart defects. It could be prevented or reduced by promoting a healthy lifestyle.
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Lung ultrasound scores in neonatal clinical practice: A narrative review of the literature. Pediatr Pulmonol 2022; 57:1157-1166. [PMID: 35229487 DOI: 10.1002/ppul.25875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 11/10/2022]
Abstract
Lung ultrasound (LU) has in recent years increasingly been used as a point-of-care method. Initially, LU was used as a so-called descriptive diagnostic method for neonatal respiratory diseases. Instead, this review article focuses on the use of LU as a "functional" tool using classification of findings in patterns or using semiquantitative scores. We review and describe the evidence that led to the implementation of LU in predicting the need for surfactant replacement therapy in preterm infants and in the identification of newborns at risk of developing bronchopulmonary dysplasia. LU appears to be a very promising method for the future of clinical management of newborns in both acute and chronic phases of pulmonary pathologies related to prematurity. However, further studies are needed to define its role before full implementation.
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Impact of Aortic Diameter Measurements at Three Anatomical Landmarks on Left Ventricular Output Calculation in Neonates. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1187-1194. [PMID: 34423855 DOI: 10.1002/jum.15808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/04/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonates, when left ventricular outflow tract diameter (LVOTD) was measured at the hinges of the aortic valve (AV), at the aortic sinus (AS), and at the sinotubular junction (STJ). METHODS This was an observational study. In the first cohort of very preterm neonates, we assessed intraobserver and interobserver repeatability of LVOTD measured at the AV, AS, and STJ and of the corresponding LVO. In the second cohort of older neonates, we compared paired LVO measurements by echo and magnetic resonance imaging (MRI). RESULTS In the first cohort of 48 neonates, mean (standard deviation) weight and age at scan were 1046 (302) g and 28.1 (2.7) weeks. Interobserver bias (95% limits of agreement [LOA]) for LVOTD at the AV, AS, and STJ was 0 (-0.3 to 0.3) mm, 0 (-0.7 to 0.7) mm, and 0 (-0.8 to 0.7) mm, respectively. Interobserver bias (95% LOA) for the corresponding LVO was -1.3 (-31 to 33) ml/kg/min, -0.5 (-88 to 87) ml/kg/min, and -7.2 (-83 to 69) ml/kg/min, respectively. In the second cohort of 10 neonates, median (range) weight and age at scan were 1942 (970-3640) g and 37.2 (31.7-39.8) weeks. LVO measured at the AV showed stronger agreement with MRI: bias (LOA) -10.6 (-74 to 52) ml/kg/min, compared to LVO measured at AS and STJ: 194 (-0.5 to 388) ml/kg/min and 43 (-72 to 159) ml/kg/min respectively. CONCLUSIONS Reproducibility and accuracy of LVO quantification by echo were better when aortic diameter was measured at AV.
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Early corneal and optic nerve changes in a paediatric population affected by obstructive sleep apnea syndrome. Int Ophthalmol 2021; 42:1281-1287. [PMID: 34738205 DOI: 10.1007/s10792-021-02115-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The relation between OSAS and eye diseases is well known in adults, while very few and contradictory data can be found regarding paediatric ages. The aim of this study is to explore the early corneal, macular and optic nerve changes in paediatric patients with OSAS. METHODS Prospective study that enrolled children aged ≥ 4 years referred to the Paediatric Pneumology Clinic in Verona for suspected obstructive sleep apnoea syndrome (OSAS) and investigated with the overnight respiratory polygraphy. Patients with apnoea-hypopnea index (AHI) > 1 were classified as OSAS, while those with AHI < 1 were classified non-OSAS. All patients underwent comprehensive eye examination including slit lamp, refraction, intraocular pression (Goldman applanation tonometry), corneal tomography (corneal astigmatism, corneal keratometry at the apex, surface asymmetry index, central corneal thickness and thinnest corneal thickness) and optical coherence tomography (central macular thickness, macular volume and retinal nerve fibre layer). RESULTS Seventy-two children were enrolled in the study. The overall prevalence of OSAS was 48.6%. Statistically significant differences were found between OSAS and non-OSAS group for corneal asymmetry (0.9 ± 0.5 and 0.6 ± 0.3, respectively; p = 0.02), thinnest corneal thickness (551.8 ± 33.9 and 563.7 ± 32.5; p = 0.04), average retinal nerve fibre layer (102.8 ± 10.5 µm and 98.1 ± 12.3 µm; p = 0.012) and in nasal quadrant (76.2 ± 15.4 µm and 66.5 ± 12.6 µm; p = 0.0002). CONCLUSIONS A comprehensive eye examination with corneal and optic nerve imaging showed early corneal and optic nerve changes in children newly diagnosed with OSAS. These could be prelude of the known ocular manifestations associated with OSAS in adult patients.
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Prolyl Endopeptidase-like (PREPL) Deficiency Associated with Growth Hormone Deficiency: Case Report. J Clin Res Pediatr Endocrinol 2021; 15:205-209. [PMID: 34693706 DOI: 10.4274/jcrpe.galenos.2021.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Prolyl endopeptidase-like (PREPL) deficiency (MIM#616224) is a rare congenital disorder characterised by neonatal hypotonia and feeding difficulties, growth hormone (GH) deficiency and hypergonadotropic hypogonadism. This syndrome is an autosomal recessive disease resulting from mutations in the PREPL gene (MIM#609557). Herein we report a 7-year-old female patient with biallelic mutations in PREPL (c.1528C>T in one allele and a whole gene deletion in the other) with early growth impairment in infancy. Growth hormone deficiency was confirmed at 20 months of life. Recombinant growth hormone treatment was introduced with a good response. Her clinical features were similar to those of previously reported cases. The description of new patients with PREPL deficiency syndrome is essential to better delineate the phenotypic and genotypic spectrum of the disease.
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Myocardial Geometry and Dysfunction in Morbidly Obese Adolescents (BMI 35-40 kg/m 2). Am J Cardiol 2021; 157:128-134. [PMID: 34392890 DOI: 10.1016/j.amjcard.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This study evaluated the preclinical effect of obesity on the ventricular remodeling in adolescents with morbid obesity, and determined if subjects labelled as metabolically healthy obesity (MHO) presented better heart index than those with metabolically unhealthy obesity (MUO). Prospective case-control research of 45 adolescents (14-year-old) with morbid obesity and 25 normal weight adolescents' gender- and age-matched with Tanner stage 4-5. Left ventricle (LV) was evaluated by conventional Doppler echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography. Compared to normal-weight subjects, adolescents with morbid obesity presented a high percentage of pathological LV geometry (87%; p<0.01), and systolic and diastolic dysfunctions only detected by E/A ratio (2.0 vs 1.7, p<0.01), global longitudinal strain (-21.0% vs -16.5%, p<0.01), and early diastolic strain rate (3.2 vs 2.2, p<0.01). A correlation was found between impaired cardiac index and body mass index (BMI), high blood pressure, hyperglycemia, low HDL-cholesterol and hypertriglyceridemia. BMI and HDL-cholesterol were the most significant independent variables. No significant differences were found in structural and functional cardiac index when MHO and MUO subjects were compared (global longitudinal strain: -17.0% vs -16.4%, p0.79). Morbidly obese adolescents have an abnormal LV geometry, closely related to BMI, and systolic and diastolic LV dysfunctions. Adolescents labelled as MHO, despite exhibiting better BMI and insulin-resistance values, present the same pathological heart changes as MUO.
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A new microfluidic method enabling the generation of multi-layered tissues-on-chips using skin cells as a proof of concept. Sci Rep 2021; 11:13160. [PMID: 34162909 PMCID: PMC8222336 DOI: 10.1038/s41598-021-91875-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
Microfluidic-based tissues-on-chips (TOCs) have thus far been restricted to modelling simple epithelia as a single cell layer, but likely due to technical difficulties, no TOCs have been reported to include both an epithelial and a stromal component despite the biological importance of the stroma for the structure and function of human tissues. We present, for the first time, a novel approach to generate 3D multilayer tissue models in microfluidic platforms. As a proof of concept, we modelled skin, including a dermal and an epidermal compartment. To accomplish this, we developed a parallel flow method enabling the deposition of bilayer tissue in the upper chamber, which was subsequently maintained under dynamic nutrient flow conditions through the lower chamber, mimicking the function of a blood vessel. We also designed and built an inexpensive, easy-to-implement, versatile, and robust vinyl-based device that overcomes some of the drawbacks present in PDMS-based chips. Preliminary tests indicate that this biochip will allow the development and maintenance of multilayer tissues, which opens the possibility of better modelling of the complex cell-cell and cell-matrix interactions that exist in and between the epithelium and mesenchyme, allowing for better-grounded tissue modelling and drug screening.
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Could myocardial function be predictive of successful extubation in newborns and infants? Pediatr Pulmonol 2021; 56:1733-1738. [PMID: 33580748 DOI: 10.1002/ppul.25316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the relationship between cardiac function and extubation readiness in infants using speckle tracking echocardiography. WORKING HYPOTHESIS Cardiac function combined with established clinical parameters may better identify readiness for extubation. STUDY DESIGN Pilot prospective observational study. PATIENT SELECTION Mechanically ventilated infants were included. METHODOLOGY Cardiac function was assessed by echocardiography immediately before extubation. Systolic and diastolic function in the left (LV) and right ventricles (RV) were assessed by measurement of longitudinal strain (LS), and circumferential strain (CS) in the LV only. Pulmonary artery pressures were assessed using the velocity of tricuspid regurgitation jet (TR), septal position, and end-systolic eccentricity index (EI ES). Cases who extubated successfully (Group 1) were compared to cases who required reintubation (Group 2). RESULTS Twenty-five cases were included. LV CS and RV LS were significantly lower in those who required reintubation (Group 2) compared to those who were successfully extubated (Group 1) (LV CS, -21 (12)% vs. -33 (3)%, p = .001; RV LS -19 (2.7)% vs. -20 (2.5)%, p = .04). TR was absent in all cases. The septal shape was normal in 18 cases (72%), displaced to the left in 7 (28%) cases. No significant differences were found in LV EI ES between groups.
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Therapy options for adrenal insufficiency and recommendations for the management of adrenal crisis. Endocrine 2021; 71:586-594. [PMID: 33661460 PMCID: PMC7929907 DOI: 10.1007/s12020-021-02649-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
Adrenal insufficiency (AI) is a life-threatening condition requiring life-long glucocorticoid (GC) substitution therapy, as well as stress adaptation to prevent adrenal crises. The number of individuals with primary and secondary adrenal insufficiency in Europe is estimated to be 20-50/100.000. A growing number of AI cases are due to side effects of GC treatment used in different treatment strategies for cancer and to immunotherapy in cancer treatment. The benefit of hormone replacement therapy is evident but long-term adverse effects may arise due to the non-physiological GC doses and treatment regimens used. Given multiple GC replacement formulations available comprising short-acting, intermediate, long-acting and novel modified-release hydrocortisone as well as subcutaneous formulations, this review offers a concise summary on the latest therapeutic improvements for treatment of AI and prevention of adrenal crises. As availability of various glucocorticoid formulations and access to expert centers across Europe varies widely, European Reference Networks on rare endocrine conditions aim at harmonizing treatment and ensure access to specialized patient care for individual case-by-case treatment decisions. To improve the availability across Europe to cost effective oral and parenteral formulations of hydrocortisone will save lives.
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Social deprivation affects the practice of routinely downloading blood glucose data at home for families and children with type 1 diabetes. Diabet Med 2021; 38:e14403. [PMID: 32939814 DOI: 10.1111/dme.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
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Breastfeeding Protection, Promotion, and Support in Humanitarian Emergencies: A Systematic Review of Literature. J Hum Lact 2020; 36:687-698. [PMID: 32032499 DOI: 10.1177/0890334419900151] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied. RESEARCH AIMS (1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature. METHODS PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits (N = 10). Articles that did not include the interventions and related outcomes were excluded (n = 1,391). RESULTS Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence. CONCLUSION In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.
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Evaluation of MMP-10 and TIMP-1 levels associated with Resveratrol supplementation. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction Resveratrol (RSV) is a natural phytoalexin present in abundance in grapes, berries, peanuts and red wine. The main benefits of resveratrol ingestion are due to its anti-inflammatory and antioxidant properties. This compound also induces therapeutic benefits in the remodelling of extracellular matrix (ECM), which plays an important role in the regulation of the activity of matrix metalloproteinases (MMPs) and its tissue inhibitors of metalloproteinases (TIMPs). The MMPs are a family of zinc dependent endopeptidases, with an important role in the physiological and pathological remodelling of ECM, once the activity of MMPs can be regulated by TIMPs. This regulation is essential, since if there is an imbalance between the MMPs and TIMPs there’s destruction of the ECM, leading to the development of several pathologies.
Objectives Evaluate RSV potential by determining serum and salivary levels of MMP-10 and TIMP-1.
Methodology The study population included 27 undergraduates between the ages of 18 and 30, divided into a control group (placebo) and an intervention group, supplemented with 100 mg RSV/day, during 30 days. MMP-10 and TIMP-1 levels were determined by slot blot. The results were analysed using a GraphPad Prism version 5 software for Windows (GraphPad Software, San Diego, California, USA).
Results It was verified the existence of a linear correlation between the serum and salivary levels of TIMP-1, as well as a tendency of increase of this biomarker after RSV supplementation. In all indicators studied, supplementation with this compound wasn’t harmful.
Conclusion The rising trend verified at TIMP-1 in both fluids may reflect benefits in the individuals under study, demonstrating that saliva has potential as a study biofluid for this type of biochemical markers. It was also verified that supplementation with this compound did not damage the evaluated parameters and, therefore, the RSV potential shouldn’t be rejected.
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A Novel Application of an Adjustable Catheter in Acute Radicular Pain Management. Pain Ther 2019; 8:141-150. [PMID: 30617904 PMCID: PMC6513925 DOI: 10.1007/s40122-018-0110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Acute lumbosacral radicular syndrome is often a medical disorder of difficult management. Epidural steroid injection is a useful approach for the herniated disc and radiculitis. The transforaminal approach is usually considered more effective and target-specific, but it can be associated with permanent lower extremity paralysis. A caudal approach with an adjustable catheter has been widely used in adhesiolysis in chronic low back pain, but there are no reports of its application in acute radicular pain. The aim of this study is to assess the clinical effectiveness of epidural steroid injection by caudal approach with an adjustable catheter in patients with severe acute radicular pain. Methods Fifty-five patients with severe acute radiculopathy were treated with epidural steroid injection by an epidural catheter whose tip can be directed laterally on the selected site. Numerical rating scale (NRS), pain relief, and analgesic consumption were observed after 1, 3, 6, and 12 months. Analgesic consumption (AC) and functional recovery (FR) have been considered secondary outcomes. Results We observed a significant reduction of NRS score that was constant every 12 months. Pain relief was good after 1 month and improved further after 3 months. Only a few patients perceived poor pain relief and only three patients relapsed. More than 70% of the patients were drug-free at the 12th month. Conclusions The caudal approach with adjustable catheter showed similar but more lasting effects on the acute severe radicular pain when compared to other epidural injections techniques; it is extremely target-specific and thus allows the use of small doses of corticosteroids; moreover, the adjustable catheter makes the procedure free from the risk of major complications. Funding No funding or sponsorship was received for this study. Sponsorship for article publication fees were funded by TSS Medical SRL.
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Massive thymic hyperplasia in a 15-month-old boy: Case report and literature review. Clin Case Rep 2019; 7:27-31. [PMID: 30656002 PMCID: PMC6333069 DOI: 10.1002/ccr3.1896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/06/2022] Open
Abstract
A surgical approach is the choice in young infants with MTH, who are furthest from the time of physiological involution of the thymus, and when the thymus achieves the largest relative size, a surgical approach is the choice. Steroid therapy has been shown to be ineffective (4, 9, 16, 18-20). No surgical complications have been reported, and the outcome is excellent. Recurrence has been seen in only one case.
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E-Cadherin overexpression in canine inflammatory mammary cancer does not occur at the transcriptional level. J Comp Pathol 2019. [DOI: 10.1016/j.jcpa.2018.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Inflammatory myofibroblastic lung tumor: its birth, its bleeding growth, its difficult diagnosis and its surgical end in a child. Clin Case Rep 2018; 6:1445-1447. [PMID: 30147879 PMCID: PMC6099031 DOI: 10.1002/ccr3.1597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023] Open
Abstract
The diagnosis of inflammatory myofibroblastic tumor is based on radiology and histology. The treatment is surgical, and the prognosis is good. For this reason, although this lung disease is rare, when a child show up at hospital with an unknown hemoptysis, this medical condition should not be underestimated.
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Duration of topical therapy in the maintenance of atopic dermatitis remission in pediatric age. Minerva Pediatr (Torino) 2018. [PMID: 29968448 DOI: 10.23736/s0026-4946.18.05064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. METHODS The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient crème in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). CONCLUSIONS The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.
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Duration of topical therapy in the maintenance of atopic dermatitis remission in pediatric age. Minerva Pediatr (Torino) 2018; 73:294-300. [PMID: 29968448 DOI: 10.23736/s2724-5276.18.05064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. METHODS The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient crème in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). CONCLUSIONS The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.
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Successful use of cinacalcet to treat parathyroid-related hypercalcemia in two pediatric patients. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180009. [PMID: 29899992 PMCID: PMC5993061 DOI: 10.1530/edm-18-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 11/30/2022] Open
Abstract
Two pediatric patients with different causes of hyperparathyroidism are reported. First patient is a 13-year-old male with severe hypercalcemia due to left upper parathyroid gland adenoma. After successful surgery, calcium and phosphate levels normalized, but parathormone levels remained elevated. Further studies revealed a second adenoma in the right gland. The second patient is a 13-year-old female with uncommon hypercalcemia symptoms. Presence of pathogenic calcium-sensing receptor gene (CASR) mutation was found, resulting in diagnosis of symptomatic familial hypocalciuric hypercalcemia. Cinacalcet, a calcium-sensing agent that increases the sensitivity of the CASR, was used in both patients with successful results.
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Temperature-induced phenotypic plasticity in the ovipositor of the invasive species Drosophila suzukii. J Therm Biol 2018; 75:62-68. [PMID: 30017053 DOI: 10.1016/j.jtherbio.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/10/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022]
Abstract
Drosophila suzukii (Matsumura, 1931) is a highly successful invasive dipteran which represents a serious threat for global fruit industry. Among other adaptive traits, D. suzukii owes its success to the derived morphological features of its ovipositor, which allows the insect to exploit the exclusive ecological niche of fresh fruit, thus avoiding competition with other closely related species. With the aim of investigating temperature-induced phenotypic plasticity of D. suzukii ovipositor, we reared this insect in four different laboratory conditions, represented by the combination of two developmental temperatures and two diet regimes for the larvae. We recorded the effects of these two factors on ovipositor size and shape and overall body size through a combination of distance-based and geometric morphometric analyses. Results showed that insects attain the largest body sizes at lower temperature, whereas the diet does not determine significant difference in size. However, the effect on size of the two factors is less pronounced in the ovipositor, which shows a negative allometry with respect to body size in all treatments. At higher temperature, ovipositor shape tends also to co-vary with its own size. Neither temperature nor diet have significant effect on ovipositor bilateral fluctuating asymmetry. These results confirm the hypothesis that in D. suzukii the toughened valve of the ovipositor are subjected to effective morpho-functional constraints, while probably being under strong selection by reason of their mechanical role.
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Employment of the Human Thymus as an Alternative Source of Regulatory T Cells to develop an immunotherapy to prevent rejection in transplanted children. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Myeloid Cancer Mutation Rates Depend on Prior Cancer Therapies. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ancestral Events Including Germline and Somatic Mutations Determine Subclonal Events and Affect Phenotype of Progression in MDS. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Autophagy Stimulation Improves Erythroid Proliferative Capacity in Models of SF3B1 Mutant MDS. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Adding Molecular Data to Prognostic Models can Improve their Predictive Power in Treated Patients with Myelodysplastic Syndromes (MDS). Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sphingosine-1-phosphate lyase mutations cause primary adrenal insufficiency and steroid-resistant nephrotic syndrome. J Clin Invest 2017; 127:942-953. [PMID: 28165343 PMCID: PMC5330744 DOI: 10.1172/jci90171] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/12/2016] [Indexed: 12/26/2022] Open
Abstract
Primary adrenal insufficiency is life threatening and can present alone or in combination with other comorbidities. Here, we have described a primary adrenal insufficiency syndrome and steroid-resistant nephrotic syndrome caused by loss-of-function mutations in sphingosine-1-phosphate lyase (SGPL1). SGPL1 executes the final decisive step of the sphingolipid breakdown pathway, mediating the irreversible cleavage of the lipid-signaling molecule sphingosine-1-phosphate (S1P). Mutations in other upstream components of the pathway lead to harmful accumulation of lysosomal sphingolipid species, which are associated with a series of conditions known as the sphingolipidoses. In this work, we have identified 4 different homozygous mutations, c.665G>A (p.R222Q), c.1633_1635delTTC (p.F545del), c.261+1G>A (p.S65Rfs*6), and c.7dupA (p.S3Kfs*11), in 5 families with the condition. In total, 8 patients were investigated, some of whom also manifested other features, including ichthyosis, primary hypothyroidism, neurological symptoms, and cryptorchidism. Sgpl1-/- mice recapitulated the main characteristics of the human disease with abnormal adrenal and renal morphology. Sgpl1-/- mice displayed disrupted adrenocortical zonation and defective expression of steroidogenic enzymes as well as renal histology in keeping with a glomerular phenotype. In summary, we have identified SGPL1 mutations in humans that perhaps represent a distinct multisystemic disorder of sphingolipid metabolism.
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Castanea spp. hybrid clones in vitro conservation: synthetic seeds vs. slow growth storage. ACTA ACUST UNITED AC 2017. [DOI: 10.17660/actahortic.2017.1155.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Profile of Steroid Receptors and Increased Aromatase Immunoexpression in Canine Inflammatory Mammary Cancer as a Potential Therapeutic Target. Reprod Domest Anim 2016; 51:269-75. [PMID: 26899138 DOI: 10.1111/rda.12676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
Canine inflammatory mammary cancer (IMC) has been proposed as a model for the study of human inflammatory breast cancer (IBC). The aims of this study were to compare the immunohistochemical expression of aromatase (Arom) and several hormone receptors [estrogen receptor α (ERα), estrogen receptor β (ERβ), progesterone receptor (PR) and androgen receptor (AR)], in 21 IMC cases vs 19 non-IMC; and to study the possible effect of letrozole on canine IMC and human inflammatory breast cancer (IBC) in vitro using IPC-366 and SUM-149 cell lines. Significant elevations of the means of Arom Total Score (TS), ERβ TS and PR TS were found in the IMC group (p = 0.025, p = 0.038 and p = 0.037, respectively). Secondary IMC tumours expressed higher levels of Arom than primary IMC (p = 0.029). Non-IMC PR- tumours contained higher levels of Arom than non-IMC PR+ tumours (p = 0.007). After the addition of letrozole, the number of IMC and IBC cells dropped drastically. The overexpression of Arom found and the results obtained in vitro further support canine IMC as a model for the study of IBC and future approaches to the treatment of dogs with mammary cancer, and especially IMC, using Arom inhibitors.
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Multi-organ resection for locally advanced adrenocortical cancer: surgical strategy and literature review. G Chir 2015; 36:225-30. [PMID: 26712261 DOI: 10.11138/gchir/2015.36.5.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine malignancy with an estimated worldwide incidence of 0.5-2 per million/year. Complete surgical removal of ACC represents the current treatment of choice for this tumor. A disease-free resection margin (R0) is an important predictor of long-term survival: surgery is demanding and must be performed by a highly experienced surgical team. We report the surgical strategy adopted in a patient with locally advanced ACC and virilization to obtain a R0 resection.
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Abstract
AIM The aim of this study was to compare the short-term surgical outcomes of laparoscopically-assisted right hemicolectomy (LRH) and open right hemicolectomy (ORH) in elderly patients. Patients and methods-Results. Seventy-five patients underwent right hemicolectomy for cancer during the study period, with 41 patients aged ≥ 70 years old. Twenty-four patients underwent ORH and seventeen patients had a LRH (58% vs 42%).We found no differences between ORH and LRH in terms of mean operative time :89,5 minutes in open vs 80 minutes in laparoscopic group and return of bowel function (2,76 vs 2,54 days). Also the length of hospital stay did not differ significantly between the two groups (8,5 days in ORH vs 7 days in LRH - p 0,06). Postoperative morbidity was higher in ORH (25% vs 5%) though not statistically significant and the incidence of anastomotic leakage was similar between the two groups (8% vs 5%). CONCLUSION Laparoscopic RH in an elderly population is feasible and safe. However, we found no evidence to suggest that it is better than open RH and think that the decision regarding the method of operation should reflect surgeon expertise, patient co-morbidities and the necessity to perform extended resections.
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Application of Infrared Thermal Imaging in a Violinist with Temporomandibular Disorder. MEDICAL PROBLEMS OF PERFORMING ARTISTS 2015; 30:251-254. [PMID: 26614980 DOI: 10.21091/mppa.2015.4044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Temporomandibular disorders (TMD) consist of a group of pathologies that affect the masticatory muscles, temporomandibular joints (TMJ), and/or related structures. String instrumentalists, like many orchestra musicians, can spend hours with head postures that may influence the biomechanical behavior of the TMJ and the muscles of the craniocervicomandibular complex (CCMC). The adoption of abnormal postures acquired during performance by musicians can lead to muscular hyperactivity of the head and cervical muscles, with the possible appearance of TMD. Medical infrared thermography is a non-invasive procedure that can monitor the changes in the superficial tissue related to blood circulation and may serve as a complement to the clinical examination. The objective of this study was to use infrared thermography to evaluate, in one subject, the cutaneous thermal changes adjacent to the CCMC that occur before, during, and after playing a string instrument.
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Abstract
INTRODUCTION Impaired wound healing represents a common operative complication after kidney transplantation. This problem seems to be affected by factors related to surgical technique, drugs, and patient/graft peculiarities. PATIENTS AND METHODS From January 2000 to December 2007, 350 consecutive kidney transplantations were performed in a population of nondiabetic patients. We evaluated the influence of various factors on impaired wound healing. RESULTS Among 350 kidney transplantation patients, we observed 54 cases (15.43%) of impaired healing of the surgical incision: 36 (10.29%) with first level and 18 (5.14%) with second level wound complications. Factors related to complications were overweight and delayed graft function. Cyclosporine and tacrolimus had similar effects. However, all patients developing second level complications showed more risk factors. In our experience, postoperative lymphocele did not occur as an unique factor but became a significant risk factor when associated with another one. Patients who did not have reconstruction of the muscle layers showed a greater incidence of incisional complications. CONCLUSION Impaired healing of the surgical incision more or less seriously influenced outcomes of transplanted patients. This complication was common and usually related to the presence of more than one risk factor.
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66 SUBCLINICAL ANCESTRAL EVENTS FOR PROGRESSION TO MANIFEST CLONAL MYELODYSPLASIA ARE PRESENT IN APLASTIC ANEMIA AT PRESENTATION: COMPARISON OF DE NOVO AND POST AA MDS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Three-dimensional analysis of the cranio-cervico-mandibular complex during piano performance. MEDICAL PROBLEMS OF PERFORMING ARTISTS 2014; 29:150-154. [PMID: 25194112 DOI: 10.21091/mppa.2014.3031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Piano players, as well as other musicians, spend a long time training to achieve the best results, sometimes adopting unnatural body positions that may cause musculoskeletal pain. This paper presents the preliminary results of a study targeting the analysis of the head and cervical postures of 17 piano players during musical performance. It was found, as a common feature, that the players tilt the head to the right and forward towards the score and keyboard. Players who know the score by heart tend to move their heads more compared to the ones who have to keep their eyes on the score.
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Determinants in predicting duration of treatment in an out-patient rehabilitation orthopedic-traumatologic service. Eur J Phys Rehabil Med 2014; 50:247-254. [PMID: 24104697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Duration of rehabilitation is an important rehabilitation clinical outcome both from a clinical and administrative point of view. Very few studies have looked at predictors oftreatment duration in out-patient rehabilitation setting especially in patients with orthopedic-traumatologic conditions. AIM We undertook a prospective study to assess treatment duration and identify variables predicting this outcome measure (primary outcome) and efficiency in range of motion and activities of daily living (secondary outcome). DESIGN Prospective and observational study. SETTING Out-patient Service for Rehabilitation. POPULATION Two hundred and ten patients admitted to Out-patient Service for Rehabilitation of orthopedic disorders were enrolled: 94 patients had limb fracture (35 wrist fracture, 28 ankle fracture, 27 shoulder fracture), and 120 and undergone elective orthopedic surgery (27 cruciate reconstruction, 93 rotator cuff repair). METHODS Univariate Regression analysis was applied to analyze relationships among variables and length of rehabilitation while backward stepwise regression analysis was used to predict treatment duration. The independent variables were age, gender, work, type of physical therapy, comorbidity, pain, onset to admission interval, initial disability, initial range of motion percentage (ROM), and diagnosis group. RESULTS Mean treatment duration was 29.7±15 days. Treatment duration following rotator cuff repair was significantly longer than that of cruciate reconstruction (P=0.005), wrist fracture (P<0.001), and ankle fracture (P=0.002). Treatment duration was related to working status, admission disability, onset to admission interval, diagnosis group, admission pain, and admission range of motion. In multivariate regression analysis, admission range of motion and onset to admission interval were the only independent predictors of treatment duration and efficiency in range of motion, while admission range of motion and admission Health Assessment Questionnaire were predictors of efficiency in Health Assessment Questionnaire score. CONCLUSION The study highlights that rehabilitative treatment duration has strong relationship with admission range of motion and onset admission interval. CLINICAL REHABILITATION IMPACT. These findings should be useful for physicians for planning therapeutic measures in patients with orthopedic-traumatologic conditions and for managing the usual activities of an Out-patient Rehabilitative Service.
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[The role of surgery in early stage small cell lung cancer: should it be re-evaluated?]. REVUE MEDICALE SUISSE 2013; 9:2170-2174. [PMID: 24354252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Two historical randomized controlled trials have demonstrated that chemo-radiotherapy offers the best survival advantage over surgery in small cell lung carcinoma (SCLC) and led to abandon surgery for the treatment of SCLC. Yet, widespread use of CT scanning increases the detection of early and very early stage SCLC. Therefore, the traditional 2 stages classification scheme--namely limited and extensive stage disease--is no longer sufficient for such early stage disease and must be completed by the TNM classification. Although randomized controlled trials are lacking, retrospective case series and large population databases suggest a beneficial role of surgery for the earliest SCLC stages. It is thus currently recommended to consider surgery in the multimodal treatment of stage I SCLC.
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Height gain at adult-height age in 184 short patients treated with growth hormone from prepubertal age to near adult-height age is not related to GH secretory status at GH therapy onset. Horm Res Paediatr 2013; 79:145-56. [PMID: 23548791 DOI: 10.1159/000348540] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND GH release after stimuli classifies short children as severe idiopathic isolated GH deficiency (IIGHD), mild IIGHD, dissociated GH release (DGHR) and normal GH release (NGHR) and anthropometric birth data as adequate for gestational age (AGA) or small for gestational age (SGA). GH release after stimuli classifies AGA patients as IIGHD or as idiopathic short stature (ISS). AIM To compare height gain induced by GH therapy (31.8 ± 3.5 µg/kg/day, 7.7 ± 1.6 years) started at prepubertal age and stopped at near adult-height age. METHODS A retrospective longitudinal multicenter study including 184 short patients classified as severe IIGHD n = 25, mild IIGHD n = 75, DGHR n = 55 and NGHR n = 29; or as IIGHD n = 78, ISS n = 57 and SGA n = 49. Height gain was evaluated throughout GH therapy and at adult-height age. RESULTS Height-SDS gain at adult-height age was similar among severe IIGHD (1.8 ± 0.8 SDS), mild IIGHD (1.6 ± 0.6 SDS), DGHR (1.7 ± 0.7 SDS) and NGHR (1.6 ± 0.7 SDS), or among IIGHD (1.7 ± 0.7 SDS), ISS (1.7 ± 0.6 SDS) and SGA (1.6 ± 0.8 SD). CONCLUSION GH-release stimuli are of little help for deciding on GH therapy in the clinical management of prepubertal children with IIGHD, ISS or SGA.
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Novel recurrent mutations in the RAS-like GTP-binding gene RIT1 in myeloid malignancies. Leukemia 2013; 27:1943-6. [PMID: 23765226 DOI: 10.1038/leu.2013.179] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Uncertainty and sensitivity analysis of void and power reactivity coefficients in an RBMK-1500 reactor core. KERNTECHNIK 2013. [DOI: 10.3139/124.100232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Uncertainty and sensitivity analyses were performed for the calculation of power and void reactivity coefficients of an RBMK-1500 reactor core state. Both parameters are important for the reactivity feedback behaviour and are of special safety relevance. The reactivity coefficients were calculated using the 3D-reactor core model QUABOX/CUBBOX-HYCA and the uncertainty and sensitivity analyses were performed by the GRS methodology applying the SUSA software package (Software System for Uncertainty and Sensitivity Analysis). A total number of 20 uncertain input parameters and their probability distributions were identified as possibly relevant for the size of the reactivity effects and taken into account in the SUSA analysis. The method helps to identify the main contributors to the uncertainty of calculated results, as well as to determine two-sided (95 %, 95 %) statistical tolerance intervals of the investigated reactivity coefficients. The approach to quantify uncertain parameters for RBMK-1500 core calculations using the SUSA code package and QUABOX/CUBBOX-HYCA was successfully performed. The results provide guidance where model improvements should be performed to increase the accuracy of the calculations efficiently.
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Uncertainty and sensitivity analysis of the CPS-CC voiding in the RBMK reactor Ignalina-2. KERNTECHNIK 2013. [DOI: 10.3139/124.100282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The best-estimate accident analysis approach is widely used for studying safety issues. The introduction of nominal values implies the evaluation of solution uncertainty, therefore an uncertainty analysis is required. New results of an uncertainty and sensitivity analysis of the Control and Protection System Cooling Circuit (CPS-CC) voiding accident in an RBMK-1500 reactor core are presented here. A typical reactor core state of Ignalina NPP Unit2 before the implementation of the independent diverse shut-down system was chosen for the study. The analyzed reactivity initiated accident is one of the most severe ones in RBMK-1500 reactors causing a positive reactivity insertion of about 2 in the case of a full CPS-CC voiding. The simulation of the CPS-CC dynamic voiding process was conducted without taking into account an additional failure of the reactor equipment. The analysis was performed by employing the GRS uncertainty and sensitivity method based on the SUSA software package in combination with the 3D core model QUABOX/CUBBOX-HYCA, adjusted for reactors of RBMK type. The results of the analysis give indications for which parameters the uncertainty of knowledge should be reduced in order to reduce the uncertainty of results most effectively.
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[The accident at work and the occupational diseases in the construction industry: the experience of Inail]. GIORNALE ITALIANO DI MEDICINA DEL LAVORO ED ERGONOMIA 2012; 34:60-65. [PMID: 23405582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The authors analyze the budget accident at work and occupational diseases in the construction industry through the data banks Inail. This analysis is carried out by comparing the data for this sector of economic activity (classification of economic activities ATECO 2002) with those general with particular attention to how an event, occurrence, mortality, by plotting the trends of this phenomenon than in previous years. It also analyzes the phenomenon of the complaints of occupational diseases with the comparison with the general data as well as with the analysis of the most frequent types of occupational diseases in this sector in the last two years.
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Prognostic Value of Histological Grading in Noninflammatory Canine Mammary Carcinomas in a Prospective Study With Two-Year Follow-Up. Vet Pathol 2012; 50:94-105. [DOI: 10.1177/0300985812447830] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this prospective study, a canine-adapted histological grading method was compared with histopathological and clinical characteristics and was evaluated as a prognostic indicator in canine mammary carcinomas (CMCs). Recruited dogs with at least 1 malignant mammary tumor ( n = 65) were clinically evaluated, surgically treated, and followed up (minimum follow-up 28 months, maximum 38 months). Histopathological diagnoses were performed according to Goldschmidt et al (2011). Tumors were graded as grade I (29/65), grade II (19/65), and grade III (17/65). The tumor size, clinical stage, histological diagnosis, presence/absence of myoepithelial proliferation, and regional lymph node metastases at diagnosis were significantly associated with histological grade. The histological grade, age, clinical stage, tumor subtype group, and lymph node metastases at time of diagnosis were significantly associated with the development of recurrences and/or metastases, cancer-associated death, and survival times (disease-free survival and overall survival) in univariate analyses. A subdivision of clinical stage I (T1N0M0) into stages IA and IB was proposed in terms of prognosis. The clinical stage, histological grade, and spay status were selected as independent prognostic variables (multivariate analyses) with disease-free survival as the dependent variable. When overall survival was evaluated as a dependent variable, clinical stage and histological grade were selected as the independent covariates. This grading system is a useful prognostic tool, facilitates histological interpretation, and offers uniform criteria for veterinary pathologists. Comparative studies on CMCs performed in different countries should take into account possible changes in the prognoses due to different proportions of spayed females among the selected dog population.
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