Short-time effects of spa rehabilitation on pain, mood and quality of life among patients with degenerative or post-surgery musculoskeletal disorders

Clinical trials have demonstrated traditional spa therapy effects in musculoskeletal disorders (MSDs). This is the first observational study in Italy aimed at evaluating in real-life the short-time effects of spa rehabilitation on pain, mood and quality of life (QoL) among degenerative or post-surgery MSDs patients. Through the involvement of six Italian spa facilities, 160 patients were enrolled; data from 123 patients were finally analysed. Seventy-nine patients (64.3%) accessed the spa for degenerative MSDs, while 44 (35.8%) had a post-surgical condition. All the patients included in the study underwent 12 sessions of water-based exercise (joint exercises, muscle strengthening, gait training, proprioceptive and balance techniques) conducted in thermal or in warm water pools, six sessions per week, for a period of 2 weeks from March 2019 up to October 2019. A group of 45 patients (36.6%) also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for 2 weeks. Evaluation before and after the treatment included the Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12) and the EuroQol-5D (EQ-5D). The analysis of the scores reported in the questionnaires after the treatment showed a significant improvement in all the scores evaluated. Comparison between patients that performed water-based exercise protocols alone (group A) and patients that in addition to water exercise performed traditional thermal interventions (group B) showed no statistically significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D variations; only NRSa value reduction was lower in group B. Sulphate water was found to be associated with a lower reduction of all the scores considered, when compared to the other water types. Patients with degenerative or post-surgery MSDs showed favourable effects on pain, mood and QoL after water exercise training alone or in combination with traditional thermal therapy. Our research provides the first proof that spa rehabilitation can be in real-life conditions an appropriate alternative strategy for post-orthopaedic surgical outcomes recovery. In the future, these results will need to be further investigated.

Probing the seismic cycle timing with coseismic twisting of subduction margins

Assessing the timing of great megathrust earthquakes is together crucial for seismic hazard analysis and deemed impossible. Geodetic instrumentation of subduction zones has revealed unexpected deformation patterns at subduction segments adjacent to those that hosted recent mega-earthquakes: coastal sites move landward with faster velocities than before the earthquake. Here, we show observations from the largest and best-monitored megathrust earthquakes, and from a scaled analog model, to reveal that these events create coseismic and postseismic deformation patterns typical of a complete gear-like rotation about a vertical axis, hereafter called twisting. We find that such twisting alters the interseismic velocity field of adjacent subduction segments depending on the time since the last earthquake. Early interactions accelerate while late interactions decelerate local kinematics. This finding opens the possibility of using megathrust earthquakes, the characteristics of the twisting pattern, and the ensuing geodetic velocity changes, as a proxy for estimating the timing of the seismic cycle at unruptured segments along the margin.

Satellite geodesy and downscaled laboratory experiments reveal that great subduction earthquakes trigger step changes in kinematics of neighboring segments. This signal is potentially informative of the timing of the seismic cycle.

Cutaneous and oral comorbidities in patients with geographic tongue: a multicenter multidisciplinary cross-sectional observational study

Geographic tongue (GT) represents a localized type of psoriasis inversa and its burden of dermatological and oral comorbidities frequently conditions its severity and diagnosis. Currently, no epidemiological studies have evaluated GT muco-cutaneous comorbidities. We aimed to study oral and dermatological comorbidities in a large sample of GT patients. In this multicenter, cross-sectional study, involving 4 primary referral centers in Italy, we evaluated adult GT patients, who were assessed by board certified dermatologists and dentists for 5 months and collected demographics and medical history. GT was evaluated using Hume's classification together with Geographic tongue severity index (GTASI) to score its severity. The prevalence of oral and dermatological comorbidities was recorded. In the sample we enrolled 137 GT patients (M/F= 5:1) with a mean age of 48,2 ± 14,7 yoa and 33.6% had GT family history. The clinical evaluation found 96 (70.1%) GT type I, 7 (5.1%) type II, 13 (9.5%) type IIIa, 19 (13.9%) type IIIb, 2 (1.5%) type IV, following Hume's classification. The mean GTASI score was 23,7 ± 14,2 and the vast majority displayed a severe form of GT. Eighty-nine patients had oral comorbidities (burning mouth syndrome, caries, parulid and lichen planus) and 80 had dermatological concurrent conditions (plaque psoriasis, inverse psoriasis and atopic dermatitis). In GT patients, both dermatological and dental evaluation should be mandatory to identify previously undiagnosed mucocutaneous comorbidities.

Geographic tongue clinical response in moderate-to-severe psoriatic patients undergoing secukinumab: a real-life, multicenter retrospective observational study

Geographic tongue (GT), a form of inverse psoriasis, is frequently linked to plaque psoriasis. The objective of the study is to evaluate IL-17 blocker (secukinumab) effect on GT severity. This reallife, multicenter, retrospective observational pilot study evaluated patients with plaque psoriasis and concomitant GT that started in label treatment with secukinumab. Patients were evaluated twice (T0=baseline and T1=after 16 weeks) by a dentist and a dermatologist collecting data on cutaneous Psoriasis Area Severity Index (PASI) and oral statuses using Hume's classification of the Geographic Tongue Severity Index (GTASI). Twenty-nine psoriatic patients with GT treated with secukinumab were enrolled for the study. Seventeen patients display type I GT, 6 type II and 6 type III with an overall GTASI of 25.52±9.57 at the baseline (T0). No correlation was found between delta GTASI and delta PASI (r=-0.27, p=0.1551). GTASI decrement from T0 to T1 was statistically significant ([95%CI -26.64 to -19.56], t=-13.36, p<0.0001). Secukinumab may enter in GT therapeutic armamentarium as the first biologic IL-17 blocker in patients with concomitant moderate-to-severe plaque psoriasis.

Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects

AIMS

Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated.

PATIENTS AND METHODS

A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54).

RESULTS

The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results.

CONCLUSION

TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.

Medical Cannabis in Patients with Chronic Pain: Effect on Pain Relief, Pain Disability, and Psychological aspects. A Prospective Non randomized Single Arm Clinical Trial

BACKGROUND

There is an increasing interest in the medical use of cannabis, particularly in the treatment of chronic pain.

OBJECTIVES

The aim is to evaluate the effects of cannabis use and the associated benefits reported by patients with various chronic pain diagnoses.

MATERIAL AND METHODS

A total of 338 patients with different chro- nic pain conditions were treated with a Cannabis Flos 19% decoction for 12 months, in addition to their pharmacological therapy. Baseline levels for pain medications, pain intensity, pain disability, anxiety and depression were recorded at 1, 3, 6 and 12 months.

RESULTS

Pain intensity records a statistically significant reduction from Baseline to 12 months follow up (X² 61.375; P<0,001); the im- provements from Baseline to 12 months follow up are also recorded in pain disability (X² 39.423; P<0,001) and in anxiety and depression symptoms (X²30.362; P<0,001; X²27.786; P<0,001).

CONCLUSIONS

Our study suggest that Cannabis therapy, as an adjun- ct a traditional analgesic therapy, can be an efficacious tool to make more effective the management of chronic pain and its consequences on functional and psychological dimension. Further randomized, controlled trials are needed to confirm our conclusions.

Goniometric evaluation of the spinal sagittal curves in children and adolescents: A reliability study

BACKGROUND

Gold standard for spine deformities assessment is X rays, but the procedure bears a risk of exposure.

OBJECTIVE

To investigate intra-rater and inter-rater reliability of a pocket compass needle goniometer (IncliMed®, University of Padua) to non-invasively evaluate spine curves in children and adolescents.

METHODS

Prospective reliability study in a paediatric population (mean age 12.5 years ± 2.5). Children with spine deformities (Scheuermann's or postural kyphosis, idiopathic scoliosis) and healthy controls were included. Two physician measured spinal curves with the surface goniometer IncliMed® within a temporal range of 10 minutes. Participants were re-tested after a mean of 28 days for the intra-rater study. Agreement limit and coefficient of repeatability were calculated according to the linear regression analysis; the Bland and Altman method was applied to obtain average of differences and standard error of the mean of the differences.

RESULTS

One hundred and thirty-nine subjects participated to the inter-rater reliability assessment; 30 to the intra-rater reliability assessment. Inter-observer variability for IncliMed® measurements was ± 11° both for kyphosis and for lordosis. The intra-observer variability for kyphosis and lordosis measurements was ± 11° and ± 12°.

CONCLUSIONS

IncliMed® is a reliable, non-invasive tool to screen and monitor spinal curves in paediatric populations.

What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion

Clinical management of breakthrough cancer pain (BTcP) is still not satisfactory despite the availability of effective pharmacological agents. This is in part linked to the lack of clarity regarding certain essential aspects of BTcP, including terminology, definition, epidemiology and assessment. Other barriers to effective management include a widespread prejudice among doctors and patients concerning the use of opioids, and inadequate assessment of pain severity, resulting in the prescription of ineffective drugs or doses. This review presents an overview of the appropriate and inappropriate actions to take in the diagnosis and treatment of BTcP, as determined by a panel of experts in the field. The ultimate aim is to provide a practical contribution to the unresolved issues in the management of BTcP. Five ‘things to do’ and five ‘things not to do’ in the diagnosis and treatment of BTcP are proposed, and evidence supporting said recommendations are described. It is the duty of all healthcare workers involved in managing cancer patients to be mindful of the possibility of BTcP occurrence and not to underestimate its severity. It is vital that all the necessary steps are carried out to establish an accurate and timely diagnosis, principally by establishing effective communication with the patient, the main information source. It is crucial that BTcP is treated with an effective pharmacological regimen and drug(s), dose and administration route prescribed are designed to suit the particular type of pain and importantly the individual needs of the patient.

Comparison of regional and global reanalysis near-surface winds with station observations over Germany

Abstract. Reanalysis near-surface wind fields from multiple reanalyses are potentially an important information source for wind energy applications. Inter-comparing reanalyses via employing independent observations can help to guide users to useful spatio-temporal scales. Here we compare the statistical properties of wind speeds observed at 210 traditional meteorological stations over Germany with the reanalyses' near-surface fields, confining the analysis to the recent years (2007 to 2010). In this period, the station time series in Germany can be expected to be mostly homogeneous. We compare with a regional reanalysis (COSMO-REA6) and two global reanalyses, ERA-Interim and ERA-20C. We show that for the majority of the stations, the Weibull parameters of the daily mean wind speed frequency distribution match remarkably well with the ones derived from the reanalysis fields. High correlations (larger than 0.9) can be found between stations and reanalysis monthly mean wind speeds all over Germany. Generally, the correlation between the higher resolved COSMO-REA6 wind fields and station observations is highest, for both assimilated and non-assimilated (i.e., independent) observations. As expected from the lower spatial resolution and reduced amount of data assimilated into ERA-20C, the correlation of monthly means decreases somewhat relative to the other reanalyses (in our investigated period of 2007 to 2010). Still, the inter-annual variability connected to the North Atlantic Oscillation (NAO) found in the reanalysis surface wind anomalies is in accordance with the anomalies recorded by the stations. We discuss some typical examples where differences are found, e.g., where the mean wind distributions differ (probably related to either height or model topography differences) and where the correlations break down (because of unresolved local topography) which applies to a minority of stations. We also identified stations with homogeneity problems in the reported station values, demonstrating how reanalyses can be applied to support quality control for the observed station data. Finally, as a demonstration of concept, we discuss how comparing feedback files of the different reanalyses can guide users to useful scales of variability.

User awareness concerning feedback data and input observations used in reanalysis systems

Abstract. A web-based survey to assess the benefits and gaps in reanalyses as part of growing climate services was carried out in 2013–2014. The survey elicited responses from about 2500 users of climate information. One of the eleven survey points specifically addressed the observations used in reanalysis, with a multiple-choice question "Have you used reanalysis input observations and feedback data?". Almost half of the respondents admitted to not knowing what such data were about. Among the others, specific queries asked for these observations to be made available more openly. This paper summarizes the main findings in regard to use of existing reanalyses as well as user awareness and needs in regard to reanalysis feedback data and input observations. In the future, the information obtained via the survey makes it possible to perform various statistically robust analyses addressing different aspects of the use of reanalysis data.

[A challenge for pediatrician: non allergic urticaria]

In general population about 15-20% of subjects have suffered from one episode of urticaria-angioedema syndrome in their life. The etiology of his condition is various and multifactorial. In children the principal cause of acute urticaria is infection, while physical factors are the main agents of chronic urticaria. All those conditions which lack an etiology are named chronic idiopathic urticaria, but in reality a considerable number of these patients is affected by a chronic autoimmune urticaria. For this reason, screening out the most frequent causes of chronic urticaria, it's useful to know when it's possible to apply specific diagnostic tests for this condition and which therapies are employable.

The value of robotic systems in stroke rehabilitation

In this paper, we discuss robot-mediated neurorehabilitation as a significant emerging field in clinical medicine. Stroke rehabilitation is advancing toward more integrated processes, using robotics to facilitate this integration. Rehabilitation approaches have tremendous value in reducing long-term impairments in stroke patients during hospitalization and after discharge, of which robotic systems are a new modality that can provide more effective rehabilitation. The function of robotics in rehabilitative interventions has been examined extensively, generating positive yet not completely satisfactory clinical results. This article presents state-of-the-art robotic systems and their prospective function in poststroke rehabilitation of the upper and lower limbs.

Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up

OBJECTIVE

To assess the 12-month's follow-up effects on pain, mobility, and physical function outcomes of a supervised training and home-based rehabilitation for ankylosing spondylitis patients stabilized with TNF-inhibitor therapy.

DESIGN

Controlled clinical trial (sequentially determined allocation) with 12-months' follow-up.

SETTING

Patients' homes.

SUBJECTS

A total of 69 subjects were allocated to either a rehabilitation programme (rehabilitation group, n = 22), an educational-behavioural programme (educational group, n = 24), and to neither programme (control group, n = 23).

INTERVENTIONS

Rehabilitation programme included supervised training and home exercises (stretching, strengthening, aerobic, chest, and spine/hip joint flexibility exercises); educational-behavioural programme included information on ankylosing spondylitis, pain and stress mechanisms, and control.

MAIN MEASURES

Spinal pain intensity, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, chest expansion, and cervical and lumbar spine active range of motion measured by a pocket goniometer.

RESULTS

At baseline, the three groups exhibited comparable demographic characteristics and basal evaluations. Intra-group changes in the rehabilitation group from baseline to 12 months yielded statistically significant gains (p < 0.05) for all outcomes. At 12-months follow-up, compared with the control and educational-behavioural, the rehabilitation group exhibited significant differences in chest expansion (p = 0.001 and p < 0.001), Bath Ankylosing Spondylitis Disease Activity Index (p = 0.012 and p = 0.050), and in some goniometric measurements as cervical rotation (p = 0.007 and p = 0.014), toraco-lumbar rotation (p = 0.009 and p = 0.050), and total cervical movements (p = 0.009 and p = 0.001).

CONCLUSION

In comparison with the educational-behavioural programme or no intervention, supervised training and home exercises improved long-term outcome in patients with ankylosing spondylitis.

The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures

Meniscal injuries represent one of the most frequent lesions in sport practicing and in particular in soccer players and skiers. Pain, functional limitation and swelling are typical symptoms associated with meniscal tears. Epidemiological studies showed that all meniscal lesions, in different sports athletes, involves 24% of medial meniscus, while 8% of lateral meniscus and about 20-30% of meniscal lesions are associated with other ligament injuries. Meniscal tears can be treated conservatively or surgically. Surgery leads in many cases to complete resolution of symptoms and allows the return to sport activity. However many studies show that this treatment can induce more frequently the development of degenerative conditions if not correctly associated to a specific rehabilitation protocol. The aim of this article is to compare different timing in specific rehabilitation programs related to the most actual surgical options.

Minimally invasive surgical approach in a large mandibular solitary cyst: case report and review of the literature

Solitary bone cyst (SBC) is an intraosseus radiolucent lesions that defers from real cysts for the fact that peripheral epithelial lining is totally absent. It could be classified as a psudocyst and occurs most frequently in young patients. In most cases SBC doesn't cause symptoms and it is often diagnosed accidentally during routine radiographic examination. A right diagnosis of this disease is also complicated because there are no pathognomonic radiographic signs and symptoms: so this form of pseudocyst is often misdiagnosed as a common odontogenic cyst. Despite numerous studies, the pathogenesis of the SBC is not yet established: the most widely accepted theory is that it could be the result of an intramedullary necrosis determined by a trauma. In this article we report a case of SBC in child treated with a minimal surgical approach. This new kind of treatment is much more conservative than the traditional one, it can be performed as outpatients, under local anesthesia and with few postoperative discomfort: For these reasons this minimal invasive technique appears to be particulary suitable for pediatric patients.

When pain is not fully explained by organic lesion: a psychiatric perspective on chronic pain patients

Recent literature demonstrates the relationship between psychopathology and medically unexplained pain, even if the results of several studies show a high degree of variability. The present study was planned with the aim of analysing both the possible relationship between the level (low/high) of organicity and the presence of psychopathology, and the degree to which these differences are related to methodological problems. Between 1998 and 2000, four hundred and thirty six consecutive patients seen at the Pisa Pain Therapy and Palliative Care Unit were requested to fill in a questionnaire, the GHQ-12, to screen the subjects probably with (GHQ-12>3) or without (GHQ-12</=3) psychopathology. All the patients scoring above the GHQ-12 threshold (score of 3), and a randomised sample of those scoring below the GHQ-12 threshold, were included in the study. These patients were then interviewed using three different instruments: the Mini International Neuropsychiatric Interview (MINI) for a standardised psychiatric diagnosis, the Semistructured Interview for Depression (SID) for the characterisation of temperament, and the Italian Pain Questionnaire (IPQ) for the evaluation of pain. Our results suggest that Somatisation Disorders are more frequent in the medically unexplained pain group than in the medically explained pain group, whereas the other psychiatric disorders have a similar prevalence in the two pain groups. Mood and anxiety disorders are correlated with high scores on GHQ-12 and medically explained pain has a higher prevalence of GHQ-12>3 than the medically unexplained pain group. These results confirm that methodology is an important factor that could modify results in psychiatric research. Both medically unexplained pain and the presence of psychopathology are significantly correlated with sex, and age: females and young patients have a higher prevalence of psychopathology and of medically unexplained pain. Our results suggest that in the correlation between the low organicity of pain and psychopathology, the age and sex play a relevant role.

Drinking water quality: an in vitro approach for the assessment of cytotoxic and genotoxic load in water sampled along distribution system

An in vitro approach was performed to assess the quality of drinking water collected at two treatment/distribution networks located near the source (Plant #1) and the mouth of River Po (Plant #2). The water was sampled at different points of each distribution network, before (raw water) and after the chlorine dioxide disinfection, and in two points of the pipeline system to evaluate the influence of the distribution system on the amount and quality of the disinfection by-product. Cytotoxicity and genotoxicity of water extracts were evaluated in human peripheral lymphocytes and Hep-G2 cells by the use of the micronucleus (MN) test and Comet assay. Raw water samples of both plants induced cytotoxic effects, but not the increases of MN frequency in Hep-G2 cells and in human lymphocytes. Increases of DNA damage in human leukocytes was detected by Comet assay for raw water of Plant #2 at concentration > or = 0.25 Leq/mL. The disinfection process generally has reduced the toxicity of water samples, even if potential direct DNA-damaging compounds have been detectable in drinking water samples. The proposal approach, if currently used together with chemical analysis, can contribute to improve the monitoring drinking water.

Association of ABCB1/MDR1 and OPRM1 Gene Polymorphisms With Morphine Pain Relief

The pharmacokinetics and pharmacodynamics of morphine are under the control of several polymorphic genes, which can account for part of the observed interindividual variation in pain relief. We focused on two such genes: ABCB1/MDR1, a major determinant of morphine bioavailability, and OPRM1, which encodes for the mu-opioid receptor, the primary site of action for morphine. One hundred and forty-five patients of Italian origin undergoing morphine therapy were genotyped for the single-nucleotide polymorphism (SNP) C3435T of ABCB1/MDR1 and for the A80G SNP of OPRM1. Pain relief variability was significantly (P<0.0001) associated with both polymorphisms. Combining the extreme genotypes of both genes, the association between patient polymorphism and pain relief improved (P<0.00001), allowing the detection of three groups: strong responders, responders, and non-responders, with sensitivity close to 100% and specificity more than 70%. This study provides a good example of the possible clinical use of pharmacogenetics.

Long-surviving case of adenosquamous carcinoma of the larynx: case report and review of literature

A singularly long-surviving (15 years) disease-free case of a stage II adenosquamous carcinoma of the larynx is described. A review of the literature reveals that prognosis of this aggressive malignant neoplasm is poor (mean 2-3 years free of disease) on account of local recurrences, early cervical lymph node metastasis and distant dissemination. This long survival rate emphasises the importance of early radical surgical treatment and the choice of total laryngectomy with neck dissection in stage II laryngeal neoplasm.

Rehabilitation after primary total hip replacement. Comparison between Italian and international protocols

AIM

In intensive rehabilitation departments (Code 56) there is a high case-load of patients with recent total hip replacement (THR). Whereas there has been a progressive standardisation and perfecting of prosthetic materials and surgical techniques, time-frames and modalities of rehabilitation programmes are still very variable. Following the Ministerial Guidelines, issued in 1998 by the Italian National Health System, and the introduction of Accreditation Requirements, methods must become more uniform and there must be increased scientific rigour in treatment so as to reduce variability and the subjective nature of the service provided. Ana-lysis of the working methods of large Rehabilitation Centres may help to focus on the problems more clearly and stimulate any improvements that may be required. The study analyses and compares rehabilitation protocols for hip replacement patients adopted in Italian and international rehabilitation centres.

METHODS

Thirty-four post-THR rehabilitation protocols were analysed; 14 Italian plus 20 international.

RESULTS

The analysis revealed that some factors are unanimously considered important and are therefore codified: 1) posture and positioning; 2) prevention of deep vein thrombosis; 3) rapid return to mobility; 4) education of patients to joint care.

CONCLUSIONS

Weight-bearing on the operated limb is not yet a standardised aspect and thus the physiatrist's attention should be focused on this for a return to walking that is safe (for patients and for implanted prosthesis) correct (from the biomechanical and kinematic standpoints) and that plays a normal role in performing activities of daily living.

Comet assay and micronucleus test in circulating erythrocytes of Cyprinus carpio specimens exposed in situ to lake waters treated with disinfectants for potabilization

The detection of a possible genotoxic effect of surface water treated with disinfectants for potabilization is the aim of the present work. The Comet assay and the micronucleus test were applied in circulating erythrocytes of Cyprinus carpio. Young specimens (20-30 g) were exposed in experimental basins, built within the potabilization plant of Castiglione del Lago (Perugia, Italy). In this plant the water of the Trasimeno Lake is treated and disinfected for potabilization before it is distributed to the people in the net of drinkable water. A continuous flow of water at a constant rate was supplied to basins; the water was continuously treated at a constant concentration with one of the three tested disinfectants (sodium hypochlorite, peracetic acid and chloride dioxide), one control basin being supplied with untreated water. Three sampling campaigns were performed: October 2000, February 2001 and June 2001. Repeated blood samplings through intracardiac punctures allowed to follow the same fish populations after different exposure times: before introduction of the disinfectant, and 10 or 20 days afterwards. An additional blood sampling was performed 3 h after addition of the disinfectant in other, simultaneously exposed, fish populations. Genotoxic damage was shown in fish exposed to water disinfected with sodium hypochlorite and chloride dioxide. The Comet assay showed an immediate response, i.e. DNA damage that was induced directly in circulating erythrocytes, whereas micronuclei reached their highest frequencies at later sampling times, when a genotoxic damage in stem cells of the cephalic kidney is expressed in circulating erythrocytes. The quality of the untreated surface water seems to be the most important parameter for the long-term DNA damage in circulating erythrocytes.

Evaluation of the genotoxicity induced by the fungicide fenarimol in mammalian and plant cells by use of the single-cell gel electrophoresis assay

Fenarimol, a systemic pyrimidine carbinol fungicide, is considered to be not genotoxic or weakly genotoxic, although the available toxicological data are controversial and incomplete. Our results obtained in vitro with leukocytes of two different rodent species (rat and mouse) show that fenarimol affects DNA, as detected by the single-cell gel electrophoresis (SCGE, Comet) assay. This fungicide is able to induce DNA damage in a dose-related manner, with significant effectiveness at 36 nM, but without significant interspecies differences. Simultaneous exposure of rat leukocytes to fenarimol (36-290 nM) and a model genotoxic compound (50 microg/ml bleomycin) produced a supra-additive cytotoxic and genotoxic effect. This supports previous findings suggesting possible co-toxic, co-mutagenic, cancer-promoting and co-carcinogenic potential of fenarimol, and modification of the effects of other xenobiotics found to be influenced by this agrotoxic chemical, with consequent different toxicological events. The potential for DNA strand breaks to act as a biomarker of genetic toxicity in plants in vivo was also considered, in view of the fact that higher plants represent reliable sensors in an ecosystem. Significant DNA breakage was observed in the nuclei of Impatiens balsamina leaves after in vivo treatment with fenarimol (145 nM, 1h). More than 50% of the cells showed such DNA damage.

Evaluation of the migration of mutagens/carcinogens from PET bottles into mineral water by Tradescantia/micronuclei test, Comet assay on leukocytes and GC/MS

This study monitored the release of mutagenic/carcinogenic compounds into mineral water (natural and carbonated) from polyethylene terephthalate (PET) bottles, using a plant mutagenicity test which reveals micronuclei formation in Tradescantia pollen cells (Trad/MCN test), a DNA damage assay (Comet assay) on human leukocytes and gas chromatography/mass spectrometry (GC/MS) for the characterisation of migrants. The water samples were collected at a bottling plant and stored in PET bottles for a period ranging from 1 to 12 months. Every month some samples were randomly collected and lyophilised, the residual powders were extracted with organic solvents and then analysed by GC/MS and tested for DNA damage in human leukocytes, or reconstituted with distilled water to obtain concentrates for the exposure of Tradescantia inflorescences. Micronuclei increase in pollen was found only in natural mineral water stored for 2 months. DNA-damaging activity was found in many of the natural and carbonated water samples. Spring water was negative in the plant micronuclei test and the Comet assay, whereas distributed spring water showed DNA-damaging effects, suggesting a possible introduction of genotoxins through the distribution pipelines. GC/MS analysis showed the presence in mineral water of di(2-ethylhexyl)phthalate, a nongenotoxic hepatocarcinogenic plasticizer, after 9 months of storage in PET bottles.

Urban airborne particulate: genotoxicity evaluation of different size fractions by mutagenesis tests on microorganisms and comet assay

The genotoxic effects of different size fractions of airborne particulate (Total, PM10 and PM25), extracted with acetone or toluene, were evaluated by: the Ames plate test (TA98 and TA100 strains, w/o S9), gene conversion and reversion (w/o endogenous metabolic activation) in the Saccharomyces cerevisiae D7 strain, and the comet assay on human leukocytes. The data on human leukocytes confirm the sensitivity of the comet assay and its applicability to assess genotoxicity in environmental samples. The PM2.5 fraction of airborne particulate generally shows the highest concentration of DNA-damaging compounds. Genotoxic response, in all the test systems applied, is highly dependent on extraction solvent used. Acetone seems to extract compounds with more similar genotoxic responses in the three test systems used than toluene extracts. Toluene appears to extract air pollutants genotoxic on yeast and leukocytes but is mainly cytotoxic on Salmonella.

Depressive symptoms and academic self-image in adolescence

The aim of this paper was to specifically analyse the relationship between the different components of academic self-image, defined as the way adolescents represent themselves as students, and self-reported depressive symptoms, assessed with the Children's Depression Inventory (CDI), in a non-clinical sample of 298 adolescents. We considered both adolescents' beliefs about their own cognitive functioning in academic performance and beliefs about their emotional attitude in achievement situations. Our data indicate that the pattern of correlation between emotional beliefs about schooling and learning are significantly related to CDI scores, but this correlation is not evident for the cognitive beliefs. This pattern of correlation is affected by actual school functioning, because correlation between CDI and beliefs is much more significant in subjects without school failure. Differences between gender in CDI scores, beliefs about schooling and learning, and pattern of correlation are considered. These results can enable to focus supporting psychological interventions on more specific targets.

Assessment of depression among cancer patients: the role of pain, cancer type and treatment

One hundred consecutive cancer patients were assessed using two structured methods for assessing major depressive disorder-Structured Clinical Interview for DSM III-R (SCID) and Endicott criteria-and using a depression rating scale-Hamilton Depression Rating Scale (HAMD). Forty-nine percent of patients were depressed using SCID (DSM III-R criteria), whereas 29% of patients were depressed using Endicott criteria. Twenty-eight percent of patients were depressed using both criteria. Age and sex did not have any influence on the assessment of major depression. Both the structured interview and the rating scale were able to identify suicide ideation. Depressed patients were not shown to have more lifetime depression than non-depressed patients using both structured methods. Patients who were depressed using both assessments of depression had more metastasis and pain than non-depressed patients.

Depressive symptoms in children and adolescents with dysthymic disorder

This report examines clinical features of 'pure' dysthymic disorder (DD, without superimposed major depressive disorder, MDD) in a sample of children and adolescents. Profiles of symptomatology and comorbidity as a function of age and gender are described. The sample consisted of 48 subjects (22 males, 26 females, age range 7-18 years, mean age 12.1 years) screened from consecutively referred children and adolescents. All subjects were comprehensively diagnosed with structured diagnostic interviews (Schedule for Affective Disorders and Schizophrenia for School Age, Diagnostic Interview for Children and Adolescents-Revised), according to DSM-IV criteria. Depressed mood, irritability, loss of energy and fatigue, guilt and low self-esteem were present in more than 70% of the subjects. Differences in symptomatic profile between males and females were not significant. Children showed less symptoms than adolescents, but the symptomatic profile was comparable (only anhedonia was significantly more frequent in adolescents). Anxiety disorders were more commonly comorbid with DD, especially separation anxiety disorder in children (33%) and generalised anxiety disorder in adolescents (67%). Externalising disorders were less frequently represented in our sample (14%). An early diagnosis of 'pure' DD before the first episode of MDD is crucial for a timely intervention.

Amifostine (WR-2721) selective protection against melphalan genotoxicity

Amifostine (WR-2721) is an aminothiol compound dephosphorylated at the tissue site by alkaline phosphatase to the active metabolite, which is able to inactivate electrophilic substances and scavenge free radicals. Amifostine effects against melphalan-induced DNA strand breaks were studied in normal human white blood cells (WBC) and K562 leukemic cells using the single cell gel electrophoresis (SCGE) or Comet assay, a reported method for measuring DNA damage in individual cells. Prior to treatment (1 h, 37 degrees C) with increasing doses of melphalan, with or without S9, the cells were treated (15 min, 37 degrees C) with a control medium or amifostine (3 mg/ml). Treatment of normal and leukemic cells with melphalan induced a dose-dependent 'comet formation'. Melphalan-induced DNA damage follows a normal distribution in WBC. On the other hand, in K562, a significant proportion of undamaged cells remains even with doses at which mean DNA damage is serious. Pretreatment with WR-2721 protects WBC, but not K562, against the genotoxic effect of melphalan. Amifostine might even strengthen the action of the antiblastic drug against K562 cells. S9 addition appears to enhance melphalan effectiveness. SCGE appears as a suitable primary screening method for in vitro and in vivo studies on drug-DNA interactions and their modulations by endogenous/exogenous factors.

Depression and school functioning in non-referred adolescents: a pilot study

Self-image and self-perceived competencies have been considered to be related to depression in childhood and adolescence. Data from literature points to school functioning as one of the most important factors in self-esteem and self-worth during adolescence. Academic self image, defined as the way adolescents represent themselves as students, directly affects the global self-image; for this reason it has important psychopathological implications. The major aim of this preliminary report is to specifically analyze the relationship between academic self-image (assessed with a specific questionnaire), and self-reported depressive symptoms (assessed with the Children's Depression Inventory) in a school sample 150 adolescents. Our data indicate that the emotional beliefs about schooling and learning were significantly related to depressive symptomatology. Females scored higher in CDI and school anxiety. A real school failure did not affect the academic self image. These data seem to suggest that different components of the academic self-image can be differently associated with depressive feelings.

[Fluoxetine versus fluvoxamine for treatment of chronic pain]

AIM

This study aimed: 1) to compare the analgesic efficacy and profile of two antidepressants with the same mechanism of action (SSRI: selective serotonine reuptake inhibitors): fluoxetine vs fluvoxamine; 2) to investigate the relationship between analgesic efficacy and antidepressant effects in both drugs; 3) to evaluate the relationship between the analgesic profile and the quality (global or neuropathic) of pain.

METHODS

Fifty-three depressed patients were randomly treated with 20 mg/die of fluoxetine and 100 mg/die of fluvoxamine for chronic pain. Forty subjects (20 with fluoxetine and 20 with fluvoxamine) completed the 2-month study and were followed up on day 14, 28 and 56 of treatment. The intensity and quality of pain was assessed using Quid and depression-anxiety symptoms with the Hamilton Rating Scale (HAMD).

RESULTS

The intensity and overall quality of pain deteriorated at day 14 in the fluvoxamine group and improved in those treated with fluoxetine. However, a comparable level of analgesia was achieved with both drugs at 2 months. After 2 weeks the neuropathic component of pain improved in patients treated with fluvoxamine. The improvement in pain observed in patients treated with fluoxetine depended on an improvement in depressive symptoms, whereas this relationship was not observed in the fluvoxamine group.

CONCLUSIONS

Although a comparable level of analgesia was observed after two months of treatment, the two drugs show different analgesic profiles. Their analgesic action appears to depend on different mechanisms.

Comet assay application in environmental monitoring: DNA damage in human leukocytes and plant cells in comparison with bacterial and yeast tests

Urban airborne particulate is a complex mixture of air pollutants, many of which have not been identified. However, short-term mutagenesis tests together with chemicophysical parameter analysis are able to better assess air quality and genotoxic load. The findings of continuous monitoring (January 1991-August 1998) of urban air genotoxicity of a Po Valley town (Italy) on Salmonella typhimurium and Saccharomyces cerevisiae are reported. During this period, various measures (catalytic devices, unleaded fuels, annual vehicle overhaul, etc.) to improve air-dispersed pollutant control were enforced. However, a continuous presence of genotoxic compounds is shown and more qualitative than quantitative changes are evident. We also demonstrate the ability of the Comet assay to detect DNA-damaging agents in airborne particulate samples. We applied the test to human leukocytes and, with major improvements, to plant cells (Allium cepa roots and epigean tissues of Impatiens balsamina). The first findings on human leukocytes confirm the sensitivity of this assay, its peculiarity and its applicability in assessing genotoxicity in environmental samples. The capability of plants to show the response of multicellular organisms to environmental pollutants largely counterbalances a probable lowering in sensitivity. Moreover, application of the Comet test to epigean tissues could be useful in estimating the bioavailability of and genotoxic damage by air pollutants, including volatile compounds (ozone, benzene, nitrogen oxides, etc.) to higher plants.

DNA damage by tobacco smoke and some antiblastic drugs evaluated using the Comet assay

The Comet assay was used in human leukocytes to detect, in vivo, DNA strand-breaks induced by smoking habit to evaluate the test sensitivity to an environmental factor, and by several antiblastic drugs to note their effectiveness at single cell level. Differences related to smoking habit, gender and age are evident. Melphalan shows the widest DNA damage. The damage induced by etoposide can be ascribed to the balancing between the production of strand-breaks and cross-links which limit the migration of DNA fragments. Interferon, fludarabine, prednisone, and oncocarbide appear to induce unexpected strand-breaks. Single cell gel electrophoresis (SCGE) is highly effective in revealing the association between DNA damage and environmental, genetic, and acquired factors, providing further data on the possible applicability of this assay in genotoxic human surveillance in addition to established tests. Moreover, the ability to point out cell subpopulations varying in mean damage levels could allow detection of potentially emerging drug-resistant populations.

Symptomatology and comorbidity of generalized anxiety disorder in children and adolescents

This study investigated the symptomatology and comorbidity of generalized anxiety disorder (GAD) in a clinically referred sample of Italian children and adolescents as a function of age and gender. The sample consisted of 58 subjects (19 children and 39 adolescents), 23 males and 35 females screened from consecutively referred children and adolescents. This sample was divided into two groups of younger children (19 subjects, eight males and 11 females aged 7 to 12 years; mean age, 9.6) and adolescents (39 subjects, 15 males and 24 females aged 12 to 18 years; mean age, 14.9). Feelings of tension, apprehension, the need for reassurance, irritability, negative self-image, and physical complaints were reported in more than 70% of the subjects. Differences in the symptomatic profile between males and females were not significant. Children and adolescents did not show significant differences in the number of symptoms. The need for reassurance was significantly more frequent in children, and brooding was more frequent in adolescents. Other anxiety disorders were commonly comorbid with GAD. More than half of the patients with GAD showed a concurrent depressive disorder; no differences were found for comorbidity between children and adolescents, except for higher rates of separation anxiety disorder in children.

Dysthymic disorder in adolescents with intellectual disability

The present report examines the clinical features of dysthymic disorder in a sample of adolescents with mild intellectual disability (ID). Frequency of symptoms, comorbidity, agreement between reports of subjects and parents, comparison between the frequency of depressive symptoms in subjects with ID and in two different groups of normal IQ dysthymic subjects (aged 7-11, 11 and 12-18 years) are described. The sample consisted of 12 subjects (age range = 12-25.6 years; mean age = 16.3 years) screened from unselected consecutively referred patients with mild ID. All the subjects were comprehensively diagnosed with a structured diagnostic interview, the Kiddie-Schedule for Affective Disorder and Schizophrenia (K-SADS), according to DSM-IV criteria. A symptomatic profile in the group with ID showed that intrapsychic and cognitive symptoms, such as depressed mood, irritability, pathological guilt and low self-image, were frequently reported in people with ID. Parents were less aware of depressed mood, but they reported high rates of low self-esteem; the agreement between the depressive reports of ID subjects and their parents was higher than in previous findings in normal IQ children. The symptomatic profile of subjects with ID was more comparable to that of prepubertal dysthymic children than that of dysthymic adolescents, but more significant are the analogies between dysthymic disorder in ID and normal IQ subjects. High rates of comorbidity with generalized anxiety disorder were evident in the group with ID. According to the present data, dysthymic disorder can be diagnosed in adolescents with mild ID. The K-SADS clinical interview seems to be a reliable instrument for the diagnosis and clinical definition of depressive symptomatology in this special population.

Emotional and cognitive aspects in adolescence-onset school difficulties

Learning disorders in adolescence can become a significant risk factor for psychopathology. The paper investigates emotional and cognitive patterns in adolescents with learning disorders. The first part of the study describes the impact of child-onset learning disorders on adolescence passage. In the second part four clinical conditions that can determine adolescence-onset learning disorders are outlined. These are adolescent turmoil, intellectual inhibition, delay in reasoning development and metacognitive dysfunctioning. Cognitive, emotional and behavioral features of these conditions are discussed, in terms of diagnostic and therapeutic implications.

Bleomycin genotoxicity alteration by glutathione and cytochrome P-450 cellular content in respiratory proficient and deficient strains of Saccharomyces cerevisiae

The genotoxic effects of the antiblastic drug bleomycin were studied in the D7 strain of Saccharomyces cerevisiae and on its derivative mitochondrial mutant rho degree at different cellular concentrations of two drug metabolizing systems, glutathione (GSH) and cytochrome P-450. Bleomycin mutagenic activity was evaluated as frequencies of mitotic gene conversion, reversion and total aberrations under different physiological conditions. In the D7 strain, petite mutant induction was also detected. This is important due to the role of the mitochondrial genome in cancer induction, ageing and degenerative diseases. Both strains showed higher convertant than revertant induction. At high cytochrome P-450 levels, bleomycin-induced gene conversion was enhanced in both strains although mitochondrial functionality showed a detoxicant role while cellular GSH content decreased the induction of convertants only in the respiratory proficient strain. Cell metabolic conditions, such as cell cycle, aerobic/hypoxic conditions of the cell and content of drug metabolizing enzymes, appeared to interact with the genotoxic effectiveness of bleomycin. Moreover, the usefulness of S.cerevisiae as a model organism for drug assessment for mutagenicity was emphasized.