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Objectives: The main objective is to propose an MRI-based screening protocol, investigating the role of MRI without the injection of contrast media (bi-parametric MRI, bpMRI) as a secondary prevention test for prostate cancer (PCa) early diagnosis, comparing MRI with the prostate specific antigen (PSA) test. For this reason, preliminary results of Prostate Cancer Secondary Screening in Sapienza (PROSA) are presented, to investigate the efficiency of an MRI-based screening protocol. PROSA is a prospective, randomized, single-center study. To date, 351 men have been enrolled and blindly randomized into two different arms: Men underwent a bpMRI regardless of their PSA values (175); Men followed as per clinical practice: those with increased PSA (61) were referred to bpMRI, while those with normal PSA (112) were not. Men who screened positive on MRI were directed to MR-directed targeted biopsy. On arm A, 4 clinically significant PCa have been detected, while none was found on arm B (p = 0.046). To evaluate the efficiency of the screening protocol, we calculated the experimental event rate (EER, 3.6%), control event rate (CER, 1.2%.), absolute risk reduction (ARR, 2.5%), and number needed to treat (NNT, 40.3). PROSA represents an interesting experience in the field of imaging-based PCa screening. The preliminary data from this trial highlight the promising role of non-contrast MRI as a screening tool for early detection of PCa. Further data will finally validate the most appropriate screening program. Clinical relevance statement: PROSA depicts an interesting experience in the field of research focused on imaging-based prostate cancer screening. Its preliminary data highlight the promising role of non-contrast MRI as a screening tool for early detection of PCa. Key Points: • Promotion of an MRI-based screening protocol, investigating the role of non-contrast MRI as a secondary prevention test for prostate cancer early diagnosis, comparing MRI with PSA test. • Prostate Cancer Secondary Screening in Sapienza (PROSA) represents an interesting experience in the field of research focused on imaging-based prostate cancer screening; its preliminary results indicate that it is possible to use non-contrast MRI as a screening tool for early detection of PCa. • This new approach to PCa screening could facilitate the early diagnosis of clinically significant prostate cancer while reducing the number of unnecessary prostate biopsies and the detection of clinically insignificant prostate cancer. [ABSTRACT FROM AUTHOR]

The new role of occupational medicine was experimented during the COVID-19 pandemic. Sanchez et al. [[5]] focused their attention on the mediation of work engagement in the relationship between emotional intelligence (EI) and work performance in front-line HCWs throughout the COVID-19 pandemic. Occupational medicine is a clinical discipline that draws attention to the health of workers and their ability to work. In modern and global occupational medicine, it is crucial to promote measures to improve the work environment that can combine adherence to legislations related to worker health and safety protection with health promotion programmes [[11]]. [Extracted from the article]

Objective: The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who have never been positive and those who have had only one positivity. Methods: A case-control study was carried out at the Teaching Hospital Policlinico Umberto I in Rome, Sapienza University of Rome, in the period between 6 March 2020 and 3 June 2022. Cases are healthcare workers who have developed a reinfection with the SARS-CoV-2 virus, while controls were either healthcare workers who tested positive once or those who have never tested positive for SARS-CoV-2. Results: 134 cases and 267 controls were recruited. Female gender is associated with a higher odds of developing reinfection (OR: 2.42; 95% CI: 1.38–4.25). Moreover, moderate or high alcohol consumption is associated with higher odds of reinfection (OR: 1.49; 95% CI: 1.19–1.87). Diabetes is also associated with higher odds of reinfection (OR: 3.45; 95% CI: 1.41–8.46). Finally, subjects with increased red blood cell counts have higher odds of reinfection (OR: 1.69; 95% CI: 1.21–2.25). Conclusion: From the prevention point of view, these findings indicate that particular attention should be paid to subjects with diabetes mellitus, women and alcoholic drinkers. These results could also suggest that contact tracing represents a fundamental approach model against the SARS-CoV-2 pandemic, together with the health information of participants. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, compared to non-COVID patients, there was a higher hospitalization rate and a longer average hospital stay in COVID-19 patients; together with the extensive use of cortisone and antibiotics for COVID treatment, this represents a risk factor for nosocomial infections, including Clostridium difficile infections (HO-CDI). Post-COVID symptoms are present in hospitalized COVID-19 survivors months after infection. The I Journal of Clinical Medicine i has published many papers on coronavirus disease 2019 (COVID-19), and it is now clear that this is not simply a respiratory disease. Despite this, the HO-CDI rate among COVID-19 patients was within the range of incidence observed in reports performed before the COVID-19 pandemic. [Extracted from the article]

This study aims to investigate whether HCWs infected with COVID-19 may experience potential psychological consequences and a higher incidence of depression, anxiety, work-related stress, and burnout compared to non-infected HCWs. A case–control study with 774 participants was conducted comparing COVID-19-infected HCWs (cases) and non-infected HCWs (controls) from the Occupational Medicine Unit at the Teaching Hospital Policlinico Umberto I, who were administered the same questionnaire including Hospital Anxiety and Depression Scale, Copenhagen Burnout Inventory and Karasek's Job Content Questionnaire. No differences in the levels of burnout and decision latitude were found between the two groups. Cases showed higher level of anxiety and job demand compared to controls. In contrast, levels of depression in the case group were significantly lower compared to the control group. The results are indicating the need for workplace health promotion activities based on stress and burnout management and prevention. Multiple organizational and work-related interventions can lower the impact of mental health-related issues in the COVID-19 pandemics, including the improvement of workplace infrastructures, as well as the adoption of correct and shared anti-contagion measures, which must include regular personal protective equipment supply, and the adoption of training programs that deal with mental health-related issues. [ABSTRACT FROM AUTHOR]

Preoperative brain shift after severe brain injury is a prognostic factor for survival. The aim of this study was to determine whether preoperative brain shift in conditions other than severe head injury has significant prognostic value. We analyzed a radiological database of 800 consecutive patients, who underwent neurosurgical treatment. Brain shift was measured at two anatomical landmarks: Monro's foramina (MF) and the corpus callosum (CC). Four hundred seventy-three patients were included. The disease exerting the highest mean brain shift was acute subdural hematoma (MF 11.6 mm, CC 12.4 mm), followed by intraparenchymal hematoma (MF 10.2 mm, CC 10.3 mm) and malignant ischemia (MF 10.4 mm, CC 10.5 mm). On univariate analysis, brain shift was a significant negative factor for survival in all diseases (p < 0.001). Analyzed individually by group, brain shift at both anatomical landmarks had a statistically significant effect on survival in malignant ischemia and at one anatomical landmark in chronic subdural and intraparenchymal hematomas. Multivariate analysis demonstrated that the only independent factor negatively impacting survival was brain shift at MF (OR = 0.89; 95% CI: 0.84–0.95) and CC (OR = 0.90; 95% CI: 0.85–0.96). Brain shift is a prognostic factor for survival in patients with expansive intracranial lesions in certain neurosurgical diseases. MF and CC are reliable anatomical landmarks and should be quoted routinely in radiological reports as well as in neurosurgical practice. [ABSTRACT FROM AUTHOR]

COVID-19 was declared a pandemic on March 12, 2020. Italy has been the most affected country in the world, right after China. Healthcare workers (HCWs) were among the hardest hit by this event from both a working and psychological point of view. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian Occupational Physicians' well-being and psychological distress, in relation to demographic and occupational characteristic, lifestyle and habits during the lockdown period. We conducted a web-based cross-sectional survey questionnaire from April 1 to April 21st, 2020. To evaluate the level of psychological distress and the level of well-being, the general Health Questionnaire-12 (GHQ-12) and the WHO-5 Wellbeing Index were utilized. Since the statistical assumptions were respected, we proceeded with an analysis of variance (ANOVA) to ascertain the differences between the averages of the scores of the GHQ-12. Doctors who live in the most affected regions have a prevalence of psychological distress higher than their colleagues from the rest of Italy. ANOVA shows significant differences relating to the female gender, and to the life changes provoked by the lockdown for example not feeling sheltered at home or suffering from loneliness. This study showed a high prevalence of psychological distress in occupational physicians. To prevent the occurrence of mental disorders among Occupational Physicians, it is urgent to put in place policies of psychological support and well-being preservation. [ABSTRACT FROM AUTHOR]

Technostress is an emergent phenomenon related to the pervasive use of technology and is associated with the increased computerisation and digitalisation seen over recent decades. This cross-sectional observational study aims to investigate the impact that stress from the use of technologies (i.e. technostress) has on the productivity and life of an individual. Cross-sectional study. Data were collected using a previously proposed and validated questionnaire. The questionnaire was translated into Italian and transformed into an online format with a Google Docs form. The questionnaire was then associated with a link and QR code (also available in paper format) and disseminated manually and through the use of e-mail and social networks, such as Facebook and Twitter. The study sample included 313 individuals, 54.6% of whom were women. The mean age of the sample participants was 34.7 years. The dependent variables were technstressors (i.e. techno-overload, techno-invasion, techno-complexity, techno-insecurity and techno-uncertainty), role stressors (i.e. role overload and role conflict) and productivity. In the multivariate analysis, techno-overload was significantly associated with female gender (β = 0.128; P = 0.018) and unemployment (β = −0.303; P < 0.001); techno-invasion was significantly associated with female gender (β = 0.098; P = 0.081) and degree-level education (β = 0.149; P = 0.008); techno-complexity was significantly associated with female gender (β = 0.107; P = 0.057) and being married (β = 0.113; P = 0.046); techno-uncertainty was significantly associated with unemployment (β = 0.337; P < 0.001); role overload was significantly associated with female gender (β = 0.160; P = 0.014) and productivity was significantly associated with degree-level education (β = 0.125; P = 0.057). This observational study evaluated the phenomenon of both work-related and non–work-related technostress of 313 individuals aged between 16 and 65 years. The present study investigated the impact of five techno-stressors, two role stressors and productivity. The results indicate that different techno-stressors are significantly associated with female gender, degree-level education and unemployment. Further research in this field is required to better understand and clarify the epidemiology, clinical presentation and determinants of technostress. • Technostress is an emergent phenomenon related to the pervasive use of technology in the current digital age. • Different techno-stressors are significantly associated with female gender, degree-level education and unemployment. • Further research is required on the epidemiology, clinical presentation and determinants of technostress. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure the burden of burnout in a sample of healthcare workers (HCWs) consisting of general practitioners, professors from the Faculty of Medicine and Surgery, nurses, medical students and nursing students. Cross-sectional questionnaire survey. A descriptive analysis was carried out, using averages, medians, standard deviations (SD) and ranges for quantitative variables. Univariate, bivariate and multivariate analyses were also performed. In total, 535 HCWs completed the survey. Multivariate analysis shows that increasing age (β = −0.183; P = 0.047), being a university professor (β = −0.118; P = 0.001), having a high physical score (β = −0.370; P < 0.001) and a high mental score (β = −0.574; P < 0.001) resulted in less personal burnout. Low work burnout was associated with being a student (β = −0.144; P < 0.001), a university professor (β = −0.146; P < 0.001), having a high physical score (β = −0.366; P < 0.001) and having a high mental score (β = −0.648; P < 0.001). Being female (β = −0.122; P < 0.001), a university professor (β = −0.333; P = 0.001), a student (β = −0.433; P < 0.001), having a high physical score (β = −0.26; P < 0.01) and having a high mental score (β = −0.460; P < 0.001) were predictors for reduced client burnout. However, high client burnout was seen in individuals who had a commuting time >30 min (β = 0.084; P = 0.012) predicts. This study shows that burnout is an important issue among HCWs and that prevention strategies must be considered, with a particular focus on physical and mental health. [ABSTRACT FROM AUTHOR]

Purpose: Techno-stress (TS) is an emergent phenomenon closely related to the pervasive use of information and communication technologies in modern society. Despite numerous studies existing in the literature, only few comprehensive reviews have been performed, which has led to fragmented information about TS. This systematic review aimed to clarify the definition, the symptoms, and the risk factors of TS, focusing on the differences between work-related and non-work-related sources of TS.Methods: A comprehensive literature review of three electronic databases was performed according to the PRISMA statement. 'Technostress' was used as the only keyword.Results: In the qualitative synthesis, 105 studies were included: 84 cross-sectional studies, 8 experimental studies and 13 reviews (11 narrative and 2 systematic reviews). 70 studies (67%) addressed work-related TS, 26 (25%) addressed non-work-related TS, while 8 (8%) did not differentiate between work and non-work fields. The presence and level of TS among individuals was described in 38 studies (29%), whilst the techno-stressors, and the consequences of TS, were described in 53 studies (51%). The antecedents of TS were reported in 47 studies (45%), its moderators in 40 studies (38%), whilst its symptoms in only 11 studies (10%).Conclusions: TS affects both professional and private life. It can determine a reduction in job and life satisfaction and in productivity, and is often associated to the occurrence of psychological and behavioral disorders. Efforts should be made to recognize situations with a high risk of causing TS, to prevent its progressive development in a prospective way using mainly cohort studies. [ABSTRACT FROM AUTHOR]

Highlights • Low PFCs concentration in children living in Sicily. • PFSO concentration is higher in girls. • Maternal parity is significantly associated with PFDA and PFHxS. • Months of breastfeeding is significantly correlated with PFUnDA. Abstract Perfluorinated compounds (PFCs) are a large group of man-made chemicals characterized by a completely fluorinated hydrophobic linear carbon chain attached to a hydrophilic head. The presence of PFCs has been related with various adverse effects on several organs and systems. 61 children (6–11 years of age) living in Sicily underwent medical examination and blood and urine routinary tests, as well as the serum concentration of 16 PFCs. These compounds (∑PFCs = 5.888 ng/mL, range 1.035–12.94 ng/mL) were widely detected in the samples of all children, showing that they had been extensively exposed to PFCs, especially perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexanesulfonate (PFHxs) and perfluorodecanoic acid (PFDA). In addition, long-chained PFCs were found in children's blood correlated with short-chained ones. Perfluorodecanoic acid (PFDA) (beta=−0.114) and PFHxS (beta = 0.003) levels were correlated with maternal parity; while the "months of breastfeeding" variable is correlated with perfluoroundecanoic acid (PFUnDA) concentrations (beta = 0.008). Female gender is negatively associated with PFOS (beta = 0.008). The adverse health effects of PFCs on young children should be noted, due to their growing phase. Therefore, further studies are needed to monitor and address adverse health outcomes of PFCs on children, especially those living in industrial regions. [ABSTRACT FROM AUTHOR]

Several studies have documented the existence of a behavioral addiction related to Video Games, which appears to be similar to other forms of addiction (gambling and substance-related) in terms of characteristics and consequences. Literature about this topic has suffered from the lack of a standard definition of this disorder before the publication of DSM-5. Thus, the prevalence of the disorder and its characteristics at the moment are unclear. The present research aimed to investigate the differences between sub-clinical problematic Video Game (VG) use and Internet use and clear Internet gaming disorder (IGD) and Internet addiction in terms of gender, amount of time spent gaming, preferential coping strategies, adjustment problems, interpersonal relations, and to identify risk factors that predict a problematic engagement in video gaming. We administered a survey containing measures about coping strategies, interpersonal relations, internalizing/externalizing problems, and Internet and Video Game addiction to 612 Italian students recruited in the four main regions of the country (age range 9-19; M = 13.94). Results show that 15.2% of participants showed a sub-clinical problematic use of Video Games, while those with a clear IGD were 2.1% (n = 13); 16.3% of them showed a sub-clinical problematic Internet use, while full-criteria Internet addiction was found in 5.9% of the sample. IGD appears to be linked to various dysfunctional outcomes including a wide range of psychological symptoms and behavioral and social problems. Also, problematic video gamers tend to preferentially adopt dysfunctional coping strategies as distraction and avoidance, so VGs seem to represent a mean to cope with problems and difficulties. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are the leading causes of mortality and morbidity in Western countries. The possible synergistic effect of poor adherence to a Mediterranean diet (MD) and other risk factors for acute myocardial infarction (AMI) such as hypertension, cholesterol, ever smoker, BMI> 25, diabetes, has not been deeply studied. Design: Case-control study. Methods: Patients with first AMI and controls from four tertiary referral Italian centers were screened for enrolment. Dietary information was collected through a questionnaire and a MD adherence score was calculated. Physical activity and smoking habits were also registered. The Synergy Index was calculated according to Rothman. Results: 127 cases and 173 controls were enrolled. The analysis was conducted using a dichotomous variable for the MD score with values ≥7 representing good adherence. Multivariate analysis showed the following variables associated to AMI: ever smoker (OR = 2.08), diabetes (OR = 1.42), hypertension (OR = 2.08), hypercholesterolemia (OR = 2.47), BMI> 25 (OR = 1.99), while a protective effect emerged both in subjects scoring > 7 on the MD score (OR = 0.55) and in subjects resident of Southern Italy (OR = 0.38). A synergistic effect does exist between poor adherence to the MD and the following risk factors: hypertension, hypercholesterolemia, BMI >25, diabetes and being a resident in central and northern Italy. Conclusion: Synergy between heart disease risk factors and MD underlines the need to enlarge the list of known modifiable cardiovascular risk factors to include and promote adherence to Mediterranean dietary habits. [ABSTRACT FROM AUTHOR]

This study represents the first systematic review and meta-analysis conducted to assess the association between swimming in recreational water and the occurrence of respiratory illness. Most studies focus their attention on gastrointestinal illnesses occurring after exposure to microbial polluted water. Fourteen independent studies that included 50,117 patients with significant heterogeneity (I² = 95.3%) were reviewed. The meta-analysis reports that people exposed to recreational water (swimmers/bathers) present a higher risk of respiratory illness compared to non-swimmers/non-bathers [relative risk (RR) = 1.63 (confidence interval at 95% [95% CI]: 1.34-1.98)]. This percentage increases if adjusted RR by age and gender [RR = 2.24 (95% CI: 1.81-2.78)] are considered. A clear association between swimming in recreational water and the occurrence of respiratory illness was found. The surveillance of water quality monitoring systems is crucial not only for gastrointestinal illness, but also for respiratory ones. [ABSTRACT FROM AUTHOR]

Background: The risk of getting influenza and pneumococcal disease is higher in cancer patients, and serum antibody levels tend to be lower in patients with hematological malignancy. Objective: To assess flu and pneumococcal vaccinations efficacy, effectiveness, and safety in oncohematological patients. Methods: Two systematic reviews and possible meta-analysis were conducted to summarize the results of all primary study in the scientific literature about the flu and pneumococcal vaccine in onco-hematological patients. Literature searches were performed using Pub-Med and Scopus databases. StatsDirect 2.8.0 was used for the analysis. Results: 22 and 26 studies were collected respectively for flu and pneumococcal vaccinations. Protection rate of booster dose was 30% (95% CI=6-62%) for H1N1. Pooled prevalence protection rate of H3N2 and B was available for meta-analysis only for first dose, 42.6% (95% CI=23.2 - 63.3 %) and 39.6 % (95% CI=26%- 54.1%) for H3N2 and B, respectively. Response rate of booster dose resulted 35% (95% CI=19.7-51.2%) for H1N1, 23% (95% CI=16.6-31.5%) for H3N2, 29% (95% CI=21.3- 37%) for B. Conclusion: Despite the low rate of response, flu, and pneumococcal vaccines are worthwhile for patients with hematological malignancies. Patients undergoing chemotherapy in particular rituximab, splenectomy, transplant recipient had lower and impaired response. No serious adverse events were reported for both vaccines. [ABSTRACT FROM AUTHOR]

Background. Healthcare professionals have an important role to play both as advisers-influencing smoking cessation-and as role models. However, many of them continue to smoke.The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach.Materials and Methods.Amulticentre cross-sectional studywas carried out in 24 Italian schools of public health.The surveywas conducted between January andApril 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors).The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ⩽ 0.05. Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions.The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools. [ABSTRACT FROM AUTHOR]

Background: Acanthamoeba keratitis (AK) is ever more frequently reported in industrialized countries. The loss of the corneal surface integrity consequent to secondary microtrauma produced by the use of contact lens (CL) favors the penetration of the parasite into the corneal tissue. Objectives: A scientific review was performed to investigate the association of CL wear as an Acanthamoeba keratitis (AK) risk factor. Methods: A computerized screening of 7834 Medline articles (4623 from PubMed; 3211 from Scopus) used a strict selection criteria of case-control studies involving CL wear and/or trauma. Results: The search yielded five case-control studies published from 1995 to 2012. All studies included showed a statistically significant positive association between AK and CL use, with a combined odds ratio (OR) of 10.21 (95%, confidence intervals [CI]; 3.57-27.64). Statistical analysis: All studies included showed a statistically significant positive association between AK and CL use, though with differing OR values. Conclusion: Though rare, AK should be held in higher consideration when ophthalmologists are faced with CL users exhibiting simplex-like lesions associated with circular stromal infiltrates and disproportionate ocular pain in respect to the objective clinical picture. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) estimates that about 180 million people, 3% of the world population, are infected with the hepatitis C virus (HCV). In Italy, the prevalence in the general population is reported to be greater than 5% and 9% among households of HCV-positive patients. Objectives: The aim of this study was to estimate the trends of HCV infection in Italy in the period 1996-2006. Materials and Methods: The formula ln (rate) = b x years was applied for logarithmic transformation of the incidence rates to obtain time trends of HCV infection, using the joinpoint regression program software version 3.3.1. Linear graphs representing trends and the annual percentage change (APC) were considered for each joinpoint. Time changes are expressed as expected annual percentage change (EAPC) with the respective 95% confidence intervals (CIs); significance levels of time trends are also reported. The null hypothesis was tested using a maximum of 3 changes in slope with an overall significance level of 0.05 divided by the number of joinpoints in the final model. Results: Considering all age groups, the incidence rate decreased from 2.02 to 0.55 per 100,000. The joinpoint analysis showed a statistically significant decrease in the incidence rates of HCV infection. No joinpoints were found in any age groups. Our data show that the incidence rates of HCV infections have considerably decreased in each age group throughout the studied period (1996-2006). Conclusions: This decreasing trend in HCV infections is, in part, attributable to behavioral and social changes. Improved hygiene, use of precautions in medical settings, blood screening, and sexual educational campaigns seem to have contributed to reduce the transmission of infection during the last 10 years. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context. Methods: Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and women''s knowledge and attitudes towards vaccination were assessed. Results: HPV infections pooled prevalence in Italy was 19% (95%CI: 10–30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in €1745.87 and €2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80–91%) and 78% (95%CI: 62–87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of €22,055. Conclusion: The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making process. [Copyright &y& Elsevier]

Summary: Background: Out-of-hospital cardiac arrest (OHCA) accounts for 250.000–350.000 sudden cardiac deaths per year in the United States. The availability of automated external defibrillators (AEDs) promoted the implementation of public access defibrillation programs based on out-of-hospital early defibrillation by non-healthcare professionals. Aim of the study: To perform a systematic review and a meta-analysis of the pooled effect of studies comparing the outcome of pts receiving cardiopulmonary resuscitation plus AED therapy (CPR+AED) vs. cardiopulmonary resuscitation (CPR) alone, both delivered by non-healthcare professionals, for the treatment of OHCA. Methods: We performed a search of the relevant literature exploring major scientific databases, carrying out a hand search of key journals, analysing conference proceedings and abstracts and discussing the topic with other researchers. Two analyses were planned to assess the outcomes of interest (survival to hospital admission and survival to hospital discharge). Results: Three studies were selected for the meta-analysis. The first meta-analysis evidenced a RR of 1.22 (95% C.I.: 1.04–1.43) of surviving to hospital admission for people treated with CPR+AED as compared to CPR-only. The second meta-analysis showed a RR of 1.39 (95% C.I.: 1.06–1.83) of surviving to hospital discharge for people treated with CPR+AED as compared to CPR-only. Conclusions: The results of our meta-analysis demonstrate that programs based on CPR plus early defibrillation with AEDs by trained non-healthcare professionals offer a survival advantage over CPR-only in OHCA. The conclusions of our meta-analysis add to previous evidence in favour of developing public-health strategies based on AED use by trained layrescuers. [Copyright &y& Elsevier]

Background: Hepatitis B (HBV) infection is an important cause of morbidity and mortality and it is associated to a higher risk of chronic evolution in infected children. In Italy the anti-HBV vaccination was introduced in 1991 for newborn and twelve years old children. Our study aims to evaluate time trends of HBV incidence rates in order to provide an assessment of compulsory vaccination health impact. Method: Data concerning HBV incidence rates coming from Acute Viral Hepatitis Integrated Epidemiological System (SEIEVA) were collected from 1985 to 2006. SEIEVA is the Italian surveillance national system that registers acute hepatitis cases. Time trends were analysed by joinpoint regression using Joinpoint Regression Program 3.3.1 according to Kim's method. A joinpoint represents the time point when a significant trend change is detected. Time changes are expressed in terms of the Expected Annual Percent Change (EAPC) with 95% confidence interval (95% CI). Results: The joinpoint analysis showed statistically significant decreasing trends in all age groups. For the age group 0-14 EAPC was -39.0 (95% CI: -59.3; -8.4), in the period up to 1987, and -12.6 (95% CI: -16.0; -9.2) thereafter. EAPCs were -17.9 (95% CI: -18.7; -17.1) and -6.7 (95% CI: -8.0; - 5.4) for 15-24 and ≥25 age groups, respectively. Nevertheless no joinpoints were found for age groups 15-24 and ≥25, whereas a joinpoint at year 1987, before compulsory vaccination, was highlighted in 0-14 age group. No joinpoint was observed after 1991. Discussion: Our results suggest that the introduction of compulsory vaccination could have contribute partly in decreasing HBV incidence rates. Compulsory vaccination health impact should be better investigated in future studies to evaluate the need for changes in current vaccination strategy. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the incidence rates and related determinants of head injuries before and after the implementation of a new universal helmet law in Italy. Methods: The investigation took place in the Emergency Room of the Accident and Emergency Department, Teaching Hospital 'Umberto I', Rome, in 1999 (before the new law), and 2000 (two periods after the new law). Personal data, injury circumstances, helmet use, others involved in injury and health data, were collected. Incidence rates by time period were calculated and differences between groups were analysed. Logistic regression models were conducted to assess the association between head trauma and potential determinants. Results: The incidence rate of all injury among scooter riders rose from 64.36/10000 person-years before the new law (1999) to 98.05110 000 person years afterwards. The incidence rate of head trauma among scooter riders showed an opposite trend, i.e. a decrease from 26.65/10 000 person-years (1999) to 8.88110 000 person-years in the second post-legislation period. Helmet use among injured scooter riders rose from 5% before the new law to 90% afterwards. Helmet use is a protective factor for being a patient with head trauma, in all the periods considered (OR 0.24-0.44). After implementation of the new law, age (18+) showed a protective effect as well (OR 0.42-0.44). Conclusion: Helmet use has a protective effect on head trauma among scooter riders. One year after implementing a universal law, helmet use has increased substantially and a sharp reduction in head trauma among persons older than 18 years could be observed. [ABSTRACT FROM AUTHOR]

Background: The coinfections HIV/HCV/HBV are an important health issue in penitentiary communities. The aim of the study was to examine HIV, HBV and HCV coinfections determinants amongst prisoners in the jails of Southern Lazio (Central Italy), in the period 1995-2000. Methods: Diagnosis of seropositivities for HIV, HBV and HCV was made using ELISA method. A multiple logistic regression analysis was conducted to verify the influence of socio-demographic factors on the HIV/HBV/HCV coinfections. Results: HIV/HCV, HBV/HCV and HIV/HBV coinfections were detected in 42 (4%), 203 (17.9%) and 31 (2.9%)inmates, respectively. These coinfections are significantly associated with the status of drug addiction (OR = 16.02; p = 0.012; OR = 4.15; p < 0.001; OR = 23.57; p = 0.002), smoking habits (OR = 3.73; p = 0.033; OR = 1.42; p = 0.088; OR = 4.25; p = 0.053) and Italian nationality (OR = 7.05; p = 0.009; OR = 2.31; p < 0.001; OR = 4.61; p = 0.04). Conclusion: The prevalence of HIV, HBV and HCV seropositivity in jails suggests that information and education programs for inmates could be useful to reduce the spread of such infections. [ABSTRACT FROM AUTHOR]

Objective: To identify determinants of regional differences in traffic accident mortality in Italy. Data and methods: Multiple linear regression models were conducted assessing the associations between regional differences in traffic mortality, case fatality and accident rates (dependent variables) with socio-demographic factors, and variables describing road behaviour, vehicles, infrastructure and medical care (independent variables). Data were derived from the National Institute of Statistics, the National Institute of Health and the Italian Automobile Club. In addition to analyses for the whole country of Italy, separate models were conducted for Northern and southern regions. Results: In Italy large regional differences in traffic mortality rates can be observed, ranging from 5.5 to 20 per 100.000 person-years. There is a North-South gradient with higher mortality rates in the Northern part of Italy. Strong predictors of regional differences in both traffic mortality and accident rates are the employment rate (directly associated) and alcohol use (directly associated). This is observed in the whole of Italy, and separately in Northern and southern regions. Conclusion: Our study has shown the need for regional policies to improve road behaviour to reduce traffic accident and mortality rates in identified high-risk areas. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To verify whether the distribution of paresthesias in patients with Carpal Tunnel Syndrome (CTS) is related to the degree of the neurophysiological involvement. Methods: We performed a cross-sectional study and retrospectively evaluated 163 patients who referred to our electromyography lab and to which a clinical and electrophysiological diagnosis of CTS was made. We divided the patients into two groups: (1) patients complaining of paresthesias at the hand as a whole and (2) patients with paresthesias in the territory of the median nerve. We referred to the distribution of paresthesias at the hand as GLOVE and to the distribution in the territory of the median nerve as MEDIAN. We compared the neurophysiological impairment in GLOVE and MEDIAN distributions. Moreover, we performed multiple regression analysis to evaluate which clinical–neurophysiological variables determined GLOVE and MEDIAN distribution. Results: In our sample, 70.4% of patients had GLOVE distribution and 29.6% of patients MEDIAN distribution. The risk of presenting MEDIAN distribution increases about twice (OR=2.07; 95% IC: 1.51–2.83) for each unitary increment of neurophysiological class. Conclusions: The distribution of paresthesias reflects the degree of nerve damage at wrist; patients suffering of SEV/EXT CTS present MEDIAN distribution. Significance: Our data have important clinical implications because they strongly suggest that we have to consider the possibility of a severe neurophysiological involvement of the median nerve at wrist in patients complaining of MEDIAN distribution. [Copyright &y& Elsevier]

Background: Determinants of intrafamilial HCV transmission are still being debated. The aim of this study is to investigate the correlates of HCV seropositivity among familial contacts of HCV positive patients in Italy. Methods: A cross-sectional study was conducted with 175 HCV positive patients (index cases), recruited from Policlinico Gemelli in Rome as well as other hospitals in Central Italy between 1995 and 2000 (40% female, mean age 57 ± 15.2 years), and 259 familial contacts. Differences in proportions of qualitative variables were tested with non-parametric tests (χ2, Yates correction, Fisher exact test), and a p value < 0.05 was considered significant. A multivariate analysis was conducted using logistic regression in order to verify which variables statistically have an influence on HCV positivity in contact individuals. Results: Seropositivity for HCV was found in 8.9% of the contacts. From the univariate analysis, risk factors significantly associated to HCV positivity in the contacts were: intravenous drug addiction (p = 0.004) and intercourse with drug addicts (p = 0.005). The only variables associated significantly and independently to HCV seropositivity in patients' contacts were intercourse with drug addicts (OR = 19.28; 95% CI: 2.01 - 184.94), the retirement status from work (OR = 3.76; 95% CI: 1.17 - 11.98), the time of the relationship (OR = 1.06; 95% CI: 1.00 - 1.11) and tattoos (OR = 7.68; 95% CI: 1.00 - 60.20). Conclusion: The present study confirms that having intercourse with a drug addict is the most significant risk factor for intrafamilial HCV transmission. The association with retirement status from work could be related to both a long-term relationship with an index case and past exposure to common risk factors. [ABSTRACT FROM AUTHOR]

Background: The relationship between physical activity and health status has been thoroughly investigated in several studies, while the relation between physical activity and socio-economic status (SES) is less investigated. The aim of this study was to measure the extra-curricular physical activity of adolescents related to the socio-economic status (SES) of their families. Methods: The survey was carried out by submitting an anonymous questionnaire to junior high school students in the following Regions: Lazio, Abruzzo, Molise, Campania, Puglia, during the school year 2002-2003. Extra-curriculum physical activity was evaluated considering whether or not present and hours of activity weekly conducted. 2411 students agreed to participate in the study. Results: Participants were 1121 males (46.5%) and 1290 females (53.5%), aged between 11 and 17 years (median age: 12 years). 71.1% of the students reported to practice extra-curricular physical activity. Parents' educational levels and work activities play an important role in predicting students' physical activity, with the more remunerative activities and higher educational levels being more predictive. Conclusion: The results confirm the relationship between adolescents' physical activity and their families' SES. In particular, a positive relationship between participation in extra-curricular physical activity and their families high SES was found. These data will be useful for school administrators and for politicians in order to reduce the gap between adolescents from the least and most disadvantaged families. [ABSTRACT FROM AUTHOR]

Abstract: Susceptibility to gastric cancer may be in part attributable to inter-individual variability in metabolic activation or detoxification of carcinogens, and in this context the polymorphic GSTM1 gene has been extensively studied. Seventeen reports detailing a possible association between GSTM1 deletion and gastric cancer have been published so far. In order to examine the risk of gastric cancer associated with GSTM1 null genotype, a meta-analysis of published case–control studies was undertaken using a random effect model. Two studies were excluded because some data were missing in the results. The principal outcome measure was the odds ratio for the risk of gastric cancer. Pooling all the 15 studies identified, the overall odds ratio of gastric cancer risk associated with GSTM1 deficiency was 1.24 (95% confidence interval, 1.00–1.54). Furthermore, by pooling four studies detailing the possible interaction between GSTM1 status smoking habits and gastric cancer risk, an overall estimate of odds ratio of 2.93 (95% confidence interval, 1.56–5.47) for ever smokers with GSTM1 deficiency compared to non-smokers with GSTM1 normal genotype has emerged. These results suggest that GSTM1 status probably has no effect on the risk of gastric cancer per se, but may modulate tobacco-related carcinogenesis of gastric cancer. Greater attention should therefore be paid to the design of future studies: only well designed population-based control studies considering all the possible confounding risk factors and based on a sample size commensurate with the detection of small genotypic risk may allow a more definitive conclusion. [Copyright &y& Elsevier]

Background: The aim of this study was to investigate the diagnostic accuracy of symptoms and signs in healthcare workers (HCW) with Sars-CoV-2. Methods: This was a case-control study. Cases consisted of symptomatic healthcare workers who had a positive SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) test, while controls were symptomatic healthcare workers with a negative RT-PCR test. For each symptom, ROCs were plotted. Diagnostic accuracy was calculated using the sensitivity, specificity, and positive and negative predictive values. A logistic regression analysis was carried out for calculating the OR (95% CI) for each symptom associated to the SARS-CoV-2 positivity. Results: We recruited 30 cases and 75 controls. Fever had the best sensitivity while dyspnea, anosmia, and ageusia had the highest specificity. The highest PPVs were found again for dyspnea (75%), anosmia (73.7%), and ageusia (66.7%). Lastly, the highest NPVs were related to anosmia (81.4%) and ageusia (79.3%). Anosmia (OR = 14.75; 95% CI: 4.27–50.87), ageusia (OR = 9.18; 95% CI: 2.80–30.15), and headache (OR = 3.92; 95% CI: 1.45–10.56) are significantly associated to SARS-CoV-2 positivity. Conclusions: Anosmia and ageusia should be considered in addition to the well-established fever, cough, and dyspnea. In a resource-limited setting, this method could save time and money. [ABSTRACT FROM AUTHOR]

Mindfulness-based interventions have emerged as unique approaches for addressing a range of clinical and subclinical difficulties such as stress, chronic pain, anxiety, or recurrent depression. Moreover, there is strong evidence about the positive effects of yoga practice on stress management and prevention of burnout among healthcare workers. The aim of this study was to conduct a single-arm clinical trial to assess the effectiveness of an intervention based on mindfulness-based stress reduction and yoga in improving healthcare workers' quality of life. Healthcare workers of two hospitals in Rome were enrolled in a 4-week yoga and mindfulness course. Four questionnaires were administered at different times (Short Form-12 (SF-12), State-Trait Anxiety Inventory (STAI) Y1 and Y2, and Positive and Negative Affect Schedule (PANAS)) to evaluate the efficacy of the intervention. Forty participants took part to the study (83.3 %). The Mental Composite Score-12, that is part of the quality of life assessment, passed from a median of 43.5 preintervention to 48.1 postintervention (p = 0.041), and the negative affect passed from a score of 16 in the preintervention to 10 in the postintervention (p < 0.001). Both the forms of the STAI questionnaires showed a decrease after the intervention. Yoga and mindfulness administered together seem to be effective to reduce stress and anxiety in healthcare workers, providing them with more consciousness and ability to manage work stressful demands. [ABSTRACT FROM AUTHOR]

Purpose: In cruciate retaining total knee arthroplasty, posterior cruciate ligament damage may occur during tibial cutting. A prospective randomized study was conducted to investigate whether a novel tibial cutting technique was more effective than the currently used techniques. Materials and methods: Patients undergoing cruciate retaining total knee arthroplasty were recruited in a prospective, randomized, controlled trial. In 25 patients (group 1) the tibial cut was performed using a double tibial cut technique; in 25 (group 2) and 25 (group 3) patients, the bone island and en bloc resection techniques were performed, respectively. Posterior cruciate ligament integrity and femoral rollback were assessed at the end of surgery. The Oxford Knee Score, WOMAC score and range of motion were assessed postoperatively. Results: Posterior cruciate ligament was completely preserved in 92% of patients in group 1 and in 64% in group 2 and 3, respectively (p = 0.03). The Oxford Knee Score and WOMAC scores did not differ between groups (p = 0.4). The mean knee flexion was 126.4°, 121.5° and 123.9° in groups 1, 2 and 3, respectively (p = 0.04). The femoral rollback at 120° flexion was 80.7%, 72.2% and 75.4% in groups 1, 2 and 3, respectively (p = 0.01). Conclusions: The double cut technique preserves the posterior cruciate ligament at significantly higher rates than the bone island or en bloc resection techniques. Better posterior cruciate ligament preservation may improve the femoral rollback and knee flexion. Level of evidence: Prospective randomized controlled trial, Level I. [ABSTRACT FROM AUTHOR]

Background: Engaging in physical activity could help improve the quality of life in patients with Alzheimer's disease. The objective of this study was to determine the association between the levels of physical activity and lifestyle, life expectancy, and quality of life in patients with Alzheimer's disease in Iran and Italy. Methods: A total of 165 participants from Iran and Italy were enrolled in this cross-sectional study. In Iran, 85 patients participated in the study. In Italy, we enrolled 80 patients at the Sapienza University teaching hospital, Policlinico Umberto 1 in Rome. The inclusion criteria in this study include patients over 60 years old, non-smokers, and non-users of antidepressants and hypnotics. Results: The results of Tukey's post hoc test of the study conducted in Iran showed that the lifestyle of patients with moderate (p = 0.001) and low (p = 0.009) physical activity levels was significantly better than inactive patients. Life expectancy in patients with moderate physical activity levels was significantly higher than inactive patients (p = 0.011). The quality of life was significantly better in patients with moderate (p = 0.001) and low (p = 0.002) physical activity levels than inactive patients. On the other hand, the findings of Tukey's post hoc test of the study in Italy showed that the quality of life in patients with low (p = 0.001) and moderate physical activity levels (p = 0.01) was significantly higher than inactive patients. Conclusions: A low to moderate level of physical activity could be associated with an improved lifestyle, life expectancy, and quality of life in patients with Alzheimer's disease compared to inactivity. [ABSTRACT FROM AUTHOR]

The article focuses on the requirement of quitting tobacco smoking among European region health professional. It states that reducing and controlling tobacco smoking is the aim for these population. It states that health-care professionals can help in tobacco usage prevention but most of them are not trained during regular courses. The study shows low prevalence of smoking among health-care professionals as compared with other developing countries which supports smoking ban.

Summary: Over the past two decades, scientific research has led to the development of a huge number of new health technologies, among which new vaccines. The decision process underlying the introduction of a new vaccine will be of particular concern in the future and a useful tool is needed to orientate decision makers towards better allocation of economic resources. Health Technology Assessment (HTA) is a multidisciplinary tool that aims to examine the clinical, economic, organizational, ethical, juridical, social and cultural implications of the introduction or the implementation of a specific technology; it could so represent an innovative and effective approach in order to support decision-making processes. [Copyright &y& Elsevier]

Patients benefit from the presence of empathic caregivers (CGs). In this regard, empathy toward the patient is one of the clinical targets for improving patient outcomes. However, relatively little is known about the impact of patients' empathic responses on the CGs' burden. Among people living with Parkinson's disease (PwP), care partners play a major role. This study involved 28 spouse-patient couples. Empathy, stress burden, and mood disorders (such as anxiety and depression) were assessed over a 6-month period, before and after the reported intervention. Our observation points out that the improvement of patient empathy is necessary for a significant burden reduction among spouses caring for PwP. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to measure the effect that a learning method using art, such as Visual Thinking Strategies, can have on nursing students and residents in Hygiene and Preventive Medicine; we also aimed to improve skills of observation, communication, empathy and collaboration with the patient and other team members, and evaluate the impact on quality of life, burnout and positivity. Methods: The experimentation was based on administering a form (written assessment) before and after the intervention, to measure the impact of the method on improving some useful skills for the nursing and medical professions by inserting one image of an artistic type and the other of a clinical type, and asking participants to answer basic questions on the VTS method. Students participated in groups of eight in 90-min sessions for four meetings in the classroom and one at the museum, on a weekly basis. Results: The experimental study concerned a randomized controlled sample involving undergraduate nursing students who voluntarily participated in the survey. 84 students took part in the study, including 50 undergraduate nursing students (mean age 22.5, SD 2.7; 14 males and 34 females) and 34 residents in Hygiene and Preventive Medicine (mean age 28.7, SD 2.6; 8 males and 26 females). For the artistic image, the median of the total score for all skills was −1.5 for the control group and 3 for the intervention group (p = 0.002), registering an increase for the Delta identified items, which was −1.5 for the control group and 1 for the intervention group (p = 0.007). For the clinical image, the median of the total score for all skills was 0 for the control group and 2 for the intervention group (p = 0.025), recording an increase for Delta observation skills, found to be 0 for the control group and 1 for the intervention group (p = 0.007). Conclusions: Most students who participated in the intervention reported considerable improvements in the skills the method promises to improve, and a reduction in personal and work burnout scores, suggesting that the use of the VTS method in health professions curricula is viable. [ABSTRACT FROM AUTHOR]

Abstract: Epidemiological studies suggest that n-3 polyunsaturated fatty acid (n-3 FA) deficiency is a risk factor for bipolar disorders (BDs). The aim of this study was to determine whether such a deficit does exist in patients with BD and to characterize the overall plasma fatty acid (FA) profile in these patients. Using gas chromatography/mass spectrometry, we measured fasting plasma levels of 15 FAs in 42 patients diagnosed with BD according to DSM-IV criteria and in 57 age- and gender-matched healthy controls. Plasma docosahexaenoic acid (DHA) levels were significantly decreased in bipolar patients (p < 0.001 versus healthy controls). Compared with controls, patients had higher plasma levels of all other FAs, including arachidonic acid (AA, p < 0.001), alpha-linolenic acid (ALA, p < 0.001), and eicosapentaenoic acid (EPA) (p < 0.001). Although in the present study we observed significant DHA deficits in the plasma of bipolar patients our findings do not support the therapeutic use of ALA and/or EPA supplementation. DHA may provide a basis for possible pharmacological intervention in psychiatric disorders at the level of second messengers linked to the phosphatidylinositol cycle. Finally, measurement of FA levels in plasma seems to be more reliable and reproducible than assays of erythrocyte FA content. [Copyright &y& Elsevier]

Ehlers-Danlos syndrome hypermobility type a. k. a. joint hypermobility syndrome (JHS/EDS-HT) is a hereditary musculoskeletal disorder associating generalized joint hypermobility with chronic pain. Anecdotal reports suggest a prominent role for kinesiophobia in disease manifestations, but no study has systematically addressed this point. Objective. To investigate the impact of kinesiophobia and its relationship with pain, fatigue, and quality of life in JHS/EDS-HT. Design. Cross-sectional study. Subjects/Patients. 42 patients (40 female and 2 male) with JHS/EDS-HT diagnosis following standardized diagnostic criteria were selected. Methods. Disease features were analyzed by means of specific questionnaires and scales evaluating kinesiophobia, pain, fatigue, and quality of life. The relationships among variables were investigated using the Spearman bivariate analysis. Results. Kinesiophobia resulted predominantly in the patients' sample. The values of kinesiophobia did not correlate with intensity of pain, quality of life, and (or) the single component of fatigue. A strong correlation was discovered between kinesiophobia and general severity of fatigue. Conclusions. In JHS/EDS-HT, the onset of pain-avoiding strategies is related to the presence of pain but not to its intensity. The clear-cut correlation between kinesiophobia and severity of fatigue suggests a direct link between musculoskeletal pain and fatigue. In JHS/EDS-HT, the underlying mechanism is likely to be facilitated by primary disease characteristics, including hypotonia. [ABSTRACT FROM AUTHOR]

1. Prior studies have suggested urinary oxygen tension ( Puo2) as a putative index of renal blood flow (RBF) and tissue oxygenation. 2. In the present study, we collected intraoperative data from eight anaemic, bladder-catheterized patients who received erythrocyte transfusions during various surgical procedures under general anaesthesia. Urinary and arterial blood gas analysis and co-oximetry were performed before and after transfusion, during an interval in which RBF was assumed to be constant. 3. Pre- and post-transfusion haematocrit levels were 23 ± 4.8 and 27 ± 6.4%, respectively, and arterial oxygen content (Cao2) was 10.5 ± 2.5 and 12.4 ± 3.1 mL/dL, respectively ( P = 0.012). Pre- and post-transfusion Puo2 was 90 ± 14 and 108 ± 20 mmHg, respectively ( P = 0.036). 4. These results, although limited, suggest that under conditions of stable haemodynamics, systemic oxygenation and renal function, intraoperative blood transfusion may increase Puo2 in anaemic anaesthetized patients. If confirmed by subsequent clinical and laboratory studies, Puo2 measurement could become a simple, non-invasive way to monitor renal medullary oxygenation and tissue oxygen availability and help determine whether red blood cells should be transfused. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate, in 5 simulated motor nerves with patchy demyelination: (1) the sensitivity of the conventional motor conduction examination; (2) the conduction velocity of single axons (SA-CV). Methods: Four damaged segments were simulated in each nerve. Myelin impairment was generated by varying two parameters: (1) percent reduction in conduction velocity, i.e. degree of damage (DEGREE); (2) percentage of affected axons, i.e. extent of damage (EXTENT). Myelin impairment was simulated in axons with different diameters. We evaluated: (1) conduction velocity; (2) temporal dispersion of the negative phase of compound motor action potential (CMAP); (3) amplitude decay of CMAP; (4) SA-CV of 20 randomly-chosen axons. Results: When the damage involved both large and small axons, the conduction velocity was pathological only when severe myelin damage involved a large number of axons. Temporal dispersion and amplitude decay were more sensitive than conduction velocity in detecting the damage. In damage involving only large axons or only small axons, all parameters remained in the normal range. SA-CV evaluation was much more sensitive than the conventional studies, regardless of the diameter of the damaged axons. Conclusions: Conventional studies are not sensitive in detecting minimal myelin damage. Decomposing the CMAPs and randomly studying 20 SA-CVs would increase the sensitivity of damage detection. Significance: These results contribute to a better understanding of the relationship between axonal properties and neurophysiological findings in motor nerve demyelination. [Copyright &y& Elsevier]

New genetic evidence strongly supports a role for the immune system in the pathogenesis of essential hypertension (EH) through chemokines and their receptors (CCR) involvement. The aim of the present study was to evaluate the possible relation between CCR2 and CCR5 alleles and blood pressure (BP) levels in hypertensive subjects. In all, 118 essential hypertensive outpatients (male 90, female 28; stage I and II; age 27–54 years; not previously treated with antihypertensive drugs) were selected for the study. All of the subjects underwent office BP measurement. Subsequently, 24-h ambulatory BP monitoring (ABPM) was performed with a Spacelabs 90207 monitor during a regular working day. CCR264I and CCR5Δ32 polymorphisms were determined by polymerase chain reaction (PCR), following the standard molecular biology protocols. Allelic frequencies were the following: CCR5Δ32= 0.097, CCR264I=0.101. Logistic regression analysis showed an association between the CCR5Δ32 allele and the following: 24-h systolic BP (SBP >140 mmHg; p = 0.027), values over the 50th percentile of 24-h SBP (p = 0.032), and the values over the 50th percentile of nighttime SBP (p = 0.039). Office BP showed an association with the Δ32 allele in a range over the 75th percentile of SBP (p = 0.087) and the 75th percentile of DBP (p = 0.085). No significant association was observed for CCR264I and BP levels or between physiological nocturnal BP decline and genotype. The observed results not only support the role of the immune system in the development and maintenance of hypertension, but they also indicate an influence of CCR5Δ32 polymorphism on the establishment of BP levels. [ABSTRACT FROM AUTHOR]

Purpose: Sulfotransferases (SULT) 1A1 detoxifie and bioactivate a broad spectrum of substrates including xenobiotics. The SULT1A1 gene possesses a G→A polymorphism that results in an Arg to His substitution at codon 213, with the His allele having a low activity. The purpose of this study was to evaluate whether SULT1A1 Arg213 His polymorphisms are risk factors for head and neck squamous cell carcinoma (SCCHN). Methods: A total of 124 consecutive primary SCCHN patients and 249 age- and sex-matched hospital controls were enrolled in this study. Genomic DNA was isolated from peripheral blood lymphocytes and genotyping was performed by PCR-RFLP. A comprehensive epidemiological interview was conducted on all participants to collect their lifestyle data. Results: The His/His frequencies in cases and controls were 6.5% (8/123) and 3.6% (9/247), respectively ( P=0.049). Multivariate logistic regression analysis showed a significant association of SCCHN and His/His genotype (OR=3.60; 95% CI=1.01–12.88). This association was stronger amongst older people, alcohol and low fruit consumers. The resulted SULT1A1 His/His genotype also associated with a higher risk of neck node positive status (OR=5.82; 95% CI=1.10–30.68). Conclusions: These preliminary findings show for the first time that the SULT1A1 His 213 allele is a possible risk factor for head and neck cancer development. [ABSTRACT FROM AUTHOR]

Abstract: Sulfotransferases (SULT) catalyse both the bioactivation and detoxification of a wide range of promutagens and carcinogens. The SULT1A1 gene possesses a G→A polymorphism that results in a Arg to His substitution at codon 213, and the His allele has been shown to have a low activity and thermal stability. To test the hypothesis that individuals carrying the variant allele may be at high risk of gastric cancer, we identified the SULT1A1 Arg213His genotype by a PCR-based RFLP in a preliminary study of 76 gastric adenocarcinoma patients that underwent curative gastrectomy and 260 age and sex-matched controls from a medical centre in Rome. A comprehensive epidemiological interview was conducted on all participants to collect lifestyle data. The prognostic significance of the SULT1A1 Arg213His polymorphism with respect to staging, differentiation and histological type of gastric cancer was also evaluated. The frequencies of His/His in cases and controls were 11.9% (9/76) and 5% (13/260), respectively (P=0.025). After adjusting for substance use, age, gender and physical activity, individuals with His/His showed a 3.32 fold increased risk of developing gastric cancer compared to those with Arg/Arg (95% CI=1.17–9.45). This positive association was more pronounced amongst males, alcohol drinkers, current smokers and consumers of grilled/barbecued meat and, unexpectedly, amongst individuals with a high intake of fruit. A statistically significant association was also found between the diffuse type of gastric cancer and the heterozygous SULT1A1 genotype. Our preliminary findings suggest for the first time that the SULT1A1 His 213 allele may be important in the development of gastric cancer, with other factors modulating such effect. [Copyright &y& Elsevier]

This is a multicenter study on peroneal mononeuropathy (PM), in which a multidimensional protocol was performed to evaluate (1) the predisposing factors and their occurrence; (2) the relationships between the etiological, clinical, and neurophysiologic findings; and (3) disability and quality of life (QoL) in a wide sample with PM. Clinical and neurophysiologic evaluation was performed in all patients; moreover, the group adopted validated disability and QoL measurements to obtain more comprehensive and reliable data on PM. From November 2002 to January 2004, 69 patients were enrolled consecutively in 11 Italian centers. Our data showed that PM involves men more frequently than women (male : female = 4.1:1). PM was idiopathic (16%) or due to prolonged posture (23.1%), surgery (20.3%), weight loss (14.5%), trauma (11.6%), bedridden condition (7.3%), external compression from cast (5.8%), and arthrogenic cyst at the fibula (1.4%). Unexpectedly, peroneal nerve lesions were not only due to surgical operation close to the peroneal region but were also associated with thoracic-abdominal surgery. We observed conduction block in about 50–70% of postural and weight loss PM; in perioperative and idiopathic PM, conduction block or mixed damage was equally present; in PM due to trauma, we observed an exclusive axonal damage in about 60% of cases. Only in three cases (one postural PM, one idiopathic PM, and one weight loss PM), we observed a slowing of conduction velocity in the popliteal fossa-fibular head segment without conduction block. The comparison between QoL in patients with PM and in healthy subjects showed a significant involvement of physical and mental aspects. With regard to disability, 68% of patients walked with difficulty. Our data show that (1) most of the cases of PM are due to an identifiable predisposing factor; (2) there is a good correlation between predisposing factors and clinical-neurophysiologic findings; and (3) PM causes disability and deterioration of the physical and emotional aspects of QoL. [ABSTRACT FROM AUTHOR]