Association between non-alcoholic fatty liver disease and subclinical hypothyroidism in children with obesity.

PURPOSE: We aimed (i) evaluating the relationship between non-alcoholic fatty liver disease (NAFLD) and thyroid function tests, (ii) testing if the relationship between NAFLD and thyroid dysfunction could be driven by the obesity and the IR degree, and (iii) exploring the influence of the patatin-like phospholipase domain-containing protein-3 (PNPLA3) I148M and the transmembrane 6 superfamily member 2 (TM6SF2) E167K polymorphisms on the association between NAFLD and thyroid function in children. METHODS: We examined 2275 children and adolescents with obesity. Subclinical hypothyroidism (SH) was defined by thyroid-stimulating hormone (TSH) > 4.2 µUI/ml with normal fT3 and fT4. RESULTS: Children with NAFLD showed higher SH prevalence than those without NAFLD (15.7% Vs 7.4%;p = 0.001) and showed an adjusted odds ratio (aOR) to have SH of 1.68 (95% CI:1.01-2.80;p = 0.04) while patients with SH had an aOR to show NAFLD of 2.13(95% CI:1.22-3.73;p = 0.008). Patients having severe obesity and IR degree presented an aOR to show both NAFLD and SH of 3.61 (95% CI:1.78-7.33;p < 0.0001). Subjects with NAFLD carrying the TM6SF2 167 K allele had lower TSH levels than non-carriers (p = 0.03) and showed an aOR to have SH of 0.10 (95% CI: 0.01-0.79;p = 0.02). No differences were found in carriers of the PNPLA3 148 M allele. A general linear model for TSH variance showed a significant association of TSH with TM6SF2 genotypes only in the NAFLD group (p = 0.001). CONCLUSION: Children with obesity and NAFLD presented increase risk of SH and vice versa likely due to the adverse effect of duration of obesity, obesity degree, and IR. The TM6SF2 E167K exerts a protective role against SH in children with obesity and NAFLD.

Cystic lung diseases: radiological aspects.

Cystic lung diseases (CLDs) are a heterogeneous group of pathophysiological entities comprising gas-filled lesions with imperceptible walls, which can occur throughout lung parenchyma. CLDs can arise from different mechanisms and may often have an unpredictable progression. As CLDs are infrequent and may be associated to many different processes, they pose a diagnostic challenge to the radiologist and referring physician. CLDs require a comprehensive diagnostic approach. An essential tool in the evaluation of CLDs is high-resolution computed tomography (HRCT). The first step is in distinction from true cysts, from other cysts mimicking entities, as emphysema, honeycombing, pneumatocoele, cavitate nodules, or bronchiectasis. Thereafter the identification of number, distribution, wall size, and other systemic manifestations provides an accurate characterisation of CLD, often avoiding further evaluation with lung biopsy. Features of pulmonary lucencies, classification of CLDs based on pathophysiological mechanisms, and radiological criteria, the less common aetiologies, and a multidisciplinary approach in pulmonary cysts are reported. Finally, a systematic diagnostic algorithm to guide radiologists in the evaluation of CLDs is discussed.

Use of Smartphones, Computers and Social Media Among People with SMI: Opportunity for Intervention.

Mobile technology provides a unique opportunity to expand access to evidence-based interventions. The objective of this study was to provide an update regarding use of technology in people with serious mental illness (SMI). In 2017, 403 people in treatment for SMI were surveyed. Technology use was common: 65.8% used a smartphone, 53.6% used the Internet on a computer or tablet in the past 6 months, and over two thirds (67.9%) used social media. Rates of technology and Facebook use were similar to rates among low-income Americans. Approximately three quarters were willing to use a device to access interventions for stress, health and mental health. Younger adults were more likely to use most forms of technology and social media compared to older adults, but willingness to try technology-delivered interventions did not vary by age. This survey supports the rationale for ongoing development and testing of digital interventions for people with SMI.

'Frequently recurring' nocturnal polyuria is predictive of response to desmopressin in monosymptomatic nocturnal enuresis in childhood.

INTRODUCTION: The nocturnal polyuria is considered a significant predictive value for response to desmopressin. The cutoff value useful to define nocturnal polyuria is still a matter of debate. Moreover, it is current notion that maximal voided volume (MVV) could be used as a predictor for desmopressin response. OBJECTIVE: The objective of this study was to assess the impact of different definitions of nocturnal polyuria (and of its frequency) and MVV in predicting the response to desmopressin. STUDY DESIGN: A total of 103 patients with frequent monosymptomatic nocturnal enuresis (≥4 wet nights/week) were enrolled. A bladder diary over a 4-day period was collected. The MVV was defined as the highest micturition volume detected at bladder diary. Nocturnal diuresis was measured in 5 wet nights. Then, patients were administered with 120 mcg of sublingual desmopressin. After 2 months, if there was no complete response, the dose was increased to 240 mcg. Nocturnal polyuria was defined as follows: 1.Definition 1: nocturnal urine production >130% of the expected bladder capacity (EBC). 2. Definition 2: >100% EBC. 3. Definition 3: > 20×(age + 9) mL. The primary outcome was 'response to desmopressin' after 3 months of treatment. RESULTS: Fifty-three patients responded to desmopressin. Comparing the responses to desmopressin on the basis of the three definitions of nocturnal polyuria, no significant difference was found. There was no cutoff value of nocturnal polyuria expressed as %EBC useful in providing a significant receiver-operating characteristic (ROC) curve. The area under the ROC curve for MVV expressed as %EBC was 0.67 (95% confidence interval [CI], 0.54-0.80; p = 0.01). A MVV >103.1% of EBC had 78.8% (95% CI, 61.1-91.0) sensitivity and 47.5% (95% CI, 31.5-63.9) specificity for predicting response to desmopressin. Among the patients with nocturnal polyuria according to definition 1, a higher percentage of subjects with nocturnal polyuria in 4 out of 5 or 5 out of 5 nights responded to desmopressin, compared with other patients. Patients presenting with nocturnal polyuria according to definition 3 in 5 out of 5 nights showed a 100% of response to desmopressin. At multivariate analysis, the only significant odds ratio (OR) to respond to desmopressin was that of patients with nocturnal polyuria according to definition 1 in >3 nights (OR = 7.1, 95% CI, 1.3-40.3). DISCUSSION AND CONCLUSIONS: The presence or absence of nocturnal polyuria-according to all three definitions-in at least one night was not effective in predicting the response to desmopressin. Predictors of desmopressin response were nocturnal polyuria in >3 out of 5 wet nights according to definition 1 and in 5 out of 5 wet nights according to definition 3.

Metachronous elastofibromas.

Elastofibroma Dorsi (EFD) is a rare pseudo-tumor characterized by the overgrowth of elastic fibers mixed to adipose and connective tissues typically growing in the subscapular region. This can be bilateral but only rarely synchronous affecting different anatomical sites at the same time. Hereby we present a case of a 42-year-old male patient found with three different metachronous elastofibromas: bilateral EFD and a further third localization by the right elbow. The two EFs in the subscapular region were resected. After surgery pain reoccurred on the right side. This required the implantation of a spinal electro-stimulator. The elbow lesion was not excised as it was asymptomatic.

Cancer stem cells in surgery.

The Cancer Stem Cells (CSC) hypothesis is based on three fundamental ideas: 1) the similarities in the mechanisms that regulate self-renewal of normal stem cells and cancer cells; 2) the possibility that tumour cells might arise from normal stem cells; 3) the notion that tumours might contain 'cancer stem cells' - rare cells with indefinite proliferative potential that drive the formation and growth of tumours. The roles for cancer stem cells have been demonstrated for some cancers, such as cancers of the hematopoietic system, breast, brain, prostate, pancreas and liver. The attractive idea about cancer stem cell hypothesis is that it could partially explain the concept of minimal residual disease. After surgical macroscopically zero residual (R0) resections, even the persistence of one single cell nestling in one of the so called "CSCs niches" could give rise to distant relapse. Furthermore the metastatic cells can remain in a "dormant status" and give rise to disease after long period of apparent disease free. These cells in many cases have acquired resistance traits to chemo and radiotherapy making adjuvant treatment vain. Clarifying the role of the cancer stem cells and their implications in the oncogenesis will play an important role in the management of cancer patient by identifying new prospective for drugs and specific markers to prevent and monitoring relapse and metastasis. The identification of the niche where the CSCs reside in a dormant status might represent a valid instrument to follow-up patients also after having obtained a R0 surgical resection. What we believe is that if new diagnostic instruments were developed specifically to identify the localization and status of activity of the CSCs during tumor dormancy, this would lead to impressive improvement in the early detection and management of relapse and metastasis.

Inclusivity, exclusivity and limit of detection of commercially available real-time PCR assays for the detection of Salmonella.

The traditional cultural detection of Salmonella spp. is both time- and labour-intensive. Salmonella is often a release criterion for the food industry and time to result is therefore an important factor. Storage of finished products and raw materials can be costly and may adversely impact available shelf-life. The application of real-time PCR for the detection of Salmonella spp. in food samples enables a potential time-saving of up to four days. The advancement of real-time PCR coupled with the development of commercially available systems in different formats has made this technology accessible for laboratories in an industrial environment. Ideally these systems are reliable and rapid as well as easy to use. The current study represents a comparative evaluation of seven commercial real-time PCR systems for the detection of Salmonella. Forty-nine target and twenty-nine non-target strains were included in the study to assess inclusivity and exclusivity. The limit of detection for each of the method was determined in four different food products. All systems evaluated were able to correctly identify the 49 Salmonella strains. Nevertheless, false positive results (Citrobacter spp.) were obtained with four of the seven systems. In milk powder and bouillon powder, the limit of detection was similar for all systems, suggesting a minimal matrix effect with these samples. Conversely, for black tea and cocoa powder some systems were prone to inhibition from matrix components. Up to 100% of the samples were inhibited using the proprietary extracts but inhibition could be reduced considerably by application of a DNA clean-up kit.

Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy.

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) may offer advantages over conventional laparoscopic cholecystectomy (LC). METHODS: MEDLINE, Embase, PubMed, CINAHL, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for randomized clinical trials on SILC versus LC until May 2012. Odds ratio (OR) and weight mean difference (WMD) were calculated with 95 per cent confidence intervals (c.i.) based on intention-to-treat analysis. RESULTS: Thirteen randomized clinical trials included a total of 923 procedures. SILC had a higher procedure failure rate than LC (OR 8·16, 95 per cent c.i. 3·42 to 19·45; P < 0·001), required a longer operating time (WMD 16·55, 95 per cent c.i. 9·95 to 23·15 min; P < 0·001) and was associated with greater intraoperative blood loss (WMD 1·58, 95% of c.i. 0·44 to 2·71 ml; P = 0·007). There were no differences between the two approaches in rate of conversion to open surgery, length of hospital stay, postoperative pain, adverse events, wound infections or port-site hernias. Better cosmetic outcomes were demonstrated in favour of SILC as measured by Body Image Scale questionnaire (WMD -0·97, 95% of c.i. -1·51 to -0·43; P < 0·001) and Cosmesis score (WMD -2·46, 95% of c.i. -2·95 to -1·97; P < 0·001), but this was based on comparison with procedures in which multiple and often large ports (10 mm) were used. CONCLUSION: SILC has a higher procedure failure rate with more blood loss and takes longer than LC. No trial was adequately powered to assess safety.

Squamous cell carcinoma of the renal pelvis with stones and inferior vena cava infiltration. Case report.

We report a rare case of a 50 year old man with renal squamous cell carcinoma (SCC) who first came to our attention with renal colic and fever not responding to antibiotic or analgesic treatment. He had a long history of kidney stones, but had not undergone any imaging in the last 5 years. Physical examination revealed tenderness and a palpable mass in the right flank and lumbar region. A whole body CT scan was performed, revealing an 11 cm mass in the right kidney infiltrating the inferior vena cava. There were areas of calcification within the mass and multiple stones within the renal pelvis. The tumor was considered unsuitable for resection according to radiological and clinical criteria. The mass was biopsied percutaneously under CT guidance and histological examination revealed squamous cell carcinoma of the renal pelvis. The patient was treated with neoadjuvant chemotherapy and embolization of the renal artery. He died one month after diagnosis. To our knowledge this is the second reported case in the world of renal SCC infiltrating the inferior vena cava and with kidney stones.

Subfascial endoscopic perforator surgery (SEPS) in chronic venous insufficiency. A 14 years experience.

INTRODUCTION: Subfascial Endoscopic Perforator Surgery (SEPS) enables the direct visualization and section of perforating veins. Morbidity and duration of hospitalization are both less than with conventional open surgery (Linton's or Felder's techniques). PATIENTS AND METHODS: A total of 322 legs from 285 patients with a mean age of 56 years (range 23-90) were treated at our Department from May 1996 to January 2010. In 309 cases, an endoscope (ETM Endoskopische Technik GmbH, Berlin, Germany) was introduced through a transverse incision approximately 1.5 cm in length and 10 cm from the tibial tuberosity, as with Linton's technique. A spacemaker balloon dissector for SEPS, involving a second incision 6 cm from the first, was used in only 13 cases. RESULTS: The procedure used in each case was decided on the basis of preoperative evaluation. SEPS and stripping were performed in 238 limbs (73.91%), SEPS and short stripping in 7 limbs (2.17%), SEPS and crossectomy in 51 limbs (15.84%), and SEPS alone in 26 limbs (8.07%). 103 patients presented a total of 158 trophic ulcers; the healing time was between 1 and 3 months, with a healing rate of 82.91% after 1 month and 98.73% after 3 months. CONCLUSION: Subfascial ligature of perforating veins is superior to sclerotherapy and minimally invasive suprafascial treatment for the treatment of CVI. It is easy to execute, minimally invasive and has few complications.

[Medullary thyroid carcinoma: a study about 28 operated patients]. / Carcinoma midollare della tiroide: studio su 28 casi operati.

In this study on 28 operated patients, the Authors show that total thyroidectomy with elective central neck dissection and ipsilateral neck dissection is the most appropriate surgical treatment for medullary thyroid carcinoma. Pathologic study on lymph nodes removed in central and in latero-cervical compartments showed malignancy respectively in 75% and in 70% of the cases. However the role of elective ipsilateral lateral neck dissection remains controversial.

The impact of the introduction of irinotecan and oxaliplatin on the outcome of patients with advanced colorectal cancer.

The effectiveness of oxaliplatin and irinotecan in advanced colorectal cancer therapy has been shown by many randomized clinical trials. We developed a retrospective study on patients treated in the clinical practice. The main inclusion criteria were: diagnosis of unresectable colorectal adenocarcinoma and having undergone chemotherapy. Univariate and multivariate analyses were performed to identify the prognostic factors of survival. The study included 286 consecutive patients. Three factors were associated with worse survival: high CA19-9 levels (p=0.003), schedules without new regimens (p=0.031) and weight loss (p=0.070). The use of new regimens was associated with a significant improvement in median survival (15 to 10 months, p<0.001). Although the new regimens improved survival in clinical practice, the median gain is smaller than that reported in randomized trials. The palliative intent of these therapies should not be forgotten in order to improve quality of life rather than absolute survival.

Investigation of cuticular hydrocarbons from Bagrada hilaris genders by SPME/GC-MS.

The cuticular hydrocarbons of male and female Bagrada hilaris Burmeister (Heteroptera: Pentatomidae) were investigated, by headspace solid-phase microextraction followed by gas chromatography-mass spectrometry. Measurements were done with fiber coatings of different polarity after optimization of headspace volumes and extraction temperatures. This resulted in the use of polyacrylate fiber, 22-ml vial as the sample holder, and an extraction temperature of 150 degrees C. The analytical procedures allowed identification of 13 peaks, corresponding to a homologous series of n-alkanes (nC(17)-nC(29)). The hydrocarbon profiles of male and female B. hilaris were qualitatively equal, but marked sex-specific quantitative differences were observed for some of the linear alkanes.

Investigation of long-range female sex pheromone of the European tarnished plant bug, Lygus rugulipennis: chemical, electrophysiological, and field studies.

The European tarnished plant bug, Lygus rugulipennis, is an important pest of agricultural and horticultural crops throughout Europe. Adult male L. rugulipennis were previously shown to be attracted to traps baited with live virgin females, which suggests the females produce a sex pheromone. Volatiles produced by virgin female L. rugulipennis were shown to contain three components, hexyl butyrate, (E)-2-hexenyl butyrate, and (E)-4-oxo-2-hexenal which elicited electroantennographic (EAG) responses from males in analyses by linked gas chromatography-electroantennography (GC-EAG). They were produced in 1.5:1:0.08 ratio, respectively, by single females. Collections from 1, 2, or 4 virgin females showed the proportions of hexyl butyrate and (E)-4-oxo-2-hexenal to increase relative to that of (E)-2-hexenyl butyrate with increasing number of females. Although these compounds were found in body extracts of both male and female L. rugulipennis, they were not detected in volatiles released by virgin males. EAG dose-response studies showed that both males and females responded to these chemicals with minimal differences in sensitivity between the sexes or to the three components, except that males were more responsive than females to (E)-4-oxo-2-hexenal at the two highest doses tested. Release rates of the compounds from rubber septa, polyethylene vials, and polyethylene sachets were measured under laboratory conditions. Four field tests were carried out using sticky traps baited with all possible binary and tertiary combinations of the three chemicals using different combinations of dispensing systems. Catches of male L. rugulipennis in baited traps were similar to those in unbaited traps. Significantly fewer females were caught on traps baited with blends containing hexyl butyrate than on traps without hexyl butyrate or unbaited traps in one test and overall. The roles of the three compounds and possible reasons for their failure to attract males are discussed.

[Diagnostic and therapeutic value of hysteroscopy in intrauterine synechiae]. / Validità diagnostica e terapeutica dell'isteroscopia nella patologia aderenziale intrauterina.

The paper evaluates the diagnostic and therapeutic value of hysteroscopy in a group of women suffering from intrauterine synechiae secondary to intrauterine mechanical manipulation following spontaneous abortion.

Hysteroscopic treatment of uterine septum.

Authors report their 4 years experience in the treatment of uterine septum by hysteroscopic metroplasty. 35 patients underwent procedure; no complications occurred. Postoperative reproductive outcome was evaluated in 29 women with follow-up longer than 6 months. Patients were divided into 2 groups according to presence or absence of associated factors compromising fertility. Group A composed of 19 women in which uterine septum was the only cause of pregnancy wastage. Preoperatively they had 40 pregnancies all ending in spontaneous abortion. Postoperatively 15 (79%) patients conceived and 13 (68%) had a live baby. Totally they had 18 pregnancies, 2 (12%) ended in abortion, 1 in molar pregnancy, 1 in premature delivery, 11 delivered at term and 3 are currently beyond 20 weeks pregnant, for a live birth rate of 78%. Life table analysis showed an estimated pregnancy rate of 82% at 12 months, monthly fecundability was 0.13. Group B composed of 10 women in which other factors compromising fertility were present. Preoperatively only 5 experienced pregnancy. Totally they had 8 pregnancies 7 (86%) of which ended in abortions and one in extrauterine pregnancy. Postoperatively only 3 (30%) had pregnancy and all had a live baby. Totally they had 4 pregnancies, 1 ended in abortion and 3 at term for a live birth rate of 75%. Life table analysis showed an estimated pregnancy rate of 11% at 12 months, monthly fecundability rate was 0.01. Hysteroscopic metroplasty proved to be safe and effective for solving pregnancy wastage caused by uterine septum. If other factors compromising fertility were present metroplasty did not increase fecundability, but improved live birth rate.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cervical endometriosis: usefulness of colposcopic examination in the diagnosis]. / L'endometriosi cervicale: utilità dell'esame colposcopico nell'approccio diagnostico.

Six cases of cervical endometriosis out of 420 colposcopies (1.42%) are described. The data suggest a correlation between electrocautery or other cervical trauma and cervical endometriosis. This study confirms that colposcopic examination is indispensable for a correct diagnosis of cervical endometriosis.