Adverse Childhood Experiences and Mental Health among Students Seeking Psychological Counseling Services.

Recent years have seen a marked rise in the number of students accessing University Psychological Counseling (UPC) services, and their concerns have been increasingly severe. This study aimed to examine the impact of cumulative adverse childhood experiences (ACEs) on mental health in students who had approached counseling services (N = 121) and students who had no experience with counseling services (N = 255). Participants completed an anonymous online self-report questionnaire measuring exposure to adverse childhood experiences (ACE-Q), psychological distress (General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), personality traits (PID-5), and coping strategies. We found that students who approached UPC services scored higher on cumulative ACEs than the non-counseling group. While ACE-Q score was a direct positive predictor of PHQ-9 (p < 0.001), it did not predict GAD-7. Moreover, the results supported the existence of a mediation effect of avoidance coping, detachment, and psychoticism on the indirect effects of ACE-Q score on PHQ-9 or GAD-7. These results underlined the importance of screening for ACEs in a UPC setting because it can help identify students at higher risk for developing mental and physical health problems and provide them with early interventions and support.

Risk Stratification in COVID-19 Pneumonia - Determining the Role of Lung Ultrasound.

LUS patterns of COVID-19 pneumonia have been described and shown to be characteristic. The aim of the study was to predict the prognosis of patients with COVID-19 pneumonia, using a score based on LUS findings. MATERIALS AND METHODS: An observational, retrospective study was conducted on patients admitted to Niguarda hospital with a diagnosis of COVID-19 pneumonia during the period of a month, from March 2nd to April 3rd 2020. Demographics, clinical, laboratory, and radiological findings were collected. LUS was performed in all patients. The chest was divided into 12 areas. The LUS report was drafted using a score from 0 to 3 with 0 corresponding to A pattern, 1 corresponding to well separated vertical artifacts (B lines), 2 corresponding to white lung and small consolidations, 3 corresponding to wide consolidations. The total score results from the sum of the scores for each area. The primary outcome was endotracheal intubation, no active further management, or death. The secondary outcome was discharge from the emergency room (ER). RESULTS: 255 patients were enrolled. 93.7 % had a positive LUS. ETI was performed in 43 patients, and 24 received a DNI order. The general mortality rate was 15.7 %. Male sex (OR 3.04, p = 0.014), cardiovascular disease and hypertension (OR 2.75, p = 0.006), P/F (OR 0.99, p < 0.001) and an LUS score > 20 (OR 2.52, p = 0.046) were independent risk factors associated with the primary outcome. Receiver operating characteristic (ROC) curve analysis for an LUS score > 20 was performed with an AUC of 0.837. Independent risk factors associated with the secondary outcome were age (OR 0.96, p = 0.073), BMI (OR 0.87, p = 0,13), P/F (OR 1.03, p < 0.001), and LUS score < 10 (OR 20.9, p = 0.006). ROC curve analysis was performed using an LUS score < 10 with an AUC 0.967. CONCLUSION: The extent of lung abnormalities evaluated by LUS score is a predictor of a worse outcome, ETI, or death. Moreover, the LUS score could be an additional tool for the safe discharge of patient from the ER.

Thunderstorm-asthma, two cases observed in Northern Italy.

Thunderstorm asthma is a rare event: in this letter we describe two cases observed during the same month of 2018 at an Italian Emergency department, assessed by the same medical team and according to the same methodology and approach. Given the infrequency of such a phenomenon and the debate around its nature, frequency, and - at times - existence, we strongly believe it is important for all specialists who observe such cases to report them, building an evidence base to expand its knowledge and understanding.

Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis.

Endometriosis is one of the most common medical conditions affecting the women. The study aimed to evaluate the safety and efficacy of robotic-assisted laparoscopic surgery (RAS) versus conventional laparoscopic surgery (LPS) in the treatment of endometriosis. PubMed, Embase, Cochrane and CINAHL databases were searched from January 1995 to March 2019. According to meta-analysis criteria, five comparative studies were selected. A total of 1527 patients were identified. In the meta-analysis, there were no significant differences in blood loss, complication, and hospital stay between RAS and LPS surgeries in the treatment of patients with endometriosis. However, RAS surgery required a higher weighted mean operating time than LPS surgery, 0.54 (95% confidence interval; 0.37 to 0.70; p < 0.00001) min. This meta-analysis confirmed that the robotic surgery is safe and feasible in patients affected by endometriosis. We could suggest that RAS is a valid option and might be considered an alternative to LPS especially in advanced cases.

Loss of 5'-Methylthioadenosine Phosphorylase (MTAP) is Frequent in High-Grade Gliomas; Nevertheless, it is Not Associated with Higher Tumor Aggressiveness.

The 5'-methylthioadenosine phosphorylase (MTAP) gene is located in the chromosomal region 9p21. MTAP deletion is a frequent event in a wide variety of human cancers; however, its biological role in tumorigenesis remains unclear. The purpose of this study was to characterize the MTAP expression profile in a series of gliomas and to associate it with patients' clinicopathological features. Moreover, we sought to evaluate, through glioma gene-edited cell lines, the biological impact of MTAP in gliomas. MTAP expression was evaluated in 507 glioma patients by immunohistochemistry (IHC), and the expression levels were associated with patients' clinicopathological features. Furthermore, an in silico study was undertaken using genomic databases totalizing 350 samples. In glioma cell lines, MTAP was edited, and following MTAP overexpression and knockout (KO), a transcriptome analysis was performed by NanoString Pan-Cancer Pathways panel. Moreover, MTAP's role in glioma cell proliferation, migration, and invasion was evaluated. Homozygous deletion of 9p21 locus was associated with a reduction of MTAP mRNA expression in the TCGA (The Cancer Genome Atlas) - glioblastoma dataset (p < 0.01). In addition, the loss of MTAP expression was markedly high in high-grade gliomas (46.6% of cases) determined by IHC and Western blotting (40% of evaluated cell lines). Reduced MTAP expression was associated with a better prognostic in the adult glioblastoma dataset (p < 0.001). Nine genes associated with five pathways were differentially expressed in MTAP-knockout (KO) cells, with six upregulated and three downregulated in MTAP. Analysis of cell proliferation, migration, and invasion did not show any significant differences between MTAP gene-edited and control cells. Our results integrating data from patients as well as in silico and in vitro models provide evidence towards the lack of strong biological importance of MTAP in gliomas. Despite the frequent loss of MTAP, it seems not to have a clinical impact in survival and does not act as a canonic tumor suppressor gene in gliomas.

Three-dimensional classical and quantum stable structures of dissipative systems.

We study the properties of classical and quantum stable structures in a three-dimensional (3D) parameter space corresponding to the dissipative kicked top. This is a model system in quantum and classical chaos that gives a starting point for many body examples. We are able to identify the influence of these structures in the spectra and eigenstates of the corresponding (super)operators. This provides a complementary view with respect to the typical two-dimensional parameter space systems found in the literature. Many properties of the eigenstates, like its localization behavior, can be generalized to this higher-dimensional parameter space and spherical phase space topology. Moreover, we find a 3D phenomenon-generalizable to more dimensions-that we call the coalescence-separation of (q)ISSs, whose main consequence is a marked enhancement of quantum localization. This could be of relevance for systems that have attracted a lot of attention very recently.

Classical counterparts of quantum attractors in generic dissipative systems.

In the context of dissipative systems, we show that for any quantum chaotic attractor a corresponding classical chaotic attractor can always be found. We provide a general way to locate them, rooted in the structure of the parameter space (which is typically bidimensional, accounting for the forcing strength and dissipation parameters). In cases where an approximate pointlike quantum distribution is found, it can be associated with exceptionally large regular structures. Moreover, supposedly anomalous quantum chaotic behavior can be very well reproduced by the classical dynamics plus Gaussian noise of the size of an effective Planck constant ℏ_{eff}. We give support to our conjectures by means of two paradigmatic examples of quantum chaos and transport theory. In particular, a dissipative driven system becomes fundamental in order to extend their validity to generic cases.

Signatures of classical structures in the leading eigenstates of quantum dissipative systems.

By analyzing a paradigmatic example of the theory of dissipative systems-the classical and quantum dissipative standard map-we are able to explain the main features of the decay to the quantum equilibrium state. The classical isoperiodic stable structures typically present in the parameter space of these kinds of systems play a fundamental role. In fact, we have found that the period of stable structures that are near in this space determines the phase of the leading eigenstates of the corresponding quantum superoperator. Moreover, the eigenvectors show a strong localization on the corresponding periodic orbits (limit cycles). We show that this sort of scarring phenomenon (an established property of Hamiltonian and projectively open systems) is present in the dissipative case and it is of extreme simplicity.

Copy Number Profiling of Brazilian Astrocytomas.

Copy number alterations (CNA) are one of the driving mechanisms of glioma tumorigenesis, and are currently used as important biomarkers in the routine setting. Therefore, we performed CNA profiling of 65 astrocytomas of distinct malignant grades (WHO grade I-IV) of Brazilian origin, using array-CGH and microsatellite instability analysis (MSI), and investigated their correlation with TERT and IDH1 mutational status and clinico-pathological features. Furthermore, in silico analysis using the Oncomine database was performed to validate our findings and extend the findings to gene expression level. We found that the number of genomic alterations increases in accordance with glioma grade. In glioblastomas (GBM), the most common alterations were gene amplifications (PDGFRA, KIT, KDR, EGFR, and MET) and deletions (CDKN2A and PTEN) Log-rank analysis correlated EGFR amplification and/or chr7 gain with better survival of the patients. MSI was observed in 11% of GBMs. A total of 69% of GBMs presented TERT mutation, whereas IDH1 mutation was most frequent in diffuse (85.7%) and anaplastic (100%) astrocytomas. The combination of 1p19q deletion and TERT and IDH1 mutational status separated tumor groups that showed distinct age of diagnosis and outcome. In silico validation pointed to less explored genes that may be worthy of future investigation, such as CDK2, DMRTA1, and MTAP Herein, using an extensive integrated analysis, we indicated potentially important genes, not extensively studied in gliomas, that could be further explored to assess their biological and clinical impact in astrocytomas.

Correspondence behavior of classical and quantum dissipative directed transport via thermal noise.

We systematically study several classical-quantum correspondence properties of the dissipative modified kicked rotator, a paradigmatic ratchet model. We explore the behavior of the asymptotic currents for finite ℏ_{eff} values in a wide range of the parameter space. We find that the correspondence between the classical currents with thermal noise providing fluctuations of size ℏ_{eff} and the quantum ones without it is very good in general with the exception of specific regions. We systematically consider the spectra of the corresponding classical Perron-Frobenius operators and quantum superoperators. By means of an average distance between the classical and quantum sets of eigenvalues we find that the correspondence is unexpectedly quite uniform. This apparent contradiction is solved with the help of the Weyl-Wigner distributions of the equilibrium eigenvectors, which reveal the key role of quantum effects by showing surviving coherences in the asymptotic states.

Classical to quantum correspondence in dissipative directed transport.

We compare the quantum and classical properties of the (quantum) isoperiodic stable structures [(Q)ISSs], which organize the parameter space of a paradigmatic dissipative ratchet model, i.e., the dissipative modified kicked rotator. We study the spectral behavior of the corresponding classical Perron-Frobenius operators with thermal noise and the quantum superoperators without it for small ℏ(eff) values. We find a remarkable similarity between the classical and quantum spectra. This finding significantly extends previous results-obtained for the mean currents and asymptotic distributions only-and, on the other hand, unveils a classical to quantum correspondence mechanism where the classical noise is qualitatively different from the quantum one. This is crucial not only for simple attractors but also for chaotic ones, where just analyzing the asymptotic distribution is revealed as insufficient. Moreover, we provide with a detailed characterization of relevant eigenvectors by means of the corresponding Weyl-Wigner distributions, in order to better identify similarities and differences. Finally, this model being generic, it allows us to conjecture that this classical to quantum correspondence mechanism is a universal feature of dissipative systems.

A pilot study on the application of the current European guidelines for the management of acute coronary syndrome without elevation of ST segment (NSTEMI) in the Emergency Department setting in the Italian region Lazio.

BACKGROUND: In 2011 the European Society of Cardiology published the new guidelines for the treatment and management of acute coronary syndrome without elevation of the ST segment (NSTEMI). For the treatment of the syndrome, the use of P2Y12 inhibitors in addition to aspirin was strongly recommended (evidence IA). We studied the application of this recommendation in the setting of the emergency department in the vast and uneven area of the Italian region Lazio, three years after the release of these drugs in Italy. METHODS: 121 consecutive patients (65% older than 65 years) affected by NSTEMI were recruited between May and July 2013. During the transition in the emergency department data was collected on patient's symptoms, syndrome severity and type & timing of treatments chosen. Adherence to the guidelines was evaluated considering the number of "good treated" patients: these being the patients that received at least 80% of the main five recommendations on percutaneous coronary intervention (PCI) timing, antiplatelet and anti-coagulant therapy suggested by the European Cardiology Task Force (ESC guidelines, 2011) for the very acute phase of NSTEMI. RESULTS: Patients were treated with: 1) 35% of cases with double antiplatelet therapy and anticoagulation (DAPT+AC), 2) 22% of cases with single antiplatelet and anticoagulation (SAPT+AC), 3) 6% of cases with a single antiplatelet therapy (SAPT), 4) 6% of cases with a double antiplatelet therapy (DAPT) and 5) 24% of cases did not receive any therapy. Data on PCI was available for 95 patients and, of these, only 82% of the patients underwent the procedure. The percentage of "good treated" patients were among of 20-40%, depending on PCI timing--as guidelines suggested--was considered as mandatory (20,5%) or as the extreme time limit (40%). Significant differences were found between patients treated in a central hospital with a hemodynamic laboratory active 24/24hr (HUB) and patients treated in the other hospital (SPOKE). HUBs showed a higher percent of "good treated" patients, a higher percentage of early invasive treated and a better adherence to recommended pharmacological therapy. CONCLUSIONS: A significant number of patients did not receive adequate treatment during the emergency department stay. The absence of hemodynamic services increases the risk of inadequate treatment.

Rhinovirus frequently detected in elderly adults attending an emergency department.

The general aim was to investigate the burden of respiratory virus illness in a hospital emergency department, during two different epidemic seasons. Consecutive patients attending an emergency department during two study periods (February/March 2009 and 2010) were enrolled using broad inclusion criteria (fever/preceding fever and one of a set of ICD-9 codes suggestive of respiratory illness); nasopharyngeal washes were tested for the most common respiratory viruses using PCR-based methods. Influenza A virus was detected in 24% of samples collected in February/March 2009, whereas no samples tested positive for influenza during February/March 2010 (pandemic H1N1 Influenza A having circulated earlier in October-December 2009). Rhinovirus (HRV) was detected in 16% and 8% of patients recruited over the two study periods, respectively. Other respiratory viruses were detected rarely. Patient data were then analyzed with specific PCR results, comparing the HRV-positive group with virus-positive and no virus-detected groups. Individuals over 65 years old with HRV presented with signs, symptoms and underlying conditions and were admitted to hospital as often as the other enrolled patients, mainly for dyspnoea and chronic obstructive pulmonary disease acute exacerbation. Conversely, younger individuals with HRV, although presenting with respiratory signs and symptoms, were generally diagnosed with non-respiratory conditions. HRV was detected frequently in elderly patients attending the emergency department for respiratory distress without distinguishing clinical features. Molecular diagnosis of lower respiratory tract infections and surveillance of infectious diseases should include tests for HRV, as this virus is associated frequently with hospitalization of the elderly.

Clinical and laboratory aspects of Ro/SSA-52 autoantibodies.

Anti-Ro/SSA antibodies, which were described for the first time in systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS), are the most prevalent extractable nuclear antigen (ENA) specificity identified in laboratories. Two types of anti-Ro/SSA antibodies have been described, anti-SSA-52 kDa (aSSA52) and anti-SSA-60 kDa (aSSA60), each specific to different antigens. Anti-Ro/SSA52 autoantibodies are more frequent than other autoantibodies possibly because of the antigen's accessible and ubiquitous nature. The sites involved and the symptoms associated with these autoantibodies depend on the antigen's structural variability. Isolated congenital complete atrioventricular block (CAVB) shows a close association with maternal anti-Ro/SSA and anti-La/SSB antibodies; the highest relative risks of CAVB are seen in offspring of mothers with antibodies against 52-kDa Ro and 48-kDa La proteins. Anti-Ro/SSA52 antibodies have little impact on adult rheumatic autoimmune diseases or adult cardiac arrhythmias, but the course of autoimmune liver diseases is greatly worsened by their presence, and solid tumours tend to relapse. Their diagnostic role in rheumatic diseases is controversial, although a significant association between isolated anti-Ro/SSA52-kDa positivity and myositis and to a lesser extent with systemic sclerosis (SSc) has been described. However, the majority of the specific diagnosis is mostly based on the simultaneous presence of other autoantibodies that seems diagnostically more relevant.

Spectral behavior of contractive noise.

We study the behavior of the spectra corresponding to quantum systems subjected to a contractive noise, i.e., the environment reduces the accessible phase space of the system, but the total probability is conserved. We find that the number of long-lived resonances grows as a power law in h, but surprisingly there is no relationship between the exponent of this power law and the fractal dimension of the corresponding classical attractor. This is in disagreement with the predictions of the fractal Weyl law which has been established for open systems, where the probability is lost under the effect of a projective opening.

Dimensión ética en la práctica odontológica: visión personalista / Dimensão ética na prática odontológica: visão personalista / Ethical dimension in dentristy practice: personalist viewpoint

En la práctica odontológica, los profesionales enfrentan permanentemente diversos dilemas éticos. Cada odontólogo debe tomar determinaciones sobre si tiene o no competencia para realizar un diagnóstico particular o para llevar a cabo tratamientos específicos en determinadas circunstancias clínicas. Asuntos como éstos han dado lugar a un número cada vez mayor de discusiones y debates respecto de la ética en cuidados de la salud. Las preocupaciones de carácter ético resultan especialmente relevantes en el campo de la odontología, en virtud de que, a medida que crece el número de estudios en este campo, se estrecha la línea que separa la práctica de la obtención de información con fines de investigación.

In the practice of dentistry, professionals face diverse ethical dilemmas permanently. Every dentist must make determinations whether he/she has competence for a particular diagnose or to carry out specific treatments in specific clinical circumstances. Issues such as these have given place to increasing discussions and debates with respect to health care ethics. Ethical worries are specially relevant in dentistry field, since while number of studies increase in this field, the limit separating practice from obtaining information for research purposes is narrowed.

Na prática odontológica, os profissionais enfrentam permanentemente diversos dilemas éticos. Cada odontólogo deve tomar decisões acerca de sua competência ou não para realizar um diagnóstico particular ou levar a cabo tratamentos específicos em determinadas circunstâncias clínicas. Assuntos como estes têm dado lugar a um número cada vez maior de discussões e debates a respeito da ética em cuidados da saúde. As preocupações de caráter ético resultam especialmente relevantes no campo da odontologia, em virtude de que, à medida que cresce o número de estudos neste campo, se estreita a linha que separa a prática da obtenção de informação com finalidades de investigação.

[Frequency and clinical associations of antineutrophil cytoplasmic antibodies. A regional experience]. / Frequenza e associazioni cliniche degli anticorpi anti citoplasma dei neutrofili. Un'esperienza locale.

Serologic and clinical aspects of 50 positives patients for antineutrophil cytoplasmic antibodies (ANCA) have been evaluated (age range 7-94 years, mean age 43 years). 40 (80%) were females. Antineutrophil nuclear antibodies (pANNA), in which the antigenic specificity is unknown, were detected in seventeen patients (34%). About half of these cases (8 patients) had primary sclerosing cholangitis and other 7 patients had severe ulcerative colitis. Two pANNA patients, with increased susceptibility to infections, had undefined diagnosis. Both had thalassemic trait. Anti MPO were detected in 9 patients in which segmental lesions prevail and anti-PR3 were detected in 9 patients with granulomatous component. The patients with higher levels of these autoantibodies (40%) had the typical syndromes described in literature (vasculitis ANCA-related) although patients with lower autoantibodies levels (60%) mostly present variable clinical symptoms with unspecified diagnosis. Fourteen patients were positive for atypical ANCA detectable with commercial kits. They present variable clinical symptoms with unspecified diagnosis but show granulomatous or neoplastic lungs and bowel involvement. Both have mostly contact with environmental microorganisms. All cases are characterized by chronic inflammatory lesions in which the relapses correlate with infectious disorder.

[Serological and clinical aspects in initial Wegener's disease. A case report]. / Granulomatosi di Wegener in fase acuta iniziale: aspetti clinici e sierologici.

The clinical and biochemical features of an acute and initial Wegener's granulomatosis case were analysed in a young woman. A multifactorial aspects are evident. A chronic inflammation of the superior respiratory tract has been observed. Staphylococcus aureus has been isolated. An oligoclonal component constituted of high levels of anti-PR3 autoantibodies was detected: initial autoreactive B cell clone activation is probable. The chronological link with postpartum is present: our study excluded foetal microchimerism; the hormonal state can be a trigger factor. Serical IL-17 was negative.