Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals.

PURPOSE: The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. METHODS: A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. RESULTS: Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. CONCLUSION: The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.

New statistical RI index allow to better track the dynamics of COVID-19 outbreak in Italy.

COVID-19 pandemic in Italy displayed a spatial distribution that made the tracking of its time course quite difficult. The most relevant anomaly was the marked spatial heterogeneity of COVID-19 diffusion. Lombardia region accounted for around 60% of fatal cases (while hosting 15% of Italian population). Moreover, 86% of fatalities concentrated in four Northern Italy regions. The 'explosive' outbreak of COVID-19 in Lombardia at the very beginning of pandemic fatally biased the R-like statistics routinely used to control the disease dynamics. To (at least partially) overcome this bias, we propose a new index RI = dH/dI (daily derivative ratio of H and I, given H = Healed and I = Infected), corresponding to the ratio between healed and infected patients relative daily changes. The proposed index is less flawed than R by the uncertainty related to the estimated number of infected persons and allows to follow (and possibly forecast) epidemic dynamics in a largely model-independent way. To analyze the dynamics of the epidemic, starting from the beginning of the virus spreading-when data are insufficient to make an estimate by adopting SIR model-a "sigmoidal family with delay" logistic model was introduced. That approach allowed in estimating the epidemic peak using the few data gathered even before mid-March. Based on this analysis, the peak was correctly predicted to occur by end of April. Analytical methodology of the dynamics of the epidemic we are proposing herein aims to forecast the time and intensity of the epidemic peak (forward prediction), while allowing identifying the (more likely) beginning of the epidemic (backward prediction). In addition, we established a relationship between hospitalization in intensive care units (ICU) versus deaths daily rates by avoiding the necessity to rely on precise estimates of the infected fraction of the population The joint evolution of the above parameters over time allows for a trustworthy and unbiased estimation of the dynamics of the epidemic, allowing us to clearly detect the qualitatively different character of the 'so-called' second wave with respect to the previous epidemic peak.

Validation of the objective assessment of facial movement with a new software-based system.

BACKGROUND: Most used subjective Unilateral Peripheral Facial Palsy (UPFP) grading systems are characterized by high variability and low reproducibility and doesn't allow a separate evaluation of single facial regions. OBJECTIVE: To assess the reliability of a new objective method for classification of UPFP, comparing it with House-Brackmann (HB) and Sunnybrook facial grading (SFGS) systems. METHOD: Forty-seven patients affected by UPFP of different HB grade were included. Each patient underwent a blinded examination by three different operators, via the two subjective methods (HBGS and SFGS) and a newly proposed objective one, that was obtained from a digital video-analysis, named SMART FACIAL system. Results were converted by validated conversion scales into HBGS grades and statistically compared. RESULTS: In 87,23% (n° 41 pts) consistency was found between the grades obtained with all the three evaluation methods; in 10,41% (n°5 pts), between HBGS and SFGS grade and in 2,08% (n°1 pt) between HBGS grades and SMART-FACIAL system. Statistical analysis showed significant correlation among the three systems (p < .000). CONCLUSIONS: The SMART FACIAL system presents high reliability also in comparison with the most frequently used subjective methods. SIGNIFICANCE: This method represents a fast, simple and thorough way to analyze UPFP, especially during physical rehabilitation.

Ultra-trace determination of total mercury in Italian bottled waters.

Mercury (Hg) is a widespread, highly toxic persistent pollutant with adverse health effects on humans. So far, concentrations below the method detection limit have always been reported by studies on the concentration of mercury in bottled water when determined using instrumental analytical methods. These are often very expensive and are unaffordable for many laboratories. In this work, a less expensive method based on cold vapour atomic fluorescence spectrometry has been employed to determine total mercury (HgT) concentrations in bottled natural mineral waters. In all, 255 waters representing 164 different typologies were analysed. They came from 136 springs located in 18 Italian regions. In all samples, HgT concentrations were found in the range of sub-nanogram to a few nanograms per litre, well below the National and European regulatory limit (1 µg L-1). Differences in HgT concentrations were related not only to the environmental characteristics of the springs but also to the extent and impact of human activities. Higher concentrations were found in waters coming from regions with former mining and/or natural thermal and volcanic activity. These data allowed us to estimate the mercury intake by population (adults, children and toddlers) from drinkable mineral waters consumption. The mean mercury daily intake was found to be remarkably lower, not only than the provisional tolerable value (1 µg L-1 according to European and Italian legislation) but also than the estimated provisional tolerable weekly intake (PTWI) value (4 µg kg-1 body weight) recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA).

Bold personality makes domestic dogs entering a shelter less vulnerable to diseases.

It is widely recognised that for vertebrate species, personalities vary along an axis with extremes represented by 'proactive' and 'reactive' individuals. The aim of this study was to verify whether there is a relationship between personality and disease vulnerability in domestic dogs (Canis familiaris) exposed to an intensely stressful situation such as entering a shelter. Twenty-eight shelter dogs participated in the study. The ethogram consisted of approximately 100 behavioural patterns. Behavioural observations of dogs in their new environment, a Novel Object and a T-maze test were used to evaluate the personality of the dogs captured as strays and entering the shelter. A blood sample from each dog was obtained at admission into the shelter and after a month to evaluate their immunological state. Based on PCA analyses of observational combined with experimental data, the dogs were ordered along the boldness-shyness axis, with the first being the boldest. Excluding one (the 6th), the first 10 dogs showed an improved health status: absence of disease symptoms during the 30 days of monitoring and improved immunological parameters; the opposite was found for shy dogs. The results of this research seem to confirm findings in other vertebrate species, i.e., bold and shy dog vulnerability to diseases might be different, especially when they must cope with a stressful and highly infectious environment such as a dog shelter.

Quality of Life in Workers and Stress: Gender Differences in Exposure to Psychosocial Risks and Perceived Well-Being.

BACKGROUND: Quality of working life is the result of many factors inherent in the workplace environment, especially in terms of exposure to psychosocial risks. OBJECTIVES: The purpose of this study is to assess the quality of life with special attention to gender differences. METHODS: The HSE-IT questionnaire and the WHO-5 Well-Being Index were administered to a group of workers (74 males and 33 females). The authors also used Cronbach's alpha test to assess the internal consistency of both questionnaires and the Mann-Whitney test to evaluate the significance of gender differences in both questionnaires. RESULTS: The HSE-IT highlighted the existence of work-related stress in all the population with a critical perception regarding the domain "Relationships." Furthermore, gender analysis highlighted the presence of two additional domains in the female population: "Demand" (p = 0,002) and "Support from Managers" (p = 0,287). The WHO-5 highlighted a well-being level below the standard cut-off point with a significant gender difference (p = 0.009) for males (18, SD = 6) as compared to females (14, SD = 6,4). Cronbach's alpha values indicated a high level of internal consistency for both of our scales. CONCLUSIONS: The risk assessment of quality of working life should take into due account the individual characteristics of workers, with special attention to gender.

Kabat rehabilitation for Bell's palsy in the elderly.

CONCLUSIONS: This study has confirmed the importance of combining the physical rehabilitation to the steroid treatment for a better outcome from BP in all age groups, especially in the old HB grade V. OBJECTIVES: To investigate the role played by aging in the recovery rate from peripheral facial nerve palsy. METHOD: In the present study, subjects affected by peripheral facial nerve palsy, distributed by age, were randomly assigned to medical treatment, either alone or associated with Kabat physical rehabilitation. Rate and speed of recovery were assessed in the younger and older groups. All the patients were also asked to fill in a specific questionnaire (beta FAce scale). A series of non-parametric tests (McNemar Chi-square and Chi-square) have been applied to verify the hypothesis of dependence of the final recovery level from the variables age and rehabilitation. RESULTS: The results show that, when treated only by medical therapy, the HB V subjects showed no significant age difference in relation to the achievement of a HB Grade III (100% in the over 65, 80% in the under 65), whilst, in the HB IV subjects, the younger population showed a better recovery, with 89% of a good recovery (HB I or II). In the patients who received the combined protocol, a better recovery rate was found, both in HB IV and V subjects, and the younger population could reach a good recovery in 90% of HB V cases in respect to the older population (50%).

An oral high dose of cholecalciferol restores vitamin D status in deficient postmenopausal HIV-1-infected women independently of protease inhibitors therapy: a pilot study.

The best repletion and maintenance dosing regimens with cholecalciferol in vitamin D-deficient HIV-1 patients remain unknown. Protease inhibitors (PIs) have been shown to inhibit vitamin D 1α- and 25α-hydroxylation in hepatocyte and monocyte cultures. We therefore evaluated the effect of a single high dose of cholecalciferol in vitamin D-deficient HIV-1 postmenopausal women undergoing treatment with highly active anti-retroviral therapy (cART), with and without PIs. Forty HIV-1 postmenopausal women treated with cART, with hypovitaminosis D (<20 ng/ml), were enrolled. We measured serum changes of 25-hydroxyvitamin D [25(OH)D]; 1,25-dihydroxyvitamin D [1,25(OH)2D], parathyroid hormone (PTH), serum calcium, and urinary calcium excretion following a loading dose of 600,000 IU of cholecalciferol after 3, 30, 60, 90, and 120 days. Patients were divided into two groups, whether or not they were taking PI. A significant increase in mean 25(OH)D and 1,25(OH)2D levels at day 3 and throughout the entire observation period was found in both groups (p < 0.001). PTH levels concomitantly decreased in both groups (p < 0.001). Mean albumin-adjusted serum calcium increases with respect to baseline were significant only at day 3 and day 30 for both groups (p < 0.01). Considering remaining parameters, there were no significant differences between the groups at any time, by two-way RM ANOVA. An oral dose of 600,000 IU of cholecalciferol in HIV-1 postmenopausal women rapidly increases 25(OH)D and 1,25(OH)2D levels reducing PTH levels, regardless of the presence of PIs in the cART scheme.

Natalizumab in multiple sclerosis: discontinuation, progressive multifocal leukoencephalopathy and possible use in children.

In the early 1990s, attention was drawn to the migration of immune cells into the central nervous system via the blood-brain barrier. The literature showed that lymphocytes binding to the endothelium were successfully inhibited by an antibody against α4ß1 integrin. These biological findings resulted in the development of a humanized antibody to α4 integrin - natalizumab (NTZ) - to treat multiple sclerosis (MS). Here, we provide a systematic review and meta-analysis on the efficacy and safety of natalizumab, trying to answer the question whether its use may be recommended both in adult and in pediatric age groups as standard MS treatment. Our results highlight the improvement of clinical and radiological findings in treated patients (p < 0.005), confirming NTZ efficacy. Nevertheless, if NTZ is shown to be efficient, further studies should be performed to evaluate its safety and to target the MS profile that could benefit from this treatment.

Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children.

PURPOSE: The purpose of this study was to define, in children following head trauma and GSC ≤ 8, at which level of intracranial pressure (ICP), the thermodilutional, and gas analytic parameters implicated in secondary cerebral insults shows initial changes. METHODS: We enrolled in the study 56 patients: 30 males and 26 females, mean age 71 ± 52 months. In all children, volumetric hemodynamic and blood gas parameters were monitored following initial resuscitation and every 4 h thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative hospital stay, a total of 1050 sets of measurements were done. All parameters were stratified in seven groups according to ICP (group A1 = 0-5 mmHg, group A2 = 6-10 mmHg, group A3 = 11-15 mmHg, group A4 16-20 mmHg, group A5 21-25 mmHg, group A6 26-30 mmHg, group A7 >31 mmHg). RESULTS: Mean values of jugular oxygen saturation (SJO2), jugular oxygen partial pressure (PJO2), extravascular lung water (EVLWi), pulmonary vascular permeability (PVPi), fluid overload (FO), and cerebral extraction of oxygen (CEO2) vary significantly from A3 (11-15 mmHg) to A4 (16-20 mmHg). They relate to ICP in a four-parameter sigmoidal function (4PS function with: r(2) = 0.90), inflection point of 15 mmHg of ICP, and a maximum curvature point on the left horizontal asymptote at 13 mmHg of ICP. CONCLUSIONS: Mean values of SJO2, PJO2, EVLWi, PVPi, FO, and CEO2 become pathologic at 15 mmHg of ICP; however, the curve turns steeper at 13 mmHg, possibly a warning level in children for the development of post head trauma secondary insult.