Gender differences and multiple determinants of perceived physical and mental health in Italy.

Background: Perceived health is largely dependent on multiple socio-demographic and behavioral lifestyles and healthcare related factors. This could be accentuated when gender is taken into account. The aim of this study is to explore gender-related differences in multiple socio-demographic and behavioral lifestyles and healthcare related factors associated with individual health status and to identify those responsible for changes in perceived physical and mental health among men and women in Italy. Study design: We conducted a cross-sectional retrospective study to investigate the association between multiple socio-demographic and behavioral lifestyles and healthcare related factors and individual health status of 99,479 adults in Italy, using data and information obtained from a nationwide survey. Methods: To identify the factors that correlate with the perceived physical and mental health status between males and females, we employed a censored regression analysis, a Tobit model, stratifying the analysis by gender. Results: Socio-demographic and behavioral lifestyles factors differently impact on males and females and this impact is stronger on perceived physical than mental health. The perceived physical and mental health status resulted better for men than for women. The integrated analysis of gender differences in socio-demographic and behavioral lifestyles and determinants of health revealed important inequalities, mainly related to citizenship and educational level, among the socio-demographic factors, and smoking habit and obesity, among the behavioral lifestyle factors. Conclusions: Gender imbalances mainly fall into inequality in social inclusion, educational level, and healthy lifestyle. This demonstrates how gender differences are still abundantly present in the modern Italian society. Such information should be taken into consideration by policy makers when interventions to improve the health and quality of life of the population are planned or evaluated.

Impact of intestinal dysbiosis-related drugs on the efficacy of immune checkpoint inhibitors in clinical practice.

PURPOSE: Intestinal dysbiosis has emerged as a biomarker of response to immune checkpoint inhibitors (ICIs). It can be caused by antibiotics, although it may also result from the use of other drugs that have been studied to a lesser extent. The objective of our study was to analyze the association between the use of potentially dysbiosis-related drugs and survival in patients treated with ICIs in the clinical practice. MATERIALS AND METHODS: A retrospective, multicenter, cohort study was conducted. Clinicopathological variables were collected and the concomitant use of drugs was analyzed. A descriptive analysis of variables and overall survival, estimated by the Kaplan-Meier method, was performed, and association with various independent variables was assessed using Cox regression. RESULTS: We included 253 patients, mainly with non-small cell lung cancer and melanoma. The most commonly used drugs were acid reducers, prescribed to 55.3% of patients, followed by corticosteroids (37.9%), anxiolytic drugs (35.6%), and antibiotics (20.5%). The use of acid reducers (9 vs. 18 months, P < .0001), antibiotics (7 vs. 15 months, P < .017), anxiolytic drugs (8 vs. 16 months, P < .015), and corticosteroids (6 vs. 19 months, P < .00001) was associated with poorer overall survival. Furthermore, the greater the number of drugs used concomitantly with ICIs, the higher the risk of death (1 drug: hazard ratio, 1.88; CI 95%, 1.07-3.30; 4 drugs: hazard ratio, 4.19; CI9 5%, 1.77-9.92; P < .001). CONCLUSION: Response to ICIs may be influenced by the use of drugs that lead to intestinal dysbiosis. Although a confirmatory prospective controlled study is required, our findings should be taken into account when analyzing ICI efficacy.

An assessment of contamination of the Fusaro Lagoon (Campania Province, southern Italy) by trace metals.

The Fusaro Lagoon is a shallow lagoon, located in SW Italy, largely influenced in the last decades by several anthropic impacts. The study examined the pollution status of the lagoon, during year 2011-2012 at nine sampling stations with the aim to find out proper measurements of water lagoon restoration. Concentrations of heavy metals (HMs) (aluminium [Al], barium [Ba], cadmium [Cd], copper [Cu], iron [Fe], manganese [Mn], vanadium [V] and zinc [Zn]) were examined in water, sediments and specimens of the ascidian Ciona intestinalis sp. A. Low levels of dissolved oxygen concentration were detected at many stations, with mean values of 5.2-6.4 mg L(-1). The redox potential of surface waters was also low, -2.7 to 50.7 mV. Sediments possessed high organic matter content, 17.7-29.4%. In sediments, the mean Zn level, 251.4 mg kg(-1), was about sixfold higher than that recorded in year 2000 (38.5 mg kg(-1)) and considerably higher than that recorded in 2007 (191 mg kg(-1)). The mean levels of Cd were outstandingly high, with a mean value of 70.5 mg kg(-1), about 30- and 50-fold higher than those determined in 2000 and 2007, respectively. Cadmium (Cd), Cu and nickel (Ni) appeared in excess with respect to most current guidelines, reaching significant pollution levels. C. intestinalis sp. A was detected only at few stations, with metals accumulated preferentially in the body in respect to the tunic, from 1.2 times for Zn (178 mg kg(-1)) to 4.0 times for V (304 mg kg(-1)). Data suggests the necessity of an immediate action of eco-compatible interventions for environmental restoration.

Reliable entanglement detection under coarse-grained measurements.

We derive reliable entanglement witnesses for coarse-grained measurements on continuous variable systems. These witnesses never return a "false positive" for identification of entanglement, under any degree of coarse graining. We show that even in the case of Gaussian states, entanglement witnesses based on the Shannon entropy can outperform those based on variances. We apply our results to experimental identification of spatial entanglement of photon pairs.

Giant right atrial thrombus in hepatocellular carcinoma: real-time characterization by cardiac magnetic resonance and real time three-dimensional echocardiography.

Hepatocellular carcinoma (HCC) with extension to the right atrium is an uncommon form of cardiac involvement. We report a case of a 67-year-old man admitted to our Department for the incidental findings of a mass in the right atrium. Physical examination revealed leg edema, distention of external jugular vein and ascites. The anamnestic collection revealed HCC occurred on post-alcoholic liver cirrhosis 3 years earlier. Transthoracic echocardiography revealed a dilated RA containing a mass, with superficial apposition of a thrombotic material. Bi-dimensional echocardiography is the most commonly used noninvasive tool for evaluating intracardiac masses. Although MRI is considered the gold standard, real-time three-dimensional echocardiography has the capability to obtain the entire volume reconstruction of an intracardiac mass, even with an irregular shape. Moreover, it permits an hemodynamic evaluation of the potential obstructive effects visualized from different angles and planes.

dsRNA induces apoptosis through an atypical death complex associating TLR3 to caspase-8.

Toll-like receptor 3 (TLR3) is a pattern-recognition receptor known to initiate an innate immune response when stimulated by double-stranded RNA (dsRNA). Components of TLR3 signaling, including TIR domain-containing adapter inducing IFN-α (TRIF), have been demonstrated to contribute to dsRNA-induced cell death through caspase-8 and receptor interacting protein (RIP)1 in various human cancer cells. We provide here a detailed analysis of the caspase-8 activating machinery triggered in response to Poly(I:C) dsRNA. Engagement of TLR3 by dsRNA in both type I and type II lung cancer cells induces the formation of an atypical caspase-8-containing complex that is devoid of classical death receptors of the TNFR superfamily, but instead is physically associated to TLR3. The recruitment of caspase-8 to TLR3 requires RIP1, and is negatively modulated by cellular inhibitor of apoptosis protein (cIAP)2-TNF receptor-associated factor (TRAF)2-TNFR-associated death domain (TRADD) ubiquitin ligase complex, which regulates RIP1 ubiquitination. Intriguingly, unlike Fas- or TRAILR-dependent death signaling, caspase-8 recruitment and activation within the TLR3 death-signaling complex appears not to be stringently dependent on Fas-associated with death domain (FADD). Our findings uncover a novel aspect of the molecular mechanisms involved during apoptosis induced by the innate immune receptor TLR3 in cancer cells.

ECHO and magnetic resonance imaging in a patient with high bleeding risk and ventricular perforation: a case report and literature review.

Myocardial perforation is a complication following pacemaker implantation that may cause cardiac tamponade. We present an original case of myocardial lead perforation not complicated by acute cardiac tamponade. The patient with an acute myocardial infarct had a high bleeding risk both in the acute phase of lead insertion (anticoagulant and triple platelet anti-aggregation therapy) and after few days, the percutaneous extraction lead for the double platelet antiaggregant therapy. Torrent-Guasp's theory is considered for explaining the clinical course of patient. Echocardiography and magnetic resonance imaging (MRI) evaluation showed a diffuse pericardial non-hemorrhagic fibrinous effusion and guide the clinical management.

Revealing hidden Einstein-Podolsky-Rosen nonlocality.

Steering is a form of quantum nonlocality that is intimately related to the famous Einstein-Podolsky-Rosen (EPR) paradox that ignited the ongoing discussion of quantum correlations. Within the hierarchy of nonlocal correlations appearing in nature, EPR steering occupies an intermediate position between Bell nonlocality and entanglement. In continuous variable systems, EPR steering correlations have been observed by violation of Reid's EPR inequality, which is based on inferred variances of complementary observables. Here we propose and experimentally test a new criterion based on entropy functions, and show that it is more powerful than the variance inequality for identifying EPR steering. Using the entropic criterion our experimental results show EPR steering, while the variance criterion does not. Our results open up the possibility of observing this type of nonlocality in a wider variety of quantum states.

Peeking through the cracks: an assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting.

Little is known about the prevalence of the recently defined polypathology notion in hospital populations. Patients admitted to medical wards were assessed using established criteria of polypathology. Prevalence of polypathology, interobserver reliability, clinical features, nutritional status, and HRQoL were assessed using clinical data and interview, mini-nutritional assessment (MNA), and the 12-item short-form health survey (SF-12) scales. Of a total of 812 patients studied, 196 (24%) met polypathology criteria (65% men, of mean age 71.3+/-11.6 years, mean defining chronic diseases 2.4+/-0.046, and other comorbidities 2.6+/-0.094). Interobserver reliability for the detection of cases was good (kappa=0.628). Their mean Charlson index/prescribed drugs were 3.3/6, respectively. Severe dyspnea, delirium, or active neoplasia were present in 44, 15, and 11%. A bad nutritional status/risk of malnutrition was evident in 10.3/52.6%, and correlated with the number of previous hospitalizations (p=0.041), and the presence of active neoplasia (p=0.037). Mean physical/mental summaries of HRQoL were 33.9+/-10, and 42+/-13, and correlated with a better nutritional status (p=0.011, and p=0.001, respectively). Polypathology affects one quarter of inpatients in a hospital setting, and can be easily and reliably identified. The diversity and complexity of patient needs underscore the need for continuity of care between community and hospital, crossing sub-speciality lines and institutional boundaries.

Quantum entanglement beyond Gaussian criteria.

Most of the attention given to continuous variable systems for quantum information processing has traditionally been focused on Gaussian states. However, non-Gaussianity is an essential requirement for universal quantum computation and entanglement distillation, and can improve the efficiency of other quantum information tasks. Here we report the experimental observation of genuine non-Gaussian entanglement using spatially entangled photon pairs. The quantum correlations are invisible to all second-order tests, which identify only Gaussian entanglement, and are revealed only under application of a higher-order entanglement criterion. Thus, the photons exhibit a variety of entanglement that cannot be reproduced by Gaussian states.

Entropic entanglement criteria for continuous variables.

We derive several entanglement criteria for bipartite continuous variable quantum systems based on the Shannon entropy. These criteria are more sensitive than those involving only second-order moments, and are equivalent to well-known variance product tests in the case of Gaussian states. Furthermore, they involve only a pair of quadrature measurements, and will thus prove extremely useful in the experimental identification of entanglement.

Observation of a nonlocal optical vortex.

We report the observation of an optical vortex in the correlations of photons produced from spontaneous parametric down-conversion. The singularity appears in a nonlocal coordinate plane consisting of 1 degree of freedom of each photon.

P53-mediated upregulation of DcR1 impairs oxaliplatin/TRAIL-induced synergistic anti-tumour potential in colon cancer cells.

Oxaliplatin has emerged as a major chemotherapeutic drug in the treatment of advanced colorectal cancer, yet like most conventional cancer therapeutics, its efficacy is often compromised due to p53 mutations. Unlike oxaliplatin, tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) triggers apoptosis in a p53-independent manner, and chemotherapy is known to overcome tumour resistance to TRAIL-induced cell death in most cancer cells. Using a panel of colon cancer cell lines, we assessed the ability of oxaliplatin to sensitize to TRAIL-induced apoptosis. We demonstrate that while both drugs additively or synergistically induced apoptosis in almost all cell lines tested, p53 wild-type colon cancer cells such as HCT116, LS513 or LS174T remained resistant. Impaired TRAIL-induced cell death resulted from a strong p53 dependent, oxaliplatin-mediated, DcR1 receptor expression increase. According to our finding, downregulation of DcR1 using siRNA, in p53 wild-type colon cancer cells, restored oxaliplatin/TRAIL synergistic apoptotic activity. On the contrary, exogenous DcR1 overexpression in SW480, a p53-mutated cell line, abolished the synergy between the two drugs. Altogether we demonstrate for the first time that p53 negatively regulates oxaliplatin-mediated TRAIL-induced apoptotic activity through DcR1 upregulation. Our findings could have important implications for future therapeutic strategies, and suggest that the association oxaliplatin/TRAIL should be restricted to patients harbouring a non-functional p53 protein.

Family physicians clinical aptitude for the nutritional management of type 2 diabetes mellitus in Guadalajara, Mexico.

There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.

Scars of the Wigner Function.

We propose a picture of Wigner function scars as a sequence of concentric rings along a two-dimensional surface inside a periodic orbit. This is verified for a two-dimensional plane that contains a classical hyperbolic orbit of a Hamiltonian system with 2 degrees of freedom. The stationary wave functions are the familiar mixture of scarred and random waves, but the spectral average of the Wigner functions in part of the plane is nearly that of a harmonic oscillator and individual states are also remarkably regular. These results are interpreted in terms of the semiclassical picture of chords and centers.

[Surgical treatment of thyroid diseases in geriatric patients]. / Il trattamento delle tireopatie chirurgiche nel paziente in età geriatrica.

Thyroid diseases have a characteristic evolution in geriatric age, whether for the symptomatology frequently mingled with typical manifestations of again, or for glandular involution. Moreover, in the aged patient, the particular aspect of the epidemiology, physiopathology, clinic and therapy are to know and interpret. In most cases, the presence of a uni- or multi-nodular goiter does not cause compression problems or cancerization risk. In the presence of these problems and in multi-nodular goiter, we prefer total thyroidectomy because, at the present time, it is possible to put at zero the risks of this operation, neither we fear hypothyroidism which all the same also appears in less extensive operations. Between thyroid diseases, cancer has a typical biological behaviour and prognosis in geriatric patients. While most tumors have a better curability in geriatric age, these have a worse prognosis. So therapeutic indications very as a function of age. About this the authors present preliminary data of a prospective trial started in 1992.

Neuroendocrine and immunocytochemical demonstrations of decreased hypothalamo-pituitary-adrenal axis responsiveness to restraint stress after long-term social isolation.

We have studied the effects of long-term social isolation of male Wistar rats, after early weaning (16 days), on the activity of the hypothalamo-pituitary-adrenal (HPA) axis. In addition to studying basal HPA activity, the response of the HPA axis to 15 min of immobilization stress was examined. Plasma corticosterone concentrations were measured, and the relative weights of adrenal glands, thymus, and testes were obtained, the latter to check whether gonadal function was affected by the isolation paradigm. Moreover, we carried out a quantitative immunohistochemical study of pituitary ACTH and its hypothalamic secretagogues: CRF, arginine vasopressin (AVP), and oxytocin (OT), both at the level of the synthesizing cell bodies in the hypothalamic paraventricular nucleus and of the releasing fibers in the median eminence (ME). Body weight and daily consumption of food and water were not altered, but social isolation caused a reduction in plasma corticosterone levels, both under basal and stress-stimulated conditions; this was correlated with an increased thymus weight, without affecting adrenal or testicular weights. The immunohistochemical study revealed that isolation caused a smaller increase in the number of ACTH-immunoreactive cells in the pars distalis of the anterior pituitary after exposure to restraint stress, as compared with control animals. This result indicates that fewer corticotrophs were activated by restraint stress in isolated animals, such cells being smaller and exhibiting a smaller ACTH-immunoreactive area than in control animals. Isolated animals also showed an increase in the content of CRF-ir fibers in the ME and a smaller decrease in the neuropeptide immunoreactivity after stress than that observed in control animals. This result could indicate a reduced release of CRF into the portal vasculature in response to acute stress and may partially explain the reduced activation of corticotrophs observed in the pituitary of isolated animals. However, no changes were found in the content of CRF, AVP, or OT within the paraventricular nucleus, nor of the AVP or OT content in the ME. The results of this study show that long-term social isolation after early weaning caused a hypofunction of the HPA axis in the adult rat. This hypofunction was particularly evident after exposure to an acute stressor, suggesting a desensitization of this axis to stressful stimuli.

[Use of mechanical staplers in surgery of aneurysms of the abdominal aorta]. / L'impiego delle cucitrici meccaniche nella chirurgia degli aneurismi dell'aorta addominale.

This research aims to illustrate the advantages of using staplers in abdominal aorta surgery. The authors describe their experience in a personal case, of a patient suffering from aneurysmatic expansion of the abdominal aorta extending to both the common iliac arteries. The use of staplers for the closing of the distal stumps in particularly advantageous because it makes less problematic the dissection of the iliac and by hypogastric artery from their underlying veins. That involves a risk diminution of the iliac vein accidental lesions, better by hypogastric artery revascularization, shortening of any times and the perfect haemostatic holding of the mechanical suture, allowing a reduction in mortality and morbidity.