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Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Preoperative rehabilitation is the set of all physiotherapeutic interventions put in place prior to a surgical approach, with the aim of an improvement in the individual’s functional abilities. Although its usefulness in patients undergoing major surgery has been demonstrated, its application in patients with musculoskeletal issues still remains an understudied and controversial area. Benefits on pain and ROM outcomes do not exceed 6-12 months after surgery, but some considerations justify the setting of prehabilitation in patients who will undergo surgery for shoulder instability [ABSTRACT FROM AUTHOR]

Since its conception, reverse total shoulder arthroplasty (RTSA) has gained considerable success due to its ability to treat subjects suffering from shoulder with arthrosis and a severe rotator cuff deficiency. Technique and surgical choices are fundamental for a good results and rehabilitation is also essential to obtain satisfactory clinical and functional outcomes, but currently no high-quality evidence exists to guide the post-surgical rehabilitation of patients undergoing RTSA. [ABSTRACT FROM AUTHOR]

Questo articolo approfondisce il tema del rapporto tra ricerca in psicoterapia e pratica clinica. Nonostante gli avanzamenti nell’ambito della ricerca negli ultimi venti anni, permangono ancora diversi ostacoli nel processo di disseminazione di tale conoscenza. a tal fine, verranno messe in evidenza le differenze tra l’evidence-based research, volta a determinare quale trattamento terapeutico sia più efficace per i singoli disturbi psichiatrici e la practice-based research, che prova ad ottenere dei risultati più vicini alla pratica professionale quotidiana, focalizzandosi su aspetti come la relazione terapeutica, le caratteristiche del terapeuta e del paziente ed i fattori contestuali. È possibile costruire una pratica clinica che non sia sganciata dalle evidenze scientifiche su vari aspetti del lavoro terapeutico. infine, verrà evidenziato come le terapie psicodinamiche abbiano ottenuto varie prove di efficacia che le rendono comparabili a trattamenti di altri orientamenti, anche se la complessità dello studio della relazione terapeutica in tale setting richiede uno sforzo sempre maggiore per integrare ricerca quantitativa e qualitativa.

Metabolomics studies the set of endogenous metabolites with a molecular weight < 1500 Dalton (the metabolome), which constitute the end products of biological processes in living systems. Using a combination of analytical and bioinformatics techniques, it records, analyzes and quantifies changes in metabolites in response to any type of exposure: from lifestyle to environmental disturbances, from genetic anomalies to reactions to drugs and therapies. The molecular profile obtained represents a unique “fingerprint” that can provide direct information on a physiological state or on a sequence of events in an organism. Therefore, by selecting an appropriate biomatrix [exhaled air condensate (EBC), urine, serum, plasma, bronchoalveolar lavage fluid (BALF), saliva or cell and tissue extracts] it is possible to study different aspects of lung diseases. [ABSTRACT FROM AUTHOR]

Background: Cardiomyopathies (CMs) are rare multifactorial diseases of the heart muscle. Neonatal forms present as a myocardial injury in the absence of primary valvular, great vessels or septal anomalies. Despite being uncommon diseases, CMs may lead to potentially severe sequelae and considerable risk of neonatal death. This study aimed to provide an overview of neonatal CM (NCM) and describe its aetiology, initial clinical findings, morbidity and mortality. Methods: Retrospective observational study of all newborns diagnosed with CM admitted to the Neonatal Intensive Care Unit (NICU) of Centro Hospitalar Universitário de S. João, in Porto, Portugal, between 1997 and 2017. Data collected included demographic and perinatal information, clinical presentation, CM type and aetiology, treatments, complications and outcome. Results: Twenty-eight newborns with CM diagnosis were selected: 26 neonates were considered to have primary CM forms and 2 secondary CMs. Of those 26 diagnosed with primary CMs, 16 had hypertrophic CM, 8 had dilated CM, and 2 had tachycardia-induced CM. Secondary CMs comprehended 1 case of infiltrative CM and another of CM due to corticosteroids toxicity. Cardiac murmur (57.1%) was the most common finding, followed by heart failure (HF, 28.6%), cyanosis (21.4%), arrhythmia and sepsis (17.9%, each), and hypertension (10.7%). Two newborns were placed on a heart transplant waiting list. Three neonates developed congestive HF and 1 had a sudden cardiac death event. A total of 4 (14.3%) newborns have deceased during the NICU stay. More than 90% of the neonates were prescribed more than one medicine at discharge. Conclusion: NCMs require critical intensive care management. Unspecific symptoms characterise clinical findings. The majority of newborns have idiopathic primary CMs, but rare heterogeneous aetiologies may be the underlying cause in some cases. Thus, a multidisciplinary approach is mandatory.

Despite significant advances, the management of giant omphalocele (GO) still remains a challenging job for neonatologists and pediatric surgeons. Early surgical treatment of GO may not be undertaken in every patient due to the risk of fatal hemodynamic and respiratory compromise and associated congenital malformations. We analyzed the profile and outcome of patients with GO who were managed conservatively using povidone-iodine as escharotic agent. A total of 27 neonates with GO were managed conservatively during the study interval (1998-2016). Mean gestational age among survivors and expired group was 37.5 ± 1.5 weeks and 35.0 ± 1.0 weeks, respectively. Mean birth weight was 2,950 ± 500 g in the survivor group and 2,300 ± 450 g in the expired group. Prenatal diagnosis was available in eight patients (29.6%). Twenty-three (85.2%) neonates were born with vaginal delivery. Associated congenital malformations were present in 37% (10/27) patients. The mean duration of complete epithelialization of sac was 10.0 ± 2.5 weeks. Surgical intervention was done at 4-9 months of age. Eight (29.6%) patients expired during the study period. We observed prematurity, low birth weight, associated congenital anomalies and sepsis as risk factors associated with increased mortality.

Background: Complex congenital heart defects (CHD) are among the non-infectious causes of childhood morbidity and mortality in developing countries, accounting for 25-30% of intensive care usage in some centers. In Abuja, the capital of Nigeria, there has been an upsurge in cases of complex CHD, thus creating the need for this study. Objectives: The study aimed at describing the incidence and outcome of complex CHD in children seen at the University of Abuja Teaching Hospital, Gwagwalada, Abuja. Methods: A prospective study of patients referred to the Pediatric Cardiology Unit of the hospital between 2013 and 2018 was performed. Results: Of the 1,420 patients examined, 344 (24.2%) had CHD; 55 (16.0%) of these belong to the complex category with a male:female ratio of 1.3:1. The incidence of complex CHD is 1.1 per 1,000 live births. Tetralogy of Fallot (TOF) was the commonest form of complex heart diseases. Patients with atresic valves tend to present in the neonatal and the immediate postnatal period, while those with TOF present much later. Only 8 (14.5%) had surgical interventions, 21 (38.2%) could not afford surgery, 14 (25.5%) were lost to follow up and 10 (18.2%) died. Patients that had need of emergency cardiac surgery had the worst prognosis. Two patients with truncus arteriosus presented too late and were classified inoperable. Financial constraint and lack of facility for cardiac surgeries contributed negatively to the outcome of patients with complex heart defects. Conclusions: Complex CHD occurred in this community with similar incidence rates as in the developed countries. The predominant complex heart defect in the locality is TOF. Defects with atresic valves carry the worst prognosis in this environment due to lack of the wherewithal to manage the condition.

Patient care pathways, or diagnostic therapeutic care paths, represent a tool of clinical governance which, by implementing in the real-world setting the best scientific evidence, makes it possible to reduce the variability of professional and organizational behaviors, so increasing appropriateness, reducing economic waste due to inefficiency, and improving health outcomes: in this article a care path is proposed for patients operated for breast cancer. [ABSTRACT FROM AUTHOR]

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Medically unexplained physical symptoms (MUPS) are somatic symptoms for which it is not possible to trace the origin and nature to a psychopathological explanation. These ailments are very difficult to treat, they tend to become chronic and disabling, and they require continuous medical consultations resulting in enormous health-care costs. Various levels of psychological intervention are common practice in the management of patients afflicted by MUPS. The article, through the systematic survey of the literature on the subject and by taking into account the most recent reviews, aims to detect the therapeutic efficacy of psychotherapy treatments for MUPS, and for somatic symptom disorders in general. We also intended to track down the therapeutic aspects which, if improved, can increase the effectiveness of standard protocols. Particular attention has been paid to the data concerning the cognitive-behavioral therapy (CBT). This research demonstrates that psychotherapy is a therapeutic option that may be proposed to MUPS patients. CBT is the first-line and evidence-based treatment. Personalizing the psychotherapy taking into accounts the psychopathological variables of patients, the intensification of treatments (> 6 months, 1-2 sessions per week), and the optimization of third wave therapies use, represent a possible improvement in terms of effectiveness. [ABSTRACT FROM AUTHOR]

The approach to research on gender differences in an evolutionary context has always been complex. Many factors, from those initially linked to preliminary considerations about the differences between the sexes in different historical and cultural moments have often influenced studies of this type. Gender Medicine, consolidated in the United States as a research field since the 1980s, studies the way in which membership in gender, male or female, affects the development and impact of disease and response to therapy. We can say that this is a new, transverse dimension of Medicine that assesses gender differences in physiology and pathophysiology of many clinical diseases, with the aim of reaching treatment decisions based on evidence in both men and women. In an historical moment focused on the individualization/personalization of care, among the objectives that modern health care has been given, there is this research aimed at identifying as early as possible gender-related diseases with the aim of identifying causes and possible methods of intervention. It leads to defining a kind of Medicine, a recent branch of biomedical science, that focuses on recognizing and analyzing the differences arising from the belonging to a gender, male or female, from several aspects: organic, functional, psychological, pharmacological, social and cultural. A gender approach to Medicine can reduce the level of error in medical practice, promote therapeutic appropriateness, improve and customize therapies and generate savings for healthcare systems. These effects have been demonstrated for adults and need to be confirmed during infancy and childhood. The purpose of this discipline is to innovate and guarantee everyone, man or woman, newborn and children, the best possible treatment based on scientific evidence.

Human milk is uniquely superior for infant feeding and represents the perfect example of individualization in Pediatrics. Human milk is not a uniform body fluid but a secretion of the mammary gland of changing composition. Foremilk differs from hindmilk, and colostrum is strikingly different from transitional and mature milk. Milk changes with time of day and during the course of lactation. Extensive research has demonstrated health, nutritional, immunologic, developmental, psychological, social, economic and environmental benefits of human milk. Breastfeeding results in improved infant and maternal health outcomes in both the industrialized and developing world. Some specific topics will be discussed such as the preventive effect of human milk on infections, overweight, obesity and diabetes, malignant disease, neurodevelopmental outcomes, reduction of necrotizing enterocolitis. Important health benefits of breastfeeding and lactation are also described for mothers. Finally, contraindications to breastfeeding and supplementation of breastfed infants are presented. Interventions to promote breastfeeding are relatively simple and inexpensive. Infant feeding should not be regarded as a lifestyle choice but rather as a basic health issue.

Background: Gastroschisis patients’ morbidity is still high, underlining the importance of identifying factors associated with adverse outcomes. Objective: To determine factors influencing gastroschisis patients’ morbimortality during the first 3 years of life in “Centro Hospitalar São João” (CHSJ). Methodology: Records of infants born with gastroschisis between January 2002 and December 2011 admitted to CHSJ were reviewed. The relation between demographic and clinical data and morbimortality during the first 3 years of life, specifically anthropometric evolution and digestive outcome, was evaluated. The factors that were compared were simple versus complex gastroschisis and primary versus secondary closure. Results: Forty records were analysed. The survival rate was 92.3%. Patients with complex gastroschisis had worse outcomes: hospital stay (median 59 versus 23.5 days), total parenteral nutrition (50 versus 19 days), total oral intake reached (47 versus 22.5 days), morphine analgesia (9 versus 3 days), intestinal occlusion (60% versus 11.8%), perforation (60% versus 0%) and ischaemia (40% versus 0%), sepsis (100% versus 32.4%), short bowel syndrome (40% versus 3.1%), laxative need during 1-year follow-up (40% versus 0%), weight percentile < 5 at 6 months (75% versus 13.6%) and gastrointestinal symptoms after the first year of life (OR: 42; 95% CI: 2.01-877.5). Secondary closure patients had worse outcomes: start of oral intake (25 versus 11.5 days), total oral intake reached (48 versus 23 days), necrotizing enterocolitis (40% versus 2.9%) and mortality (40% versus 2.9%). Conclusion: Complex gastroschisis and secondary closure were both associated with higher morbidity. Secondary closure was also associated with higher mortality. Complex gastroschisis revealed to be a predictive factor for higher incidence of gastrointestinal symptoms after the first year of life. Therefore, follow-up at least until 3 years of life of patients with complex gastroschisis is recommended. Further research is needed to determine management strategies that improve prognosis.

The placenta has traditionally been considered as an asexual organ. Thus, most of the studies focusing on the placenta have not taken the sex of the embryo into account. However, as trophoblast cells originate from the embryo, they reflect fetal sex as either XX or XY, allowing for possible sex differences in placental biochemistry, function, and signaling. The placenta is a temporary organ performing the functions of many adult organs for the growing fetus. The placenta plays a key role in fetal growth and development, it is designed for exchange of oxygen, nutrients, antibodies, hormonal compounds and waste products between the mother and fetus and may carry significant information about the pregnancy. The placenta is considered also a major endocrine organ being responsible for synthesizing vast quantities of hormones and cytokines that have important effects on both maternal and fetal physiology. The investigation of placenta and its functions helps to identify molecular mechanisms that have both early- and long-term effects on health of the fetus. Gender differences were observed in the placenta at multiple levels: epigenetic modifications of DNA, gene expression, protein expression and immune function. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)

The article presents an evaluation work carried out by the association of S. Maurizio Borghi (FC) concerning the professional quality exerted within communities managed by the association until December 2015. The skills required to carry out the professional mandate are at the heart of this evaluation research which tried not only to describe what qualifies as the assessed quality but also to highlight premises and consequences. In addition to the skills needed for the professional mission, we refer to the requirements needed to perform the task (e.g. structural equipment), the work context (e.g. the way I feel with my colleagues) and the consequent results that can be achieved through the daily work professionals do within communities (e.g.: user autonomy and his or her re-employment). The results have allowed a clarification of the professional quality actually exerted and the implementation of concrete development actions. [ABSTRACT FROM AUTHOR]

Periventricular leucomalacia (PVL) is traditionally considered a multifactorial lesion related to three main mechanisms: ischemia, inflammation and excitotoxicity. For years it was believed that hypoperfusion, associated with the peculiar vascular anatomy of the premature brain (border zones), was the conditio sine qua non in the pathogenesis of PVL. More recently this theory has been questioned. Many studies have stressed the importance of the association between inflammation/infection and white matter injury and have supported the multi hit hypothesis according to which several (genetic, hormonal, immune and nutritional) factors may team up in a multi-hit fashion. The emerging concept is that the fetal white cell activation together with the interaction between the innate and adaptive immune system play a main role in white matter damage. Currently there are increasing evidence that PVL is a disease of connectivity. In this article we review the news in the basics of pathogenesis, the incidence, the definition and the diagnosis of PVL. Furthermore, recent follow-up studies and neuroprotective therapies are mentioned. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014) · Cagliari (Italy) · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

Perinatal hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia is one of the most critical pathologic conditions in neonatal medicine due to the potential for neurological sequelae in later life. The aim of our study is to identify the factors that are associated with a higher degree of severity in HIE and evaluate the outcomes. We performed a retrospective study of all newborns with HIE treated at our neonatal intensive care unit (NICU) from January 2010 to December 2013. Data collected include information about prenatal period, peripartum period, demographic characteristics, admission and evolution during NICU stay and outcomes (assessed in three different times: at discharge, at 6-9 months and 18 months). Forty seven newborns were enrolled in our study, 11 (23.4%) with mild HIE, 21 (44.7%) with moderate HIE and 15 (31.9%) with severe HIE. Prenatal, perinatal and demographic data showed no statistically significant differences between groups. Statistically significant differences were found in values of Thompson score (p < 0.0001), abnormal aEEG/EEG at admission (p = 0.025) and at 48 hours (p = 0.018), need of mechanical ventilation (p = 0.004), acute renal failure (p = 0.002) and length of stay (p = 0.038) with high rates in the moderate and severe HIE groups. Regarding the outcomes, statistically significant differences were found in the prevalence of death (p = 0.010); need of antiepileptic drugs at discharge (p = 0.001); motor deficits requiring physiotherapy (p = 0.046), abnormal deep tendon reflex (p = 0.006) and need of antiepileptic drugs (p = 0.001) at 6-9 months follow-up; and cerebral palsy with cognitive impairment at 18 months (p = 0.041) with high rates in the severe HIE group. These results suggest that Thompson score, abnormal aEEG/EEG at admission and at 48 hours, mechanical ventilation, acute renal failure and length of stay are associated with more severe HIE. We also concluded that more severe HIE reflects worse outcomes whereas mild HIE is associated with normal outcome in the majority of patients at 18 months.

Survival of extremely low birth weight (ELBW) and extremely premature (EP) infants has shown consistent improvement thanks to advances and innovations in perinatal and neonatal care. Regionalization, with high-risk deliveries in a tertiary perinatal center, offers the coordinated, collaborative, expert and specialized care needed by these mothers and their infants. Despite decreasing rates of the major neonatal morbidities observed in recent years, these continue still to be significant for ELBW/EP infants, impacting their overall prognosis. After NICU discharge and in the first years of life, issues with health, growth and development are common. In school age and adolescence, problems with behavior, socialization and cognition are prevalent. Adult outcomes of ELBW/EP need further clarity, emphasizing the importance for consistent long-term follow-up for this special cohort. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

Background: Omphalocele is a midline abdominal hernia that conditions important rates of mortality and morbidity. Infants born with omphalocele present an increased risk of having structural and chromosomal anomalies or syndromes. It is a defect that requires surgical treatment with multiple postoperative comorbidities. Purpose: To identify and characterize the cases of omphalocele of a Level III Neonatal Intensive Care Unit and analyse the impact of clinical and demographic characteristics of both infant and mother in patients’ outcome. Methods: This is a retrospective study based on the record analysis of infants that have been hospitalized in the Neonatal Intensive Care Unit of “Centro Hospitalar de São João” with the diagnosis of omphalocele between 2003 and 2012. Sixteen patients fulfilled these criteria. For each one, data about pregnancy, maternal history, prenatal diagnosis, delivery, newborn, treatment and follow-up was collected and analysed. Results: The mean birth weight was 2,761 grams and the mean gestational age was 37 weeks. Prenatal diagnosis was performed in 12 (75%) of the cases; mean gestational week of diagnosis was lower in patients that died. Overall, 50% (80% of deceased patients) had large defects. Major malformations were seen in 25% of cases most often in deceased infants. Low 1st minute Apgar score, need of inotropic support, more days of parenteral nutrition and lower birth weight had statistically significant impact on mortality. After surgical correction 31.3% died, 18.8% had a residual hernia and 12.5% a gastroesophageal reflux, respectively. Conclusion: The mortality rates of patients with the diagnosis of omphalocele are not negligible because of associated anomalies or postoperative complications. We have been able to correlate some clinical features with mortality and found out that patients who survive can have other comorbidities mainly in the first years of life. However the majority of infants are expected to have a good long-term development and quality of life.

Aims: Although the long-term outcomes of hypospadias surgery are considered important for psychosexual development, only a few attempts have been made to evaluate patient psico-pathology. Material and Methods: 20 out 40 patients who received under sealed cover two envelopes - the first containing the assessment tools, the other empty and prepaid for the answer – joined the study. The results came from the analysis of anamnestic interview specially created in order to gather information on how to access to surgery and the degree of information that the parents had from the surgeon, from the analysis of the CBCL (Child Behavior CheckList 2001:4-16 years) and TMA (Multidimensional self-esteem Test: the Italian version of the MSCS Multidimensional Self-Concept Scale). Of the 20 patients recruited, 15, aged from 9 to 18 years (mean age 12.5), age at operation between 2 and 5 years (mean age 3.3 yrs), have returned the questionnaires correctly compiled. Patient data were compared with those of a control group not suffering from genital pathology. Results: From the CBCL: the area of the identification of the problems showed no significant differences between the study group and the control. The area of competence, altered in both groups, did not show statistically significant differences. From the analysis of TMA: there were no statistically significant differences between the two groups in sub-domains: Social, Competence, Affect, Family and Physical. Within the subdomain school the two groups differed significantly for low self-esteem in the group of surgical patients. Conclusion: The MST test indicate that hypospadias surgery does not change the global self-esteem but, surprisingly, at least in this patient population, only a lower self-esteem in school performance in the age group considered . This study may indicate the importance of psychological support during the transition from adolescence to adulthood.

BACKGROUND. The aim of this study was to translate and validate in Italian the condition-specific patient-reported outcome measure for urethral stricture surgery (PROM-USS-Q) and evaluate its psychometric properties to determine whether it was suitable for routine use. METHODS. We translated the English version; 52 men scheduled for bulbar urethroplasty at our high volume center agreed to self-complete PROM-USS-Q pre-operatively, and between four and six months post-operatively. We undertook an in-depth psychometric assessment of the questionnaire constructs. RESULTS. There was excellent correlation between change in voiding symptom score and change in Qmax (ρ=0.746) with parallel improvements in EQ-5D visual analogue and time trade-off scores demonstrating criterion validity. Test-retest reliability and internal consistency statistics were similarly robust: intra-class correlation coeficients ranged from 0.81 to 0.90 for the individual voiding questions. Cronbach's alpha was 0.79 for the overall score and ranged between 0.74 and 0.81. These indices exceeded our predeined reliability thresholds for inclusion. Statistically highly signiicant improvements in construct scores occurred following urethroplasty, demonstrating responsiveness to change. CONCLUSIONS. The PROM-USS-Q is a practical and robust instrument for assessing voiding symptoms and health-related quality of life following urethral stricture surgery. [ABSTRACT FROM AUTHOR]

Copyright of Scienza Riabilitativa is the property of Associazione Italiana Fisioterapisti and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)