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Radiation (RT) remains the most frequently used treatment against cancer. The main limitation of RT is its lack of specificity for cancer tissues and the limited maximum radiation dose that can be safely delivered without damaging the surrounding healthy tissues. A step forward in the development of better RT is achieved by coupling it with other treatments, such as photodynamic therapy (PDT). PDT is an anti-cancer therapy that relies on the light activation of non-toxic molecules—called photosensitizers—to generate ROS such as singlet oxygen. By conjugating photosensitizers to dense nanoscintillators in hybrid architectures, the PDT could be activated during RT, leading to cell death through an additional pathway with respect to the one activated by RT alone. Therefore, combining RT and PDT can lead to a synergistic enhancement of the overall efficacy of RT. However, the involvement of hybrids in combination with ionizing radiation is not trivial: the comprehension of the relationship among RT, scintillation emission of the nanoscintillator, and therapeutic effects of the locally excited photosensitizers is desirable to optimize the design of the hybrid nanoparticles for improved effects in radio-oncology. Here, we discuss the working principles of the PDT-activated RT methods, pointing out the guidelines for the development of effective coadjutants to be tested in clinics.

Little is known about the outcome predictors in peripheral neuropathy (PN). This prospective observational study aimed to identify possible factors predicting the functional abilities in older patients with PN undergoing motor rehabilitation. Data were collected in 80 PN patients, aged over 65 years, performing a standard inpatient motor rehabilitation program. The total Functional Independence Measure (FIM) score after rehabilitation, as well as efficiency and effectiveness in total-FIM, were the outcome measures. Backward multiple regression analyses identified the predictors of functional status. At the end of rehabilitation, total-FIM score was 102.66 ± 10.75, efficiency in total-FIM 0.64 ± 0.29 and effectiveness in total-FIM 48.81 ± 15.35%. Katz index at admission was a predictor of the final total-FIM score (beta 0.46, p

As a model radio-photodynamic therapy (RPDT) agent, we developed a multicomponent nanomaterial by anchoring conjugated chromophores on the surface of scintillating chrysotile nanotubes. Its ultimate composition makes the system a scintillation-activated photosensitizer for the singlet oxygen production. This nanomaterial shows a remarkable ability to enhance the production of singlet oxygen in an aqueous environment, under X-ray irradiation, boosting its production by almost 1 order of magnitude. Its efficiency as a coadjutant for radiotherapy has been tested in vitro, showing a striking efficacy in enhancing both the prompt cytotoxicity of the ionizing radiation and the long-term cytotoxicity given by radiation-activated apoptosis. Notably, the beneficial activity of the RPDT agent is prominent at low levels of delivered doses comparable to the one employed in clinical treatments. This opens the possibility of effectively reducing the therapy exposure and consequently undesired collateral effects due to prolonged exposure of patients to high-energy radiation.

Friedreich ataxia (FRDA) is caused by the reduced expression of the mitochondrial protein frataxin (FXN) due to an intronic GAA trinucleotide repeat expansion in the FXN gene. Although FRDA has no cure and few treatment options, there is research dedicated to finding an agent that can curb disease progression and address symptoms as neurobehavioral deficits, muscle endurance, and heart contractile dysfunctions. Because oxidative stress and mitochondrial dysfunctions are implicated in FRDA, we demonstrated the systemic delivery of catalysts activity of gold cluster superstructures (Au8-pXs) to improve cell response to mitochondrial reactive oxygen species and thereby alleviate FRDA-related pathology in mesenchymal stem cells from patients with FRDA. We also found that systemic injection of Au8-pXs ameliorated motor function and cardiac contractility of YG8sR mouse model that recapitulates the FRDA phenotype. These effects were associated to long-term improvement of mitochondrial functions and antioxidant cell responses. We related these events to an increased expression of frataxin, which was sustained by reduced autophagy. Overall, these results encourage further optimization of Au8-pXs in experimental clinical strategies for the treatment of FRDA.

The aim of this prospective observational cohort study was to verify the relationship between number of drugs used and functional outcome in hip fracture patients undergoing rehabilitation. This study was conducted on 139 patients with hip fracture who underwent a rehabilitation program. Efficiency rate in the Functional Independence Measure (FIM) and Berg Balance Scale (BBS), and length of stay (LOS) were the outcome measures. At the end of rehabilitation, 66.1% of patients showed an increase in number of drugs used, while 33.9% used the same or lower number of drugs than at admission. At the end of rehabilitation patients with increased pharmacotherapy took a higher total number of drug classes (p = 0.001), had longer LOS (p = 0.009) and lower Berg efficiency (p = 0.048) than patients with the same or lower pharmacotherapy. The number of drugs used at discharge was an independent determinant of LOS (beta = 0.19, p = 0.022) and FIM efficiency (beta = − 0.20, p = 0.025). Age was a determinant of LOS (beta = 0.17, p = 0.044) and BBS efficiency (beta = − 0.23, p = 0.009), while CIRS severity was a determinant of BBS efficiency only (beta = − 0.22, p = 0.016). Findings of study indicate that in hip fracture patients, the number of drugs prescribed at discharge is an important indicator of LOS and rehabilitation efficiency. These findings can help the physician to better plan the rehabilitation of hip fracture patients who require polypharmacy.

We have identified a clinical association between self-reported non-celiac wheat sensitivity (NCWS) and Familial Mediterranean Fever (FMF). Objectives: A) To determine whether a 2-week double-blind placebo-controlled (DBPC) cross-over wheat vs. rice challenge exacerbates the clinical manifestations of FMF, B) to evaluate innate immune responses in NCWS/FMF patients challenged with wheat vs. rice. The study was conducted at the Department of Internal Medicine of the University Hospital of Palermo and the Hospital of Sciacca, Italy. Six female volunteers with FMF/NCWS (mean age 36 &plusmn, 6 years) were enrolled, 12 age-matched non-FMF, NCWS females, and 8 sex- and age-matched healthy subjects served as controls. We evaluated: 1. clinical symptoms by the FMF-specific AIDAI (Auto-Inflammatory Diseases Activity Index) score, 2. serum soluble CD14 (sCD14), C-reactive protein (CRP), and serum amyloid A (SSA), 3. circulating CD14+ monocytes expressing interleukin (IL)-1&beta, and tumor necrosis factor (TNF)-&alpha, The AIDAI score significantly increased in FMF patients during DBPC with wheat, but not with rice (19 &plusmn, 6.3 vs. 7 &plusmn, 1.6, p = 0.028). sCD14 values did not differ in FMF patients before and after the challenge, but were higher in FMF patients than in healthy controls (median values 11357 vs. 8710 pg/ml, p = 0.002). The percentage of circulating CD14+/IL-1&beta, + and of CD14+/TNF-&alpha, + monocytes increased significantly after DBPC with wheat vs. baseline or rice challenge. Self-reported NCWS can hide an FMF diagnosis. Wheat ingestion exacerbated clinical and immunological features of FMF. Future studies performed on consecutive FMF patients recruited in centers for auto-inflammatory diseases will determine the real frequency and relevance of this association.

Parkinson's disease is one of the most described neurodegenerative pathologies; though it is one of the most complex pathologies, is not fully understood, correctly identified, with its different types of presentation, its clinical course and the neural networks involved. We report on a series consisting of 432 de novo PD diagnosed patients, and 457 control cases. We identify a possible independent relationship between two clinical PD presentation, akinetic-rigid and tremor-dominant, and cognitive and behavioral changes. A 24-months follow-up allows to identify new information still not fully explored.

The aim of study was to identify factors predicting balance in older hip fracture patients undergoing motor rehabilitation.The aim of study was to identify factors predicting balance in older hip fracture patients undergoing motor rehabilitation. Cognitive function, comorbidity and hip muscles strength are important predictors of balance in hip fracture patients. Knowledge of specific predictors could be useful for physicians to identify patients needing specific rehabilitation programs for balance. Little is known about the factors predicting balance in hip fracture patients. The aim of this retrospective observational study was to assess balance before and after inpatient rehabilitation and, secondarily, to identify factors predicting the balance levels in older hip fracture patients after motor rehabilitation. Data were collected in 124 hip fracture patients over a 2-year period. All patients underwent a standard motor rehabilitation program. A modified version of Berg Balance Scale (BBS) score after rehabilitation, daily gain and percentage of improvement in BBS were the outcome measures. Multivariate regression analysis was performed to identify the predictors of balance. The mean BBS score was 8.33 ± 7.23 at admission and 21.79 ± 12.15 at the end of rehabilitation (p

Executed studies did not clearly identify which index of comorbidity was an independent outcome determinant. The aim of this prospective observational cohort study was to address this issue. We analyzed 200 consecutive patients with hip fracture. All patients underwent rehabilitation. At admission comorbidity was assessed through the cumulative severity, severity index, and comorbidity index of the Cumulative Illness Rating Scale. Discharge scores and effectiveness in the Functional Independence Measure motor subscale, and discharge destination were the outcome measures. Multivariate regression analyses were performed to identify determinants of outcome. Mini Mental State Examination and comorbidity index of the Cumulative Illness Rating Scale were important independent determinants of final (respectively, β = 0.46 and −0.25) and effectiveness (respectively, β = 0.47 and −0.25) in motor Functional Independence Measure scores, while hip strength and Rankin score were determinants of final motor Functional Independence Measure score (respectively, β = 0.21 and −0.20). Comorbidity index of the Cumulative Illness Rating Scale (odds ratio 8.18 for ≥3 versus < 3 comorbidity score; 95% confidence interval, 1.03–64.7) and Geriatric Depression Scale (odds ratio 4.02 for ≥6 versus ≤5 depression scale score; 95% confidence interval, 1.52–10.63) were risk indicators for nursing home. Among the indices of the Cumulative Illness Rating Scale, comorbidity index is the sole independent determinant of both motor Functional Independence Measure scores and discharge destination in hip fracture patients. This suggests to specifically evaluate this index to identify the patients who may be admitted to a rehabilitation program.

The role of microRNAs (miRNAs) in celiac disease (CD) is unclear. We evaluated inflammation-related miRNA-146a, miRNA-155, miRNA-21, and miRNA-125b expression in peripheral blood and intestinal mucosa of CD adults. Thirty patients with CD were included: patients with active CD on a gluten-containing diet (CD-active, n = 10), patients on a gluten-free diet (for at least 1 year), and patients with negative blood antibodies (CD-inactivePE, n = 10). In addition, ten healthy volunteers formed the comparison/control group. MiRNA expression was measured in duodenal biopsies from patients (CD-inactiveMU, n = 10) after in vitro exposure to PT gliadin and 33-mer peptide. MiRNAs expression was measured in plasma and in peripheral blood mononuclear cells (PBMCs) and monocytes, before and after in vitro exposure to native gliadin (gliadinN). Expression levels of miRNA-146a, miRNA-155, and miRNA-21 in PBMCs, miRNA-155 in monocytes and miRNA-155, miRNA-21, and miRNA-125b in plasma were elevated in both groups of celiac patients. After in vitro exposure with gliadinN, miRNA-146a and miRNA-155 expression markedly increased in PBMCs and monocytes, while miRNA-155 and miRNA-21 increased in the CD-active group. MiRNAs expression in intestinal mucosa did not change. MiRNA-146a and miRNA-155 expression showed high sensitivity and specificity for the presence of CD, irrespective of the current dietary treatment. Selected inflammation-related miRNAs expression is elevated in the peripheral blood of celiac. This suggests their participation in the immune processes underlying the pathology. Their similar response in active and inactive CD suggests that they should be further evaluated, as potential diagnostic biomarkers for CD.

Celiac disease (CD) is the most common autoimmune enteropathy worldwide. In CD, dietary gluten triggers a T cell driven small intestinal inflammation in a subset of genetically predisposed subjects, expressing the HLA DQ2 and/or DQ8 genes on their antigen presenting cells. HLA DQ2/DQ8 can bind gluten peptides after their prior modification by the CD autoantigen, tissue transglutaminase (TG2). This process leads to the activation of gluten reactive T cells, small bowel villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis, the histological hallmarks of CD. The clinical picture of CD is extremely heterogeneous including intestinal (especially diarrhea, abdominal pain, bloating) and extraintestinal (especially associated autoimmune diseases, anemia, osteoporosis) manifestations. The prevalence of CD in most parts of the world is estimated at 1:100-1:150 and its diagnosis is based on the presence of circulating autoantibodies (anti-TG2) and the histological detection of villous atrophy. Treatment is a lifelong gluten free diet but adjunctive therapies are in development. Although CD is a well-characterized disease, it is grossly underdiagnosed, despite the severe consequences of long-term gluten ingestion in CD, such as enhanced autoimmunity, refractory CD and intestinal T cell lymphoma. The aim of the presented review is to provide a clinical guide and to summarize the most recent clinical progress in CD research.

Introduction High levels of reactive oxygen species (ROS) and impaired antioxidant defense systems lead to oxidative stress (OxS) and tissue injury in different intestinal and extra intestinal conditions, including celiac disease (CD). The aim of the present study was to investigate the role and potential use of ROS and other biomarkers of OxS in the clinical management of CD. Methods We collected duodenal specimens and blood samples from naïve patients (N-CD), patients on a gluten free diet (GFD) including responders (CD-GFD) and non-responders (NRCD). We measured plasmatic ROS production (electron paramagnetic resonance, EPR), lipid peroxidation (thiobarbituric acid-reactive substances, TBARS), protein oxidation (protein carbonyl, PC), total antioxidant capacity (TAC), nitric oxides and glutathione (GSH) in erythrocytes. Results Fifty-four patients affected by CD were enrolled (17 N-CD, 18 CD-GFD and 19 NRCD; 44 F; age 44 ± 13 years). A significant increase of plasmatic OxS biomarkers (ROS, peroxidated lipids, oxidized proteins, and nitrate concentrations) and decrease of antioxidant species (TAC and GSH levels) were found in NRCD and N-CD compared to CD-GFD. Comparably, a significant direct relationship between the severity of duodenal atrophy, ROS production rates and TBARS was found; conversely, TAC and GSH presented an inverse correlation. Discussion OxS is involved in CD tissue damage and correlates with the degree of duodenal atrophy. These findings suggest the possible role of OxS biomarkers as indicators of CD activity during the clinical follow-up.

Background Gliadins are involved in gluten-related disorders and are responsible for the alteration of the cellular redox balance. It is not clear if the gliadin-related oxidative stress can induce DNA damage in enterocytes. Aim To investigate any possible genotoxicity caused by gliadin and to assess its relationship with oxidative stress in vitro and ex vivo. Methods Caco-2 cells were exposed for 6–12–24 h to increasing concentrations (250 μg/mL–1000 μg/mL) of digested gliadin. We investigated: cytotoxicity, oxidative balance (reactive oxygen species, ROS), DNA damage (comet assay and γ-H2AX detection), transglutaminase type 2 (TG2) activity and annexin V expression. H2AX and 8-OHG immunohistochemistry has been evaluated on duodenal biopsies of celiac subjects and controls. Results Gliadin induced a significant increase (+50%) of ROS after 12 h of exposition starting with a 500 μg/mL dose of gliadin. Comet assay and γ-H2AX demonstrated DNA damage, evident at the gliadin concentration of 500 μg/mL after 24 h. TG2 activity increased in chromatin and cytoskeleton cellular compartments at different gliadin doses (250/500/1000 μg/mL). The γ-H2AX and 8-OHG immunohistochemistry was altered in the duodenal biopsies of celiac patients. Conclusions Gliadin induces cellular oxidative stress, DNA damage and pro-apoptotic stimulation in Caco-2 cells and in the duodenal mucosa of celiac patients.

Background Until now, non-invasive prenatal diagnosis of genetic diseases found only limited routine applications. In autosomal recessive diseases, it can be used to determine the carrier status of the fetus through the detection of a paternally inherited disease allele in cases where maternal and paternal mutated alleles differ. Methods Conditions for non-invasive identification of fetal paternally inherited mutations in maternal plasma were developed by two independent approaches: coamplification at lower denaturation temperature-PCR (COLD-PCR) and highly sensitive microarrays. Assays were designed for identifying 14 mutations, 7 causing β-thalassaemia and 7 cystic fibrosis. Results In total, 87 non-invasive prenatal diagnoses were performed by COLD-PCR in 75 couples at risk for β-thalassaemia and 12 for cystic fibrosis. First, to identify the more appropriate methodology for the analysis of minority mutated fetal alleles in maternal plasma, both fast and full COLD-PCR protocols were developed for the most common Italian β-thalassaemia Cd39 and IVSI.110 mutations. In 5 out of 31 samples, no enrichment was obtained with the fast protocol, while full COLD-PCR provided the correct fetal genotypes. Thus, full COLD-PCR protocols were developed for all the remaining mutations and all analyses confirmed the fetal genotypes obtained by invasive prenatal diagnosis. Microarray analysis was performed on 40 samples from 28 couples at risk for β-thalassaemia and 12 for cystic fibrosis. Results were in complete concordance with those obtained by both COLD-PCR and invasive procedures. Conclusions COLD-PCR and microarray approaches are not expensive, simple to handle, fast and can be easily set up in specialised clinical laboratories where prenatal diagnosis is routinely performed.

Background Spinal muscular atrophy (SMA) is an autosomal recessive motor neuron disease caused by mutations in the survival motor neuron gene ( SMN1 ) and the leading genetic cause of infant mortality. Currently, there is no effective treatment other than supportive care. Objective This article provides a general overview of the main aspects that need to be taken into account to design a more efficient clinical trial and to summarize the most promising molecular trials that are currently in development or are being planned for the treatment of SMA. Methods A systematic review of the literature was performed, identifying key clinical trials involving novel molecular therapies in SMA. In addition, abstracts presented at the meetings of the Families of Spinal Muscular Atrophy were searched and the Families of Spinal Muscular Atrophy Web site was carefully analyzed. Finally, a selection of SMA clinical trials registered at clinical- trials.gov has been included in the article. Results The past decade has seen a marked advancement in the understanding of both SMA genetics and molecular mechanisms. New molecules targeting SMN have shown promise in preclinical studies, and various clinical trials have started to test the drugs that were discovered through basic research. Conclusions Both preclinical and early clinical trial results involving novel molecular therapies suggest that the clinical care paradigm in SMA will soon change.

BACKGROUND: The aim of this study was to evaluate the incidence and management of complications of videosurgical procedures that occurred during a 4-year period in eight Italian pediatric surgery centers. METHODS: Between 1996 and 1999, 2305 videosurgical procedures were performed in 11 centers of pediatric surgery. The data from 3 centers, for a total of 616 procedures, were largely incomplete and were thus excluded from the study. We analyzed the data from 8 centers only, for a total of 1689 laparoscopic or thoracoscopic operations on patients aged between 15 days and 16 years. The type of operations performed ranged from basic videosurgical interventions, such as varicocelectomy and cryptorchidism, to advanced laparoscopic procedures, such as splenectomy, total colectomy, and esophageal achalasia. Each patient's file was examined for any complications that may have occurred during the surgical procedure and for a record of how these were managed. RESULTS: We recorded 79 complications (4.6%) in our series. In 57 cases (72.2%) the problem was solved by videosurgery. Twenty-two cases (27.8%) required conversion to open surgery. There was no mortality in our series. At a maximum follow-up of 4 years, all children were alive and had no problems related to the videosurgical complications. CONCLUSIONS: We believe that the routine use of open laparoscopy in pediatric patients is a key factor to avoiding complications related to the Veress needle and blind introduction of the first trocar. Moreover, the surgeon's laparoscopic experience, the correct indications for laparoscopic surgery, and the verification of the laparoscopic equipment before surgery are also important rules to follow to reduce the incidence of complications. In the beginning, it is preferable to have the assistance of an expert laparoscopic surgeon to decrease the complications related to the learning curve period.

BACKGROUND: Few reports have elucidated the role of minimally invasive surgery (MIS) for pediatric malignancies. This study aimed to review the results of a multicenter study on the management of thoracic tumors in children using MIS. METHODS: A 5-year retrospective review of all MIS procedures for the treatment of pediatric malignancies performed in seven centers belonging to the Italian Society of Videosurgey in Infancy is reported. The data from 145 pediatric oncologic patients (80 girls and 65 boys) ages 30 days to 17 years (median, 7.2 years) were analyzed. Of the procedures performed, 87 were laparoscopies (60%), 55 were thoracoscopies (38%), and 3 were lumboscopies (2%). This study focused only on the results of the 55 thoracoscopic procedures performed for diagnostic purposes in 19 cases (34.6%) and for therapeutic purposes in 36 cases (65.4%). RESULTS: The duration of surgery was 15 to 180 min (median, 65 min). Metastasectomies were performed for various etiologies in 31 of the 55 cases. Of the 55 patients, 5 underwent resection of a mediastinal tumor, and 19 underwent a diagnostic thoracoscopy. During a mean follow-up period of 25.6 months, 2 (3.6%) of the 55 patients experienced perioperative complications. CONCLUSIONS: The role of MIS in tumor resection for children is currently limited, but may be used in individual cases when the preoperative workup shows it to be feasible. Its indication is strictly dependent on the thoracoscopic experience of the surgeon and the tumor site for preoperative imaging techniques. When the indication for thoracoscopy is correct, this approach has high therapeutic applicability (65.4% in our series). Our preliminary experience shows that careful patient selection and an appropriate level of technical skill make thoracoscopy a reasonable and safe option for the treatment of pediatric malignancies.

Purpose To evaluate the diagnostic performance of quantitative apparent diffusion coefficient (ADC) measurements, in the assessment of the therapeutic response to chemo-radiation therapy (CRT) in patients with locally advanced rectal cancer, by analyzing post CRT values of ADC, in relation to tumor regression grade (TRG) obtained by histopathologic evaluation of the rectal specimen. Methods This prospective study was approved by an Institutional Review Board, and informed consent was obtained from all patients. Thirty-one patients with locally advanced rectal cancer underwent pre and post CRT MR imaging at 1.5 T. ADC values were measured in regions of interest (ROIs) drawn independently by two radiologists, blinded to the pathology results, on three slices of the pre and post CRT DW-MR image sets with the corresponding T2 weighted images (T2WI) available for anatomic reference. The two readers’ measurements were compared for differences in ADC values, inter-observer variability (measured as the intraclass correlation coefficient; ICC) and the ADC distributions of responders vs non-responders. The diagnostic performance of ADC in the prediction of the response to CRT was evaluated by calculating the area under the ROC curve (AUC) and the optimal cut-off values. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed. Results The two readers showed an overall strong agreement in measuring ADC values. For both readers, no differences in ADC pre-treatment measurements were observed between responders and non-responders. For reader 1, the post-CRT ADC and the ΔADC presented the higher AUC (0.823 and 0.803, respectively), while Δ%ADC provided the lower AUC value (0.682). The optimal cutoff point was 1.294 s/mm 2 for post-CRT measures (sensitivity = 86.4%, specificity = 66.7%, PPV = 86.4%, NPV = 66.7%), 0.500 for ΔADC (sensitivity = 81.8%, specificity = 66.7%, PPV = 85.7%, NPV = 60.0%) and 59.3% for Δ%ADC (sensitivity = 63.4%, specificity = 66.7, PPV = 82.4%, NPV = 42.9%). Similar results were observed for reader 2, with better performance obtained with the ADC post-CRT (AUC of 0.833) and an optimal cut off of 1.277 × 10 −3 s/mm 2 . Conclusion Post-CRT ADC measurements are reliable and reproducible and may be used as a non-invasive tool to evaluate response to therapy as post-CRT ADC values and ΔADC presented good diagnostic performance to select responder patients.

The aim of this study was to evaluate the correlation between the changes of SUV(max) and of apparent diffusion coefficient (ADC) before and after neoadjuvant therapy, to enable us predict the therapy response, in patients with locally advanced rectal cancer (LARC). A total of 30 patients with LARC who underwent CRT were recruited for our study. All the patients underwent a whole body 18F-FDG-PET/CT scan and a pelvic MR examination including DW imaging for staging (PET/CT1 and RM1), and after the chemoradiation therapy (PET/CT2, and RM2). Histopathologic analysis of rectal specimen, according to tumor regression grade (Mandard's criteria) was used as the standard reference. MR and PET-CT images were analyzed, and measurements of ADC values and SUV(max) were taken. Diagnostic performance for selection of complete responders (TRG1-2) and overall diagnostic accuracy for each item were calculated. After neoadjuvant therapy, all patients were submitted to surgery. According to Mandard's criteria, 21 tumors showed complete (TRG1) or subtotal regression (TRG2) and were classified as responders; nine tumors were classified as non responders (TRG3, 4, and 5). In all the patients, mean value of SUV(max) in PET/CT1 was higher than those in PET/CT2 (P&nbsp

Very few studies have investigated activities of daily living (ADLs) post hip-surgery as a possible determinant of functional outcome after hip fracture.This prospective, observational study aimed to correlate hip-fracture patients' ADLs on admission to in-hospital rehabilitation with their functional outcome post-rehabilitation.Of 216 consecutive hip-fracture patients admitted to our Rehabilitation Unit, 204 patients were eligible for the final analyses. All patients underwent the usual rehabilitation. At admission, basic ADLs were assessed by the Functional Independence Measure (FIM) scale. Discharge scores, efficiency and effectiveness in motor-FIM, and discharge destination were outcome measures. Backward stepwise regressions were performed to identify determinants of outcome measures. Age, sex, education, number of relatives, orthopedic treatment, onset to admission interval, Mini Mental State Examination (MMSE), Cumulative Illness Rating Scale, Neuropsychiatric Inventory, ROM, Muscle Strength, and FIM scores at admission were independent variables.There was functional gain in all ADLs post-rehabilitation, walking being the FIM-item with the highest efficiency and effectiveness (respectively, 0.14±0.0 and 64.2±21). Multivariate analyses showed that MMSE was a determinant of final score, efficiency, and effectiveness in motor-FIM. Bladder control was a determinant of final score and effectiveness in motor-FIM, while eating and bathing were determinants of final motor-FIM score. Bowel management was the only determinant of discharge destination.Basic ADLs, in particular eating, bathing, bladder and bowel management, are important determinants of outcome in hip fracture.The results of this study suggest that, in designing studies on outcome prediction in hip fracture, researchers should include tests assessing performance of basic ADLs as independent variables, as this could allow to identify new prognostic indicators that may be helpful for physicians in managing hip fracture patients post-rehabilitation.

The correlation between single neuropsychiatric symptoms and functional outcome in hip fracture patients is little investigated in the literature, and it is not yet established which neuropsychiatric symptoms are the most important determinants of functional outcome.To determine which neuropsychiatric symptoms are the most important determinants of functional outcome.This prospective study was carried out in 204 consecutive patients with primary diagnosis of hip fracture admitted to our Rehabilitation Unit for a course of rehabilitation. Neuropsychiatric symptoms were assessed at admission with the Neuropsychiatric Inventory (NPI). Outcome measures of rehabilitation were: final score, efficiency and effectiveness in motor-Functional Independence Measure (motor-FIM), and discharge destination. Pearson's correlation coefficients were used to assess the relationship between NPI variables and the outcome measures, while backward stepwise regression was used to identify determinants of the outcome measures.Pearson's correlation showed that night-time behavior disturbances were related to all outcome measures, while agitation, depression, elation, apathy, disinhibition and irritability were significantly related to motor-FIM outcomes. At multivariate regression analysis agitation was the only determinant of final motor-FIM score, while irritability was the only determinant of efficiency and effectiveness in motor-FIM score. No neuropsychiatric symptom was a determinant of discharge destination.This study highlights that in hip fracture patients there are relationships between specific neuropsychiatric symptoms and functional outcome. Among the neuropsychiatric symptoms, irritability and agitation are the most important. They are associated to poor functional outcome and are the only determinants of motor-FIM outcome measures.Relationships between specific neuropsychiatric symptoms and functional outcome have not been clearly described in hip fracture patients. Irritability and agitation have been shown to have the strongest relationship with poor functional outcomes. Appropriate identification, assessment and treatment of neuropsychiatric symptoms may be useful to physicians for the management of hip fracture patients.

OBJECTIVE: The aim of this study was to determine the association between functional recovery and neuropsychiatric symptoms in hip fracture patients undergoing in-hospital rehabilitation. Very few studies have extensively evaluated neuropsychiatric symptoms in hip fracture patients, and the relationship between these symptoms and rehabilitation outcome is not yet clearly defined. DESIGN: This study was conducted on 200 patients with hip fracture who underwent a rehabilitation program. The Neuropsychiatric Inventory was used to identify neuropsychiatric symptoms. Efficiency and effectiveness in terms of the motor-Functional Independence Measure and length of stay were considered as outcome measures. RESULTS: At admission, 74% of the patients had neuropsychiatric symptoms. At the end of rehabilitation, the patients with neuropsychiatric symptoms had a lower motor-Functional Independence Measure effectiveness (P = 0.015) and efficiency (P = 0.002) and a longer length of stay (P = 0.008) than those without neuropsychiatric symptoms. However, after adjustment for the Mini-Mental State Examination, the patients with neuropsychiatric symptoms differed from those without symptoms only in terms of longer length of stay (P = 0.006) and lower motor-Functional Independence Measure efficiency (P = 0.008). CONCLUSIONS: Neuropsychiatric symptoms make the rehabilitation process slower and less efficient in hip fracture patients. Understanding the relationship between neuropsychiatric symptoms and outcome may be useful to physicians for the management of hip fracture patients. Language: en

Angioedema is a pathologic condition first descrive by Quincke and Osler. It can be genetically determined or acquired, and it is caused by a vascular reaction induced by deficiency or functional alteration of the C1 inhibitor (C1-INH), an enzyme involved in the regulation of complement, contact, fibrinolytic, and coagulation systems. Two forms of angioedema have been described in the literature: hereditary angioedema (HAE) and acquired or idiopathic angioedema (AAE). HAE is characterized by dominant autosomal transmission, early onset, and a positive family history. It is caused by a mutation of the gene for C1-INH, localized on chromosome 11. Type 1 HAE is the most frequent form (85% of cases) and is associated with deficiency of functional C1-INH in plasma (10%-30% of normal values). Type 2 HAE is characterized by normal or elevated plasma levels of dysfunctional C1- INH.8 Type 3 HAE occurs mainly in women. Affected persons display the typical clinical features of C1-INH deficiency but have normal plasma levels and functionality of C1-INH. Mutations in the coagulation factor XII gene have been detected in some of these patients. AAE is characterized by late onset, usually after the fourth decade, and is not associated with a positive family history.6 Type 1 AAE is caused by increate catabolism of C1-INH and is generally associated with a positive history of benign or malignant lymphoproliferative disorders. Type 2 AAE is associated with autoantibodies against C1-INH. Deficiency or dysfunction of C1-INH can cause a deregulation of the fibrinolytic system, of the complement pathway, of the contact system, and of the coagulation cascade, resulting in release of vasoactive substances, an increase in vessel permeability, and development of diffuse edemas. Hereditary and acquired forms of angioedema are clinically indistinguishable. Edemas develop gradually over a period of 12 to 36 hours and require 2 to 5 days to subside completely. The frequency and severity of edema attacks vary from patient to patient and even in the same individual. This variability can change significantly over a patient’s lifetime: symptoms may intensify dramatically after puberty, although some cases have been reported that had been asymptomatic until the second decade of life and later. The diagnosis of angioedema can often be suspected from a positive family history associated with the typical symptoms. Nevertheless, the diagnosis needs to be confirmed by laboratory tests to assess the quantity and function of C1-INH. The differential diagnosis of angioedema includes anaphylactic shock. Considering the potential risk of asphyxia, it is essential to obtain an accurate patient history to ensure that the most appropriate approach to emergency treatment is chosen, because cortico-steroids, antihistamines, and epinephrine are ineffective in the treatment of acute attacks of angioedema. Although angioedema attacks can occur without any specific precipitating factor, in 50% of cases the precipitating cause is tissue trauma. Trigger factors include dental procedures, endotracheal intubation, surgical or diagnostic interventions in the cephalic or cervical region (such as oral or maxillofacial surgery and tonsillectomy), mental or physical stress, infection, hormonal changes (menstruation, pregnancy, intake of oral contraceptives), intake of specific drugs (such as estrogens or angiotensin-converting enzyme inhibitors) or foods containing histamine or able to induce histamine release, insect bites, and strong temperature variation. At present, it is possible to intervene with a specific therapy according to the patient’s needs.

We evaluate the results and complications of laparoscopic urological procedures in children.In a 3-year period 4,350 laparoscopic procedures were performed at 8 Italian centers of pediatric surgery. We analyzed only the data of urological procedures for a total of 701 laparoscopic operations on patients 1 month to 14 years old. The indications for surgery were cryptorchidism in 414 cases, varicoceles in 159, ambiguous genitalia in 37, total nephrectomy in 34, partial nephrectomy in 4, adrenalectomy in 3 and other diagnostic procedures in 50. We adopted a retroperitoneoscopic approach in 72 cases (10.3%) and a laparoscopic approach in 629 (89.7%). Patient records were analyzed to search for any complication that may have occurred during the laparoscopic procedure and assess how they were managed.We recorded 19 complications (2.7%) in our series, of which 6 required conversion to open surgery and 13 did not. There was no mortality. At a maximum followup of 4 years all children were alive and had no problems related to the laparoscopic complications.Our study shows that pediatric laparoscopic urological surgery has an acceptable rate of complications with no mortality. We believe that routine use of open laparoscopy in pediatric patients is a key factor to help avoid complications. Most complications can be avoided with surgeon and team experience, together with proper compliance with the indications for surgery.

Background: The aim of this study was to evaluate the results and complications of laparoscopic varicocelectomy in children. Methods: Over a 36-month period, 211 children underwent laparoscopic treatment of varicocele. Their ages ranged between 6 and 17 years; the varicocele was located on the left side in 209 cases (99.1%) and was bilateral in 2 (0.9%). In 195 patients the laparoscopic transperitoneal approach was used and in 16 retroperitoneoscopy was used. Thirty children (14.2%) underwent ligation of the veins alone, and 181 (85.8%) underwent ligation of testicular veins and artery. In 15 (7.1%) cases an additional procedure was applied during the same operation. Results: Average operating time was 30 minutes and hospitalization about 24 hours. At an average follow-up of 26 months, there were 19 (9%) postoperative complications: 14 children had a left hydrocele, 3 children a scrotal emphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicocele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo’s. Testicular atrophy did not occur in any patient of this series. Conclusions: This preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. The ligation of testicular veins and artery is preferable to the ligation of the testicular veins alone. Hydrocele seems to be the most frequent postoperative complication and a potential problem, especially in children operated on with the Palomo procedure. J Pediatr Surg 36:767-769. Copyright © 2001 by W.B. Saunders Company.

Purpose: We report preliminary results of a multicenter study of the Italian Society of Video Surgery in Infancy on the laparoscopic treatment of pediatric varicocele. Materials and Methods: A total of 161 children 6 to 16 years old (median age 12.5) underwent laparoscopic treatment of varicocele at 6 pediatric surgery divisions. Varicocele was on the left side in 159 cases (98.7%) and bilateral in 2 (1.3%). Two boys had recurrent left varicocele. All children were treated with laparoscopy, including ligation of the spermatic veins only in 28 (17.3%), and ligation of the testicular veins and artery in 133 (82.7%). In 10 boys (6.2%) an additional procedure was done simultaneously, including closure of an apparently patent peritoneal vaginal duct on the right side in 7 and resection of epiploic adhesions between the intestinal loops and abdominal wall from previous appendectomy in the remaining 3. Results: Average operative time was 30 minutes and hospitalization was about 24 hours. At followup there were 13 minor complications (8%), including left hydrocele in 9 children who underwent the Palomo technique, minor scrotal emphysema in 2 and umbilical granuloma in 2. In our series varicocele recurred in 1 boy (3.5%) who underwent ligation of the spermatic veins only and in 3 (2.2%) treated with the Palomo technique. Conclusions: Our preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows treatment of other intra-abdominal pathological conditions using the same anesthesia, as in 10 patients in our series. We believe that ligating the testicular veins and artery is preferable to ligating the testicular veins only, even if the incidence of hydrocele is not negligible after the Palomo procedure.

Few data exist about walking and motility after infratentorial stroke (IS). The aim of this study was to objectively quantify pre-rehabilitation and post-rehabilitation walking and mobility in a group of IS patients admitted for inpatient rehabilitation and to determine factors influencing functional outcomes.Seventy-two patients with IS were selected on the basis of clinical criteria and computer tomography (CT) images. Mean age was 76.5 +/- 10 (31 men and 41 women). The stroke was ischemic in 55 patients and hemorrhagic in 17 Walking (Lindmark scale), mobility (Rivermead Mobility Index) (RMI) and stroke severity (National Institute of Health Stroke Scale) (NIH) were evaluated in all patients at admission to study and at discharge.Before rehabilitation 1.4% of patients were independent in walking and 23.7% were over 75th percentile in RMI. After rehabilitation, 80.5% of the patients were able to walk independently and 84.7% were over 75th percentile of mobility. Age, onset to admission interval, and extent of the stroke did non correlate with Lindmark and RIM. Lindmark and RMI were correlated only with NIH. Patients with higher NIH score (NIH+) had significantly worse walking capacity and mobility than patients with lower NIH score (NIH-) before and after rehabilitation. Moreover, in patients NIH+ length of rehabilitation therapy was significantly longer compared to patients NIH-. In addition, patients NIH+ had efficiency in walking and in mobility significantly lower than patients NIH-.The study shows that: (1) IS patients have a significant functional recovery in walking and mobility after rehabilitation, (2) stroke severity is related with walking and mobility.

Background and Purpose— The aim of this study was to verify whether the presence of anosognosia (A) affects the rehabilitative prognosis of hemiplegic subjects with neglect (N). Methods— This study was carried out on 30 patients with left hemiplegia: 15 patients had neglect (group N) and 15 had neglect and anosognosia (group N+A). Mean age was 68.2±6.3 in group N (9 men and 6 women) and 72.1±6.4 in group N+A (7 men and 8 women). The average interval from onset of stroke to admission for rehabilitation was 23 and 23.6 days, respectively, in group N and in group N+A. Patients were assessed through the Mesulam test, Bisiach test, Wechsler Adult Intelligence Scale, Fugl-Meyer scale, Functional Independence Measure (FIM), and Rankin scale. Results— Before rehabilitation, cognitive FIM scores of patients of group N were significantly higher than those of group N+A ( P =0.001), whereas motor FIM scores and total FIM scores did not differ between the 2 groups. After rehabilitation, cognitive FIM scores ( P =0.000) and even motor ( P =0.009) and total FIM scores ( P =0.000) were statistically higher in group N than in group N+A. Effectiveness ( P =0.005) and efficiency ( P =0.012) in the motor FIM scores of group N were significantly greater than those of group N+A. Disability was lower in group N ( P =0.040). Conclusions— Our study shows that the presence of anosognosia worsens the rehabilitation prognosis in hemiplegic subjects who also have neglect.

Aim of this study is to verify if the presence of extracerebellar stroke lesions negatively affects walking and functional capacities recovery of patients with cerebellar stroke.This study was carried out on 43 patients. Patients' selection was made through CT and MRI scans. Neuroimaging data were used to divide patients into 2 groups: 1) a group composed of 20 patients with isolated cerebellar involvement (group C); (2) a group composed of 23 patients with cerebellar plus extracerebellar involvement (group C+E). Patients were assessed through trunk control test (TCT), Lindmark scale and Rankin scale at admission and at discharge. Before rehabilitation, there were no significant differences in disability, TCT and Lindmark scores between the 2 groups of patients.After rehabilitation, Lindmark scale (P=0.022) and TCT (P=0.015) scores of group C were statistically higher than those of group C+E. Disability was greater in group C+E (P=0.036). In these patients disability was absent in 17.4% of subjects, moderate-slight in 47.8% and severe in 34.8%. In group C disability was absent in 40% of subjects, slight-moderate in 55% and severe in 5%. Effectiveness in walking was 79.1% in group C and 57% in group C+E. Efficiency in walking was 0.13 in C group and 0.07 in C+E subjects. Effectiveness (P=0.008) and efficiency (P=0.008) of group C were significantly greater than of group C+E.The study shows that the rehabilitation prognosis of cerebellar stroke is affected by the presence of extracerebellar stroke lesions.

Influenza and Streptococcus pneumoniae diseases can cause severe complications in HIV-1 infected individuals leading to increases in hospital admission and even death. Both vaccinations are recommended for such individuals, but some studies reported that such immunizations may stimulate an increase of HIV-1 viral load and decrease of CD4+ cells count. A review of published studies, including our studies carried out in HIV-1 infected former drugs addicts, indicates that influenza and pneumococcal vaccinations are well tolerated in individuals with HIV-1, and do not induce deterioration of the course of HIV-1 infection, even though the immune response to vaccination is lower than that one observed in immunocompetent individuals. Therefore the lack of significant changes of virological and immunological parameters indicates that such immunizations can be safely administrated to HIV-1 infected individuals.

A rare case of placental teratoma is described. Major features were the presentation as a pedunculated mass from the fetal surface of the placenta, the mixture of different tissues derived from all three germ layers (skin with dermal appendages, ganglion-like cells, and nervous structures, gut structures, osteocartilagineous and smooth and striated muscle), and the absence of segmental organization. © 1994 Wiley-Liss, Inc. © 1994 Wiley-Liss, Inc.

Antibody to the recently identified HCV and type of liver disease were investigated in 25 children with homozygous beta thalassemia. All patients were tested at regular intervals by second generation ORTHO-ELISA test. 19/25 (76%) patients were found repeatedly positive: in 11 cases seroconversion from anti-HCV- to anti-HCV+ status could be also documented. Liver disease was more severe in anti-HCV positive children. Seroconversion however did not produce major changes in liver disease outcome.

The importance of AR for a prompt and upkeep therapy is underlined by the Authors on the base of a statistical and clinical study about 67 cases of thoracic trauma treated from January 1975 to November 1979. The different alteration of the chest wall and surrounding structures are taken into consideration. The possible association of thoracic trauma with head trauma, severe shock and bony traumatism are also considered from a statistical and from a clinical point of view. The various therapeutic measures in case of thoracic trauma are also mentioned.

19 patients subjected to surgery for correction of p.e. have been followed up. The technique adopted is described. The results show the importance of early correction of the malformation and allow the indication to be extended to purely aesthetic needs.

Two clinical cases of acute gastric dilatation (Cast syndrome) in wearers of surgical corsets for kyphoscoliosis are described. One patient died in spite of surgical treatment, whereas the other responded favourably to conservative management. Fifty cases from the literature are examined. The seriousness and rapid progression of the syndrome are clear from its persistently high mortality (22%). Treatment was conservative in 70% of cases: antishock therapy, nasogastric aspiration, removal of the cast, while duodenojejunostomy was performed in the other 30%. In the two cases described, the seriousness of gastric distress due to compression of the duodenum by the aorta and mesentery was furthered evident from the observation of interstitial gastric emphysema.

Two cases of traumatic perforation of the gallbladder following open and closed injury to the abdomen respectively are described. Their common feature was a long, oligosymptomatic free interval. A brief account is given of the aetiopathogenetic, clinical and therapeutic problems raised by cases of this kind.

Complications and accidents in subarachnoid anaesthesia, their frequency, and methods for their prevention are described. Reference is also made to a personal series in which the low incidence of untoward consequence was probably attributable to the precautions described.