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Objectives: Fibromyalgia syndrome [FMS] is a musculoskeletal condition that is defined by widespread pain, mood disturbance, and cognitive dysfunction. There is debate surrounding the causes of this disorder, with growing attention being placed on central nervous system [CNS] abnormalities. Neurofeedback is a form of biofeedback that is designed to alter neurophysiological processes using electro-encephalogram [EEG] technology. This review includes systematic examination and comparison of neurofeedback interventions used to treat FMS symptoms [i.e. pain, fatigue, cognitive function, depression, anxiety, FMS impact]. Systematic searches were conducted on PubMed, PsycINFO, Cochrane Library, Medline, Web of Science, and the Society of Behavioral Medicine listserv for published and unpublished reports of interventions studies.Findings: Seven of the identified 255 studies met the criteria for inclusion. Three of these reports described traditional neurofeedback interventions and four described alternat...

Objectives: To compare men who were diagnosed with fibromyalgia syndrome [FMS] to those with osteoarthritis [OA] on psychological well-being, health status, and health care costs.Methods: Twenty-six men with FMS and 130 men with OA completed a battery of measures that assessed depression, self-efficacy over their condition, and health status. Demographic information was also recorded. Health care use data were collected from patient medical records for the year prior to the baseline assessment.Results: The results indicated that despite being significantly younger, men with FMS experienced lower quality of well-being, lower self-efficacy, and higher depression than men with OA. However, there were no significant differences in overall health care costs.Conclusion: The findings indicate that there are identifiable differences among men with FMS and OA that should be considered in the design of interventions and treatment options. The findings from the present study replicate those found among women...

The purpose of the present study was to examine the effects of smoking, stress, and depression on fibromyalgia health status. Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition that negatively affects health status. Health status is not only affected by the constellation of physical symptoms, but also by mood symptoms, stress levels, and patient behaviors (e.g. smoking). Participants were 491 individuals with a physician's diagnosis of FMS. They completed self-report measures of their current levels of depression, stress, the number of cigarettes smoked per day, and health status. A linear regression analysis was conducted to determine whether these measures predicted FMS health status. All three measures predicted worse health status, predicting 51.5% of the variance in health status. However, it is important to evaluate and treat more than just the physical symptoms of FMS. Attention should also be paid to mental health status and to engagement in unhealthy behaviors in order to reduce their effects on FMS health status. Future researchers should design and evaluate interventions that target these modifiable risk factors to determine the extent to which they could improve health outcomes.

Women account for over 80 % of the fibromyalgia syndrome (FMS) population. Some researchers have noted that a large percentage of women with FMS have had hysterectomies. The purpose of this study was to examine the relationship between FMS and hysterectomies, and to examine the impact of having a hysterectomy on health status and health care costs. A sample of 573 American women, who were members of a health maintenance organization with a confirmed diagnosis of FMS, reported whether they had a hysterectomy. Participants completed the Quality of Well-Being Scale and their annual health care costs were calculated based on their medical records. Almost half of the sample (48.3 %) reported having had a hysterectomy, with 90.7 % reporting having had the surgery before their FMS diagnosis. Those who had a hysterectomy had significantly lower general health status and incurred higher health care costs than the women with FMS who did not have a hysterectomy. The percentage of women with FMS who had a hysterectomy was considerably higher than that found in the general population. In this study, having a hysterectomy and a diagnosis of FMS was related to poorer health status and higher health care costs.

Summary Background An excess of intracellular β-catenin protein is triggered by various genetic alterations in melanoma cell lines, and has been suggested to play a role in melanoma tumorigenesis. Objectives To investigate the role played in vivo by β-catenin in melanoma tumorigenesis, we compared the cytoplasmic detection of β-catenin in benign melanocytic cells vs. malignant melanoma cells presumably generated from these benign melanocytic cells. For this purpose, melanocytic naevi occurring in association with melanoma, which were suggested to be melanoma precursors, were compared with their associated melanoma for β-catenin cytoplasmic immunoreactivity. Methods Fifty-seven consecutive cases of primary cutaneous melanoma were considered, and 15 of them were found to be associated with a melanocytic naevus portion. The naevus portion showed features of acquired melanocytic naevus (total 12 cases: five dysplastic, seven intradermal) or congenital growth pattern naevus (total three cases: one superficial, two deep). All specimens were immunohistochemically investigated for β-catenin. Results Virtually all primary cutaneous melanomas, including those associated with a naevus portion, showed cytoplasmic β-catenin positivity. However, the intradermal naevus portion was consistently cytoplasmic β-catenin negative, while both the dysplastic and the congenital naevus portions were cytoplasmic β-catenin positive. Conclusions β-Catenin excess may play a role in melanoma tumorigenesis, because β-catenin cytoplasmic reactivity was found in primary cutaneous melanoma but not in its associated intradermal naevus precursor. As, however, β-catenin cytoplasmic reactivity was detected not only in primary cutaneous melanoma but also in its associated dysplastic/congenital naevus precursors, β-catenin stabilization alone is not sufficient to play a decisive role for melanoma onset.

Objective:To describe voluntarily reported errors in an Emergency Department using a reward-based system.Methods:Prospective, observational study in urban, academic Emergency Department with 107,000 annual visits. All Emergency Department staff with direct patient contact voluntarily reported medica

A 'can't intubate, can't oxygenate' scenario in a child is fortunately extremely rare. We report a case of this life-threatening event in a four-year-old boy suffering from a rare genetic disorder, fibrodysplasia ossificans progressiva. He presented for manipulation of his dislocated jaw and was identified preoperatively as having a difficult airway. Despite extensive preparation, a catastrophic loss of airway control occurred minutes after induction of general anaesthesia, necessitating a life saving emergency tracheostomy. This report highlights the small evidence base and lack of definitive algorithms relating to how best to rescue a paediatric 'can't intubate, can't oxygenate' situation. Paediatric anatomical factors dictate that immediate procession to a tracheal surgical airway may be the optimal management.

Background Three aromatase inhibitors, namely anastrozole, letrozole and exemestane, which reduce circulating oestrogen, are used to treat breast cancer patients; the therapeutic use of such aromatase inhibitors is quickly increasing. Objective We intended (i) to review aromatase inhibitor-induced cutaneous adverse effects and (ii) to describe a recently observed case of cutaneous vasculitis triggered by exemestane. Patients/methods The so-far reported literature cases of aromatase inhibitor-induced cutaneous adverse effects were analysed retrospectively. Especially, the clinical case of exemestane-induced cutaneous vasculitis herein reported is unique, because such an observation has not yet been published in the literature. Results Merely 12 cases of cutaneous adverse reactions induced by aromatase inhibitors, namely erythema nodosum (6), subacute cutaneous lupus erythematosus (1), cutaneous rashes (2), vasculitis (3, including the one described in this study), are reported in the literature. In fact, in the present case, cutaneous vasculitis was strictly related to exemestane. Conclusion As aromatase inhibitors (e.g. exemestane) are increasingly incorporated into the treatment strategy of breast cancer patients, it is important to recognize possible cutaneous adverse effects. Specifically, with regard to cutaneous vasculitis, some patients might progress to severe vasculitis manifestations if the offending drug (e.g. exemestane) is not quickly stopped.

We report a case of a 70-year-old man with a history of prostatic adenocarcinoma and a 3-month history of right hemiscrotal swelling. The patient underwent a CT scan, scrotal ultrasound, and F-18 FDG-PET scan to evaluate for metastatic prostate cancer. The CT scan demonstrated an ill-defined soft-tissue mass extending along the right gonadal vein. Scrotal ultrasound revealed a heterogeneous right testicular mass. The F-18 FDG-PET scan demonstrated intense hypermetabolic activity along the course of the right gonadal vein extending to the right hemiscrotum. Subsequent right radical orchiectomy and pathologic examination revealed a B-cell lymphoma, infiltrating the testicular parenchyma, spermatic cord, gonadal vessels, and adjacent soft-tissues. Lymphoma or other tumors rarely infiltrate the spermatic cord, and have only very rarely been demonstrated on PET imaging.

Male pseudohermaphroditism due to steroid 5 alpha-reductase deficiency is the consequence of mutations in the gene encoding the type 2 isoenzyme. Most (60%) affected subjects have homozygous mutations, and the remainder are compound heterozygotes or presumed compound heterozygotes. We report an Italian subject with phenotypic and endocrine features of 5 alpha-reductase 2 deficiency who is homozygous for a substitution mutation (H231R). Although close consanguinity is not present, genealogical data demonstrated that the parents are distantly related, and both parents and the maternal grandmother are heterozygous carriers of the mutation. The fact that this particular mutation results in the formation of an enzyme with considerable residual activity may explain in part the significant degree of virilization that took place in this subject in early infancy. This same mutation (H231R) is present in heterozygous form in two other families, an African-American family and an American family of northern European descent.

OBJECTIVE To determine whether the severity of retinopathy is higher in a group of NIDDM patients with sBP ≥ 140 mmHg compared with NIDDM patients with sBP < 140 mmHg. RESEARCH DESIGN AND METHODS Ophthalmoscopy and FAG were conducted among a group of NIDDM patients with either a sBP above (n = 54) or below (n = 55) 140 mmHg. The groups were matched according to diabetes duration, metabolic control (HbA1c), and AER. RESULTS Patients with sBP > 140 mmHg had a higher prevalence of retinopathy, as established according to a rating scale (4.9 ± 3.8 vs. 3.2 ± 3.3, P < 0.02); furthermore, their BMI values were higher (28.1 ± 4.5 vs. 24.9 ± 4.1 kg/m2, P < 0.001). The group of normotensive subjects showed the highest rate of low grading (0–2) values. However, the highest prevalence rates of 8–10 grading values (proliferative retinopathy) were found in the hypertensive group. CONCLUSIONS These data suggest that sBP values ≥ 140 mmHg favor the onset of retinopathy in NIDDM patients during their 1st 10 yr of disease.

The authors describe two cases in which computerized tomography (CT) revealed the presence of cervical intramedullary metastases in the form of increased density areas.

Background: Nucleos(t)ide reverse transcriptase inhibitors (NRTI) toxicity may represent a threat for long-term success of combined antiretroviral therapy. Some studies have suggested a possible improvement of NRTI-related toxicity after switching to NRTI-sparing regimens. Objectives: We aimed to explore the efficacy and tolerability of switching to darunavir/ritonavir (DRV/r) plus raltegravir (RAL) while having a viral load (VL) ≤50 copies/mL in the clinical setting. Study design: Treatment-experienced HIV 1-infected patients enrolled in the ICONA Foundation Study cohort were included if they switched their current regimen to DRV/rÂ+ÂRAL with a HIV-RNA ≤50Âcopies/mL. Different definitions of virological failure (VF) and treatment failure (TF) were employed. Kaplan–Meier curves and Cox regression models were performed to estimate time to event probability. Results: We included 72 HIV-infected patients, 22 (31%) of these were female, 31 (43%) men who have sex with men (MSM) amd 15 (21%) had hepatitis co-infections. Median age was 44 (IQR: 35-50) years amd CD4 count was 389 (IQR 283-606) cells/mmc. Median follow-up time for TF was 24 (IQR 9–31)Âmonths. Twenty-five discontinuations occurred (60% simplifications); only 2 (8%) were toxicity-driven (lipid elevations). The probability of VF (confirmed VL >50 copies/mL) was estimated at 7% [95% confidence interval (CI) 1–13%] by 12 and 9% (95% CI 2–16%) by 24Âmonths. When considering TF, we found a probability of stop/intensification/single VLÂ>Â200 copies/mL of 13% (95% CI 1–17%) and 22% (95% CI 11–33%) by 12 and 24Âmonths. Female gender (adjusted relative hazard, ARHÂ=Â0.10; 95% CI 0.01–0.74; pÂ=Â0.024) and older age (AHRÂ=Â0.50 per 10Âyears older; 95% CI 0.25–0.99; pÂ=Â0.045) were associated with a lower risk of TF. A previous PI failure was strongly associated with TF (AHRÂ=Â52.6, 95% CI 3.6–779; pÂ=Â0.004). Conclusions: DRV/rÂ+ÂRAL is a valuable NRTI-sparing option, especially in female and older patients, with a relatively low risk of VF and good tolerability after 2Âyears since start in an ART-experienced population. However, previous PI-failure should be a limiting factor for this strategy.

Objective To estimate the incidence of hepatitis C virus (HCV) seroconversion and the risk of severe fibrosis/cirrhosis in HCV seroconverters among persons with human immunodeficiency virus (HIV) infection. Methods We analysed data on 4059 persons with HIV enrolled in a cohort study in Italy. Results Incidence rate of seroconversion was 0.6/100 person-years overall, and drug users and men-who-have-sex-with-men were at highest risk. The cumulative risk of progression to severe fibrosis/cirrhosis was 30% by 10 years after seroconversion. Conclusions New HCV infections have a rapidly progressive course in this population. Persons with HIV and HCV superinfection should be prioritized for treatment with anti-HCV direct-acting antivirals.

A 6-year-old girl was admitted to the paediatric emergency department with colicky abdominal pain. She had a significant medical history, with four previous admissions due to recurrent abdominal pain in the past year. On examination the abdomen was soft, there was no rebound tenderness and Rovsing's sign was negative. Her blood tests revealed a raised white cells count, although her C reactive protein was within the normal range. Abdominal x-ray revealed small bowel obstruction. During her assessment the patient rapidly deteriorated and seemed to go into shock. Her clinical state in addition to the radiological findings meant that she was taken to theatre for surgical exploration. This showed a triple volvulus with necrotic bowel loops that had herniated through a mesenteric defect. The necrotic bowel was subsequently resected.