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Objective: To correlate, RSI with SVHI, in a group of singing students, by means of a specific anamnestic questionnaire which analyzes the physical, social, emotional, and economic impacts of voice problems on their lives. This study is a cross-sectional single-center observational study., Methods: Forty-two modern singing students (26F/16M; average age: 24.9 ± 5.7; range: 16-46 years old) were recruited. A self-assessment of the singing-voice (SVHI) and of reflux symptom (RSI) was performed., Results: Using the validated RSI threshold, 31% of participants were classified as RSI greater than 13 as an indication of suspected LPR. Classifying the SVHI score as proposed in the recent literature (cutoff of 20.35) our sample was a voice disorders prevalence of 71.4%. There was no significant positive or negative relationship between RSI and SVHI total score (rho = 0.238, P = 0.13). Instead, by considering the relationship between the individual items of the two questionnaires, it is highlighted that the item 1 of SVHI was significantly correlated with most of the RSI items (P = 0.0001-0.006). In the same vein, the item 5 of SVHI was correlated to hoarseness and coughing (P = 0.005-0.006). The item 20 of SVHI was significantly correlated with hoarseness, excess mucus in the throat or postnasal drip and with the pharyngeal Globus sensation (P = 0.001-0.005). By aggregating the SVHI item response as a positive response (2-4) versus a negative response (0 or 1) between "RSI pathology classification," a significant association was observed for SVHI item 1 (P < 0.021), item 5 (P < 0.006), item 20 (P < 0.042), item 24 (P < 0.044) item 25 (P < 0.047). These associations were confirmed by univariate binary logistic. Multivariate binary logistic regression confirms that SVHI Item 1, Item 5 were more associated with RSI positive. Based on results, we propose a questionnaire that combines the most relevant SVHI items correlated to LPRD (SVHI-10-LPRD questionnaire). Cronbach's alpha coefficient for the 10 items selected was 0.87; item-total correlation coefficients for each item were in the range of 0.461 to 0.670., Conclusions: This pilot study shows that, in case of significant RSI for LPR, it is possible to observe a significant association with some symptoms described in SVHI. These results underline that the association of the RSI and SVHI questionnaires administered to singers and singing students, can represent a simple screening to reveal possible alterations of the singing voice correlate to LPR. Moreover, we propose a Singing Voice Handicap Index correlated to LPR (SVHI-10-LPRD). It will be necessary to increase the sample of subjects in the study to confirm these preliminary data., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Second victim syndrome is a hidden pitfall inside health care organizations. The impact of a patient safety incident on health and safety of health care workers (HCWs) is still a matter with limited evidence in terms of prevalence, etiology, and effects. The aims of this study were to validate the Italian version of the Second Victim Experience and Support Tool (I-SVEST) and determine its psychometric properties in a group of HCWs exposed to patient safety incidents., Materials and Methods: An observational cross-sectional study was conducted using an online survey. Construct validity for the total score and for each of the 7 subscales was assessed using principal component analysis and internal consistency using Cronbach α coefficient., Results: The prevalence of second victims in our sample was 35.4% (85/240). The component SVEST was positively associated with turnover intentions but not directly related to absenteeism and sociodemographic characteristics. Absenteeism and sociodemographic characteristics components were positively associated with turnover intentions. Factor analysis confirmed that the questionnaire has 7 dimensions: psychological distress, physical distress, colleague support, supervisor support, institutional support, non-work-related support, and professional self-efficacy. Cronbach α for the Italian version was strong at α = 0.855. Cronbach α ranged from 0.613 for colleague support to 0.882 for supervisor support., Conclusions: The Italian version of the SVEST has excellent psychometric properties and can be used to detect prevalence in different contexts, to support studies and preventive interventions for Italian HCWs. The SVEST provides a robust model to describe the concept of second victim and to conduct comparisons with cross-sectional and longitudinal studies., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Atherosclerosis is a chronic inflammatory disease. The balance between pro- and anti-inflammatory factors, acting on the arterial wall, promotes less or more coronary plaque macro-calcification, respectively. We investigated the association between monocyte phenotypic polarization and CTCA-assessed plaque dense-calcium volume (DCV) in patients with stable coronary artery disease (CAD)., Methods: In 55 patients, individual DCV component was assessed by quantitative CTCA and normalized to total plaque volume. Flow cytometry expression of CD14, CD16, CD18, CD11b, HLA-DR, CD163, CCR2, CCR5, CX3CR1 and CXCR4 was quantified. Adhesion molecules and cytokines were measured by ELISA., Results: DCV values were significantly associated, by multiple regression analysis, with the expression (RFI) of CCR5 ( p = 0.04), CX3CR1 ( p = 0.03), CCR2 ( p = 0.02), CD163 ( p = 0.005) on all monocytes, and with the phenotypic M2-like polarization ratio, RFI CCR5/CD11b ( p = 0.01). A positive correlation with the increased expression of chemokines receptors CCR2, CCR5 and CX3CR1 on subsets Mon1 was also present. Among cytokines, the ratio between IL-10 and IL-6 was found to be strongly associated with DCV ( p = 0.009)., Conclusions: The association between DCV and M2-like phenotypic polarization of circulating monocytes indicates that plaque macro-calcification in stable CAD may be partly modulated by an anti-inflammatory monocyte functional state, as evidenced by cell membrane receptor patterns.

To assess influenza vaccine uptake during the 2020/2021 flu season and compare it with that of the 2019/2020 flu season among respondents to the second phase of the web-based EPICOVID-19 survey, we performed an observational web-based nationwide online survey (January-February 2021) in which respondents to the first survey (April-June 2020) were contacted and asked to complete a second questionnaire. Factors associated with vaccine uptake in the 2020/2021 flu season were assessed by applying a multivariable multinomial logistic regression model. Out of the 198,822 respondents to the first survey, 41,473 (20.9%) agreed to fill out the follow-up questionnaire; of these, 8339 (20.1%) were vaccinated only during the 2020/2021 season, 8828 (21.3%) were vaccinated during both seasons and 22,710 (54.8%) were vaccinated in neither season. Educational level (medium (aOR 1.33 95%CI 1.13-1.56) and high (aOR 1.69 95%CI 1.44-1.97) vs. low) and socio-economic deprivation according to SES scoring (1 point aOR 0.83 (95%CI 0.78-0.89), 2 aOR 0.68 (95%CI 0.60-0.77) points or ≥3 points aOR 0.42 (95%CI 0.28-0.45) vs. 0 points) were found to be associated with flu vaccine uptake. Our study shows that social determinants seemed to affect flu vaccination uptake and identifies specific categories of the population to target during future influenza vaccination campaigns.

Introduction: An innovative teleconsultation platform has been designed, developed and validated between summer 2017 and winter 2018, in five mountain huts and in three remote outpatient clinical centres of the Italian region Valle d'Aosta of the Mont Blanc massif area., Methods: An ad-hoc videoconference system was developed within the framework of the e-Rés@MONT (Interreg ALCOTRA) European project, to tackle general health problems and high-altitude diseases (such as acute mountain sickness, high-altitude pulmonary and cerebral oedema). The system allows for contacting physicians at the main hospital in Aosta to perform a specific diagnosis and to give specific advice and therapy to the patients in an extreme environment out-hospital setting. At an altitude between 1500-3500 m, five trained nurses performed clinical evaluations (anamnesis, blood pressure, heart rate, oxygen saturation), electrocardiographic and echography monitoring on both tourists and residents as necessary; all of the collected data were sent to the physicians in Aosta., Results: A total of 702 teleconsultation cases were performed: 333 dismissed (47%), 356 observed (51%) and 13 immediate interventions (2%). In 30 cases the physicians decided there was no need for helicopter and ambulance rescue intervention and hospital admissions. The main physiological measures, the classified pathologies, the severe cases and the cost savings are described in this article., Discussion: The e-Rés@MONT teleconsultation platform has been discussed in terms of treated cases, feasibility, proactivity in reducing complexities, direct and indirect advantages, and diagnostics help; moreover, general and specific pros and cons have been debated, and future steps have been exposed.

Objective: To evaluate retrospectively the incidence of complications during fiberoptic endoscopic evaluation of swallowing (FEES) in 5,680 examinations., Patients and Methods: 5,680 patients were evaluated at the Department of Otorhinolaryngology, Audiology and Phoniatrics of Pisa University Hospital between January 2014 and December 2018, involving both inpatients and outpatients. Most common comorbidities included neurological pathologies such as stroke (11.8%), neurodegenerative diseases (28.9%) and a history of previous head and neck surgery (24.6%). The evaluation was conducted by clinicians with experience in swallowing for a minimum of 10 years with the assistance of one or more speech-language pathologists., Results: In all patients studied the endoscope insertion was tolerated, and it was possible to visualize the pharyngolaryngeal structures. Three subjects refused to undergo the procedure after being informed regarding the protocol and were therefore not included in this study. Most patients reported discomfort (70.1%) and gagging (20.8%). In a minority of patients complications were recorded, such as anterior epistaxis (0.1%), posterior epistaxis (0.02%), vasovagal crises (0.08%) and laryngospasm (0.04%). Especially laryngospasm was recorded in patients affected by amyotrophic lateral sclerosis. Multivariate binary logistic regression showed that discomfort (OR 9.944; CI 7.643-12.937), chronic gastrointestinal diseases (OR 2.003; CI 1.518-2.644), neurodegenerative diseases (OR 1.550; CI 1.302-1.846) and brain tumors (OR 1.577; CI 1.179-2.111) were risk factors associated with minor complications., Conclusions: FEES proved to be easy to perform, well tolerated by the patients and cost-effective. It can be performed at the patient's bedside, and it is characterized by a low rate of complications. As a matter of fact, normally only discomfort, gagging and/or vomiting are reported. Complications occurred only rarely, such as anterior or posterior epistaxis episodes or vasovagal crises, but these are still easily managed. Exceptionally, more severe complications are reported: adverse drug reactions to substances such as blue dye (methylene blue) and local anesthetics (not used in our protocol), and laryngospasm., (© 2022 S. Karger AG, Basel.)

Background: Ultrasound evaluation of inferior vena cava and internal jugular vein dia-meters predicts the intravascular volume status in critical patients. The aim of the present study was to determine which ultrasound-derived index is most strongly associated with central venous pressure (CVP). Furthermore, we determined the utility of selected variables in predicting low volume status (CVP < 8 mmHg)., Methods: All patients underwent a transthoracic echocardiogram, vascular ultrasound examination, invasive central venous pressure, and intra-abdominal pressure determination. The following indexes were calculated: inferior vena cava diameter, internal jugular vein maximum diameter, collapsibility index, and internal jugular vein ratio., Results: 41 spontaneously breathing patients were recruited. Central venous pressure significantly correlated with inferior vena cava diameter ( r = 0.35, P = 0.02), internal jugular vein ratio ( r = 0.35, P = 0.03), and internal jugular vein maximum diameter ( r = 0.58, P < 0.001). The inferior vena cava collapsibility index did not show any association. The areas under the receiver operating characteristic curves to discriminate a low central venous pressure (< 8 mmHg) were the following: internal jugular vein diameter 0.80 (95% CI: 0.63-0.90); inferior vena cava diameter 0.66 (95% CI: 0.49-0.80); and internal jugular vein ratio 0.68 (95% CI: 0.51-0.82)., Conclusions: The internal jugular vein diameter, the internal jugular vein ratio, and the inferior vena cava diameter showed a significant correlation with central venous pressure. In particular, the internal jugular vein diameter showed good accuracy in predicting a low central venous pressure.

Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies., Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population., Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post)., Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001)., Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups., (©Francesca Mastorci, Paolo Piaggi, Gabriele Trivellini, Cristina Doveri, Anselmo Casu, Luca Bastiani, Irene Marinaro, Cristina Vassalle, Alessandro Pingitore. Originally published in JMIR Formative Research (https://formative.jmir.org), 02.12.2021.)

Background: Energy Drinks (ED) are caffeinated beverages marketed as attention and endurance enhancers. The main purpose of this study is to provide national estimates of the prevalence of alcohol mixed with energy drink (AmED) and ED use among school-aged adolescents. A secondary objective is to examine the differences in the prevalence of AmED and ED consumption by gender., Methods: For this study, we used data from twelve consecutive years, from ESPAD-Italia®2008 to ESPAD-Italia®2019., Results: From 2008-2019, the prevalence of lifetime consumption of energy drinks increased significantly for male (64.5-75.7%, p < 0.001) and female (46.8-61.8%, p < 0.001). We also observed an increase in both genders for last year prevalence (male: 51.6-63.4%, p < 0.001; female: 32.5-38.3%, p < 0.001), instead prevalence in last month showed an increase only in males (males: 37.5-45.4%, p = <0.001; females: 19.9-20.3%, p = 0.426). Finally, frequent use showed a fluctuating trend, particularly in females (males: 3.2-4.3%, p = 0.422; females: 0.8-0.8%, p = 0.643). From 2013-2019, the prevalence of AmED consumption did not show relevant changes among adolescents. A clear gender gap is evident for both ED and AmED usage prevalence, in all the years considered for lifetime, last year, last month and frequent use., Conclusions: The findings suggest that the prevalence of ED consumption among Italian high school students is very high and has grown substantially over the past 12 years. Differently the prevalence of AmED use, although widespread, did not increase overall since 2013., (Copyright © 2021. Published by Elsevier B.V.)

In the recent literature the rates of gambling in psychiatric patients have been compared only indirectly with those found in community samples and no study has so far matched a clinical sample with community controls. We selected 875 outpatients attending two community mental health centers and 3.500 community subjects, matched for age and sex. At-risk gambling was defined according to the four categories of the Canadian Problem Gambling Index (CPGI) scores: 0 no-risk, 1-2 low-risk, 3-7 moderate-risk, 8+ high-risk. Data were also collected on substance, alcohol, and tobacco use. Patients were diagnosed with schizophrenia, bipolar disorder, unipolar depression, cluster B personality. At-risk gambling was significantly higher in psychiatric patients compared to community subjects. In the univariate multinomial logistic regression analysis, high-risk gambling was associated with lifetime substance use and being unmarried, moderate-risk with age at onset of alcohol use and lifetime tobacco use, and low-risk with higher education. In the multinomial logistic regression analysis high risk-gambling in psychiatric patients was four times that of community controls, while in substance users high-risk gambling was two times that of non-users. The results suggest that screening for gambling could improve the care of psychiatric patients who suffer from a comorbid behavioral addiction., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Importance: Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite technological advancements and campaigns calling for better awareness and minimization of unnecessary exposures., Objective: To assess patients' knowledge about medical radiation and related risks., Design, Setting, and Participants: A survey study of hospitals in Italy was conducted; all patients in waiting rooms for medical imaging procedures before undergoing imaging examinations at 16 teaching and nonteaching hospitals were approached to take the survey. The survey was performed from June 1, 2019, to May 31, 2020., Main Outcomes and Measures: Survey respondents' basic knowledge of ionizing radiation levels and health risks, earlier imaging tests performed, and information and communication about radiation protection issues., Results: Among 3039 patients invited to participate, the response rate was 94.3% (n = 2866). Participants included 1531 women (53.4%); mean (SD) age was 44.9 (17.3) years. Of the 2866 participants, 1529 (53.3%) were aware of the existence of natural sources of ionizing radiation. Mammography (1101 [38.4%]) and magnetic resonance imaging (1231 [43.0%]) were categorized as radiation-based imaging modalities. More than half of the 2866 patients (1579 [55.1%]; P = .03) did not know that chest computed tomography delivers a larger dose of radiation than chest radiography, and only 1499 (52.3%) knew that radiation can be emitted after nuclear medicine examinations (P = .004). A total of 667 patients (23.3%) believed that radiation risks were unrelated to age, 1273 (44.4%) deemed their knowledge about radiation risks inadequate, and 2305 (80.4%) preferred to be informed about radiation risks by medical staff. A better knowledge of radiation issues was associated with receiving information from health care professionals (odds ratio [OR], 1.71; 95% CI, 1.43-2.03; P < .001) and having a higher educational level (intermediate vs low: OR, 1.48; 95% CI, 1.17-1.88; P < .001; high vs low: OR, 2.68; 95% CI, 2.09-3.43; P < .001)., Conclusions and Relevance: The results of this survey suggest that patients undergoing medical imaging procedures have overall limited knowledge about medical radiation. Intervention to achieve better patient awareness of radiation risks related to medical exposures may be beneficial.

The COVID-19 pandemic provided an extraordinary and naturalistic context to observe young people's psychosocial profiles and to study how a condition of environmental deprivation and lack of direct social contact, affects the well-being and health status of adolescents. The study explored whether the COVID-19 outbreak changes, in the short term, the acute well-being perception in adolescents, as measured by a Personalized Well-Being Index (PWBI) and the four components affecting health (i.e., lifestyle habits, social context, emotional status, mental skills), in a sample of early adolescent students. Data from 10 schools were collected on 1019 adolescents (males 48.3%, mean age 12.53 ± 1.25 y). Measurements were obtained at two time points, in September/October 2019, (baseline condition, BC) as part of the "A new purpose for promotion and eVAluation of healTh and well-being Among healthy teenageRs" (AVATAR) project and during the Italian Lockdown Phase (mid-late April 2020, LP), with the same students using an online questionnaire. During COVID-19 quarantine, adolescents showed a lower PWBI ( p < 0.001) as compared to the BC. Considering the four health-related well-being components, lifestyle habits ( p < 0.001), social context ( p < 0.001), and emotional status ( p < 0.001), showed significantly lower values during LP than BC. However, mental skills, in LP, displayed a significant increase as compared to BC ( p < 0.001). In this study, we have provided data on the personalized well-being index and the different components affecting health in adolescents during the COVID-19 lockdown, showing a general decrease in well-being perception, expressed in lifestyle habits, social, and emotional components, demonstrating detrimental effects in the first phase of quarantine on adolescents' psychosocial profiles. Our results shed new light on adolescence as a crucial period of risk behavior, especially when social support is lacking.

Total pancreatectomy (TP) is a highly invasive procedure often performed in patients affected by anorexia, malabsorption, cachexia, and malnutrition, which are risk factors for bad surgical outcome and even may cause enhanced toxicity to chemo-radiotherapy. The role of nutritional therapies and the association between nutritional aspects and the outcome of patients who have undergone TP is described in some studies. The aim of this comprehensive review is to summarize the available recent evidence about the influence of nutritional factors in TP. Preoperative nutritional and metabolic assessment, but also intra-operative and post-operative nutritional therapies and their consequences, are analyzed in order to identify the aspects that can influence the outcome of patients undergoing TP. The results of this review show that preoperative nutritional status, sarcopenia, BMI and serum albumin are prognostic factors both in TP for pancreatic cancer to support chemotherapy, prevent recurrence and prolong survival, and in TP with islet auto-transplantation for chronic pancreatitis to improve postoperative glycemic control and obtain better outcomes. When it is possible, enteral nutrition is always preferable to parenteral nutrition, with the aim to prevent or reduce cachexia. Nowadays, the nutritional consequences of TP, including diabetes control, are improved and become more manageable.

Background: Several studies have reported a low prevalence of current smoking among hospitalized COVID-19 cases; however, no definitive conclusions can be drawn., Objective: We investigated the association of tobacco smoke exposure with nasopharyngeal swab (NPS) test results for SARS-CoV-2 infection and disease severity accounting for possible confounders., Methods: The nationwide, self-administered, cross-sectional web-based Italian National Epidemiological Survey on COVID-19 (EPICOVID19) was administered to an Italian population of 198,822 adult volunteers who filled in an online questionnaire between April 13 and June 2, 2020. For this study, we analyzed 6857 individuals with known NPS test results. The associations of smoking status and the dose-response relationship with a positive NPS test result and infection severity were calculated as odds ratios (ORs) with 95% CIs by means of logistic and multinomial regression models adjusting for sociodemographic, clinical, and behavioral characteristics., Results: Out of the 6857 individuals (mean age 47.9 years, SD 14.1; 4516/6857, 65.9% female), 63.2% (4334/6857) had never smoked, 21.3% (1463/6857) were former smokers, and 15.5% (1060/6857) were current smokers. Compared to nonsmokers, current smokers were younger, were more educated, were less affected by chronic diseases, reported COVID-19-like symptoms less frequently, were less frequently hospitalized, and less frequently tested positive for COVID-19. In multivariate analysis, current smokers had almost half the odds of a positive NPS test result (OR 0.54, 95% CI 0.45-0.65) compared to nonsmokers. We also found a dose-dependent relationship with tobacco smoke: mild smokers (adjusted OR [aOR] 0.76, 95% CI 0.55-1.05), moderate smokers (aOR 0.56, 95% CI 0.42-0.73), and heavy smokers (aOR 0.38, 95% CI 0.27-0.53). This inverse association also persisted when considering the severity of the infection. Current smokers had a statistically significantly lower probability of having asymptomatic (aOR 0.50, 95% CI 0.27-0.92), mild (aOR 0.65, 95% CI 0.53-0.81), and severe infections (aOR 0.27, 95% CI 0.17-0.42) compared to those who never smoked., Conclusions: Current smoking was negatively associated with SARS-CoV-2 infection with a dose-dependent relationship. Ad hoc experimental studies are needed to elucidate the mechanisms underlying this association., Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701., (©Federica Prinelli, Fabrizio Bianchi, Gaspare Drago, Silvia Ruggieri, Aleksandra Sojic, Nithiya Jesuthasan, Sabrina Molinaro, Luca Bastiani, Stefania Maggi, Marianna Noale, Massimo Galli, Andrea Giacomelli, Raffaele Antonelli Incalzi, Fulvio Adorni, Fabio Cibella, EPICOVID19 Working Group. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 28.04.2021.)

Background: The influence of aging and multimorbidity on Covid-19 clinical presentation is still unclear., Objectives: We investigated whether the association between symptoms (or cluster of symptoms) and positive SARS-CoV-2 nasopharyngeal swab (NPS) was different according to patients' age and presence of multimorbidity., Methods: The study included 6680 participants in the EPICOVID19 web-based survey, who reported information about symptoms from February to June 2020 and who underwent at least one NPS. Symptom clusters were identified through hierarchical cluster analysis. The associations between symptoms (and clusters of symptoms) and positive NPS were investigated through multivariable binary logistic regression in the sample stratified by age (<65 vs ≥65 years) and number of chronic diseases (0 vs 1 vs ≥2)., Results: The direct association between taste/smell disorders and positive NPS was weaker in older and multimorbid patients than in their younger and healthier counterparts. Having reported no symptoms reduced the chance of positive NPS by 86% in younger (95%CI: 0.11-0.18), and by 46% in older participants (95%CI: 0.37-0.79). Of the four symptom clusters identified (asymptomatic, generic, flu-like, and combined generic and flu-like symptoms), those associated with a higher probability of SARS-CoV-2 infection were the flu-like for older people, and the combined generic and flu-like for the younger ones., Conclusions: Older age and pre-existing chronic diseases may influence the clinical presentation of Covid-19. Symptoms at disease onset tend to aggregate differently by age. New diagnostic algorithms considering age and chronic conditions may ease Covid-19 diagnosis and optimize health resources allocation., Trial Registration: NCT04471701 (ClinicalTrials.gov)., (Copyright © 2021. Published by Elsevier B.V.)

The purpose of this study was to evaluate the clinical features of mild-to-moderate coronavirus disease 2019 (COVID-19) in a sample of Italian patients and to investigate the occurrence of smell and taste disorders. Infected individuals with suspected (clinical diagnosis) or laboratory-confirmed COVID-19 infection were recruited. Patients completed a survey-based questionnaire with the aim of assessing their epidemiological and clinical characteristics, general otorhinolaryngological symptoms, and smell and taste disorders. A total of 294 patients with mild-to-moderate COVID-19 completed the survey (147 females). The most prevalent general symptoms included fever, myalgia, cough, and headache. A total of 70.4% and 59.2% of patients reported smell and taste disorders, respectively. A significant association between the two above-mentioned disorders was found (rs: 0.412; P < .001). Smell disorders occurred before the other symptoms in 11.6% of patients and was not significantly associated with nasal obstruction or rhinorrhea. Interestingly, our statistical analysis did not show any significant difference, either for general symptoms or otorhinolaryngological features, between the clinical diagnosis group and the laboratory-confirmed diagnosis (polymerase chain reaction) group. The structural equation model confirmed significant standardized paths (P < .05) between general symptoms, comorbidities, and general otorhinolaryngological complaints in the absence of a significant correlation between these elements and smell and taste alterations. The prevalence of smell and taste disorders in mild-to-moderate Italian COVID-19 patients is significant both in suspected and laboratory-confirmed cases and reveals a strong correlation between these clinical signs regardless of the presence of general or otorhinolaryngological symptoms, such as nasal obstruction or rhinorrhea., (© 2020 Wiley Periodicals LLC.)

Background: Confirmed COVID-19 cases have been registered in more than 200 countries, and as of July 28, 2020, over 16 million cases have been reported to the World Health Organization. This study was conducted during the epidemic peak of COVID-19 in Italy. The early identification of individuals with suspected COVID-19 is critical in immediately quarantining such individuals. Although surveys are widely used for identifying COVID-19 cases, outcomes, and associated risks, no validated epidemiological tool exists for surveying SARS-CoV-2 infection in the general population., Objective: We evaluated the capability of self-reported symptoms in discriminating COVID-19 to identify individuals who need to undergo instrumental measurements. We defined and validated a method for identifying a cutoff score., Methods: Our study is phase II of the EPICOVID19 Italian national survey, which launched in April 2020 and included a convenience sample of 201,121 adults who completed the EPICOVID19 questionnaire. The Phase II questionnaire, which focused on the results of nasopharyngeal swab (NPS) and serological tests, was mailed to all subjects who previously underwent NPS tests., Results: Of 2703 subjects who completed the Phase II questionnaire, 694 (25.7%) were NPS positive. Of the 472 subjects who underwent the immunoglobulin G (IgG) test and 421 who underwent the immunoglobulin M test, 22.9% (108/472) and 11.6% (49/421) tested positive, respectively. Compared to NPS-negative subjects, NPS-positive subjects had a higher incidence of fever (421/694, 60.7% vs 391/2009, 19.5%; P<.001), loss of taste and smell (365/694, 52.6% vs 239/2009, 11.9%; P<.001), and cough (352/694, 50.7% vs 580/2009, 28.9%; P<.001). With regard to subjects who underwent serological tests, IgG-positive subjects had a higher incidence of fever (65/108, 60.2% vs 43/364, 11.8%; P<.001) and pain in muscles/bones/joints (73/108, 67.6% vs 71/364, 19.5%; P<.001) than IgG-negative subjects. An analysis of self-reported COVID-19 symptom items revealed a 1-factor solution, the EPICOVID19 diagnostic scale. The following optimal scores were identified: 1.03 for respiratory problems, 1.07 for chest pain, 0.97 for loss of taste and smell 0.97, and 1.05 for tachycardia (ie, heart palpitations). These were the most important symptoms. For adults aged 18-84 years, the cutoff score was 2.56 (sensitivity: 76.56%; specificity: 68.24%) for NPS-positive subjects and 2.59 (sensitivity: 80.37%; specificity: 80.17%) for IgG-positive subjects. For subjects aged ≥60 years, the cutoff score was 1.28, and accuracy based on the presence of IgG antibodies improved (sensitivity: 88.00%; specificity: 89.58%)., Conclusions: We developed a short diagnostic scale to detect subjects with symptoms that were potentially associated with COVID-19 from a wide population. Our results support the potential of self-reported symptoms in identifying individuals who require immediate clinical evaluations. Although these results come from the Italian pandemic period, this short diagnostic scale could be optimized and tested as a screening tool for future similar pandemics., (©Luca Bastiani, Loredana Fortunato, Stefania Pieroni, Fabrizio Bianchi, Fulvio Adorni, Federica Prinelli, Andrea Giacomelli, Gabriele Pagani, Stefania Maggi, Caterina Trevisan, Marianna Noale, Nithiya Jesuthasan, Aleksandra Sojic, Carla Pettenati, Massimo Andreoni, Raffaele Antonelli Incalzi, Massimo Galli, Sabrina Molinaro. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.01.2021.)

The aim of this study was to investigate if compression therapy (CT) can be safely applied in diabetic patients with Venous Leg Ulcers (VLU), even when a moderate arterial impairment (defined by an Ankle-Brachial Pressure Index 0.5-0.8) occurs as in mixed leg ulcers (MLU)., Materials and Methods: in one of our previous publications we compared the outcomes of two groups of patients with recalcitrant leg ulcers. Seventy-one patients were affected by mixed venous and arterial impairment and 109 by isolated venous disease. Both groups were treated by tailored inelastic CT (with compression pressure <40 mm Hg in patients with MLU and >60 mm Hg in patients with VLU) and ultrasound guided foam sclerotherapy (UGFS) of the superficial incompetent veins with the reflux directed to the ulcer bed. In the present sub analysis of the same patients we compared the healing time of 107 non-diabetic patients (NDP), 69 with VLU and 38 with MLU) with the healing time of 73 diabetic patients (DP), 40 with VLU and 33 with MLU., Results: Twenty-five patients were lost at follow up. The results refer to 155 patients who completed the treatment protocol. In the VLU group median healing time was 25 weeks for NDP and 28 weeks in DP ( p = 0.09). In the MLU group median healing time was 27 weeks for NDP and 29 weeks for DP ( p = -0.19)., Conclusions: when providing leg ulcer treatment by means of tailored compression regimen and foam sclerotherapy for superficial venous refluxes, diabetes has only a minor or no effect on the healing time of recalcitrant VLU or MLU.

Objectives: To investigate the psychometric properties of the reflux symptom index (RSI) as short screening approach for the diagnostic of laryngopharyngeal reflux (LPR) in patients with confirmed diagnosed regarding the 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH)., Methods: From January 2017 to December 2018, 56 patients with LPR symptoms and 71 healthy individuals (control group) were prospectively enrolled. The LPR diagnosis was confirmed through MII-pH results. All subjects (n = 127) fulfilled RSI and the Reflux Finding Score (RFS) was performed through flexible fiberoptic endoscopy. The sensitivity and the specificity of RSI was assessed by ROC (Receiver Operating Characteristic) analysis., Results: A total of 15 LPR patients (26.8%) of the clinical group met MII-pH diagnostic criteria. Among subjects classified as positive for MII- pH diagnoses, RSI and RFS mean scores were respectively 20 (SD ± 10.5) and 7.1 (SD ± 2.5), values not significantly different compared to the negative MII-pH group. The metric analysis of the items led to the realization of a binary recoding of the score. Both versions had similar psychometric properties, α was 0.840 for RSI original version and 0.836 for RSI binary version. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without LPR pathology diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for LPR pathology were ≥ 5 for RSI binary version and ≥ 15 for RSI original version. Both version overestimated LPR prevalence. The original version had more sensitivity and the RSI Binary version had more specificity., Conclusions: It would be necessary to think about modifying the original RSI in order to improve its sensitivity and specificity (RSI binary version, adding or changing some items), or to introduce new scores in order to better frame the probably affected of LPR patient.

Background: Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce., Objective: The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population., Methods: EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19-like infection in the nontested population., Results: A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection., Conclusions: Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection., Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701., (©Fulvio Adorni, Federica Prinelli, Fabrizio Bianchi, Andrea Giacomelli, Gabriele Pagani, Dario Bernacchia, Stefano Rusconi, Stefania Maggi, Caterina Trevisan, Marianna Noale, Sabrina Molinaro, Luca Bastiani, Loredana Fortunato, Nithiya Jesuthasan, Aleksandra Sojic, Carla Pettenati, Marcello Tavio, Massimo Andreoni, Claudio Mastroianni, Raffaele Antonelli Incalzi, Massimo Galli. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 18.09.2020.)

Background and Aims: Atherosclerosis is an inflammatory disease with long-lasting activation of innate immunity and monocytes are the main blood cellular effectors. We aimed to investigate monocyte phenotype (subset fraction and marker expression) at different stages of coronary atherosclerosis in stable coronary artery disease (CAD) patients., Methods: 73 patients with chronic coronary syndrome were evaluated by CT coronary angiography (CTCA) and classified by maximal diameter stenosis of major vessels into three groups of CAD severity: CAD1 (no CAD/minimal CAD, n ° = 30), CAD2 (non-obstructive CAD, n ° = 21), and CAD3 (obstructive CAD, n ° = 22). Flow cytometry for CD14, CD16, and CCR2 was used to quantify Mon1, Mon2, and Mon3 subsets. Expression of CD14, CD16, CD18, CD11b, HLA-DR, CD163, CCR2, CCR5, CX3CR1, and CXCR4 was also measured. Adhesion molecules and cytokines were quantified by ELISA., Results: Total cell count and fraction of Mon2 were higher in CAD2 and CAD3 compared to CAD1. By multivariate regression analysis, Mon2 cell fraction and Mon2 expression of CX3CR1, CD18, and CD16 showed a statistically significant and independent increase, parallel to stenosis severity, from CAD1 to CAD2 and CAD3 groups. A similar trend was also present for CX3CR1 and HLA-DR expressions on total monocyte population. A less calcified plaque composition was associated to a higher Mon2 expression of CD16 and higher TNF- α levels. IL-10 levels were lower at greater stenosis severity, while the IFN- γ /IL-10 ratio, a marker of a systemic pro-inflammatory imbalance, was directly correlated to stenosis degree and number of noncalcified plaques., Conclusions: The results of this study suggest that a specific pattern of inflammation-correlated monocyte marker expression is associated to higher stenosis severity and less calcified lesions in stable CAD. The clinical trial Identifier is NCT04448691., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Silverio Sbrana et al.)

Adolescence is a period characterized by rapid physical maturation, involving bodily changes that often necessitate a reorganization of self-perception. The current study investigated the impact of menarche on the determinants of quality of life in healthy female adolescents. Data were collected from 361 healthy female adolescents divided into two groups: pre- and post-menarcheal event. Participants, according the AVATAR project, completed Italian version of KIDSCREEN-52 questionnaires on health-related quality of life. Pre-menarcheal females had the higher score in psychological well-being and mood than post-menarcheal females. As concerns self-perception, post-menarcheal females exhibited lower score compared to pre-menarcheal females. In social context, pre-menarcheal females perceived a better school environment, also when we considered it in terms of social acceptance.Conclusion: Menarche event affects all the components of quality of life, from mood, self-esteem to social relationships, underlining how this hormonal variation is responsible of psychological and emotional changes, opening up the opportunity for preventive approaches aimed not only at traditional risk factors but according a more integrated perspective.What is Known:• Adolescence is a time of increasing behavioural divergence between males and females, probably due to the different hormonal development.• There is a possible link between menarche and the health-related quality of life variables.What is New:• Menarche condition affects all the components of quality of life, from mood to social relationships.• Post-menarcheal condition is associated to psychosocial and emotional changes, with possible multiple pathways to post-pubertal depressive symptoms.

Adolescence is not only typically considered a time of good health but also characterized by an emergence of risk factors that may have long-term consequences for well-being that represents strong predictors of adverse health outcomes. The aim of the study is to assess adolescence well-being through the development of an integrated Well-Being Index (WBI) including variables of lifestyle habits, social context, emotional status, and mental skills. One thousand two hundred forty-eight healthy adolescents (Female 48%; Male 52%; mean age 13 years) were recruited from five Italian junior high schools, by KIDSCREEN-52 and cognitive processing using the Stroop Test. School performance was estimated by questions concerning the scholastic achievement. Social context was the most important predictor of perceived well-being (β = 0.972, SE = 0.014, p < 0.0001), with parent relation ( p < 0.0001) as the most observed variable. Subsequently, WBI was strongly represented by lifestyle habits (β = 0.954, SE = 0.017, p < 0.000) with autonomy ( p < 0.0001), and emotional status (β = 0.949, SE = 0.017, p < 0.000) with psychological well-being perception ( p < 0.0001). Finally, mental skills (β= -0.1417, SE = 0.031, p < 0.0.00) was the least important predictor for the WBI index ( p < 0.0001). Personalised (P) WBI was obtained by the sum of each centered and scaled WBI variable, weighted by the corresponding ratio between factor loading and residual variance. Social context was the more important predictor of WBI, followed by lifestyle, emotional factors, and lastly mental skills. PWBI provides an integrated and personalized perspective of adolescents' well-being, on the basis of a cooperation between school, family, and community with the common intent to promote and protect adolescent health., (Copyright © 2020 Mastorci, Bastiani, Doveri, Trivellini, Casu, Vassalle and Pingitore.)

Background: More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases., Aim: To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk., Methods: A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65-74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared., Results: Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients., Conclusions: Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.

Background: Limited number of studies examined the relationship between factors (lifestyle, social, emotional, cognitive) affecting adolescents' health and well-being. The aims of this study were to identify the more important variables of the different components affecting adolescents' health [lifestyle habits (LH); emotional status (ES); social context (SC); and cognitive abilities (CA)], and explore the relationship between the aforementioned components., Methods: Data were collected between 2017 and 2018 from 756 eligible students, recruited from 5 Italian junior high school, by using KIDSCREEN-52 and cognitive processing using the Stroop Test. School engagement was estimated through questions concerning the scholastic achievement., Results: Of 756 adolescents, 395 were boys with a mean (SD) age of 12.19 (0.81) years. Compared to International T-value of reference group for KIDSCREEN-52, autonomy, bullying, psychological well-being and mood were lower than the reference groups, while self-perception score was higher. For LH, the most important predictor was autonomy (p < .0001). The most important aspects in the SC were the relationship with the parents (p < .0001), and the adolescent's relationships with peers (p < .0001). For ES, mood variables had the greatest contribution (p < .0001). The School performance related to Language & Literature (p < .0001) was the most important predictor in the CA latent variable. LH was positively associated with SC (p < .0001), ES (p < .0001), and CA (p < .0001). SC was positively associated with ES (p < .0001) and with CA (p < .0001)., Conclusions: This study suggests the importance of an integrated approach to characterize adolescents' health and well-being. The approach suggested here may highlight additive synergistic effects of the various components in health and well-being assessment that may not be considered with a late approach and focused only on single factors.

Background: Leg ulcers that do not heal despite appropriate treatment are defined as recalcitrant ulcers. Large surface area, depth, and long duration represent some of most important factors impeding ulcer healing. After sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence., Objective: Assessing if, after sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence., Patients and Methods: Among patients admitted to our hospital for all types of chronic leg ulcers, we retrospectively reviewed the records of patients affected by recalcitrant ulcers (surface greater than 100 cm, tissue loss involving epidermis, dermis, and subcutaneous tissue, duration longer than 1 year, and showing no healing tendency). After sharp debridement, the ulcers were covered by allografts with strict follow-up after discharge. Multiple allografts were performed when necessary, and a final autograft was applied in case of incomplete healing., Results: The records of 414 patients were analyzed. Forty-three patients were lost at follow-up, and the remaining 371 healed after 765 grafting procedures. In 163 patients, the ulcers healed by means of a final autograft. In all the remaining cases, allograft led to ulcer healing., Conclusion: Allografts represent an effective treatment option in case of recalcitrant, large, deep and long-lasting leg ulcers.

Objectives: To assess the influence of the CT localizer radiograph on the automatic tube current modulation system of 7 CT scanners produced by 4 different CT manufacturers., Methods: The influence of the localizer orientation, table height, tube current and tube potential values on the radiation dose of the related CT scan were evaluated. Images were acquired by using an anthropomorphic phantom positioned in the CT gantry isocenter as well as from -6 cm to +6 cm vertically to the isocenter., Results: Vertical movement of the CT table height affected the radiation dose in all scanners using anterior-posterior or a posterior-anterior localizer orientation albeit differently, depending on the manufacturer; only in 1/7 scanner no influence was observed. The latero-lateral localizer orientation proved to be more effective in limiting the influence of the vertical miscentering in all scanners. Changing localizer's tube voltage influenced the scan radiation dose in scanners produced by two manufacturers, while no significant effect was observed in scanners produced by the other two manufacturers. No significant dose variation was observed in 6/7 scanners when changing the localizer's tube current., Conclusion: Localizer radiograph shows a significant influence on the radiation exposure but with different outcomes depending on the manufacturer of the CT scanner. Radiologists and radiographers should have a thorough understanding of these differences to assure patients the best examination in terms of radiation dose and image quality., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Patients with pancreatic cystic neoplasms (PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime image-based surveillance follow-up. In these patients, the current European evidenced-based guidelines advise magnetic resonance imaging (MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound (US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US., Aim: To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI., Methods: We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings. In this communication, we reported the clinical results of this alternative follow-up, and the results of a comparative cost-analysis between our surveillance protocol (abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol., Results: In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients (1%) because of the appearance of suspicious features at imaging (with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients (14%). These comprised main pancreatic duct dilatation ( n = 1), increased size of the main cyst ( n = 14) and increased number of PNC ( n = 13). In all of these patients, MRI confirmed US findings, without adding more information. The bi-annual MRI identified evolution of the lesions not identified by US in only 11 patients with intraductal papillary mucinous neoplasms (5.5%), largely consisting of an increased number of very small PCN ( P = 0.14). The overall mean cost of surveillance, based on a theoretical use of the European evidenced-based exclusive MRI surveillance in the same group of patients, would have been 1158.9 ± 798.6 € per patient, in contrast with a significantly lower cost of 366.4 ± 348.7 € ( P < 0.0001) incurred by the US-restricted MRI surveillance used at our institution., Conclusion: In patients with non-surgical PCN at the time of diagnosis, US surveillance could be a safe complementary approach to MRI, delaying and reducing the numbers of second level examinations and therefore reducing the costs., Competing Interests: Conflict-of-interest statement: No conflict of interest.

Robotic exoskeletons are regarded as promising technologies for neurological gait rehabilitation but have been investigated comparatively little as training aides to facilitate active aging in the elderly. This study investigated the feasibility of an exoskeletal Active Pelvis Orthosis (APO) for cardiopulmonary gait training in the elderly. Ten healthy elderly volunteers exhibited a decreased (-26.6 ± 16.1%) Metabolic Cost of Transport (MCoT) during treadmill walking following a 4-week APO-assisted training program, while no significant changes were observed for a randomly assigned control group (n = 10) performing traditional self-paced overground walking. Moreover, robot-assisted locomotion was found to require 4.24 ± 2.57% less oxygen consumption than free treadmill walking at the same speed. These findings support the adoption of exoskeletal devices for the training of frail individuals, thus opening new possibilities for sustainable strategies for healthy aging.

Background: Exposure to indoor biomass fuel smoke is associated with increased morbidity and mortality. The aim of this study is to evaluate the association between exposure to indoor biomass burning and early pulmonary and cardiovascular damage., Methods: The indoor levels of particulate matter (PM) [PM 10 , PM 2.5 ] and black carbon (BC) were monitored in 32 houses in a Himalayan village. Seventy-eight subjects were submitted to spirometry and cardiovascular evaluation [carotid to femoral pulse wave velocity (PWV) and echocardiography]., Results: Peak indoor BC concentration up to 100 μg m -3 and PM 10 - PM 2.5 up to 1945-592 μg m -3 were measured. We found a non-reversible bronchial obstruction in 18% of subjects ≥40 yr; mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF 25-75 ) <80% in 54% of subjects, suggestive of early respiratory impairment, significantly and inversely related to age. Average BC was correlated with right ventricular-right atrium gradient (R = 0.449,p = .002), total peripheral resistances (TPR) (R = 0.313,p = .029) and PWV (R = 0.589,p < .0001) especially in subjects >30 yr. In multiple variable analysis, BC remained an independent predictor of PWV (β = 0.556,p = .001), and TPR (β = 0.366;p = .018)., Conclusions: Indoor pollution exposure is associated to early pulmonary and cardiovascular damages, more evident for longer duration and higher intensity exposure., (Copyright © 2018. Published by Elsevier B.V.)

Objectives: To compare two different medical compression stockings after varicose vein treatment., Patients and Methods: A randomized single-blind controlled study on two compression regimes after saphenous catheter foam sclerotherapy + phlebectomy was performed. After pads and 5 mmHg contention sock, 23 mmHg (group A, Struva 23®) or 35 mmHg (group B, Struva 35®) medical compression stocking was applied 24 h/day for seven days; subsequently 21-23 mmHg medical compression stocking in daytime. Symptoms, compliance, skin findings, and bioimpedance spectroscopy parameters were assessed., Results: A total of 94 patients (48 and 49 limbs in groups A and B, respectively) were enrolled. Three (T3) and seven (T7) days post-operatively, most symptoms were significantly milder in group B, especially pain and heaviness at T7 and at day 40 (T40). Ambulation, medical compression stocking stability/tolerability and skin healing were significantly better in group B, with p = 0.046, 0.021/0.060, and 0.010, respectively, at T7. Bioimpedance parameters increased at T7 and decreased at T40 in both groups; leg reactance and limb L-Dex improved in group B at T7 and T40, respectively (p = 0.039 and 0.012)., Conclusions: Compression with 23 and 35 mmHg medical compression stocking after catheter foam sclerotherapy + phlebectomy was effective and well tolerated at immediate/short term. Compression with 35 mmHg medical compression stocking provided less adverse post-operative symptoms and better tissue healing. Bioimpedance results confirmed a slightly better edema improvement with 35 mmHg medical compression stocking.

Background: The da Vinci® Table Motion (dVTM) comprises a combination of a unique operating table (Trumpf Medical™ TruSystem® 7000dV) capable of isocenter motion connected wirelessly with the da Vinci Xi® robotic platform, thereby enabling patients to be repositioned without removal of instruments and or undocking the robot., Materials and Methods: Between May 2015 to October 2015, the first human use of dVTM was carried out in this prospective, single-arm, post-market study in the EU, for which 40 patients from general surgery (GS), urology (U), or gynecology (G) were enrolled prospectively. Primary endpoints of the study were dVTM feasibility, efficacy, and safety., Results: Surgeons from the three specialties obtained targeting success and the required table positioning in all cases. Table movement/repositioning was necessary to gain exposure of the operating field in 106/116 table moves (91.3%), change target in 2/116 table moves (1.7%), achieve hemodynamic relief in 4/116 table moves (3.5%), and improve external access for tumor removal in 4/116 table moves (3.5%). There was a significantly higher use of tilt and tilt plus Trendelenburg in GS group (GS vs. U p = 0.055 and GS vs. G p = 0.054). There were no dVTM safety-related or adverse events., Conclusions: The dVTM with TruSystem 7000dV operating table in wireless communication with the da Vinci Xi is a perfectly safe and effective synergistic combination, which allows repositioning of the patient whenever needed without imposing any delay in the execution of the operation. Moreover, it is helpful in avoiding extreme positions and enables the anesthesiologist to provide immediate and effective hemodynamic relief to the patient when needed.

Background and Aims: Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross-country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on-/off-line mode and to examine the association with individual and family characteristics and substance use., Design: Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study, a survey using self-administered anonymous questionnaires., Setting: Thirty-three European countries., Participants: Sixteen-year-old-year-old students (n = 93 875; F = 50.8%)., Measurements: The primary outcome measure was prevalence of past-year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring)., Findings: A total of 22.6% of 16-year-old students in Europe gambled in the past year: 16.2% on-line, 18.5% off-line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39-1.53), life-time use of inhalants (OR = 1.57, 95% CI = 1.47-1.68) and other substances (OR = 1.78, 95% CI = 1.65-1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18-1.35), going out at night (OR = 1.32, 95% CI = 1.26-1.38), participating in sports (OR = 1.30, 95% CI = 1.24-1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79-0.86), parents' monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77-0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84-0.94)., Conclusions: Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money., (© 2018 Society for the Study of Addiction.)

The present study examined adult gambling behaviours from a local perspective in order to assess the adult at risk and problem gambler's profile stratified by genre and by different forms of game. 4773 Italian adults from 18 to 94 years old were administered a survey to assess socio-cultural information related to gambling behaviour and the SOGS to evaluate gambling behaviour severity. Logistic regression evidenced that both at risk and problem gamblers are associated with male gender, players that use to play to more than one game, gambling with strategy-based games. People with a gambler father or both parents who used to gamble were significantly more associated with problem gambling behaviour than participants with non-gambler parents. These results present adult profiles of at risk and problem providing a more clear understanding about the relationships between gambling behavior severity and type of gambling.

Background: The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM., Methods: Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group)., Results: Overall robotic operative time was shorter in the Xi-dVTM group ( P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group ( P = .024)., Conclusions: In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.

Purpose: To assess the variability of radiation dose exposure in patients affected by lymphoma undergoing repeat CT (computed tomography) examinations and to evaluate the influence of different scan parameters on the overall radiation dose., Materials and Methods: A series of 34 patients (12 men and 22 women with a median age of 34.4 years) with lymphoma, after the initial staging CT underwent repeat follow-up CT examinations. For each patient and each repeat examination, age, sex, use of AEC system (Automated Exposure Control, i.e. current modulation), scan length, kV value, number of acquired scans (i.e. number of phases), abdominal size diameter and dose length product (DLP) were recorded. The radiation dose of just one venous phase was singled out from the DLP of the entire examination. All scan data were retrieved by our PACS (Picture Archiving and Communication System) by means of a dose monitoring software., Results: Among the variables we considered, no significant difference of radiation dose was observed among patients of different ages nor concerning tube voltage. On the contrary the dose delivered to the patients varied depending on sex, scan length and usage of AEC. No significant difference was observed depending on the behaviour of technologists, while radiologists' choices had indirectly an impact on the radiation dose due to the different number of scans requested by each of them., Conclusions: Our results demonstrate that patients affected by lymphoma who undergo repeat whole body CT scanning may receive unnecessary overexposure. We quantified and analyzed the most relevant variables in order to provide a useful tool to manage properly CT dose variability, estimating the amount of additional radiation dose for every single significant variable. Additional scans, incorrect scan length and incorrect usage of AEC system are the most relevant cause of patient radiation exposure.

Objectives: This was a prospective observational study to assess the short- to mid-term efficacy and safety of catheter foam sclerotherapy (CFS) of the great saphenous vein (GSV), including peri-saphenous tumescence infiltration (PST) and intra-saphenous saline irrigation (ISI), in combination with phlebectomy of the varicose tributaries., Methods: Eighty-eight limbs in 82 patients (19 male, 63 female, mean age 55.7 years) affected by varices related to GSV incompetence were submitted to CFS of the refluxing GSV segment after PST and ISI, combined with phlebectomy of the varicose tributaries. Sodium tetradecylsulfate (STS) 3% + CO 2 /O 2 sclerosant foam (SF) (median 7 mL) was injected in the GSV trunk (median caliber 7.1 mm) by means of a 4F catheter. Clinical and colour duplex ultrasound (CDU) investigation was performed pre-operatively, and 40 days, 6, 12, and 36 months post-operatively. A visual analogue scale (VAS) was used to assess procedure related symptoms and venous symptoms before and 40 days after the treatment., Results: Clinical recurrence (visible varices) at 40 days, 6 and 12 months was 0%, whereas at 36 months it was 4.7%; VAS pre-operative score of heaviness, pain, and cramps/paraesthesiae decreased from 6 (IQR 6-8) to 1 (IQR 0-3), from 3 (IQR 0-7) to 0 (IQR 0-1), and from 3 (IQR 0-7) to 0 (IQR 0-1) respectively at 40 days. The CDU based occlusion rate at 40 days, 6, 12, and 36 months was 100% (88/88), 100% (88/88), 94.3% (83/88), and 89.4% (76/85) respectively. Six of the nine patent saphenous veins (average diameter 1.4 mm) had anterograde flow (overall 96.5% reflux free GSVs). One superficial venous thrombosis was recorded without any further relevant complication., Conclusions: GSV treatment by means of CFS and adjuvant PST + ISI, combined with phlebectomy of varicose tributaries, proved to be safe and effective in terms of clinical and duplex based outcomes at short/mid-term follow-up., (Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents., Methods: A representative sample of 30,588 Italian high school students, aged 15-19years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors' characteristics with the ED and AmED drinking during the last year., Results: Respectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving., Conclusions: This study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15-19years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Ujka, Kristian, Rosa Maria Bruno, Luca Bastiani, Eva Bernardi, Paolo Sdringola, Nenad Dikic, Bikash Basyal, Sanjeeb Sundarshan Bhandari, Buddha Basnyat, Annalisa Cogo, and Lorenza Pratali. Relationship between occupational physical activity and subclinical vascular damage in moderate-altitude dwellers. High Alt Med Biol. 18:249-257, 2017., Background: Occupational physical activity (OPA) has been associated with increased cardiovascular (CV) events. The aim of this study was to investigate the association between OPA and markers of subclinical vascular damage among a moderate-altitude population living in the rural village of Chaurikharka (Nepal; 2600 m sea level)., Methods: Seventy-two individuals (age 42 ± 15 years, ranges 15-85 years, 23 men) were enrolled. Physical activity (PA) was evaluated using the International Physical Activity Questionnaire (IPAQ). Carotid-femoral pulse wave velocity (PWV), carotid ultrasound assessment, and flow-mediated dilation (FMD) were performed., Results: OPA was 9860 ± 5385 Metabolic Equivalent of Task (MET)-minutes/week, representing 77% of total energy expenditure, with 97% of the population performing high-intensity PA. In the univariate analysis, OPA was significantly associated with PWV (β = 0.474, p = 0.001) and carotid stiffness (CS) (β = 0.29, p = 0.019). In the multivariate analysis, including age, sex, oxygen saturation, mean blood pressure, low-density lipoprotein (LDL), and OPA, OPA remained an independent predictor of PWV (β = 0.403, p = 0.001) but not of CS (β = 0.028, p = 0.8). OPA remained an independent predictor of PWV independently from the Framingham risk score (FRS)., Conclusion: High-intensity OPA shows a positive, independent association with aortic stiffness in Himalayan moderate-altitude dwellers. This study suggests how vigorous OPA performed in moderate altitude may be a CV risk factor.

Background: Strenuous and endurance exercise training have been associated with morphological and functional heart remodeling. Two-dimensional speckle-tracking echocardiography (STE) is a novel technique that allows an accurate quantification of global myocardium deformation. Our aim was to evaluate together left and right cardiac remodeling in different long-distance running athletes: marathon runners (42 km) (M) and endurance mountain runners (>300 Km) (UT). Methods: A total of 92 athletes (70 males, 76%) including 47 M [age 45 ± 7 years; training: 18 (9-53) years * days/week], 45 UT [age 42 ± 9, training: 30 (15-66) years * days/week] underwent conventional echocardiography and STE (Beyond Diogenes 2.0, AMID) during the agonistic season. Results: Right ventricle (RV) end-diastolic area ( p = 0.026), fractional area changing (FAC) ( p = 0.008) and RV global longitudinal strain (GLS) were significantly increasedin UT athletes. Furthermore, UT showed larger right atrium (RA) volume ( p = 0.03), reduced RA GLS and significantly increased RA global circumferential strain (GCS) compared to M. After adjustment for age, sex, and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M. Conclusion: Athletes enrolled in UT endurance activities showed RV and RA morphological and functional remodeling to increased preload in comparison with M runners characterized by increased RV FAC and reduced RA GLS. Follow-up studies are needed to better assess the long-term clinical impact of these modifications. 2D STE is a useful tool for investigating the deformation dynamic in different sports specialties.

Objective: Our aim was to evaluate the relationship between the disease severity of Amyotrophic Lateral Sclerosis (ALS) and the following parameters of Fiberoptic Endoscopic Evaluation of Swallowing (FEES): premature spillage, post-swallowing residue and aspiration., Methods: We studied 202 patients (95 women and 107 men) with ALS; of these, 136 had spinal and 66 had bulbar onset. They were analyzed according to the Amyotrophic Lateral Sclerosis Functioning Rating Scale (ALSFRS) and the b-ALSFRS subscale (bulbar scale). All subjects underwent FEES. Post-swallowing residue was classified into four classes (0-3); premature spillage and aspiration were considered either present or absent., Results: Spearman's correlation test showed a highly significant correlation (p<0.0001) between the value of ALSFRS and b-ALSFRS and the FEES parameters as the following: disease severity and dysphagia severity are closely related, both in spinal and bulbar onset, no matter what bolus texture was used. Spearman's Rho was more significant for post-swallowing residue, ≤-0.500 with all three consistencies (p<0.0001) in spinal onset and -0.520 only with liquid bolus (p<0.0001) in bulbar onset. Independent T-Test revealed a significant difference (p<0.0001) between the mean ALSFRS and b-ALSFRS scores and the presence/absence of aspiration. For the premature spillage in spinal onset (ALSFRS), we found a statistically significant difference for all three bolus textures (p<0.0001). Analysis of variance for the post-swallowing residue in spinal onset (ALSFRS) revealed a statistically significant difference (p<0.0001) for most of the comparisons between groups for all three textures. For the premature spillage in bulbar onset (b-ALSFRS), we found a statistically significant difference for all three textures (p<0.0001). Analysis of variance for the post-swallowing residue in bulbar onset (b-ALSFRS) showed a statistically significant difference (p<0.0001) for most of the comparisons between groups for all three textures. Kruskal-Wallis test showed a highly significant association between the classes of severity in bulbar forms and all the FEES parameters, no matter what type of bolus was administered (p<0.0001), whereas a significant correlation in spinal forms only for post-swallowing residue with solid (p=0.026) and semisolid (p=0.031) boluses., Conclusion: There is a highly significant relationship as the following between the FEES parameters and the disease severity assessed via ALSFRS and b-ALSFRS: classes of greater severity entail a greater deterioration of FEES parameters. FEES can be considered a good indicator of the dysphagia severity and a useful test for the follow-up of dysphagia in patients with ALS, whether of spinal or bulbar onset., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Laparoscopic cholecystectomy (LC) carried out within 3 days after an attack of non-severe acute gallstone pancreatitis (NSAGP) is recommended to reduce hospital stay and overall costs. Aim of the study was to evaluate factors that may delay a timely surgical management of NSAGP and the consequences of this deviation., Methods: We reviewed the charts of patients admitted for NSAGP and managed by LC during the last 14 years. A total number of 316 patients entered the study, 98 of whom underwent early LC. A comparison of pre-operative and outcome data from the group of patients undergone early LC and those who received a delayed LC (>3 days since the admission) was made., Results: Only 31% of patients presenting with NSAGP were managed by early LC. Respect to these, patients who received a delayed LC were significantly older and had a greater occurrence of clinical signs suggesting common bile duct stones (CBDS). Stabilization of co-morbidities and need to investigate preoperatively the common duct were the main factors associated to the surgical delay. By comparing patients undergone early LC and those who received delayed LC, differences regarding conversion to open surgery (2% vs. 1.3%), need to explore the common bile duct (18.3% vs. 25.6%), CBDS clearance rates (94.4% vs. 94.6%), morbidity (8.1% vs. 8.7%), and postoperative hospital stay (3.9 vs. 3.2 days) were however statistically not significant., Conclusions: Several reasons could delay the 3-day recommendation for surgery in NSAGP. These include the need to achieve before surgery the control of age-related co morbidities, and the workup to investigate for common duct stones. A fast track program aiming to early surgery would be advisable for patients presenting with NSAGP. Compared to delayed LC, early LC appears to shorten overall hospitalization but it does not seem to have any clinical impact on the course.

Purpose: To evaluate the awareness of radiation protection issues and the knowledge of dose levels of imaging procedures among medical students, radiology residents, and radiography students at an academic hospital., Material and Methods: A total of 159 young doctors and students (including 60 radiology residents, 56 medical students, and 43 radiography students) were issued a questionnaire consisting of 16 multiple choice questions divided into three separated sections (i.e., demographic data, awareness about radiation protection issues, and knowledge about radiation dose levels of common radiological examinations)., Results: Medical students claimed to have at least a good knowledge of radiation protection issues more frequently than radiology residents and radiography students (94.4% vs 55% and 35.7%, respectively; P<0.05), with no cases of perceived excellent knowledge among radiography students. However, the actual knowledge of essential radiation protection topics such as regulations, patient and tissue susceptibility to radiation damage, professional radiation risk and dose optimisation, as well as of radiation doses delivered by common radiological procedures was significantly worse among medical students than radiology residents and radiography students (P<0.05). Those latter significantly outperformed radiology residents as to knowledge of radiation protection issues (P<0.01). Overall, less than 50% of survey respondents correctly answered all questions of the survey., Conclusions: Radiology residents, radiography students and medical students have a limited awareness about radiation protection, with a specific gap of knowledge concerning real radiation doses of daily radiological examinations. Both undergraduate and postgraduate teaching needs to be effectively implemented with radiation safety courses., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Strenuous and chronic exercise training can have detrimental effects on cardiac morphology and function. Our aim was to evaluate the cardiac adaptation between 2 different specialties' endurance athletes: marathon runners (M) and ultra-trailers (UT)., Methods: 47 M (age 45±7, men 32; training: 18 (9-53) years*days/week), 41 UT (age 42±9, men 38, training: 30 (15-66) years*days/week) were submitted in rest condition to conventional 2D echocardiography and Speckle-Tracking echo (STE) (Beyond Diogenes 2.0, AMID) during agonistic season and compared with 15 age matched sedentary individuals (S) (age 43±6, men 10)., Results: Left ventricle (LV) global longitudinal strain (GLS) and global radial strain (GRS) were increased in M and UT compared to S (see table) without differences in LV anatomy and function. Right ventricle (RV) end-diastolic area (p=0.026), fractional area changing (p=0.008) and RV GLS were increased in UT compared to M. Moreover UT showed larger right atrium (RA) volume compared to M (p=0.03) and S (p=0.003). RA GLS was reduced in UT compared to M while the RA Global Circumferential Strain was significantly increased in UT. After adjusted for age, sex and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M; while when compared to S subjects, UT showed increased RA volume (OR 1.048; CI 1.002-1.096) and RV GLS (OR 0.667; CI 0.490-0.907)., Conclusion: UT showed higher RV and RA morphological and functional remodeling in comparison with M. 2D-STE is a useful tool to investigate the deformation dynamic in different sport specialties. Further studies will be necessary to clarify the long-term consequences for cardiac health due to myocardial perturbations., MUTSpLV GLS-28.59±3.43*-27.64±4.18*-24.82±4.53<0.05LV GRS69.85±8.94*66.59±11.19*56.27±16.25<0.001RV GLS-25.60±10.54-30.41±4.38*-27.10±4.64<0.05RA GLS37.15±13.4931.65±9.60*35.37±9.99<0.05RA GCS17.46±6.4222.28±8.97*23.37±6.47<0.01., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: Journals.permissions@oup.com.)

Purpose: The role of the da Vinci Robotic System ® in adrenal gland surgery is not yet well defined. The goal of this study was to compare robotic-assisted surgery with pure laparoscopic surgery in a single center., Methods: One hundred and 16 patients underwent minimally invasive adrenalectomies in our department between June 1994 and December 2014, 41 of whom were treated with a robotic-assisted approach (robotic adrenalectomy, RA). Patients who underwent RA were matched according to BMI, age, gender, and nodule dimensions, and compared with 41 patients who had undergone laparoscopic adrenalectomies (LA). Statistical analysis was performed using the Student's t test for independent samples, and the relationship between the operative time and other covariates were evaluated with a multivariable linear regression model. P < 0.05 was considered significant., Results: Mean operative time was significantly shorter in the RA group compared to the LA group. The subgroup analysis showed a shorter mean operative time in the RA group in patients with nodules ≥6 cm, BMI ≥ 30 kg/m 2 and in those who had previous abdominal surgery (p < 0.05). Results from the multiple regression model confirmed a shorter mean operative time with RA with nodules ≥6 cm (p = 0.010). Conversion rate and postoperative complications were 2.4 and 4.8 % in the LA group and 0 and 4.8 % in the RA group., Conclusions: In our experience, RA shows potential benefits compared to classic LA, in particular on patients with nodules ≥6 cm, BMI ≥ 30 kg/m2, and with previous abdominal surgery.

The origin of gambling disorders is uncertain; however, research has shown a tendency to focus on specific types of games as a potential important risk factor. The principal aim of this study is to examine the relationships between types of gambling practices and gambling disorder. The data were extracted from IPSAD-Italia(®) 2010-2011 (Italian Population Survey on Alcohol and other Drugs), a survey among the Italian general population which collects socio-cultural information, information about the use of drugs, legal substances and gambling habits. In order to identify the "problem gambler" we used the Problem Gambling Severity Index. Three groups are considered in this analysis: no-risk gamblers, low-risk gamblers, moderate-risk/problem gamblers. Type of gambling practice was considered among two types of gambler: one-game players and multi-games players. 1.9 % of multi-game players were considered problem gamblers, only 0.6 % of one-game players were problem gamblers (p < 0.001). The percentage of players who were low and moderate-risk gamblers was approximately double among multi-game players, with 14.4 % low-risk and 5.8 % moderate-risk; compared with 7.7 % low-risk and 2.5 % moderate risk among one-game players. Results of ordinal logistic regression analysis confirmed that higher level of gambling severity was associated with multi-game players (OR = 2.23, p < 0.0001). Video-poker/slot-machines show the highest association with gambling severity among both one-game players and multi-game players, with scores of OR equal to 4.3 and 4.5 respectively. These findings suggest a popular perception of risk associated with this type of gambling for the development of gambling problems.

The aim of the present research is to investigate the prevalence of Specific Learning Disorders (SLD) in Ogliastra, an area of the island of Sardinia, Italy. Having experienced centuries of isolation, Ogliastra has become a high genetic homogeneity area, and is considered particularly interesting for studies on different kinds of pathologies. Here we are going to describe the results of a screening carried out throughout 2 consecutive years in 49 second grade classes (24 considered in the first year and 25 in the second year of the study) of the Ogliastra region. A total of 610 pupils (average age 7.54 years; 293 female, 317 male) corresponding to 68.69% of all pupils who were attending second grade in the area, took part in the study. The tool used for the screening was "RSR-DSA. Questionnaire for the detection of learning difficulties and disorders", which allowed the identification of 83 subjects at risk (13.61% of the whole sample involved in the study). These subjects took part in an enhancement training program of about 6 months. After the program, pupils underwent assessment for reading, writing and calculation abilities, as well as cognitive assessment. According to the results of the assessment, the prevalence of SLDs is 6.06%. For what concerns dyslexia, 4.75% of the total sample manifested this disorder either in isolation or in comorbidity with other disorders. According to the first national epidemiological investigation carried out in Italy, the prevalence of dyslexia is 3.1-3.2%, which is lower than the prevalence obtained in the present study. Given the genetic basis of SLDs, this result, together with the presence of several cases of SLD in isolation (17.14%) and with a 3:1 ratio of males to females diagnosed with a SLD, was to be expected in a sample coming from a high genetic homogeneity area., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study used a nationally representative sample of 14,910 high school adolescents, aged 15-19 years. The large sample size presents a unique opportunity to evaluate firstly the geographical distribution of gambling prevalence, secondly, on a subsample of 5,920 adolescents, we studied the association of "no-problem-gambling", "at-risk gambling" and a relatively rare condition, "problem gambling", with demographic, environmental and behavioral variables. It differs from other studies due to the broad sample, thus enabling the combined analysis of the above variables that typically have only been studied separately. This integrated analysis, involving multiple variables, individual and environmental, allows the control of important covariates. Multivariate analysis showed that at-risk/problem gamblers were more likely to be engaged in behaviors contrary to social rules/law including heavy episodic drinking, tranquillizer/sedatives use as well as to approve gambling and have friends who gamble. It's important to emphasize that risk-perception is not related to gambling. Furthermore, the great geographical variability of at-risk and problem-gambling rates suggest that social aspects have to be considered. Currently universal prevention specifically targeting gambling is lacking, thus an associative model such as social analysis have been implemented in this study, in order to construct the basis for the design of a future prevention program based on scientific results and thus having important implications for implementation within community based activities. Prevention is fundamental: 53.5% of underage individuals have engaged in gambling even though legislation attempts to restrict access.