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Transmission models for infectious diseases are typically formulated in terms of dynamics between individuals or groups with processes such as disease progression or recovery for each individual captured phenomenologically, without reference to underlying biological processes. Furthermore, the construction of these models is often monolithic: they do not allow one to readily modify the processes involved or include the new ones, or to combine models at different scales. We show how to construct a simple model of immune response to a respiratory virus and a model of transmission using an easily modifiable set of rules allowing further refining and merging the two models together. The immune response model reproduces the expected response curve of PCR testing for COVID-19 and implies a long-tailed distribution of infectiousness reflective of individual heterogeneity. This immune response model, when combined with a transmission model, reproduces the previously reported shift in the population distribution of viral loads along an epidemic trajectory. This article is part of the theme issue ‘Technical challenges of modelling real-life epidemics and examples of overcoming these’.

The rapid spread of COVID-19 worldwide has impo-sed the need to identify a test that quickly recognizes affected subjects, both symptomatic and asymptomatic. The most reliable option has been proven to be the RT-PCR, which allows to detect virus RNA on a specimen from a high viral load site, such as nasopharynx. Nasopha-ryngeal sample collection is possible by means of a nasopharyngeal swab (NPS) and is a practical and relatively non-invasive technique, but rather bothersome for the recipient.The aim of the present study is to evaluate the discomfort evoked during NPS.We surveyed 429 patients receiving NPS before hospitalization or other procedures non related to COVID-19. For each one we noted the discomfort level felt during the swab using a 11-point numeric rating scale (NRS) for pain and the total time needed for the procedure to be taken. Sex, age, smoking status and positive history of previous swab have been taken into account.We found that, among the variables, sex had a statistically significant impact on the perceived discomfort of nasal swab, with females experiencing slightly more discomfort.NPS is largely a none-to-minimum discomfort in-ducing procedure. The differences in perceived discomfort could be explained based on anatomical features, and should remark the need for a tailored and anatomy-oriented approach in each patient.

Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant. © Copyright © 2020 Abu-Raya, Maertens, Edwards, Omer, Englund, Flanagan, Snape, Amirthalingam, Leuridan, Damme, Papaevangelou, Launay, Dagan, Campins, Cavaliere, Frusca, Guidi, O'Ryan, Heininger, Tan, Alsuwaidi, Safadi, Vilca, Wanlapakorn, Madhi, Giles, Prymula, Ladhani, Martinón-Torres, Tan, Michelin, Scambia, Principi and Esposito.

To evaluate the effect of the MRI-am-a-Hero program on sedation utilization for outpatient pediatric MRI studies.The MRI-am-a-Hero program, which utilizes multimedia educational material and popular comic book characters to educate and support pediatric patients during MRI scan, was implemented at the radiology facility of a single tertiary care, academic medical center. The effect of the MRI-am-a-Hero program on sedation utilization for pediatric MRI was retrospectively evaluated using multivariate regressions yielding odds ratio of sedation before and after program implementation. The institutional review board approved the study with HIPAA compliancy. Effectiveness of the program was evaluated while controlling for age, neurological MRI examination, number of examinations in the case, and use of intravenous contrast. Further analysis was performed in subgroups categorized by age, neurological MRI versus nonneurological MRI, and the use of contrast.The percent of MRI cases with sedation decreased from 22.9% to 17.3% after the MRI-am-a-Hero program was implemented. When controlling for other variables, including patient age, neurological MRI, number of examinations in a case, and use of intravenous contrast, the odds of a study being performed with sedation after program implementation are 40% less than the odds before program implementation (odds ratio [OR] 0.60, P.001). The effect of the program was greatest for patients aged 4 to 7 (OR 0.56, P .001), followed by patients aged 8 to 11 (OR 0.64, P = .019). It was not statistically significant for patients aged 12 to 15 (OR 0.97, P = .919).MRI-am-a-Hero is a generalizable and inexpensive program for reducing sedation utilization for outpatient pediatric MRI studies, especially for patients aged 4 to 11.

La Risonanza Magnetica pesata in diffusione (RM-DWI) distingue qualitativamente il colesteatoma dal tessuto di granulazione nei pazienti con otite media cronica. Il calcolo del coefficiente di diffusione apparente (ADC) consente un'analisi quantitativa identificando un cut-off numerico che differenzia le due tipologie tissutali. MATERIALI E METODI: lo studio retrospettivo ha riguardato 100 pazienti sottoposti a Timpanoplastica per colesteatoma primario o residuo/recidivante. Tutti i pazienti sono stati sottoposti a RM-DWI preoperatoria tra Aprile 2015 e Marzo 2019, con calcolo di ADC (R-version 3.2.5). La presenza di colesteatoma è stata accertata intraoperatoriamente e confermata istologicamente. RISULTATI: i reperti chirurgici di 100 pazienti sono stati confrontati con i valori medi ADC ed analizzata la distribuzione di quest’ultimi per colesteatoma/tessuto di granulazione, evidenziando due gruppi. La differenza nel valore medio di ADC tra colesteatoma (0,86 × 10-3mm2/s) e tessuto di granulazione (2.22×10-3mm2/s) ha rilevato una differenza statisticamente significativa di ADC per i pazienti con/senza colesteatoma (p

BACKGROUND: Intravenous immunoglobulin (IVIg) treatment partially replaces antibody defects and modulates innate and adaptive immune cells in patients with primary antibody deficiencies. MATERIALS AND METHODS: This study was focused on the evaluation of the effects of in vivo IVIg administration on neutrophils from patients with common variable immune disorders (CVID). We examined polymorphonuclear neutrophil (PMN) phagocytosis, PMN oxidative burst, release of neutrophil elastase, serum level of interleukin-8 and PMN expression of CXCR1, CD11c and CD66b. RESULTS: CVID patients on chronic IVIg treatment had reduced elastase release, but normal expression of CXCR1, CD66b and CD11c receptors on PMN, normal phagocytic ability and normal secretion of interleukin-8. We found that IVIg infusions rapidly reduced the serum level of interleukin-8, the expression of its receptor, CXCR1, and the release of neutrophil elastase, suggesting that IVIg exert a dampening effect on neutrophil activity. In contrast, IVIg infusions did not alter neutrophil phagocytosis or the expression of the other receptors analysed. DISCUSSION: These findings add further information regarding the anti-inflammatory role of immunoglobulins and suggest additional benefits in keeping with recent attempts to use new therapies targeting neutrophil inflammation.

Purpose The investigators hypothesized that low-dose hyperfractionated radiation would impair mandibular distraction osteogenesis (DO) in a murine mandibular model. Materials and Methods Male Sprague-Dawley rats underwent fractionated radiation (30 Gy) of the left mandible. After a 2-week recovery period, an external frame distractor was applied and gradual distraction of the mandible was performed. Tissue was harvested after a 28-day consolidation period. Gross, radiologic, and histologic evaluations were undertaken. Control animals underwent surgery for an identical time frame without preoperative radiation. Results Animals subjected to preoperative radiation (n = 10) showed suboptimal bone formation, including bone atrophy, incomplete bridging of the distraction gap, and gross bony defects or nonunion, compared with controls (n = 10). Although physical lengthening was achieved, irradiation consistently led to a detrimental effect on the normal process of DO. Conclusion This set of experiments establishes a valuable rodent model to evaluate the effects of radiation on DO and may help to formulate strategies to optimize DO before it is widely applied in oncologic reconstruction.

Orbital cellulitis is a septic process of the soft tissues behind the orbital septum and is the most frequent cause of the monolateral exophthalmos in pediatrics. Approximately 90% of the orbital cellulitis in pediatrics are associated to acute ethmoiditis. From the 01.01.2001 to 31.12.2010 we treated 36 patients, less than 18 years-old affected by Chandler stage II, III, or IV orbital cellulitis. The inflammation was resolved medically in 6 patients. In the 30 cases that showed no improvement in 48-72 h, an endoscopic drainage of the pus was performed by the transethmoidal route. In children, an adenoidectomy should be included, in order to eliminate eventual infections of this lymphatic organ. Endoscopic treatment has resulted in rapid resolution of disease without any complications. In addition, postoperative discomfort is minimal, with a rapid return to daily activities.

Background: A previous report demonstrated that the wide abdominal rectus plication abdominoplasty is an effective treatment modality in select patients with low back pain who failed to achieve relief with conservative therapy. Methods: The authors studied eight female patients who presented with chronic low back pain and marked lower abdominal wall muscular laxity. All had failed to respond to conservative management for their chronic back pain. They all underwent wide abdominal rectus plication abdominoplasty. Patient selection and details of the procedure are discussed. Results: There were no significant complications in this series, and all the patients had prompt and prolonged alleviation of their back pain. Length of follow-up ranged from 2 to 11 years. Conclusions: Changes in the biomechanics of the lower abdominal musculature as a result of the wide abdominal rectus plication abdominoplasty are discussed in the context of increasing spinal stability, leading to an alleviation of chronic low back pain. An argument is made that this abdominoplasty procedure produces a spine-stabilizing effect by (1) tightening the muscles of the lateral abdominal complex and thus increasing intraabdominal pressure and (2) increasing the efficiency of these muscles so that their effectiveness as spine stabilizers is increased. Even though this is a small series, the fact that all the patients sustained long-term alleviation of their preoperative chronic back pain suggests that the wide abdominal rectus plication abdominoplasty should be considered as an option for patients with weak lower abdominal muscles and intractable low back pain who have failed conservative management.

Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.

The prevalence of nasal polyps in a group of paediatric patients with cystic fibrosis was prospectively studied in comparison with a control group with cystic fibrosis but without polyps. Clinical variables, including pulmonary function tests, skin testing and mucociliary transport, were carried out in both groups, as well as genotype analysis. Endoscopic intranasal evaluation identified polyps in 29 of 89 patients (33%). Statistical analysis revealed that patients with nasal polyposis had better pulmonary function, a higher rate of Pseudomonas aeruginosa colonization, more hospitalizations, and more prevalence of allergy to Aspergillus fumigatus than did the comparison group. We found no statistically different genotype distribution between the polyposis and the control group. However, it can be emphasized that the prevalence of the compound heterozygous genotype is higher in the nasal polyposis group than in controls. Our observations suggest that other genetic and environmental factors could play an important role in the development of nasal polyposis.

The introduction of distraction osteogenesis (DO) as a method of mandibular elongation has provided the craniofacial surgeon with a valuable tool in the approach to patients with mandibular deficiencies. A growing number of case reports and clinical series have proven the efficacy of mandibular DO as an augmentative technique in patients with hemifacial microsomia (HFM). Although DO has become a part of the treatment algorithm for many patients with HFM, surgeons have been reluctant to apply the technique in patients with complete agenesis of the ascending mandibular ramus and condyle (grade III HFM). In the following cases, mandibular DO was successfully performed in two patients with grade III HFM. Preoperative images and intraoperative findings confirmed that both patients lacked the entire ascending mandibular ramus and condyle on the affected side. After unilateral multiplanar DO, both patients showed new bone formation within the distraction gap and development of a pseudoarthrosis between the proximal segment of the mandible and the skull base. Facial symmetry improved dramatically, and speech and mandibular excursion were maintained. The patients have been followed for 1 to 2 years after distraction with durable functional and esthetic outcomes. Mandibular DO offers many advantages compared with rib grafting, including avoidance of donor site morbidity, application in patients who are not candidates for graft harvest, and use after rib graft failure. The following cases support the use of mandibular DO as a mechanism of endogenous tissue engineering in patients with complete agenesis of the ascending mandibular ramus and condyle.

Cyclic vomiting syndrome is a disorder characterized by recurrent episodes of nausea and vomiting with complete resolution of symptoms between attacks. Nitric oxide plays a critical role in regulating several components of gastrointestinal mucosal defense and injury. Interleukin-6 has a wide variety of actions in the gastrointestinal apparatus. The purpose of this study was to evaluate the synthesis and release of nitric oxide and interleukin-6 by the esophageal and gastric mucosa in 10 children with cyclic vomiting syndrome, during symptom-free periods, and in 10 controls. The nitric oxide and interleukin-6 release by esophageal mucosa cells obtained from cyclic vomiting patients was quite similar to that in controls, but the release of nitric oxide from gastric mucosa cells of patients was significantly higher than that of controls. Conversely, no interleukin-6 was detectable in gastric mucosa cell supernatants in any of the patients. Further studies are needed to evaluate the relationship between factors triggering cyclic vomiting syndrome and the release of nitric oxide and interleukin-6 by gastric mucosa.

We studied the possible involvement of mucosal amino acid metabolism in the pathogenesis of gastroesophageal reflux disease in children. Eighteen children with gastroesophageal reflux disease (8 with reflux esophagitis and 10 without) and 10 children with normal 24-h esophageal pH monitoring as a comparative group underwent esophagogastroduodenoscopy with biopsies. Plasma and esophageal mucosa amino acids were assayed by liquid chromatography. In children affected by gastroesophageal reflux disease we found an increase of mucosal taurine (P < 0.01) and a decrease of serine (P < 0.01). No differences were noted between patients with and without esophagitis. Significant positive correlations (P < 0.001; r = 0.626) were found between mucosal taurine content and reflux index. Plasma amino acid concentrations did not show any significant differences among groups. Our results indicate that biochemical alterations precede the histological findings of inflammation, likely reflecting the adaptive response of the esophageal mucosa to the gastric contents exposure.

Fumonisin B-1 (FB1) is a water-soluble fungal metabolite that elicits a wide spectrum of toxicological effects. Cellular targets of FB1 include immune cells and in particular macrophages. In the present study the cytotoxic effect of FB1 (1-100 muM) was evaluated using a murine macrophage cell line (J774A.1) as model system. The effect of FB1 on nitric oxide (NO) and prostaglandin E-2 (PGE(2)) production induced by lipopolysaccharide (LPS, 10 and 100 ng/ml) was also investigated. Macrophages were pretreated with FB1 for 72 h and then stimulated with LPS for 24 h. The increase of LPS-induced production of these inflammatory mediators was observed at increasing concentrations of FB1 (0.1-10 10 muM) and was found to be concentration dependent. By western blot analysis we demonstrated that the observed increase of NO and PGE(2) production by FB1 was related to an enhancement of iNOS and COX-2 expression.

A positive association between Helicobacter pylori antibodies and food allergy presenting with gastrointestinal symptoms has recently been reported. A subset of a H. pylori strain possesses an antigen, CagA, as a virulence factor. Anti-H. pylori and anti-CagA IgG titre have been determined in children with atopic dermatitis (AD) as the sole clinical manifestation of food allergy. In this study, thirty patients with AD as the sole clinical manifestation of food allergy were examined (group A). For comparative purposes, 30 patients affected by food allergy with gastrointestinal symptoms (group B) and 30 affected by atopic asthma (group C) were studied. Anti-H. pylori and anti-CagA immunoglobulin G (IgG) were determined in all individuals by means of the enzyme-linked immunosorbent assay. The anti-H. pylori IgG titre was significantly higher in group A and group B vs. group C (p 0.05). No significant difference in anti-CagA titre was found between the groups. These data demonstrate a positive association between H. pylori antibodies and AD as the sole manifestation of food allergy. Further investigations are needed to evaluate the cause-effect relationship between H. pylori seropositivity and AD.

The siting activity carried out by ENEL since 1979 has led to the conclusion that exploitable wind conditions can be found mainly on the ridges of Central and Southern Apennines. Mountaineous areas, on the other hand, are often located above 1000 m a.s.l., where very harsh conditions (heavy icing, snowfalls, high turbulence, high vertical component of wind velocity, etc.) can occur, especially during winter months; furthermore, they generally feature complex profile of terrain. Very little experience has been gained worldwide of operating wind turbines in very hostile conditions. The need for research about the feasibility of wind plants and the viability of present commercial medium-sized wind turbines in such prospective location led to the construction of a mountain test site at Acqua Spruzza on the Apennines, where a thorough testing activity is being carried out, aimed at assessing, among other things, the performances and lifetime of machines.

The ability of irradiated tissue to support bony growth remains poorly defined, although there are anecdotal cases reported showing mixed results for the use of mandibular distraction osteogenesis after radiation for head and neck cancer. Many of these reports lack objective measures that would allow adequate analysis of outcomes or efficacy. The purpose of this experiment was to utilize a rat model of mandibular distraction osteogenesis after high dose and highly fractionated radiation therapy and to evaluate and quantify distracted bone formation under these conditions. Male Sprague–Dawley rats underwent 12 fractions of external beam radiation (48 Gray) of the left mandible. Following a two week recovery period, an external frame distractor was applied and gradual distraction of the mandible was performed. Tissue was harvested after a twenty-eight day consolidation period. Gross, radiologic and histological evaluations were undertaken. Those animals subjected to pre-operative radiation showed severe attenuation of bone formation including bone atrophy, incomplete bridging of the distraction gap, and gross bony defects or non-union. Although physical lengthening was achieved, the irradiated bone consistently demonstrated marked damaging effects on the normal process of distraction osteogenesis. This murine model has provided reliable evidence of the injurious effects of high dose radiation on bone repair and regeneration in distraction osteogenesis utilizing accurate and reproducible metrics. These results can now be used to assist in the development of therapies directed at mitigating the adverse consequences of radiation on the regeneration of bone and to optimize distraction osteogenesis so it can be successfully applied to post-oncologic reconstruction.

Orbital cellulitis is a septic process of the soft tissues behind the orbital septum and is the most frequent cause of the monolateral exophthalmos in pediatrics. Approximately 90% of the orbital cellulitis in pediatrics are associated to acute ethmoiditis. From the 01.01.2001 to 31.12.2010 we treated 36 patients, less than 18 years-old affected by Chandler stage II, III, or IV orbital cellulitis. The inflammation was resolved medically in 6 patients. In the 30 cases that showed no improvement in 48-72 h, an endoscopic drainage of the pus was performed by the transethmoidal route. In children, an adenoidectomy should be included, in order to eliminate eventual infections of this lymphatic organ. Endoscopic treatment has resulted in rapid resolution of disease without any complications. In addition, postoperative discomfort is minimal, with a rapid return to daily activities.

Facio-audio-symphalangism syndrome is a rare autosomal dominant genetic disorder with characteristic facies, early hearing loss, proximal symphalangism, carpal and tarsal synostosis and other skeletal abnormalities. We report the case of a young patient affected by this syndrome discussing the therapeutic choice adopted according to more recent literature.

We evaluated the data provided by Computed Tomography (CT) scan reports for assessing otologic disease and planning surgery; we also examined their correspondence with surgical findings. Methods: We retrospectively analyzed preoperative CT reports of 202 patients (57% men, 43% women) aged between 15 and 78 years, suffering from chronic otitis media and underwent radical mastoidectomy (17%), closed (31%) or open (52%) tympanoplasty at the Department of Otorhinolaryngology of Federico II University in Naples between January 2003 and October 2010. We then compared ‘quantity’ and ‘quality’ of informations contained in CT reports with intraoperative findings. Results: Radiologic reports show the presence of cholesteatoma in 28% (intraoperatively found in 69%), defining the remaining 72% as inflammatory tissue. In 50% the involvement of middle ear generally refers to tympanic cavity and/or mastoid, without considerations of single subsites. Ossicular chain is described in 77% (73% intraoperatively), but 69% of reports refer to the whole chain, mentioning each ossicle only in 8%. Alterations in tegmen tympani are overestimated (20% versus 10%), as erosion of labyrinthine structures (18% versus 6%). Involvement of facial nerve canal is underestimated (7% versus 26%). Procidentia of sigmoid sinus is described in 2% (10% intraoperatively); jugular bulb, really high in 2%, is never described. Obstruction of eustachian tube is reported in 3% (21% intraoperatively). Conclusions: CT is essential to assess chronic otitis media; however insufficient informations should lead to greater cooperation between surgeon and radiologist through more detailed descriptions of the ear to operate or alternative imaging techniques (Magnetic Resonance).

In this study, we aimed to evaluate virus shedding in the saliva of healthy adults from the metropolitan region of the city of Rio de Janeiro, Brazil, in order to verify the prevalence of both human herpesviruses 6 and 7 (HHV-6, HHV-7). The studied group comprised 182 healthy individuals at Pedro Ernesto University Hospital, who were being seen for annual odontologic revisions. Saliva specimens were subjected to a multiplex polymerase chain reaction (PCR) to detect the presence of HHV-6A, HHV-6B and HHV-7. The total Roseolovirus DNA prevalence was 22.4%. The PCR detected a HHV-6 prevalence of 9.8%, with HHV-6A detected in 7.1% of the samples and HHV-6B in 2.7%. HHV-7 DNA was revealed in 12.6% of the studied cases. Multiple infections caused by HHV-6A and 7 were found in 2.1% of the samples. No statistical differences were observed regarding age, but for HHV-7 infection, an upward trend was observed in female patients. Compared to studies from other countries, low prevalence rates of herpesvirus DNA were detected in saliva from the healthy individuals in our sample. PCR methodology thus proved to be a useful tool for Roseolovirus detection and it is important to consider possible geographic and populations differences that could explain the comparatively low prevalence rates described here.

Purpose Management of end-stage rheumatoid wrist disease remains controversial. Total wrist arthrodesis provides reliable pain relief and stability and is the most commonly applied management strategy. Total wrist arthroplasty is a motion-preserving alternative that is gaining popularity. The purpose of this study was to perform a cost-utility analysis comparing nonsurgical management, total wrist arthroplasty, and total wrist arthrodesis for the rheumatoid wrist. Methods A time trade-off utility survey was developed to investigate patient and physician preferences for the potential outcomes of total wrist arthroplasty and total wrist arthrodesis. The study sample consisted of rheumatoid patients (N = 49) recruited as part of an ongoing prospective study and a national random sample of hand surgeons and rheumatologists (N = 109). A decision tree was created using utility values derived from the survey, and the expected quality-adjusted life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the Current Procedural Terminology codes associated with total wrist arthroplasty and total wrist arthrodesis and their potential complications. Costs per QALY were calculated and compared. Results Patients and physicians both showed a preference for surgical management over nonsurgical management. Application of cost data indicated that the incremental cost per additional QALY gained for total wrist arthroplasty over nonsurgical management was $2,281 and the incremental cost per QALY gained with total wrist arthroplasty over total wrist arthrodesis was $2,328, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. Conclusions In the absence of rigorous outcome data, cost-utility analysis is a useful tool to guide treatment decisions. Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that total wrist arthroplasty has only a small incremental cost over the traditional total wrist arthrodesis procedure. Based on this economic model, total wrist arthroplasty may be worthy of further consideration, and cost should not be considered prohibitive. Type of study/level of evidence Decision Analysis II.

Management of the end-stage rheumatoid wrist is controversial. The most common treatment is total wrist fusion. Total wrist arthroplasty offers a motion-preserving alternative. Comparison of outcomes for total wrist arthroplasty and total wrist fusion is necessary for evidence-based decision making. The purpose of this systematic review was to scientifically evaluate the existing literature for outcomes of both procedures in rheumatoid arthritis.A MEDLINE database review was performed. Search included "wrist and arthroplasty," "wrist and arthrodesis," and "wrist and fusion." Silicone arthroplasty was excluded. Data extraction included demographic information, surgical technique, pain, and active arc of motion. Complications and satisfaction were recorded.Literature review identified 1750 citations that were screened for inclusion criteria. Formal review identified 18 total wrist arthroplasty studies representing approximately 500 procedures. Data from 20 total wrist fusion studies represented over 800 procedures. Comparison of outcomes showed that total wrist fusion provides more reliable relief than total wrist arthroplasty. Complication and revision rates were higher for total wrist arthroplasty. Satisfaction was high in both groups. Postoperative motion was reviewed to evaluate whether arthroplasty provides a functional active arc of motion. Of 14 studies reporting appropriate data, three showed average active arc of motion within the functional range.In this systematic review, outcomes for total wrist fusion were comparable and possibly better than those for total wrist arthroplasty in rheumatoid patients. In this era of cost-conscious medical care, expensive interventions must demonstrate superior outcomes. Existing data do not support widespread application of total wrist arthroplasty for the rheumatoid arthritis wrist.

Oncocytic cysts of the larynx are rare benign, slow growing lesions that are lined predominantly or exclusively by oncocytes, the cytoplasm of which contains a considerable number of hypertrophied mitochondria, which accounts for their eosinophilia and swollen appearance. The oncocytic change is a phenomenon of metaplasia which occurs frequently in epithelial endocrine cells with high metabolic activity and it is also associated with inflammation, degenerative process or cellular ageing. In the larynx, oncocytic metaplasia is very uncommon, but it is occasionally seen in the lining of laryngeal cysts, which are found most commonly in the ventricles or in the false vocal cords, where seromucinous glands are more abundant. Oncocytic cysts typically occur in the elderly and are usually solitary, with involvement of an isolated site, whereas diffuse involvement with multiple cysts is extremely rare. Hoarseness is the most common presenting symptom, while pain, stridor or laryngeal obstruction are unusual complaints. Management of these lesions is conservative and consists of local excision, endoscopic removal being the treatment of choice. Although oncocytic cysts are benign lesions, follow-up is recommended, as recurrence is possible, especially in the case of patients with multiple involvement, since they may show a tendency to develop new cysts. To date, approximately 150 cases of laryngeal oncocytic cysts have been published. Herein, a very unusual case is presented occurring in a 43-year-old male patient, therefore, “epidemiologically” atypical for developing oncocytic lesions. Causes of oncocytic changes and pathogenesis of laryngeal cysts are discussed.

Efficacy of the liberatory manoeuvre and of gradual otolitis dispersion technique, with or without associated drug therapy, have been compared. Included in this prospective study were 103 patients with benign paroxysmal positional vertigo seen in the Outpatient Department. Patients were classified into 4 groups according to treatment: Liberatory Manoeuvre according to methods described by Semont et al., with and without betahistine, Gradual Otolitis Dispersion Technique according to Brandt and Daroff, with and without betahistine. Evaluation was performed at baseline and at 3, 7, 14, 30, 60 and 90 days after start of treatment. Response to treatment was evaluated using criteria of Epley. At day 14, liberatory manoeuvre-betahistine and Brandt and Daroff-betahistine groups did significantly better than liberatory manoeuvre and Brandt and Daroff groups (p < 0.05). Improvement reached at day 30 was: 100% in liberatory manoeuvre-betahistine group; 96.30% (p > 0.05) in Brandt and Daroff-betahistine group; these results were significantly better (p < 0.05) than those of liberatory manoeuvre (54.17%) and Brandt and Daroff (25%) groups. As far as concerns differences between disease onset and start of therapy (less and more than 2 weeks), and age (≤ 60 years and ≥ 60 years), response to treatment was similar. In conclusion, both liberatory manoeuvre and Brandt and Daroff, when associated with betahistine, were significantly more effective than manoeuvres alone (p < 0.05). Improvement in liberatory manoeuvre-betahistine group, in the initial phase, was greater that in Brandt and Daroff-betahistine group, albeit, differences were not significant (p > 0.05). Age-related effects of manoeuvres were compared in 71 patients < 60 years and 32 patients ≥ 60 years, showing a similar improvement rate at the end of the investigation in both groups. In our opinion, liberatory manoeuvre and Brandt and Daroff associated with betahistamine produces faster recovery compared to liberatory manoeuvre and Brandt and Daroff alone. Nevertheless, 3 months after onset of treatment, all patients showed complete recovery due to spontaneous evolution of paroxysmal positional vertigo, in other words, treatment does not appear to influence the final improvement rate and its role should be accepted as a significant reduction in persistence of symptoms.

The correlation between laryngo-pharyngeal reflux and dysphonia has been evaluated in patients without significant laryngoscopic findings and without vocal misuse. Studies were performed, using a validated questionnaire on typical reflux symptoms as well as instrumental means, e.g. videolaryngoscopy, multi-electrode 24-hr oesophageal pH monitoring, vocal acoustic analysis, gastro-oesophagoscopy, on 62 patients (51 male, 11 female) with dysphonia foror = 3 months, selected from 350) consecutive patients presenting with voice disorders. Standard criteria were: absence of laryngeal neoformation (benign or malignant) and correct use of voice. Anti-reflux treatment was prescribed in all selected patients. A group of 62 selected patients without laryngo-pharyngeal disease were studied as controls. Mean values of the harmonic to noise ratio and maximum phonation time were pathological in all patients with dysphonia and significantly correlated (p = 0) with the entity of the larynx alteration. The 24-hour pH monitoring revealed gastro-oesophageal reflux in all cases with a clear prevalence of episodes in the upright, compared to supine, position. From a multiple regression analysis of pH-metric values, considered important in predicting maximum phonation time and harmonic to noise ratio alteration. the significant predictors (p0.01) were those parameters indicating the existence of a laryngo-pharyngeal reflux disease: in an upright position, the prevalence of the number of refluxes and of time of pH4. In conclusion, the association between electro-acoustic reliefs and laryngoscopic data, as well as an alteration in maximum phonation time and harmonic to noise ratio in patients with pH-metric indicative parameters of laryngo-pharyngeal reflux disease led to the hypothesis of a possible correlation between entity and duration of the reflux and dysfunction of the arytenoid muscles, upon which chronic vocal fatigue, with consequent laryngeal compensatory stress, depends.

Prolongation of the QT interval is a serious electrocardiogram finding because of its association with torsades de pointes and sudden cardiac death.1 Both congenital and acquired factors can lead to abnormal lengthening of the QT interval. Six types of congenital long QT syndrome (LQT1–LQT6) have been described, each involving mutations in genes encoding potassium or sodium transmembrane channel proteins.2 Acquired causes of QT prolongation include hypokalaemia, hypomagnesaemia, hypocalcaemia, human immunodeficiency virus infection, and myocardial ischaemia.2–4 Numerous drugs have also been found to cause prolongation of the QT interval. A listing of these drugs can be found on a web site (http://www.qtdrugs.org). The main membrane channel these drugs affect is the human ether-a-go-go-related gene (HERG) encoded potassium channel; congenital mutations involving this gene lead to the LQT2 type of the inherited long QT syndromes.2,5 Cocaine use has been associated with many cardiac complications including ventricular arrhythmias and sudden death, …

Concentrations of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCs) were found in tissue of marine organisms such as Mediterranean mussel, Norway lobster, red mullet, common cuttle-fish, European flying squid, European anchovy, European pilchard and Atlantic mackerel, coming from two sites along the Abruzzo coast of the Adriatic Sea. Species were selected due to their habitat, trophic level, feeding behaviour and their use in the Italian diet. Mussels, filter feeder and sedentary organisms, were used in order to test water pollution whereas Norway lobster and red mullet (benthic fish) were used in order to test sediment pollution. The concentration of ?PCBs exceeded that of ?OCs in the samples analysed. The highest concentrations of ?PCBs (1415 ng/g lipid weight) and ?OCs (507 ng/g lipid weight) were found in pilchard while the lowest concentrations of the same pollutants were found in cephalopods. Our results have shown that species such as anchovy, pilchard and mackerel, were the most polluted due to their location at the last level of the trophic chain. All samples contained different concentrations of PCBs and among these, congeners 153 and 138 were the most representative. Among the OCs, except for the cuttle-fish, the highest concentrations were found for p,p(')-DDE and p,p(')-DDD that are metabolite of DDT. The prevailing DDE presence, compared to DDT (high DDE/DDT ratio), suggested that the biotransformation rate of pollutants was very efficacious in fish and above all in crustaceans. Results have also been interpreted in terms of geographical distribution and organisms' biological cycle. None of the samples analysed exceeded the tolerance limits established by the OCs Italian legislation.

The prevalence of nasal polyps in a group of paediatric patients with cystic fibrosis was prospectively studied in comparison with a control group with cystic fibrosis but without polyps. Clinical variables, including pulmonary function tests, skin testing and mucociliary transport, were carried out in both groups, as well as genotype analysis. Endoscopic intranasal evaluation identified polyps in 29 of 89 patients (33%). Statistical analysis revealed that patients with nasal polyposis had better pulmonary function, a higher rate of Pseudomonas aeruginosa colonization, more hospitalizations, and more prevalence of allergy to Aspergillus fumigatus than did the comparison group. We found no statistically different genotype distribution between the polyposis and the control group. However, it can be emphasized that the prevalence of the compound heterozygous genotype is higher in the nasal polyposis group than in controls. Our observations suggest that other genetic and environmental factors could play an important role in the development of nasal polyposis.

Thrombotic disease is one of the most relevant clinical problems for morbility and mortality. We can differentiate congenital and acquired forms. In this short communication we describe 1 case observed by us that seems interesting for the association of a congenital and acquired form [Protein S deficiency and inflammatory bowel disease (IBD)] and for the dramatic events suffered before receiving a complete diagnosis and therapy, indicating the importance of recollection of information from the patients, starting from anamnestic data.

Extended abstract of a paper presented at Microscopy and Microanalysis 2011 in Nashville, Tennessee, USA, August 7–August 11, 2011.

Cyclic vomiting syndrome is a disorder characterized by recurrent episodes of nausea and vomiting with complete resolution of symptoms between attacks. Nitric oxide plays a critical role in regulating several components of gastrointestinal mucosal defense and injury. Interleukin-6 has a wide variety of actions in the gastrointestinal apparatus. The purpose of this study was to evaluate the synthesis and release of nitric oxide and interleukin-6 by the esophageal and gastric mucosa in 10 children with cyclic vomiting syndrome, during symptom-free periods, and in 10 controls. The nitric oxide and interleukin-6 release by esophageal mucosa cells obtained from cyclic vomiting patients was quite similar to that in controls, but the release of nitric oxide from gastric mucosa cells of patients was significantly higher than that of controls. Conversely, no interleukin-6 was detectable in gastric mucosa cell supernatants in any of the patients. Further studies are needed to evaluate the relationship between factors triggering cyclic vomiting syndrome and the release of nitric oxide and interleukin-6 by gastric mucosa.

Sandifer's syndrome is a rare manifestation of gastroesophageal reflux (GER) in children, occurring in association with abnormal movements of the head, neck, and upper part of the trunk. Out of 65 children with Sandifer's syndrome described in literature, only 2 were breast-fed. We report on a 15-day-old breast-fed girl affected by Sandifer's syndrome. Pathological GER was diagnosed with 24 h pH esophageal monitoring. In our patient, all the symptoms of Sandifer's syndrome disappeared when she was cow's milk formula-fed. The role of food allergy to dietary proteins ingested by a lactating mother is discussed.

A positive association between Helicobacter pylori antibodies and food allergy presenting with gastrointestinal symptoms has recently been reported. A subset of a H. pylori strain possesses an antigen, CagA, as a virulence factor. Anti-H. pylori and anti-CagA IgG titre have been determined in children with atopic dermatitis (AD) as the sole clinical manifestation of food allergy. In this study, thirty patients with AD as the sole clinical manifestation of food allergy were examined (group A). For comparative purposes, 30 patients affected by food allergy with gastrointestinal symptoms (group B) and 30 affected by atopic asthma (group C) were studied. Anti-H. pylori and anti-CagA immunoglobulin G (IgG) were determined in all individuals by means of the enzyme-linked immunosorbent assay. The anti-H. pylori IgG titre was significantly higher in group A and group B vs. group C (p0.05); no significant difference was detected between group A and group B (p0.05). No significant difference in anti-CagA titre was found between the groups. These data demonstrate a positive association between H. pylori antibodies and AD as the sole manifestation of food allergy. Further investigations are needed to evaluate the cause-effect relationship between H. pylori seropositivity and AD.

GM-IVA is a short and effective induction therapy of non M3 de novo AML including GM-CSF (300 mcg 12 hrs before starting therapy), Ara-C (250 mg/sqm c.i. x 3 days), VP16 (100 mg/sqm x 3 days) and idarubicin (12 mg/sqm x 3 days); it was followed by a fludarabine containing salvage protocol (FLANG). Patients60 years of age achieving CR received 2 courses of FLANG and autologous or allogeneic BMT when possible. Patients60 years of age in CR received a second course of GM-IVA. Twenty-one consecutive patients (mean age 64, range 29-85) entered the study. Three patients (14%) died during induction therapy. After one course of GM-IVA, CR was achieved in 12 patients (57%). Two further patients were salvaged with FLANG therapy so that the final CR rate was 14/21 (67%). In elderly patients the final CR rate (62%) is noteworthy, considering that 6 patients were70 years of age and 3 were80. All three patients80 achieved CR (lasting 5 to 7 months). The median time of granulocyte and platelet recovery was 15 days. Our scheme was well tolerated. In the group of elderly patients 3 out of 14 died during induction (21%) and 4 life-threatening infections were observed (28%). The short duration of cytotoxic therapy and perhaps the use of G-CSF contributed to a reduction of the hospitalization period (median of 22 days), thus providing major savings on induction costs and allowing for better utilization of beds as well as significantly improving patients' quality of life.