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The aim of the study was to evaluate the relationships between carotid-femoral pulse wave velocity (PVW-cf), cardio-ankle vascular index (CAVI) and CAVI0 (which is a mathematical elaboration of CAVI, theoretically less dependent on blood pressure), age and comorbidity burden. Furthermore, 183 patients (119 female, mean age 67.5 ± 14.3 years) referred to the Geriatric Ward and Outpatient Clinic at Verona University Hospital were included; demographic, clinical and blood analysis data were collected. Charlson Comorbidity Index (CCI), PVW-cf, CAVI and CAVI 0 were obtained. Significant correlations were found between CAVI, CAVI0, PVW-cf and both age (r = 0.698, r = 0.717, r = 0.410, respectively p < 0.001 for all) and CCI, (r = 0.654; r = 0.658; r = 0.448 respectively and p < 0.001 for all), still significant after adjustment for several variables. In a stepwise multiple regression model, considering several variables, CCI was the only predictor of PWV-cf, whereas age and CCI were significant predictors of both CAVI and CAVI 0. In conclusion, all arterial stiffness indexes are associated with CCI and aging; the latter correlation is more evident for CAVI and CAVI 0 than for PVW-cf. Arterial stiffness parameters can complement the characterization of patients affected by a remarkable comorbidity burden across aging; arterial stiffening might mirror the complexity of these individuals.

ObjectiveTo report the demographics and the clinical course of patients with multiple evanescent white dot syndrome (MEWDS) and to investigate for those factors which influence visual acuity (VA) recovery.MethodsThis is a retrospective single-centre observational study. Electronic medical records and retinal imaging of patients with a diagnosis of MEWDS with a minimum follow-up of 3 months were reviewed. Patients were categorised into three groups according to the VA at presentation and at the last visit: group 1 >0.48 logarithm of the minimum angle of resolution (LogMAR), group 2 ≤0.48 and ≥0.18 LogMAR and group 3 ResultsA total of 51 eyes from 51 patients (41 women, mean age 29.8±7.8 years) were included. Significantly more patients presented in the autumn (X2=8.69, p=0.034). The percentage of eyes recovering vision to 0.0 LogMAR or better was 80.3% (41/51). Worse presenting vision and young age at presentation were independent significant predictive variables for poorer final VA (p=0.002 and p=0.02, respectively). No imaging features were significantly predictive of complete versus incomplete recovery, but disc hyperfluorescence on fluorescein angiography was more common in those with incomplete recovery.ConclusionsAlthough the majority of cases have a benign prognosis, the clinical spectrum of MEWDS includes incomplete visual recovery. In our series, poor presenting VA and young age were associated with poor VA outcome. Further study is warranted to confirm these findings.

BackgroundDuring adolescence and young adulthood people appear to be more prone to violent behaviour. A greater tendency to violent behaviour appears to be associated with hyperactivity, impulsivity and low tolerance for frustration and provocation in social settings.AimsThis prospective cohort study aimed to evaluate rates of violent behaviour among young people with mental disorders, compared with older age groups.MethodA total of 340 individuals with severe mental disorders (125 living in residential facilities and 215 out-patients) were evaluated at baseline with the SCID-I and II, Brief Psychiatric Rating Scale, Specific Level of Functioning scale, Brown–Goodwin Lifetime History of Aggression scale, Buss–Durkee Hostility Inventory, Barratt Impulsiveness Scale and State–Trait Anger Expression Inventory-2. Aggressive behaviour was rated every 15 days with the Modified Overt Aggression Scale (MOAS).ResultsThe sample comprised 28 individuals aged 18–29 years, 202 aged 30–49 and 110 aged 50 and over. Younger age was associated with a personality disorder diagnosis, substance use disorder, being single and employed. These results were confirmed even controlling for the gender effect. The patterns of the cumulative MOAS mean scores showed that younger (18–29 years old) individuals were significantly more aggressive than older (≥50) ones (P < 0.001).ConclusionsThis study highlights how young age in people with severe mental disorders is correlated with higher levels of impulsivity, anger and hostility, confirming previous analyses. Our results may assist clinicians in implementing early interventions to improve anger and impulsivity control to reduce the risk of future aggressive behaviours.

It is well known that traffic injuries still represent one of the main causes of death and that high blood alcohol concentrations while driving significantly increase the occurrence of accidents. However, only limited literature on the correlation between chronic alcohol abuse and accident risk is available. The aim of the present study was to investigate the hypothesis of an association between elevated concentrations of carbohydrate deficient transferrin (CDT) and the occurrence of alcohol-related traffic accidents.The analytical determinations of BAC and CDT were performed following certified methods in HS-GC-FID and HPLC, respectively. For BAC, 0.50 g/L was used as cut-off, whereas 2.0% was used for CDT, according to the standardisation proposed by IFCC. A total of 929 drivers, tested for BAC at the time of hospital admission after a traffic accident, were classified into two groups: InjDr 1 (BAC ≤ 0.50 g/L) and InjDr 2 (BAC0.50 g/L); all drivers were also tested for CDT.InjDr 1 included 674 individuals, only 2.5% showing a CDT above the cutoff, whereas InjDr 2 group consisted of 255 subjects, 28.6% testing positive for CDT (Odds Ratio 15.5). When subdividing the InjDr group into increasing classes of CDT, a steady increase in the percentage of BAC-positive drivers was appreciated. Moreover, average BAC was found to parallel each class of CDT.The reported data strongly support the use of CDT as a biomarker of increased risk of alcohol-related traffic accidents in the procedures of re-granting of the driving license upon confiscation for "drink driving".

BACKGROUND AND OBJECTIVES: Surgical indications in stages 4B and 5 retinopathy of prematurity (ROP) are not universally accepted. The authors' purpose is to evaluate the long-term anatomic and visual outcomes of vitrectomy for retinal detachment (RD) associated with stages 4B and 5 ROP. PATIENTS AND METHODS: Data of patients who consecutively underwent vitrectomy for stages 4B and 5 ROP from 1999 to 2013 were retrospectively reviewed and included grade of retinal attachment and visual acuity (VA) at the last follow-up. RESULTS: Seventy eyes of 38 infants were included: 23 with stage 4B and 47 with stage 5 ROP. Lens-sparing vitrectomy was performed in 11 eyes, combined lensectomy / vitrectomy in 59 eyes. Mean follow-up was 8.5 years. Anatomic success was maintained in 41 eyes (58.5%), and among them, VA greater than 5/200 was achieved in 17 eyes (41.4%). CONCLUSION: The long-term visual and anatomic success rates were encouraging for the surgical correction of RD associated with late stages ROP. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50:208–214.]

In the context of fitness certification to hold the driving license, GGT and CDT have been used, sometimes in combination (γ-CDT), to exclude chronic alcohol abuse. The present study was carried out with the aim of comparing the power of these biomarkers as tools for the objective screening of subjects at high risk of alcohol-associated traffic injuries.288 male drivers admitted to hospital after traffic accidents were examined by determination of GGT, CDT and BAC. The degree of association of GGT, CDT and γ-CDT with BAC was analysed using non-parametric statistics.Partitioning the cases using the cut-off concentrations of 0.5 g/L for BAC (the legal limit adopted in most European countries), 55 U/L for GGT and 1.9% for CDT, a highly significant difference was found between the frequency of elevated GGT or CDT in cases where BAC was within the legal limits and those with elevated BAC values (Fisher's exact test: p 0.001). However, the calculation of the odds ratio showed a much higher increase for CDT (28 times) than for GGT (6 times) in those drivers with a BAC above the Italian legal limit in comparison with those showing a BAC within the cut-off; conversely, γ-CDT does not provide any significant advantage vs. CDT alone.Both GGT and CDT provide objective evidence of an association with the occurrence of alcohol-related severe traffic accidents, but CDT shows superior association with these events. Therefore, CDT, notwithstanding higher costs, should be preferred in a forensic/certification context.

This work concerns the subjective impression of perceived illumination. The purpose of the study is to test attributes expressing qualitative experiences referring to ambient lighting that can be applied as descriptors. Seventy participants viewed an actual model room, with the fourth wall removed (viewing booth). Walls, floor, and ceiling were achromatic. Two achromatic cubes were placed inside the room: One was a reflectance increment to the walls, the other a decrement. The room was illuminated by two different light sources, Artificial Daylight (D65) or Tungsten Filament (F), the order of which was randomized across participants. The participants’ task was to evaluate ambient illumination for each light source. A semantic differential method was employed with 27 pairs of adjectives on 1 to 7 rating scales, categorized in three groups: characteristics of atmosphere, time, and cross-modal. Only the ratings of nine pairs of adjectives were not influenced by the type of illumination. The most differentiated couples under different illuminants were hot/cold and modern/old, but large differences also appeared with the following couples: hard/soft, technological/primitive, summery/wintry, warm/cool, sensual/frigid, natural/artificial, and hospitable/inhospitable. The hypothesis that there would be consistency among the subjects in evaluations of the characteristics tested and that these would be differently perceived under different illuminants was confirmed. The results show that it is possible to identify subjective perceived illumination as a phenomenon endowed with specific filling-in qualities and that as a perceptual experience it can be categorized, with implications for application in architecture and design.

The aim of this study is to verify the conditions under which a series of visual stimuli (line segments) will be subjectively perceived as visual lines or surfaces employing four experiments. Two experiments were conducted with the method of subjective evaluation of the line segments, and the other two with the Osgood semantic differential. We analysed five variables (thickness, type, orientation, and colour) potentially responsible for the lines’ categorisation. The four experiments gave similar results: higher importance of the variables thickness and type; general lower significance of the variable colour; and general insignificance of the variable orientation. Interestingly, for the variable type, straight lines are evaluated as surfaces more frequently than curved lines and perceived as geometrical, flat, hard, static, rough, sharp, bound, sour, frigid, masculine, cold and passive. Curved lines are prevalently evaluated as lines, and categorised as organic, rounded, soft, dynamic, fluffy, blunt, free, sweet, sensual, feminine, warm and active. These results highlight the specificity of perceptual characteristics for the considered variables and confirm the relevance of the characteristics of variables such as thickness and type.

Recent findings have shown that sounds improve visual detection in low vision individuals when the audiovisual stimuli pairs of stimuli are presented simultaneously and from the same spatial position. The present study purports to investigate the temporal aspects of the audiovisual enhancement effect previously reported. Low vision participants were asked to detect the presence of a visual stimulus (yes/no task) presented either alone or together with an auditory stimulus at different stimulus onset asynchronies (SOAs). In the first experiment, the sound was presented either simultaneously or before the visual stimulus (i.e., SOAs 0, 100, 250, 400 ms). The results show that the presence of a task-irrelevant auditory stimulus produced a significant visual detection enhancement in all the conditions. In the second experiment, the sound was either synchronized with, or randomly preceded/lagged behind the visual stimulus (i.e., SOAs 0, ± 250, ± 400 ms). The visual detection enhancement was reduced in magnitude and limited only to the synchronous condition and to the condition in which the sound stimulus was presented 250 ms before the visual stimulus. Taken together, the evidence of the present study seems to suggest that audiovisual interaction in low vision individuals is highly modulated by top-down mechanisms.

This study analyzes shells of marine gastropods of a zoological museum and the Latin epithets expressing perceptual and connotative attributes that they have received in the standard, Linnaean nomenclature. Making use of the Osgood semantic differential, we presented the subjects with digital 3-D reproductions of the shell specimens to be subjectively evaluated according to 17 pairs of attributes. The results show that, overall, the subjective evaluations given by the subjects are consistent, which suggests that an intersubjective characterization of the shells as wholes according to their qualitative and morphological traits is possible and scientifically explicable. This may apply to other biological items as well. The results also show that the epithets given to the shells by taxonomists do not always reflect the perceptual evaluation of the general population, being a product of the well-known ambiguity in taxonomic categorization and naming.

Background: The term premature pubarche (PP) refers to the appearance of pubic hair before age 8 in girls and before age 9 in boys. Although idiopathic PP (often associated with premature adrenarche) is considered an extreme variation from the norm, it may be an initial sign of persistent hyperandrogenism. Factors contributing to PP onset and progression have not been identified to date. Aims: The objectives of this study are to describe a group of Italian children with PP, to identify potential factors for its onset, and to define its clinical and biochemical progression. Methods: We retrospectively enrolled all infants born between 2001 and 2014 with PP. Children with advanced bone age (BA) underwent functional tests to determine the cause of PP. Hormonal analysis and BA determination were performed annually during a 4-year follow-up period. Results: A total of 334 children with PP were identified: idiopathic PP (92.5%, associated with premature adrenarche in some cases); related to precocious puberty (6.6%); late-onset 21-hydroxylase deficiency (0.9%). Low birth weight was associated with premature adrenal activation. Body mass index (BMI) was the only factor that influenced the progression of BA during follow-up. Conclusions: Low birth weight is a predisposing factor for premature adrenal activation. The increase in BMI in patients with idiopathic PP during the 4-years of follow-up was responsible for BA acceleration. We recommend prevention of excessive weight gain in children with PP and strict adherence to follow-up in order to prevent serious metabolic consequences.

Objectives.To assess admission rates to seven General Hospital Psychiatric Wards (GHPWs) located in the Lombardy Region in the 40 days after the start of Coronavirus disease 2019 (COVID-19) epidemic, compared to similar periods of 2020 and 2019.Methods.Anonymized data from the regional psychiatric care register have been obtained and analyzed. The seven GHPWs care for approximately 1.4 million inhabitants and have a total of 119 beds.Results.In the 40-day period (February 21–March 31, 2020) after the start of the COVID-19 epidemic in Italy, compared to a similar 40-day period prior to February 21, and compared to two 40-day periods of 2019, there has been a marked reduction in psychiatric admission rates. The reduction was explained by voluntary admissions, while there was not a noticeable reduction for involuntary admissions. The reduction was visible for all diagnostic groups, except for a group of ‘Other’ diagnoses, which includes anxiety disorders, neurocognitive disorders, etc.Conclusions.Large-scale pandemics can modify voluntary admission rates to psychiatric facilities in the early phases following pandemic onset. We suggest that the reduction in admission rates may be due to fear of hospitals, seen as possible sites of contagion, as well as to a change in thresholds of behavioral problems acting as a trigger for admission requests from family relatives or referrals from treating clinicians. It is unclear from the study whether the reduction in admissions was contributed to most by the current pandemic or the lockdown imposed due to the pandemic.

Introduction Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.

This study investigates the existence of cross-modal correspondences between a series of paintings by Kandinsky and a series of selections from Schönberg music. The experiment was conducted in two phases. In the first phase, by means of the Osgood semantic differential, the participants evaluated the perceptual characteristics first of visual stimuli (some pictures of Kandinsky’s paintings, with varying perceptual characteristics and contents) and then of auditory stimuli (musical excerpts taken from the repertoire of Schönberg’s piano works) relative to 11 pairs of adjectives tested on a continuous bipolar scale. In the second phase, participants were required to associate pictures and musical excerpts. The results of the semantic differential test show that certain paintings and musical excerpts were evaluated as semantically more similar, while others were evaluated as semantically more different. The results of the direct association between musical excerpts and paintings showed both attractions and repulsions among the stimuli. The overall results provide significant insights into the relationship between concrete and abstract concepts and into the process of perceptual grouping in cross-modal phenomena.

The study analyzes the existence of naturally biased associations in the general population between a series of musical selections and a series of quatrains. Differently from other studies in the field, the association is tested between complex stimuli involving literary texts, which increases the load of the semantic factors. The stimuli were eight quatrains taken from the same poem and eight musical clips taken from a classical musical version of the poem. The experiment was conducted in two phases. First, the participants were asked to rate 10 couples of opposite adjectives on a continuous bipolar scale when reading a quatrain or when listening to a musical clip; then they were asked to associate a given clip directly with the quatrains in decreasing order. The results showed the existence of significant associations between the semantics of the quatrains and the musical selections. They also confirmed the correspondences experienced by the composer when writing the musical version of the poem. Connotative dimensions such as rough or smooth, distressing or serene, turbid or clear, and gloomy or bright, characterizing both the semantic and the auditory stimuli, may have played a role in the associations. The results also shed light on the accomplishment of the two diverse methodologies adopted in the two different phases of the test. Finally, the role of specific musical components and their combinations is likely to have played an important role in the associations, an aspect that shall be addressed in further studies.

In our research, we tested for the existence of cross-modal visual and tactile associations in the experience of abstract art. Specifically, we measured the association of 60 abstract paintings with four couples of antonyms related to texture, such as warm or cold, smooth or rough, lightweight or heavy, soft or hard, investigating if the different modality of presentation on a computer screen (color versions: natural colors, inverted colors, black and white) gave rise to different associations relative to the four couples of opponent qualities. Second, we tested whether there might be differences between the ratings of the paintings when they were presented as images on a computer screen versus in real life at the museum. The results confirmed that associations between visual and tactile experience with such complex stimuli exist. In the case of the couple warm or cold, a significant inversion of associated qualities occurs when the images are presented in inverted colors as opposed to natural colors; furthermore, when presented in black and white, warm evaluations are “cooled down,” but cold evaluations remain the same. The degree of smoothness could be considered not associated with the color versions. When seen in black and white, both the mean softness and the mean lightweight-ness of the paintings were reduced; however, in the last case, this effect was more evident for the most lightweight pictures. There is only a slight difference between the two presentations of the paintings as images presented on a computer screen and seen in real life, relative to the warm or cold and soft or hard dimensions. Of the four opponent qualities, the three pairs warm or cold, lightweight or heavy, and soft or hard showed the most interesting results in relation to the cross-modal associations.

Summary There are relatively few prospective studies evaluating the combined effect of abdominal obesity and low muscle strength on worsening disability and on mortality. The study aimed at evaluating prospectively the prognostic value of dynapenic abdominal obesity definition on disability worsening in a 5.5-year follow-up and mortality in a 10-year follow-up. Methods In 93 men and 169 women aged between 66 and 78 years, leg isometric strength, waist circumference (WC), BMI, glycemia, HOMA, lipid profile, vitamin D3, albumin, fibrinogen, physical activity level, income, smoking status and comorbidities were evaluated at the baseline. Reported disabilities were measured at baseline, 1-y, 2-y, 3-y and 5.5-y follow-up and mortality rate was evaluated during a 10-y follow-up. The study population was categorized in dynapenic abdominal obese (D/AO), nondynapenic abdominal obese (ND/AO), dynapenic nonabdominal obese (D/NAO), nondynapenic nonabdominal obese (ND/NAO) according to muscle strength/WC tertiles. Results D/NAO subjects presented a disability worsening risk of 1.69 times (95%CI:1.11–2.57), ND/AO subjects showed a 2-fold increase in risk (95%CI:1.34–2.98), while being D/AO more than trebled the risk, even after considering confounding variables (HR:3.39,95%CI:1.91–6.02). Mortality risk after adjustment for other confounding variables was 1.57 (95%CI:1.16–2.13) for ND/AO and 2.46 (95%CI:1.34–4.52) for D/AO. Conclusions Dynapenic abdominal obese subjects are at higher risk of worsening disability and mortality than subjects with dynapenia or central fat distribution only.

BACKGROUND Erythrocyte mean corpuscular volume (MCV) has been used for decades as a biomarker of chronic alcohol abuse and in the treatment of alcohol dependence. More recently, it has also been adopted to investigate the fitness of subjects to hold the driving license to prevent traffic accidents. So far, however, the studies on the association of MCV with an increased risk of alcohol-associated car accidents are extremely scarce, if not totally absent. To the best of our knowledge, the present work is the first specifically aimed at studying a plausible association between elevated MCV and crash accidents correlated with alcohol abuse. METHODS A total of 6,244 drivers involved in traffic accidents underwent mandatory laboratory analyses including blood alcohol concentration (BAC) determination and MCV analysis. BAC and MCV determinations were performed by headspace gas chromatography and complete blood count, respectively. RESULTS The chi-square test evaluating the proportions of subjects with elevated MCVs (>95 fl) yielded a highly significant result (χ2 = 68.0; p 0.5 g/l). However, when considering only drivers showing BACs in the range of 0.51 to 1.5 g/l, the frequencies of elevated MCV values are fairly comparable (χ2 = 0.062, p = 0.80). In contrast, limiting the evaluation to BACs > 1.5 g/l, the frequency of elevated MCVs raised to 19.1% (χ2 = 58.9, p value

Fat may accumulate around the heart in epicardial adipose tissue or inside the heart as lipid droplets (LDs).To compare myocardial steatosis between subjects with and without coronary artery disease (CAD and non-CAD) and to identify which cells contain LDs.Body mass index, waist circumference, glucose, insulin, homeostasis model assessment index, leptin, adiponectin, and high-sensitivity C-reactive protein were evaluated in CAD and non-CAD subjects. Biopsies were collected from right atrial myocardium. Immunohistochemistry for perilipin (PLIN) 1 and 2 was used to characterize LDs and their localization in adipocytes or myocardial cells, respectively. Cardiomyocytes apoptosis and hypoxia inducible factor 1 alpha were obtained in a subgroup of subjects.The study took place in a hospital.Male subjects consecutively undergoing elective cardiac surgery either for coronary bypass grafting (CAD, n = 23) or for valve replacement (non-CAD, n = 18).The study was designed to compare myocardial steatosis between subjects with and without coronary artery disease.PLIN1 and PLIN2 resulted significantly higher in CAD than in non-CAD subjects, as did apoptosis. PLIN1 was positively associated with circulating leptin, high-sensitivity C-reactive protein, and apoptosis, and negatively with adiponectin. PLIN2 was positively associated with body mass index, waist circumference, and leptin and negatively with adiponectin. After taking into account the absence/presence of hypertension, diabetes, and CAD/non-CAD, adiponectin was negatively associated with PLIN1 (r(2) = 0.532); waist circumference and adiponectin were associated with PLIN2 (r(2) = 0.399).Myocardial steatosis is greater in CAD than non-CAD subjects, depending on both metabolically active adipocytes interspersed among cardiomyocytes and higher fat deposition inside cardiomyocytes; serum adiponectin and waist circumference are independent predictors of myocardial steatosis.

Children with Down syndrome (DS) are known to have difficulty in learning to read and write. This weak literacy can be attributed to learning disability or to poor phonological awareness, which can also be found in typically developing children with dyslexia. The aim of this study is to verify whether phonological awareness is linked to literacy in children with DS as it is in typically developing ones. In order to show this link the authors investigate the relationship between single word reading ability and several phonological variables. Thirty-two native Italian children with DS were asked to read 50 single words and to perform phonological tests concerning phoneme and syllable segmentation, phoneme and syllable blending, alliteration and non-word repetition. Gender, intelligence quotient, age and years of schooling were also taken into consideration in the statistical analysis. Phoneme blending, phoneme segmentation, syllable segmentation, alliteration, non-word repetition were the variables which were seen to be significantly related to reading. However, it was observed that gender, intelligence quotient, chronological age, years of education, syllable blending were not related to single word reading ability. Our study underpins the theory that literacy is linked to phonological awareness in Italian speaking children with DS in the same way that it occurs in typically developing children. Phonemic rather than syllabic awareness is seen to be the basic skill necessary in order to be able to read fluently, at least for single words, as observed in our participants with DS.

Background Neonatal screening for 21 hydroxylase deficiency is designed to detect classical form of congenital adrenal hyperplasia (CAH). It is still unclear whether newborns who result false positives at neonatal screening might later develop signs of androgen excess. The aim of this study is to verify whether a slightly elevated 17-OHP at newborn screening is a predictive factor for premature pubarche. Methods We evaluated all infants born between 2001 and 2014 with premature pubarche. In case of increased bone age, they were submitted to functional tests to find out the cause of their symptoms. Their 17-OHP values at newborn screening for CAH were reconsidered. Results We identified 330 patients (269 females, 61 males) with premature pubarche. All these children had a normal 17-OHP at newborn screening with the exception of a child, born preterm and not affected by CAH. Conclusions An elevated 17-OHP at newborn screening is not a predictive factor for premature pubarche. A likely cause of increased 17-OHP level at screening is an immaturity of adrenal gland or a neonatal stress. Therefore a strict follow up of these neonates during childhood is not necessary.

In this paper, the authors discuss the effectiveness of MOOCs as part of a pedagogical strategy aimed at supporting Physics' preliminary undergraduate students in large-size lectures. Our study is based on an experimental activity based on a blended course, which integrated a parallel MOOC delivered through the POK (PoliMi Open Knowledge, http://www.pok.polimi.it), the Politecnico di Milano's MOOC portal. The blended model also delivered face-to-face activities that included intensive technology enhanced learning, like feedback based on clickers. Specifically, we introduce the several elements of the approach (the tutors' pedagogy, the adoption of clickers, the diversity amongst learning groups) and its process of implementation. The findings in this study highlight that the integrated model is effective in terms' of students' learning both for small and large size lectures. More importantly, it was found that the students in large size lectures demonstrated similar or even better performance than students in a small size group. Moreover, the students in all sizes lectures showed higher satisfaction with the MOOCs' against other factors adopted within the learning design.

This article presents an experimental study on the natural association between angles and colour. Specifically, for each angle width — formed by two segments joined at their vertex — studied, participants were asked to indicate the colour that they perceived as most closely related to it, choosing from the NCS Hue Circle. The results show that participants systematically established a natural and consistent association between certain angles and colours, when explicitly asked to choose the colour that they perceived as most naturally related to a given angle presented as two lines. The overall results suggest an association between acute angles and warm colours and obtuse angles and cool colours, confirming Kandinsky’s hypothesis. In particular, the strongest relations were found between the angle of 22.5° and yellows, the angles of 45°, 90° and 135° and green-yellows, and the angle of 157.5° and red-blues, when angles were presented on a white background.

This study analyses the categorical ambiguity between visual appearances that belong in different categories, such as Oriental Calligraphy and certain Abstract Paintings selected from the works of Klee. In particular, the aim of our research was to identify whether there exist abstract features at the basis of purely visual configurations that determine the way in which they are categorized. Specifically, the intention was to determine whether, and to what extent, two artistic forms that display documented shared graphic and conceptual characteristics differ, or do not differ, visually, and whether certain features exist that identify them as a specific type of graphic work. The assumption that both categories had shared characteristics that made them graphically and conceptually similar and that resulted in categorical ambiguity, was confirmed. Moreover, the presence of some constituent features specific to one or the other was also confirmed. The results show that a Calligraphic Image and an Abstract Painting by Klee can be ‘exchanged’, but the tendency to confuse Calligraphy with an Abstract Painting is greater than that of confusing an Abstract Painting with Calligraphy.

to validate the MSRA questionnaire proposed as prescreening tool for sarcopenia, in a population of community-dwelling elderly subjects. observational study. community dwelling elderly subjects. 274 community dwelling elderly subjects, 177 women and 97 men, aged 66-78 years. Based on EWGSOP diagnostic criteria subjects were classified as sarcopenic and nonsarcopenic. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, is composed of seven questions and investigates anamnestic and nutritional characteristics related to risk of sarcopenia onset (age, protein and dairy products consumption, number of meals per day, physical activity level, number of hospitalizations and weight loss in the last year). 33.5% of the study population, were classified as sarcopenic. With the 7-item MSRA score, subjects with a score of 30 or less, had a 4-fold greater risk of being sarcopenic than subjects with a score higher than 30 (OR:4.20;95% CI:2.26–8.06); area under the ROC curve was 0.786 (95% CI:0.725-0.847). In a logistic regression, considering as dependent variable the probability of being sarcopenic, and as independent variables the 7 items of the questionnaire, two items (number of meals and milk and dairy products consumption) showed non-significant diagnostic power. A 5-item score was then derived and the area under the ROC curve was 0.789 (95% IC:0.728-0.851). Taking into account the cost of false positive and false negative costs and the prevalence of sarcopenia, the “optimal” threshold of the original MSRA score (based on 7 items) is 30, with a sensitivity of 0.804 and a specificity of 0.505, while the “optimal” threshold of the MSRA score based on 5 items, is 45, with a sensitivity of 0.804 and a specificity of 0.604. this preliminary study shows that the MSRA questionnaire is predictive of sarcopenia and can be suggested as prescreening instrument to detect this condition. The use of a short form of the MSRA questionnaire improves the capacity to identify sarcopenic subjects.

In this study, the participation of 119 students in an online asynchronous forum as part of an academic course on statistical methods was evaluated. The pattern of accesses during the course was analyzed by means of the cumulative mean function. Taking into account the times (hours) at which accesses occurred, it is possible to achieve more accurate and more sensitive assessment of the role of concomitant variables (gender, final mark of the high school attended, examination outcome). As far as academic achievement was concerned, it emerged that graduating probability within 3.5 years from the end of the course was related only to a regular posting activity and not to the overall number of accesses. [ABSTRACT FROM AUTHOR]

The mechanisms impairing muscle quality and leading to myofibrosis (MF) and myosteatosis (MS) are incompletely known. In biopsies of paraspinous muscle (PM) of 16 elderly men undergoing elective vertebral surgery, we histologically determined the area of MF and MS expressed as muscle quality index (MQI), in order to investigate the relation between them, as well as the main predictors of muscle quality. Total PM area and intermuscular adipose tissue (IMAT) were evaluated by MRI and body composition by DXA. Circulating fasting glucose, insulin, hs-CRP, leptin, adiponectin and IL-6 were measured and HOMA index calculated. Quantification of gene expression in PM and in subcutaneous adipose tissue (SAT) overlying the muscle was performed by rt-PCR. The degree of MS and MF was significantly and positively related to each other and positively associated with BMI, waist, FM and FM% as well as with IMAT. The area of PM was negatively related with MF even after adjustment for weight. Leptin was positively associated with MF and MS, whereas hs-CRP to MF. In backward regression analyses, larger waist and smaller PM area explained 90% of MF variance, whereas leptin about 80% of MS variance. IL-6 expression in SAT was significantly higher in participants with higher MQI values. In PM biopsies we found significantly higher expression of SOCS-3 and a trend toward higher expression of myostatin with greater degrees of MQI. MS and MF are related phenomena that concur to alter muscle quality and both should be considered in further studies on the evolution of sarcopenia.

This article presents an experimental study on the naturally biased association between shape and color. For each basic geometric shape studied, participants were asked to indicate the color perceived as most closely related to it, choosing from the Natural Color System Hue Circle. Results show that the choices of color for each shape were not random, that is, participants systematically established an association between shapes and colors when explicitly asked to choose the color that, in their view, without any presupposition, they saw as the most naturally related to a series of given shapes. The strongest relations were found between the triangle and yellows, and the circle and square with reds. By contrast, the parallelogram was connected particularly infrequently with yellows and the pyramid with reds. Correspondence analysis suggested that two main aspects determine these relationships, namely the "warmth" and degree of "natural lightness" of hues.

Background The determination of Carbohydrate Deficient Transferrin (CDT) in a forensic context should be based on the use of a screening technique followed, for the “positive samples”, by a confirmatory technique. The aim of this study was to compare the two most used automated screening methods for CDT analysis, immuno-nephelometric assay (INA) and multi-capillary electrophoresis (mCE), with a validated HPLC procedure, used as confirmation test, in order to re-evaluate the cut-off concentrations of the screening methods. Methods 195 serum samples underwent CDT analysis by using the N Latex CDT direct immuno-nephelometric assay, the multicapillary system Capillarys™ and an anion exchange HPLC method with UV-visible detection at 460 nm developed and validated at our laboratories. Statistical analyses were performed by using Bland–Altman plots and ROC curves. Results and discussion The 95% limits of agreement were ± 0.94% when comparing INA and HPLC and ± 0.60% when comparing mCE and HPLC. The ROC analysis of both INA and mCE, using HPLC as the reference method, showed that no false negative results were found when the cut-off was fixed to 1.2% for mCE and to 2.3% for INA. Conclusions The study showed a good agreement among CDT determinations carried out either with mCE or INA or HPLC. However, the usual cut-offs of both mCE (1.3%) and INA (2.5%) should be lowered to minimize false negatives at the screening analysis.

Objective Evidence is limited regarding outcome of patients with ectopic Cushing’s syndrome (ECS) due to neuroendocrine tumors (NETs). Design We assessed the prognostic factors affecting the survival of patients with NETs and ECS. Methods Retrospective analysis of clinicopathological features, severity of hormonal syndrome, treatments from a large cohort of patients with NETs and ECS collected from 17 Italian centers. Results Our series included 110 patients, 58.2% female, with mean (±s.d.) age at diagnosis of 49.5 ± 15.9 years. The main sources of ectopic ACTH were bronchial carcinoids (BC) (40.9%), occult tumors (22.7%) and pancreatic (p)NETs (15.5%). Curative surgery was performed in 56.7% (70.2% of BC, 11% of pNETs). Overall survival was significantly higher in BC compared with pNETs and occult tumors (P = 0.033) and in G1-NETs compared with G2 and G3 (P = 0.007). Negative predictive factors for survival were severity of hypercortisolism (P P = 0.001), diabetes mellitus (P = 0.0146) and distant metastases (P P Conclusions Multiple factors affect prognosis of ECS patients: type of NET, grading, distant metastases, severity of hypercortisolism, hypokalemia and diabetes mellitus. BCs have the highest curative surgical rate and better survival compared with occult tumors and pNETs. Hypercortisolism plays a primary role in affecting outcome and quality of life; therefore, prompt and vigorous treatment of hormonal excess by NET surgery and medical therapy should be a key therapeutic goal. In refractory cases, adrenalectomy should be considered as it affects outcome positively at least in the first 2 years.

The study shows a systematic naturally biased association between percepts and concepts. Specifically, it shows that a series of terms pertaining to an abstract semantic field (related to the frame of ethics in social behaviour) has a nonrandom, highly significant, association with colours (hues). This is the first time that consistent associations between abstract terms and colours have been reported in the general population. The main hypothesis, ie that there appear to be ‘hues of concepts’, was borne out by the results: The abstract terms considered were coloured with blue/green (ie cool) colours as well as their synonyms, while their antonyms were coloured with red/yellow (ie warm) colours. The association provides information about the nature of abstract concepts and their relationship with perception. It also sheds light on the interrelations among words in semantic domains that, to date, have been studied from only a computational viewpoint.

Fecal elastase-1(FE-1) has been suggested as an alternative to steatorrhea quantification to evaluate pancreatic insufficiency, but its diagnostic performance has not been compared with steatorrhea in chronic pancreatitis or after pancreatic resection.The relationship between steatorrhea and FE-1 was studied in patients with chronic pancreatic disorders or pancreatic resection. Student's t test and ANOVA were used for statistical analysis, accepting 0.05 as limit for significance.Eighty-two patients were studied (42 non-operated; 40 previously submitted to pancreatic resection). Fat output was higher in operated than non-operated patients (29.2 ± 3.1 vs 9.9 ± 2.2 g/day, p0.001) FE-1 was more severely reduced in operated patients (202 ± 32.3 μg/g in non operated vs 68.6 ± 18.2 in operated patients; p0.001). Steatorrhea was significantly more severe in operated patients across different levels of FE-1. The relationship between FE-1 and steatorrhea was described by a power regression model, with a regression line significantly different in operated and non-operated patients (p0.001). A steatorrhea of 7 g (upper limit of normal range) was calculated by this regression line when FE-1 is 15 μg/g in non-operated, but as high as 225 μg/g in operated patients.FE-1 is useful to identify pancreatic insufficiency. Steatorrhea is anticipated in non-operated patients only when FE-1 is below the limit for a confident measurement of our assay. In operated patients, steatorrhea may be present even if FE-1 is only slightly reduced, that suggests a role for non pancreatic factors. FE1 is not useful to identify operated patients at risk of malabsorption.

Background/aims: Early diagnosis is essential for reducing the high mortality of CM (cutaneous melanoma). An expert dermatologist has a diagnostic accuracy of 85% but, in performing mass screening, the problem is to transfer the experience of a specialized centre to peripheral health clinics. Therefore, some computerized analysis systems were made. The aim of this paper is to compare the diagnostic accuracy of one such system, the Skin View System (SVS), to the accuracy of a well trained dermatologist in order to establish the real usefulness of the instrument and to verify how much it can help the diagnostic accuracy of the clinician in a dermatology setting. Method: During a campaign for the early diagnosis of CM, 176 patients with small and flat pigmentary lesions underwent clinical diagnosis, computerized analysis with SVS and skin biopsy. For clinical and computerized diagnosis, we evaluated sensitivity, specificity, true and negative predictive value. Results: The statistical evaluation, in our study, reveals that the computerized system has a diagnostic accuracy lower than that of a trained dermatologist. Conclusions: This computerized system does not help the clinician in the diagnosis of pigmented lesions.

One of the most famous controversies in the history of Statistics regards the number of the degrees of freedom of a chi-square test. In 1900, Pearson introduced the chi-square test for goodness of fit without recognizing that the degrees of freedom depend on the number of estimated parameters under the null hypothesis. Yule tried an ‘experimental’ approach to check the results by a short series of ‘experiments’. Nowadays, an open-source language such as R gives the opportunity to empirically check the adequateness of Pearson's arguments. Pearson paid crucial attention to the relative error, which he stated ‘will, as a rule, be small’. However, this point is fallacious, as is made evident by the simulations carried out with R. The simulations concentrate on 2×2 tables where the fallacy of the argument is most evident. Moreover, this is one of the most employed cases in the research field.

Professional teachers at first stage of secondary school were asked to assess the relative weights of five dimensions that in Italy must be considered when the final grades of students are decided. The teachers were also asked to give an overall evaluation of two samples of typical (i.e., students who record similar performances on all the dimensions) vs. atypical students (i.e., students who exhibit poor performance on at least one dimension and good or excellent performances on the others). The results show that the teachers shared a weighting scheme for assessment of the importance of the five dimensions. However, their overall evaluations were consistent with this weighting scheme only with reference to typical students. When the teachers evaluated atypical students, their judgements were highly inconsistent. The paper briefly discusses the implications of these findings.

Deposition of fat between skeletal muscle bundles and beneath the muscle fascia, recently called intermuscular adipose tissue (IMAT), is gaining attention as potential contributor to insulin resistance, metabolic syndrome, muscle function impairment, and disability. The aim of this study was to compare IMAT as measured at the erector spinae level by magnetic resonance imaging (MRI), a well-recognized gold standard method to evaluate fat content inside muscles, and histology estimates. In 18 healthy elderly men and women with a wide range of BMI (25.05-35.58 kg/m(2)), undergoing elective vertebral surgery, IMAT within the erector spinae muscle was evaluated by MRI, by body composition using dual-energy X-ray absorptiometry and histological evaluation of intraoperative biopsy sample. The concordance between IMAT/total area (TA) ratio evaluated by MRI and histological examination was analyzed employing Lin's concordance correlation coefficient and the procedure proposed by Bland and Altman. Two thresholds to distinguish between muscle and IMAT calculated, respectively, by 20 and 10% reduction of the gray-level intensity evaluated by MRI from surrounding subcutaneous adipose tissue (SAT) were used. With a 20% reduction, calculated IMAT/TA as evaluated by MRI on average exceeds histological evaluation by 21.79%, whereas by reducing the threshold by 10% agreement between MRI and histology improved with a 12.42% difference. Our data show a good degree of concordance between IMAT assessment by MRI and histology and seems to show that agreement between the two methods could be improved by using a more restrictive threshold between muscle and fat.