Predictors of Prolonged Hospitalization and In-Hospital Mortality After Hip Fracture: A Retrospective Study on Discharge Registry.

Background: Hip fracture injury is one of the principal health problems affecting the elderly. Patients reporting hip fractures often show relevant comorbidities leading to prolonged hospital stay, significant complications and higher mortality rates. This study aims to assess the risk factors associated with prolonged hospitalization after hip fracture, in-hospital mortality and transfers to other facilities. Study design: Retrospective cross-sectional study. Methods: The study considered all admissions performed between 2006 and 2015 in Abruzzo region, Italy. Logistic regression analyses were performed to evaluate odds ratios for each risk factor as predictor of in-hospital mortality, length of stay, and transfer to other facilities. Results: Age over 85 (OR=5.38) and cancer (OR=3.62) were identified as the strongest risk predictors for in hospital mortality; diabetes (OR=2.24) and heart failure (OR=1.57) were identified as predictors of prolonged length of stay and age over 85 (OR=1.38) and atrial fibrillation (OR=1.69) were identified as predictors of transfer to other facilities. Conclusions: With the rising incidence of hip fractures, identification of modifiable factors may help to reduce morbidity and mortality.

Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: A multi-institutional study.

OBJECTIVE: To assess predictors of recurrence following laparoscopic radical hysterectomy (LRH) for apparent early stage cervical cancer (CC). METHODS: This is a retrospective multi-institutional study reviewing data of consecutive patients who underwent LRH for FIGO 2009 stage IA1 (with lymphovascular space invasion (LVSI)), IA2 and IB1(≤4 cm) CC, between January 2006 and December 2017. The following histotypes were included: squamous, adenosquamous, and adenocarcinoma. Multivariable models were used to estimate adjusted odds ratio (OR) and corresponding 95% CI. Factors influencing disease-free survival (DFS) and disease-specific survival (DSS) were also explored. RESULTS: 428 patients were included in the analysis. With a median follow-up of 56 months (1-162) 54 patients recurred (12.6%). At multivariable analysis, tumor size (OR:1.04, 95%CI:1.01-1.09, p = .02), and presence of cervical residual tumor at final pathology (OR: 5.29, 95%CI:1.34-20.76, p = .02) were found as predictors of recurrence; conversely preoperative conization reduced the risk (OR:0.32, 95%CI:0.11-0.90, p = .03). These predictors remained significant also in the IB1 subgroup: tumor size: OR:1.05, 95%CI:1.01-1.09, p = .01; residual tumor at final pathology: OR: 6.26, 95%CI:1.58-24.83, p = .01; preoperative conization: OR:0.33, 95%CI:0.12-0.95, p = .04. Preoperative conization (HR: 0.29, 95%CI: 0.13-0.91; p = .03) and the presence of residual tumor on the cervix at the time of surgery (HR: 8.89; 95%CI: 1.39-17.23; p = .01) independently correlated with DFS. No independent factors were associated with DSS. CONCLUSIONS: In women with early stage CC the presence of high-volume disease at time of surgery represent an independent predictor of recurrence after LRH. Conversely, preoperative conization and the absence of residual disease at the time of surgery might play a protective role.

Impact of sexual maturity on the welfare of immunocastrated v. entire heavy female pigs.

During oestrus, fattening female pigs are more prone to lameness, fractures and wounds due to mounting and agonistic behaviours of penmates. This study assessed the effect of sexual maturity on the behaviour and welfare of heavy female pigs slaughtered at 36 weeks of age (180±10 kg) for dry-cured ham production. An immunocastrated control group was used for comparison. In all, 56 15-week-old female pigs, individually identifiable by back tattoos were equally distributed among four pens. All animals from two pens were subject to a three-dose immunocastration schedule at 16, 20 and 32 weeks of age. Skin lesions and behaviours were assessed at 18, 23, 28, 33 and 36 weeks of age. A blood sample was collected at 20, 24, 28 and 32 weeks of age for assessing health/stress parameters and GnRH antibodies. At slaughter, ovaries were weighed, measured and histologically examined; stomachs, carcasses and lungs were scored for lesions and a further blood sample was taken. Immunocastrated pigs did not significantly differ from controls in growth rate, feed efficiency and slaughter performances (lung score, gastric score, backfat thickness). However, they showed a lower frequency of aggressive interactions at 33 and 36 weeks, lower front lesions at 28 weeks, but higher at 30 weeks; a lower haptoglobin level at 28 weeks, a lower level of cortisol and back lesions at slaughter (36 weeks). These findings suggest a low, yet not negligible, impact of sexual maturity on the welfare of heavy female pigs.

Adjuvant topical treatment with imiquimod 5% after excisional surgery for VIN 2/3.

OBJECTIVE: Vulvar intraepithelial neoplasia (VIN) is a premalignant lesion of the vulva. The incidence of VIN is increasing. The surgery is currently the gold standard therapy for VIN, but Imiquimod could be a completion to surgery. The aim of this study is to compare the overall complete response, the recurrence rate and the risk factors for recurrence among two groups of patients: women with high grade VIN underwent surgery and patients treated with surgery plus Imiquimod. PATIENTS AND METHODS: 80 patients with histologically diagnosed VIN 2/3 were enrolled in this prospective study. Our patients were divided into two groups: 40 women underwent surgery (A) and 40 patients were treated with surgery plus Imiquimod (B). All women had a 5-year follow-up. Recurrence rate and complete response were evaluated. The following patients' characteristics were analyzed: smoke, multifocal disease, multicentric disease, degree of the lesion. RESULTS: In the group A recurrence rate was 44.8%, in the group B it was 48.4%. In both groups the presence of multifocal lesions (p = 0.02) and VIN 3 (p = 0.006) before treatment was associated with a higher risk of recurrence. CONCLUSIONS: This study found that surgery remains the principal approach for VIN with regard to relapse and complete response since the treatment with Imiquimod associated with surgery didn't show a lower recurrence rate. Although the surgical treatments remain the best therapeutic option for VIN with regard to recurrence and overall complete response, the combined therapy seems to be an interesting modality, but further studies are needed.

Borderline ovarian tumors, fertility-sparing surgery and pregnancy outcome.

BACKGROUND: Borderline ovarian tumors (BOTs) represent a type of epithelial tumors having a biologic intermediate behavior between clearly malignant and straight benign tumors. Most of BOTs interest women during fertile age, for which it is necessary to consider a fertility sparing surgery. AIM: To evaluate the clinical aspects and pregnancy rate of women affected by borderline ovarian tumors who have undergone fertility sparing surgery. PATIENTS AND METHODS: A study of 22 patients affected by BOTs who have been treated with a fertility sparing surgery was conducted between January 2005 and October 2011 at Sant'Andrea Hospital, "Sapienza" University of Rome. The patients' characteristics analyzed were: age, histological type, tumor size, adnexal surgery, pre-operative serum CA-125, diagnostic circumstances, number of patients who became pregnant and number of overall pregnancies. RESULTS: Among the 22 patients treated with a fertility sparing surgery, only sixteen wanted to get pregnant. Eleven patents out of 16 accomplished it. The pregnancy rate was 68.7%. CONCLUSIONS: Fertility sparing surgery can be considered a safe procedure for young women affected by borderline ovarian tumors.

Primary and reactivated HHV8 infection and disease after liver transplantation: a prospective study.

Human herpesvirus 8 (HHV8) is pathogenic in humans, especially in cases of immunosuppression. We evaluated the risk of HHV8 transmission from liver donors, and its clinical impact in southern Italy, where its seroprevalence in the general population is reported to be as high as 18.3%. We tested 179 liver transplant recipients and their donors for HHV8 antibodies at the time of transplantation, and implemented in all recipients a 12-month posttransplant surveillance program for HHV8 infection. Of the 179 liver transplant recipients enrolled, 10.6% were HHV8 seropositive before transplantation, whereas the organ donor's seroprevalence was 4.4%. Eight seronegative patients received a liver from a seropositive donor, and four of them developed primary HHV8 infection. Two of these patients had lethal nonmalignant illness with systemic involvement and multiorgan failure. Among the 19 HHV8 seropositive recipients, two had viral reactivation after liver transplantation. In addition, an HHV8 seronegative recipient of a seronegative donor developed primary HHV8 infection and multicentric Castleman's disease. In conclusion, primary HHV8 infection transmitted from a seropositive donor to a seronegative liver transplant recipient can cause a severe nonmalignant illness associated with high mortality. Donor screening for HHV8 should be considered in geographic areas with a high prevalence of such infection.

Dual-time-point [18F]-FDG PET/CT in the diagnostic evaluation of suspicious breast lesions.

PURPOSE: The authors sought to evaluate whether the reacquisition of images 3 h after administration of radiotracer improves the sensitivity of fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography ([(18)F]-FDG PET/CT) in patients with suspicious breast lesions. MATERIALS AND METHODS: Forty-eight patients with 59 breast lesions underwent an [(18)F]-FDG PET/CT study in the prone position with a dual-time-point acquisition performed in the early phase 1 h after FDG administration (PET-1) and in the delayed phase 3 h after FDG administration (PET-2). Both examinations were evaluated qualitatively and semiquantitatively with calculation of the mean percentage variation of the standard uptake values (Delta% SUV(max)) between PET-1 and PET-2. All lesions with an SUV(max) >or=2.5 at PET-1 or a reduction in SUV between PET-1 and PET-2 were considered benign. The definitive histopathological diagnosis was available for all patients included in the study. RESULTS: The dual-time-point acquisition of [(18)F]-FDG PET/CT displayed an accuracy of 85% for lesions with an SUV(max) >or=2.5 and/or positive Delta% SUV(max), with sensitivity and specificity values of 81% and 100% compared with 69%, 63% (both p<0.001) and 100% (p=n.s.), respectively, for the single-time-point acquisition. Malignant lesions showed an increase in FDG uptake between PET-1 and PET-2, with a Delta% SUV(max) of 10+/-7 (p<0.04). In contrast, benign lesions showed a decrease in SUV between PET-1 and PET-2, with a Delta% SUV(max) of -21+/-7 (p<0.001). CONCLUSIONS: The delayed repeat acquisition of PET images improves the accuracy of [(18)F]-FDG PET/CT in patients with suspicious breast lesions with respect to the single-time-point acquisition. In addition, malignant breast lesions displayed an increase in FDG uptake over time, whereas benign lesions showed a reduction. These variations in FDG uptake between PET-1 and PET-2 are a reliable parameter that can be used for differentiating between benign and malignant breast lesions.

Estrogen receptor polymorphism, estrogen content and idiopathic scoliosis in human: a possible genetic linkage.

Idiopathic scoliosis (IS) is a largely diffused disease in human population but its pathogenesis is still unknown. There is a relationship between scoliotic phenotype and the patient age, since in the early stage the pathology shows a ratio of 50% between male and female teenagers. During puberty the sex ratio is 8.4/1 (female/male), suggesting a sex-conditioned manifestation of the disease. Genetic inheritance of idiopathic scoliosis is still unclear although some authors claim for its X-linked dominant inheritance. There is large agreement in considering the IS as a sex-conditioned disease, in terms of steroid content and their receptor activity, although no evidence has been found yet. The blood content of 17beta-estradiol in teenagers with IS shows lower levels than teenagers of the same age without IS. Also testosterone and progesterone content are lower in IS girls with respect to the control girls. Furthermore, we extracted DNA from white blood cells of IS patients and their relatives until the third generation in order to examine estrogen receptor alpha polymorphisms, considering this tool a plausible molecular marker for IS prognosis. In this respect, we identified four polymorphisms in the exons encoding for the steroid binding domain and two other in the trans-activation domain. Our results show a clear relationship with clinical manifestation of IS.

Combined effects of traffic and electromagnetic fields on the immune system of fertile atopic women.

Object of this preliminary study was the immune response to high or low frequency electromagnetic fields (ELMF) of non-atopic and atopic fertile women with uniform exposure to toxic compounds produced by traffic. Women were divided in group A (non-atopic, non-exposed to ELMF); B (atopic, non-exposed to ELMF); C (non-atopic, exposed to ELMF); D (atopic, exposed to ELMF). "In vitro" cell proliferation of peripheral blood mononuclear cells (PBMC) of atopic women (groups B and D) stimulated by phytohaemoglutinin (PHA) was reduced. The ELMF exposed women (groups C and D) showed lower levels of blood NK CD16(+)-CD56+ lymphocyte subpopulations and of "in vitro" production of interferon-gamma (both spontaneously and in presence of PHA) by PBMC, suggesting that ELMF reduces blood cytotoxic activity. Serum IgE of the atopic women exposed to ELMF (group D) was higher than that of the other groups. Linear discriminant analysis including serum zinc and copper (essential enzymes for immune functions), blood lead and urinary transtrans muconic acid, a metabolite of benzene (markers of exposure to traffic) and key parameters of immune functions (CD16(+)-CD56+ lymphocyte subset, serum IgE, interferon-gamma produced by PBMC in presence of PHA, stimulation index of blastogenesis) showed absence of significant difference between groups A and C and a marked separation of groups B and D. This datum suggests that ELMF have a greater influence on atopic women exposed to traffic than on non-atopic ones.

[Needle aspiration cytology in thyroid surgery (our experience in 104 operated cases)]. / La citologia per agoaspirato in chirurgia tiroidea: (la nostra esperienza su 104 casi operati).

In the least years Fine Needle Aspiration Biopsy (FNAB) is more and more becoming a routine exam in the thyroid diagnostics. Nevertheless, its exact role and diagnostic value is still an argument under discussion, in spite of well known usefulness and safety of the method. The aim of this study, based on our experience, is to verify, if and how much FNAB findings could have modified the diagnostic schedule, the surgical indications and the number of malignancies in a group of operated patients for thyroid nodular disease. In this experience a series of 104 patients have been studied in the Ia Clinica Chirurgica-Ia Facoltà, Università degli Studi di Napoli in the years 1988-90; the indication for a surgical treatment was due to a nodular thyroid disease. Aspiration cytology was performed in these patients before surgery and afterwards was determined the correlation between cytologic and hystological findings. The clinical and scan assessment also contributed to indicate the surgical management of the disease. On the basis of this study FNAB has to be considered as a quite reliable diagnostic tool in thyroid lesions; it results free of complications, with good sensitivity (75%), specificity (82.6%) and diagnostic accuracy (81.7%). A peculiar consequence of the use of cytology, is the increased number of adenoca (11.5%) preoperatively diagnosed, a percentage of which otherwise would have been a histopathological postoperative "surprise". However, the possibility of "false negative" and "false positive" lends further support to the concept that FNAB alone cannot determinate the choice between medical or surgical treatment of thyroid nodular lesions.

[The emergency surgical treatment of hemoperitoneum due to the spontaneous rupture of a hepatocarcinoma in a cirrhotic liver]. / Trattamento chirurgico d'urgenza di emoperitoneo da rottura spontanea di epatocarcinoma in fegato cirrotico.

A case of intraperitoneal hemorrhage from rupture of a unknown hepatocarcinoma on a cirrhotic liver treated in emergency is reported. Owing to the severity of the general conditions of the aging patient the diagnostic was not higher than of probability. The surgical treatment was an atypical wedge resection, that proved efficacious for the surgical recovery, and perhaps also for a limited oncologic treatment in consideration of the underlying cirrhosis.

[Blood levels of neopterin in patients with liver cirrhosis]. / Studio dei livelli sierici di neopterina in pazienti con cirrosi epatica.

Neopterin is a pyrazino-pyrimidine compound which is biosynthesized by macrophages. Increased concentrations of neopterin have been reported in conditions causing stimulation of cellular immunity, such as viral and other infections, graft versus host disease, autoimmune diseases and different malignancies. Recently, increased urinary neopterin levels have been found in patients with acute viral hepatitis and NANB chronic hepatitis. In the present study, neopterin serum levels were measured in 23 cirrhotic patients (6 HBV related, 7 alcoholic and 10 cryptogenetic cirrhosis) and in 24 normal subjects. Mean values of serum neopterin were statistically increased in cirrhotics (3.92 +/- 3.28 ng/mL versus 1.24 +/- 0.51 ng/mL in controls, p less than 0.01). Serum neopterin values were not statistically different either in cirrhotics assessed in three different classes according to Child's classification or in cirrhotics with or without serological findings of active disease. In fact, in cirrhotic patients, serum neopterin levels did not correlate with serum aspartate and alanine aminotransferases, alkaline phosphatase, gamma-glutamyltransferase and gammaglobulins values. These data show that increased levels of serum neopterin occur in cirrhotic patients, but there is no relation between serum neopterin values and the histological activity or the clinical severity of the disease. The results are consistent with the hypothesis that activated macrophages are involved in all forms and in all stages of liver cirrhosis.

[Association of serum tumor markers in solid neoplasms (CEA, ferritin, alpha 1-antitrypsin, parathormone and calcitonin)]. / Studio di una associazione di markers tumorali sierici in alcune neoplasie solide (CEA, ferritina, alfa-1-antitripsina, paratormone e calcitonina).

The Authors have tested serum levels of CEA, ferritin, Alpha-1-antitrypsin, parathyroid hormone (PTH) and calcitonin (CT) in 286 patients affected by lung, gastrointestinal, breast and other kinds of cancer and by non neoplastic diseases. 50 healthy subjects were tested as matched controls too. None of the tested patients was subjected to blood transfusion, therapy with iron, radio- or chemotherapy before the blood drawing. Cea, ferritin, PTH and CT were tested by radioimmunoassay; AAT by laser nephelometry. All the healthy subjects showed serum levels of the markers in the normal ranges. Also the percent of cases with contemporaneous pathological markers was examined. The obtained data have been statistically controlled with "chi square" test. The results show that CEA, ferritin, AAT and CT are higher in the tumor groups than in the others. On the contrary PTH seems to be not useful as tumor marker. The Authors conclude affirming that it is not possible to use any of the tested substances as a specific tumor marker but it is useful to test at the same time these markers in the patients suspected to be affected by cancer for an early diagnosis and therapy, as there are few false positive and false negative cases.

[Serum tumor markers in lung neoplasms (correlation with histological types)]. / Utilizzazione di alcuni markers tumorali sierici nelle neoplasie del polmone (rapporto con i quadri istologici).

The AA. have tested serum levels of ferritin, alpha-1-antitripsyn, C4 and Phosphohexoseisomerase (PHI) in 50 patients affected by primary lung cancer, 40 patients affected by chronic lung diseases and a control group of 40 healthy males and females. All the test have a percentage of pathological case higher in the group of neoplasms than in the group of chronic diseases and ferritin seems to have the highest sensitivity. Obtained results have been correlated also to the morphoradiological and histological kind of neoplasm. "Peripheral" morphoradiological kind and III WHO histological kind are the group with more pathological cases. All the data have been statistically controlled.

[Serum levels of GPI, AAT and CEA in primary lung neoplasms and chronic bronchopneumopathies]. / I livelli sierici di GPI, A1AT e CEA nelle neoplasie polmonari primitive e nelle broncopneumopatie croniche.

The Authors have tested serum levels of alpha-1-antitrypsin (A1AT), phosphohexose-isomerase (GPI) and carcinoembryonic antigen (CEA) in 133 patients affected with primary lung cancer, not treated with any drug, and in 183 patients affected with not neoplastic lung diseases or healthy, to control the utility of these markers in the early diagnosis of lung cancer. In many patients all the tests have been made at the same time. The three tumoral markers have been also examined in connection with the histological kinds of lung cancer. Results show that is suitable to test GIP and A1AT at the same time because they are percentually more pathological; serum levels of CEA, that are not very elevated in the pathological cases, seem in correlation with the histological kind of cancer.