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1.
Rheumatol Int ; 44(2): 307-318, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37702804

RESUMO

The engineered Hand Test System (HTS) glove has shown high reliability in assessing the baseline functional status of rheumatoid arthritis (RA) hand. Starting from this achievement, the aim of the present observational prospective study was to assess the functionality of the single fingers of rheumatoid hand at follow-up. Eighty RA patients performed HTS glove tests at baseline and among these fifty-six patients were re-tested after 7 months. The HTS glove parameters [Touch Duration (TD), Movement Rate (MR), Inter Tapping Interval (ITI)] were correlated with disease activity and disability clinimetric indexes [Disease Activity Score 28 joint count-C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire-Disability Index (HAQ-DI), grip strength, visual analogue scale of pain (VAS), patient global assessment (PGA)], and with laboratory values. HTS glove parameters (TD, ITI, and MR) showed statistically significant correlations with clinimetric and clinical indexes at both time points (p < 0.05). During follow-up, a statistically significant variation of all HTS glove parameters for the fingers that have performed both the worst or best HTS test at baseline was detected (p < 0.05), while the mean HTS glove parameter values by considering all fingers did not show a statistically significant variation over time, as well as the traditional clinimetric indexes. Besides the objective role in assessing the RA hand function by integrating the traditional clinimetric indexes, the HTS glove seems a useful tool for evaluating worst or best finger function during time by measuring the movement speed.


Assuntos
Artrite Reumatoide , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Artrite Reumatoide/diagnóstico , Proteína C-Reativa , Dor , Índice de Gravidade de Doença
2.
Eur J Neurol ; 27(2): 280-287, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31444929

RESUMO

BACKGROUND AND PURPOSE: Muscle-strengthening, stretching or proprioceptive treatments may slow symptom progression in Charcot-Marie-Tooth (CMT) neuropathy. The aim of the study was to evaluate safety and efficacy of treadmill training in CMT1A. METHODS: We planned a multicenter, prospective, randomized, single-blind, controlled study. We recruited 53 outpatients affected by CMT1A and randomized them into two treatment groups: one underwent stretching and proprioceptive exercise, whereas the other was additionally treated with treadmill training (TreSPE). Primary outcome measures (OMs) were the walking evaluations and secondary OM was the balance assessment. All participants were assessed at baseline and after 3 and 6 months of treatment. RESULTS: Most patients showed an improvement in at least one OM after 3 months [42/47 (89.4%)] and 6 months [38/40 (95%)] of treatment. No adverse events were reported in either group. CONCLUSIONS: The most important finding was that both stretching and proprioceptive exercise and treadmill training had an objective benefit on patients affected by CMT disease, without causing overwork weakness. We had a low rate of drop out and did not find deterioration in motor performance. Our results also confirm that applying evidence-based medicine methods to rehabilitative research is the correct way to test the efficacy of a treatment.


Assuntos
Doença de Charcot-Marie-Tooth/reabilitação , Terapia por Exercício/métodos , Adulto , Idoso , Doença de Charcot-Marie-Tooth/psicologia , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fadiga Muscular , Exercícios de Alongamento Muscular , Propriocepção , Estudos Prospectivos , Qualidade de Vida , Método Simples-Cego , Resultado do Tratamento , Caminhada , Adulto Jovem
3.
Eur J Neurol ; 27(12): 2561-2567, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32805743

RESUMO

BACKGROUND AND PURPOSE: The importance of upper limb function in multiple sclerosis (MS) is increasingly recognized, especially for the evaluation of patients with progressive MS with reduced mobility. Two sensor-engineered gloves, able to measure quantitatively the timing of finger opposition movements, were previously used to assess upper limb disability in MS. The aims of the present study were: (1) to confirm the association between glove-derived variables and standard measures of MS disability in a larger cohort; (2) to assess the correlation with quantitative magnetic resonance imaging (MRI) and quality of life (QoL) measures; and (3) to determine if the glove-derived variables offer advantages over the standard measure for assessing upper limb function in MS, namely, the Nine-Hole Peg Test (9HPT). METHODS: Sixty-five patients with MS, stable on disease-modifying treatment, were evaluated at baseline using the glove, and through clinical examination (Expanded Disability Status Scale, Symbol Digit Modalities Test, Timed 25-Foot Walk Test and 9HPT), MRI evaluation and QoL questionnaires. Correlations between the glove-derived variables and clinical, MRI and QoL variables were assessed using Spearman's rank correlation coefficient analysis. RESULTS: Glove-derived variables significantly differed between patients with relapsing-remitting and those with progressive MS, with similar or slightly higher correlations of the 9HPT with clinical variables. We found greater correlations of the QoL physical component with glove-derived variables than with the 9HPT, and a significant correlation of its mental component with the glove-derived variables but not with the 9HPT. CONCLUSION: The study results, confirming previous findings and showing advantages over the 9HPT, encourage the investigation of sensitivity to change in glove-derived variables in a longitudinal setting.


Assuntos
Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla , Avaliação da Deficiência , Humanos , Esclerose Múltipla/diagnóstico por imagem , Testes Neuropsicológicos , Qualidade de Vida , Extremidade Superior
4.
Neurol Sci ; 41(11): 3235-3241, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32388646

RESUMO

BACKGROUND: Patient-reported outcomes (PROs) may help patients and clinicians in selecting disease-modifying therapies (DMTs) for multiple sclerosis (MS). OBJECTIVE: To evaluate PRO differences among first-line DMTs for relapsing-remitting (RR) people with MS (pwMS). METHODS: Multicenter study. RR pwMS on first-line DMTs completed Fatigue Severity Scale (FSS), PROs Indices for MS (PRIMUS), 36-item Short-Form Health Survey (SF-36), treatment satisfaction questionnaire for medication (TSQM), Beck Depression Inventory-II (BDI-II), and Symbol Digit Modalities Test (SDMT). Differences among PROs across DMTs were tested by ANOVA. Multivariable linear regressions were used to investigate associations between PROs and the treatment group. RESULTS: Two-hundred eighty pwMS were enrolled: 56% were on interferons (INF), 22% on dimethylfumarate (DMF), 13% on glatiramer acetate, and 9% on teriflunomide (Teri). Compared with INF, pwMS on Teri were the oldest, with higher disability, worst depression at BDI, worst cognitive performances at SDMT (p = 0.001), fatigue at FSS (p = 0.001), and activity limitation and quality of life respectively at PRIMUS (p = 0.005) and SF-36 Mental Composite Score (p < 0.001); pwMS on DMF reported highest side effects and, together with pwMS on Teri, better treatment satisfaction at TSQM. CONCLUSIONS: Compared with INF-treated patients, pwMS on DMF and Teri reported the best treatment satisfaction, although DMF-treated pwMS reported higher side effects and those on Teri the worst QoL and fatigue; however, the older age, higher disability and depression, and worse cognitive performance of pwMS on Teri suggest to be careful in evaluating these results.


Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Idoso , Acetato de Glatiramer/uso terapêutico , Humanos , Esclerose Múltipla/tratamento farmacológico , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida
5.
J Antimicrob Chemother ; 74(8): 2341-2346, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31119272

RESUMO

BACKGROUND: Isavuconazole is the newest triazole antifungal approved for the treatment of invasive aspergillosis (IA) and invasive mucormycosis in adult patients. OBJECTIVES: To characterize the assessment of the blood levels of isavuconazole and their association with efficacy and toxicity. METHODS: From January 2017 to May 2018, blood samples obtained from patients receiving isavuconazole were analysed for therapeutic drug monitoring. Factors influencing the blood concentrations of isavuconazole, such as weight, length of treatment, route of administration and results of selected liver function tests, were analysed in univariate and multivariate models. The receiver operating characteristic (ROC) curve was analysed to detect the best cut-off for isavuconazole toxicity. RESULTS: A total of 264 isavuconazole blood concentrations in 19 patients were analysed. The median value of isavuconazole concentration in all patients during the first 30 days of therapy was 3.69 mg/L (range 0.64-8.13 mg/L). A linear increase of 0.032 mg/L (range 0.023-0.041 mg/L) for each day of treatment (P = 0.002) was observed. In multivariate analysis the association between the length of treatment and higher levels of isavuconazole (P < 0.001) and higher serum GGT and lower isavuconazole levels (P = 0.001) was confirmed. Adverse events, mainly gastrointestinal, were reported in six patients (31.6%). Based on time-dependent and fixed-time ROC curve analysis, 4.87 mg/L and 5.13 mg/L, respectively, were the identified thresholds for toxicity. CONCLUSIONS: Isavuconazole was efficacious and well tolerated. Side effects, mainly gastrointestinal, were associated with prolonged administration and high serum levels.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/farmacocinética , Nitrilas/administração & dosagem , Nitrilas/farmacocinética , Piridinas/administração & dosagem , Piridinas/farmacocinética , Soro/química , Triazóis/administração & dosagem , Triazóis/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/efeitos adversos , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nitrilas/efeitos adversos , Piridinas/efeitos adversos , Curva ROC , Estudos Retrospectivos , Triazóis/efeitos adversos
6.
Eur J Neurol ; 25(10): 1270-1275, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29851435

RESUMO

BACKGROUND AND PURPOSE: There is debate as to whether the apparent rebound after fingolimod discontinuation is related to the discontinuation itself or whether it is due to the natural course of highly active multiple sclerosis (MS). Our aim was to survey the prevalence of severe reactivation and rebound after discontinuation of fingolimod in a cohort of Italian patients with MS. METHODS: Patients with relapsing-remitting MS who were treated with fingolimod for at least 6 months and who stopped treatment for reasons that were unrelated to inefficacy were included in the analysis. RESULTS: A total of 100 patients who had discontinued fingolimod were included in the study. Fourteen patients (14%) had a relapse within 3 months after fingolimod discontinuation, and an additional 12 (12%) had a relapse within 6 months. According to this study's criteria, 10 patients (10%) had a severe reactivation. Amongst these patients, five (5%) had a reactivation that was considered to be a rebound. CONCLUSIONS: The present study showed that more than 26% of patients are at risk of having a relapse within 6 months after fingolimod discontinuation. Nevertheless, the risk of severe reactivations and rebound is lower than has been previously described.


Assuntos
Cloridrato de Fingolimode/uso terapêutico , Imunossupressores/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Itália , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Recidiva , Suspensão de Tratamento , Adulto Jovem
7.
Eur J Neurol ; 22(6): 960-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25786797

RESUMO

BACKGROUND AND PURPOSE: No subgroups of patients with higher treatment effects have been clearly detected in multiple sclerosis (MS). The aim of the present work was to evaluate whether there are subgroups of relapsing-remitting MS (RRMS) patients who are more responsive to treatments. METHODS: All published randomized clinical trials in RRMS reporting a subgroup analysis of treatment effect were collected. Two main outcomes, the annualized relapse rate (ARR) and the disability progression, were studied. The treatment effect in each subgroup was reported as a relative effect (RE), defined as the treatment effect in the subgroup relative to the overall effect. A meta-analysis was run to compare the RE between subgroups. RESULTS: Six trials (6693 RRMS patients) were included. Treatment effects on ARR were significantly higher in younger than in older subjects (RE = 0.83 vs. RE = 1.30, P < 0.001), in patients with than those without gadolinium activity (RE = 0.86 vs. RE = 1.15, P = 0.005) and in patients with lower than in those with higher Expanded Disability Status Scale (RE = 0.96 vs. RE = 1.23, P = 0.02), and on disability progression in younger than in older subjects (RE = 0.82 vs. RE = 1.28, P = 0.017). CONCLUSIONS: This study formally shows that in RRMS higher treatment effects are associated with characteristics of earlier (lower age and Expanded Disability Status Scale) and more active (higher gadolinium activity) disease.


Assuntos
Progressão da Doença , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Humanos , Pessoa de Meia-Idade
8.
J Eur Acad Dermatol Venereol ; 29(5): 973-80, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25296638

RESUMO

BACKGROUND: Dermatological emergencies exist and should not be underestimated. On the other hand, many accesses to the emergency department (ED) of patients with dermatological conditions are unjustified. OBJECTIVE: Our main objective is to describe dermatological conditions seen in an ED observation unit (EDOU). Secondly, our aim is to identify alarm symptoms and signs of 'true emergencies'. METHODS: We conducted a prospective study, including dermatological patients admitted to EDOU of the University Hospital of San Martino, Genoa, Italy, in 3 years. RESULTS: Overall 372 patients were studied. The most common condition seen was infection (41.67%) (mainly bacterial), followed by atypical exanthem (13.98%) and vasculitis (11.29%). The highest rate of cases peaked in May (13%); infectious diseases showed two peaks (spring and autumn). CONCLUSION: Given constraints involved in health care today, it is crucial to understand which dermatological presentations are 'true emergencies'. In such a scenario knowing the epidemiology of dermatological emergencies and the alarming skin signs and symptoms might be useful.


Assuntos
Dermatologia/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Dermatopatias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Emergências , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Estações do Ano , Adulto Jovem
9.
Minerva Stomatol ; 64(3): 117-28, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25799445

RESUMO

AIM: The aim of this prospective controlled investigation was to analyze the short-term cephalometric treatment outcomes, according to the denture frame analysis proposed by Sato, of rapid palatal expansion (RPE) and facial mask (FM) therapy. METHODS: A group of 21 patients with Class III malocclusion treated with the RPE and FM (TG) was compared with untreated Class III controls (CG). The mean age of treatment group was 8.8 years; treatment consisted of 4 weeks of RPE activation (0.20 mm/die) followed by 14 hours wear of the FM for a mean of 333.1 days. As CG were used the data published by Tanaka and Sato. Pre- and post-treatment cephalometric values were compared and statistical analyzed with one-sample t-test. A P-value <0.05 was considered statistically significant. RESULTS: For almost all parameters the differences pre and post treatment values resulted significantly different compared to those observed in CG. Regarding conventional occlusal plane (POC) values some differences compared to control group were found but they were not statistically significant (P=0.067) while for aterior occlusal plane (POA) no differences where noticed. CONCLUSION: This study revealed an increase in inter-jaw angle during treatment with FM and RPE, an increase in the inclination of the posterior occlusal plane with respect to the Frankfurt plane and a posterior and lower adaptation of the mandible.


Assuntos
Má Oclusão Classe III de Angle/terapia , Técnica de Expansão Palatina , Estudos de Casos e Controles , Cefalometria , Criança , Aparelhos de Tração Extrabucal , Feminino , Humanos , Masculino , Estudos Prospectivos
10.
Mult Scler ; 19(4): 466-74, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22914849

RESUMO

BACKGROUND: The increasing number of effective therapies to treat multiple sclerosis (MS) raises ethical concerns for the use of placebo in clinical trials, suggesting that new clinical trial design strategies are needed. OBJECTIVES: To evaluate time to first relapse as an endpoint for MS clinical trials. METHODS: A recently-developed model fitting the distribution of time to first relapse in MS was used for simulations estimating the sample sizes of trials using this as an outcome, and for comparison with the size of trials using the annualized relapse rate (ARR) as the primary outcome. RESULTS: Trials based on time to first relapse were feasible, requiring sample sizes that were similar or even smaller than if the study was based on ARR instead. In the case of low ARR (0.4 relapses/year), as is expected in future trials, the 1-year trials designed to detect a treatment effect of 30%, with 90% power, require fewer patients when based on time to first relapse (470 patients/arm) than if based on ARR (540 patients/arm). CONCLUSIONS: Our simulations show that time to first relapse is not less powerful than ARR in MS trials; thus, this measure would be a potentially useful primary outcome offering the advantage of an ethically sound design, as the patients randomized to placebo can then switch to the active drug, once they relapse. A potential drawback is the loss of information for other endpoints collected at fixed time points.


Assuntos
Modelos Teóricos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Projetos de Pesquisa , Humanos
11.
Mult Scler ; 19(5): 605-12, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23012253

RESUMO

BACKGROUND: We employed clinical and magnetic resonance imaging (MRI) measures in combination, to assess patient responses to interferon in multiple sclerosis. OBJECTIVE: To optimize and validate a scoring system able to discriminate responses to interferon treatment in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: Our analysis included two large, independent datasets of RRMS patients who were treated with interferons that included 4-year follow-up data. The first dataset ("training set") comprised of 373 RRMS patients from a randomized clinical trial of subcutaneous interferon beta-1a. The second ("validation set") included an observational cohort of 222 RRMS patients treated with different interferons. The new scoring system, a modified version of that previously proposed by Rio et al., was first tested on the training set, then validated using the validation set. The association between disability progression and risk group, as defined by the score, was evaluated by Kaplan Meier survival curves and Cox regression, and quantified by hazard ratios (HRs). RESULTS: The score (0-3) was based on the number of new T2 lesions (>5) and clinical relapses (0,1 or 2) during the first year of therapy. The risk of disability progression increased with higher scores. In the validation set, patients with score of 0 showed a 3-year progression probability of 24%, while those with a score of 1 increased to 33% (HR = 1.56; p = 0.13), and those with score greater than or equal to 2 increased to 65% (HR = 4.60; p < 0.001). CONCLUSIONS: We report development of a simple, quantitative and complementary tool for predicting responses in interferon-treated patients that could help clinicians make treatment decisions.


Assuntos
Encéfalo/patologia , Fatores Imunológicos/uso terapêutico , Interferon beta/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Adulto , Progressão da Doença , Feminino , Humanos , Interferon beta-1a , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla Recidivante-Remitente/patologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Resultado do Tratamento , Adulto Jovem
12.
Eur Ann Allergy Clin Immunol ; 45(4): 123-9, 2013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-24067337

RESUMO

BACKGROUND: Allergic rhinitis and asthma may be associated, bronchial hyperreactivity (BHR) is quite common in AR patients. It has been reported that allergen bronchial challenge induces nasal inflammation. Methacholine (MCH) is a stimulus able to elicit BHR. There is no study that investigated the effect of MCH bronchial challenge on the nose. OBJECTIVE: The aim of this study was to evaluate whether MCH bronchial challenge is able to induce changes in nasal symptom perception and nasal function in patients with AR. METHODS: 122 patients (117 males, median age 28 years) suffering from AR were evaluated. Values for bronchial function (FVC, FEV1, FEF25-75, and FEV1/FVC ratio), MCH bronchial challenge, VAS for nasal and bronchial symptoms, and nasal airflow and resistance were assessed. RESULTS: 23 patients (18.9%) had BHR. MCH bronchial challenge induced a significant reduction of nasal obstruction perception (p<0.001), but did not affect the nasal function. Most of patients (91) did not perceive impairment of respiration. The perception of nasal obstruction was strongly related to the AR duration (r=0.65). The highest values of both baseline rhinoVAS and Δ bronchial VAS predicted BHR (OR 1.7 and 2.9 respectively). CONCLUSIONS: The present study demonstrates that in AR patients MCH bronchial challenge does not substantially affect nasal symptoms and function, also in subjects with an acute bronchospasm, such as in BHR patients. However, severity of nasal obstruction perception might predict BHR.


Assuntos
Testes de Provocação Brônquica , Broncoconstritores , Pulmão/fisiopatologia , Cloreto de Metacolina , Cavidade Nasal/fisiopatologia , Rinite Alérgica Sazonal/diagnóstico , Rinite Alérgica/diagnóstico , Adulto , Broncoconstrição , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Exposição por Inalação , Pulmão/imunologia , Masculino , Fluxo Máximo Médio Expiratório , Cavidade Nasal/imunologia , Obstrução Nasal/imunologia , Obstrução Nasal/fisiopatologia , Percepção , Valor Preditivo dos Testes , Rinite Alérgica/imunologia , Rinite Alérgica/fisiopatologia , Rinite Alérgica/psicologia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/fisiopatologia , Rinite Alérgica Sazonal/psicologia , Índice de Gravidade de Doença , Capacidade Vital , Adulto Jovem
13.
Eur J Orthod ; 35(3): 401-5, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22267706

RESUMO

The thread shape factor (TSF) to evaluate the relationships between geometrical characteristics and mechanical properties of the temporary anchorage devices (TADs) has recently been introduced. This in vitro experimental study evaluated in 30 different tests with three TADs: ORTHOImplant (1.8 mm diameter and 10 mm length; 3M Unitek), Tomas (1.6 mm diameter and 10 mm length; Dentaurum), and Orthoeasy (1.7 mm diameter and 10 mm length; Forestadent). Scanning electron microscopy images were acquired for each TAD to measure the TSF; afterwards, the maximum insertion torque (MIT) was evaluated and thereafter pull-out tests on two differently designed organic bone analogs were carried out using a testing machine with a crosshead speed of 2 mm/minute being applied. One-way analysis of variance with group as factor was performed. Post hoc multiple comparisons Bonferroni test was used. Rank-transformed data were used when asymmetry of data was shown. To assess correlation between characteristics, load, and MIT, Spearman's rank correlation coefficient was used. A P-value of 0.05 was considered statistically significant. Significant direct correlations were found between TSF and depth and both load and MIT. Particularly, a correlation of 0.90 (P < 0.001) was found between depth and MIT for 2.2 mm cortical thickness. The authors conclude that MIT and maximum load values of pull-out test are statistically related to depth of the thread of the screw and to TSF.


Assuntos
Parafusos Ósseos , Procedimentos de Ancoragem Ortodôntica/instrumentação , Procedimentos de Ancoragem Ortodôntica/métodos , Análise do Estresse Dentário , Humanos , Desenho de Aparelho Ortodôntico , Estatísticas não Paramétricas , Estresse Mecânico , Torque
14.
J Prev Med Hyg ; 54(2): 97-103, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24396990

RESUMO

INTRODUCTION: Tobacco smoking, which usually begins in teenage, is one of the most important lifestyle risk factors for chronic diseases and a major public health problem worldwide. The aims of the study were to determine the prevalence of tobacco smoking and the mean age of initiation among adolescents in Genoa (Italy) and to identify some socio-demographic predictors that could be associated with the onset of smoking. MATERIALS AND METHODS: 2,301 randomly selected students (14-19 years old) in Genoa completed an ad hoc questionnaire. The Kaplan-Meier method was used to evaluate the instantaneous risk of experimenting with smoking. A multivariate logistic regression model was used to determine whether current or previous smoking status was associated with socio-demographic characteristics. RESULTS: 59.5% of respondents had tried smoking, while 35.6% defined themselves as current smokers. No difference in current smoking prevalence emerged between males and females (35.2% and 35.9%, respectively, p = 0.83). The mean age on initiation was 13.5 years for males and 13.9 years for females. The instantaneous probability of trying smoking changed with age, reaching a maximum at 14 years. Subjects who tried smoking before this age were more inclined to continue smoking. The probability of being a current smoker was significantly higher among students from unmarried-parent families and those attending vocational and technical secondary schools. CONCLUSIONS: There is a great need for the activation of new health promotion interventions and enforcement of those already existing, in order to raise awareness of the damage caused by smoking among adolescents, especially those belonging to high-risk groups.


Assuntos
Fumar/epidemiologia , Adolescente , Comportamento do Adolescente , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , População Urbana , Adulto Jovem
15.
Minerva Stomatol ; 62(9): 307-19, 2013 Sep.
Artigo em Inglês, Italiano | MEDLINE | ID: mdl-24126597

RESUMO

AIM: The aim of this preliminary study was to evaluate short-term dentoskeletal changes obtained with a functional appliance for Class II Division I malocclusions called propulsor universal light (PUL). METHODS: Fifteen Class II Division 1 patients (10.6±1.2 years) were consecutively treated by one expert operator with PUL appliance and they were compared with a longitudinal group of Class II Division I untreated patients (9.9±1.9 years) matched for pubertal growth spurt stage and sex. Lateral cephalograms were taken before PUL therapy and at the end of treatment. The mean duration of treatment was 11.2±0.3 months; t-test or Mann-Whitney U-test was used (P <0.05). RESULTS: Statistically significant reduction of the overjet, WITS and ANB was noticed in treated group as well as a significant improvement of CoGo and Ramus. CONCLUSION: Class II Division I malocclusion in the short term was efficiently treated by PUL appliance with both skeletal and dentoalveolar changes.


Assuntos
Cefalometria/normas , Má Oclusão Classe II de Angle/terapia , Aparelhos Ortodônticos Funcionais , Aparelhos Ortodônticos Removíveis , Criança , Método Duplo-Cego , Feminino , Humanos , Masculino , Má Oclusão Classe II de Angle/diagnóstico por imagem , Mandíbula/diagnóstico por imagem , Maxila/diagnóstico por imagem , Desenho de Aparelho Ortodôntico , Projetos Piloto , Radiografia , Resultado do Tratamento
16.
J Biol Regul Homeost Agents ; 26(1 Suppl): S15-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22691245

RESUMO

The present study confirms that sensitization is very frequent in the general population and suggests that impaired FEF25-75 may be a marker of sensitization. Therefore, when spirometry is abnormal, mainly concerning FEF25-75, sensitization should be suspected.


Assuntos
Hipersensibilidade/diagnóstico , Fluxo Máximo Médio Expiratório/fisiologia , Espirometria , Adulto , Feminino , Humanos , Hipersensibilidade/fisiopatologia , Masculino
17.
Eur J Orthod ; 34(5): 582-6, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21367816

RESUMO

The resistance to extraction of temporary anchorage devices (TADs) depends on various factors, including miniscrew design, shear strength, and bone density. This research introduces the thread shape factor (TSF) as a new factor for the evaluation of TAD mechanical properties. The authors evaluated three TADs for a total of 27 tests: Mini-impianto autoforante (Leone, 1.75 mm diameter and 8 mm length), Orthoscrew (Leader Ortodonzia, 1.65 mm diameter and 9 mm length), and MAS (Miniscrew Anchorage System, 1.3 mm diameter and 11 mm length). For each TAD, the images were acquired via a 20.00 kV scanning electron microscopy to measure their respective mean depth of thread (D), pitch (P), and the relationship between the two (TSF). Subsequently, pullout tests on organic bone analogue were carried out using a testing machine; a crosshead speed of 2 mm/minutes was applied. A two-way analysis of variance was performed to evaluate the interaction between the type of miniscrew and the cortical thickness. A post hoc analysis for single comparisons was subsequently employed. In addition, if homogeneity of variances was not rejected, Scheffè's test was performed, while Tamhane's test was carried out if the homogeneity of variance assumption was not met. Univariate linear regression models were fitted to evaluate the relationship between the outcomes and TSF, D, and P separately. A P value of 0.05 was considered statistically significant. From univariate linear regression, TSF, D, and P were statistically significant predictors of 'peak load'. The tests showed that TSF has a statistical significance for describing the mechanical competency of TADs.


Assuntos
Parafusos Ósseos , Procedimentos de Ancoragem Ortodôntica/instrumentação , Desenho de Aparelho Ortodôntico , Análise de Variância , Densidade Óssea , Análise do Estresse Dentário , Modelos Lineares , Estresse Mecânico
18.
Eur J Paediatr Dent ; 13(4): 301-6, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23270288

RESUMO

AIM: This was to clarify dentoalveolar, skeletal and facial profile modifications induced by Fränkel II functional treatment in Class II division 1 subjects in prepubertal stages CS1-2. MATERIALS AND METHODS: Evaluation of 25 caucasian subjects (15 males, 10 females), mean age 8y 11m, in vertebral stages CS1-2. The mean duration of functional treatment was 1y 11m. STUDY DESIGN: Prospective controlled study. The sample was evaluated at T0, start of treatment, and T1, end of Fränkel II therapy. Untreated subjects in Class II division 1 were the control group. STATISTICS: T-test for paired data was calculated before and after treatment (P< 0.05). RESULTS: A statistically significant increase between T0 and T1 was obtained for SNB (p = 0.022), ANB (p <0.001), Mx/Mn differential (p = 0.001), Co-Go-Me (p = 0.014), OJ (p < 0.001), OB (p = 0.042), IMPA (p = 0.021) . OJ (p < 0.001) and OB (p = 0.003) showed a higher significant change in the Fränkel group compared to control group. CONCLUSION: The Fränkel II appliance produced, in CS1-2 subiects, significant effects in teeth position, skeletal modifications and soft tissue changes, although the pubertal growth spurt would occur at least two years later.


Assuntos
Má Oclusão Classe II de Angle/terapia , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Funcionais , Retrognatismo/terapia , Cefalometria/métodos , Criança , Queixo/patologia , Dentição Mista , Feminino , Seguimentos , Humanos , Masculino , Má Oclusão Classe II de Angle/patologia , Mandíbula/patologia , Côndilo Mandibular/patologia , Maxila/patologia , Osso Nasal/patologia , Sobremordida/patologia , Sobremordida/terapia , Estudos Prospectivos , Retrognatismo/patologia , Sela Túrcica/patologia
19.
ESMO Open ; 7(6): 100634, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36493602

RESUMO

BACKGROUND: The Meet-URO score allowed a more accurate prognostication than the International Metastatic RCC Database Consortium (IMDC) for patients with pre-treated metastatic renal cell carcinoma (mRCC) by adding the pre-treatment neutrophil-to-lymphocyte ratio and presence of bone metastases. MATERIALS AND METHODS: A post hoc analysis was carried out to validate the Meet-URO score on the overall survival (OS) of patients with IMDC intermediate-poor-risk mRCC treated with first-line nivolumab plus ipilimumab within the prospective Italian Expanded Access Programme (EAP). We additionally considered progression-free survival (PFS) and disease response rates. Harrell's c-index was calculated to compare the accuracy of survival prediction. RESULTS: Overall the EAP included 306 patients, with a median follow-up of 12.2 months, median OS was not reached, 1-year OS was 66.8% and median PFS was 7.9 months. By univariable analysis, both the IMDC score and the two additional variables of the Meet-URO score were associated with either OS or PFS (P < 0.001 for all comparisons). The four Meet-URO risk groups (G) had 1-year OS of 92%, 72%, 50% and 21% for G2 (29.1% of patients), G3 (28.8%), G4 (33.0%) and G5 (9.1%), respectively. OS was significantly shorter in each consecutive G (P = 0.001 for G3, P < 0.001 for both G4 and G5 compared to G2). Similarly, Meet-URO Gs 2-5 showed decreasing median PFS and response rates. The Meet-URO score showed the highest c-index for both OS (0.73) and PFS (0.67). Limitations include the post hoc nature of this analysis and the lack of a comparative arm to assess predictive value. CONCLUSION: The Meet-URO score appeared to show better prognostic classification than the IMDC alone in patients with mRCC at IMDC intermediate-poor risk treated with first-line nivolumab and ipilimumab.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/secundário , Nivolumabe/farmacologia , Nivolumabe/uso terapêutico , Ipilimumab/farmacologia , Ipilimumab/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Estudos Prospectivos , Estudos Retrospectivos
20.
Allergy ; 66(5): 694-8, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21261662

RESUMO

BACKGROUND: Allergic rhinitis (AR) may be considered a risk factor for the onset of asthma. Recently, it has been reported that forced expiratory flow between 25% and 75% of vital capacity (FEF25₋75) may predict a positive response to bronchodilation test in asthmatic children. The aim of this study was to evaluate a large group of adult AR patients to investigate the frequency of response to bronchodilation test and FEF25₋75 values. METHODS: One thousand four hundred and sixty-nine consecutive patients suffering from persistent AR were evaluated. Clinical examination, spirometry, and bronchodilation test were performed in all patients. RESULTS: In this study, 62.9% of patients had reversibility to bronchodilation test and 17.8% had impaired FEF25₋75 values (≤ 65% of predicted). Impaired FEF25₋75 values associated with longer rhinitis duration may predict reversibility to bronchodilation test (OR = 11.3; P < 0.001). In addition, a FEF25₋75 cutoff value ≤ 71% of predicted may already discriminate patients with reversibility. CONCLUSIONS: This study highlights that about two-thirds of patients with persistent AR may be considered at risk of becoming asthmatic. This finding should be adequately considered as a precocious spirometry may allow the early detection of patients prone to develop asthma and consequently to treat them.


Assuntos
Testes de Provocação Brônquica/estatística & dados numéricos , Valor Preditivo dos Testes , Rinite Alérgica Perene/complicações , Rinite Alérgica Sazonal/complicações , Adulto , Asma/diagnóstico , Asma/etiologia , Testes de Provocação Brônquica/métodos , Testes de Provocação Brônquica/normas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica Sazonal/diagnóstico , Rinite Alérgica Sazonal/epidemiologia , Espirometria , Adulto Jovem
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