Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic.

During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14 years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12 years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12 years old (IRR 0,87; CI 0,68-1,10).   Conclusion: In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.

Pathway specific activation of ventral hippocampal cells projecting to the prelimbic cortex diminishes fear renewal.

The ability to learn that a stimulus no longer signals danger is known as extinction. A major characteristic of extinction is that it is context-dependent, which means that fear reduction only occurs in the same context as extinction training. In other contexts, there is re-emergence of fear, known as contextual renewal. The ability to properly extinguish fear memories and generalize safety associations to multiple contexts provides therapeutic potential, but little is known about the specific neural pathways that mediate fear renewal and extinction generalization. The ventral hippocampus (VH) is thought to provide a contextual gating mechanism that determines whether fear or safety is expressed in particular contexts through its projections to areas of the fear circuit, including the infralimbic (IL) and prelimbic (PL) cortices. Moreover, VH principal cells fire in large, overlapping regions of the environment, a characteristic that is ideal to support generalization; yet it is unclear how different projection cells mediate this process. Using a pathway-specific (intersectional) chemogenetic approach, we demonstrate that selective activation of VH cells projecting to PL attenuates fear renewal without affecting fear expression. These results have implications for anxiety disorders since they uncover a neural pathway associated with extinction generalization.

Behaviour of dental pulp stem cells on different types of innovative mesoporous and nanoporous silicon scaffolds with different functionalizations of the surfaces.

Dental pulp stem cells (DPSCs) are stem cells found in the dental pulp. The ability of DPSCs to differentiate towards odontoblastic and osteoblastic phenotype was reported first in the literature, then in the following years, numerous studies on odontogenesis were carried out, starting from mesenchymal stem cells isolated from tissues of dental and oral origin. The aim of this research was to evaluate the behaviour of DPSCs grown on silicon nanoporous and mesoporous matrices and differentiated towards the osteogenic phenotype, but also to investigate the use of DPSCs in pilot studies focused on the biological compatibility of innovative dental biomaterials. Twenty-eight silicon samples were created with standardized procedures. These scaffolds were divided into samples made of silicon bulk, nanoporous silicon, mesoporous silicon, nanoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS) and methanol (MeOH), nanoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS)/toluene, mesoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS) and methanol (MeOH) andmesoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS)/toluene. DPSC proliferation on the tested silicon scaffolds was analyzed at 3 and 5 days. The assay showed that DPSCs proliferated better on mesoporous scaffolds functionalized with APTMS/toluene compared to a silicon one. These results show that the functionalization of silicon scaffold with APTMS/toluene supports the growth of DPSCs and could be used for future applications in tissue engineering.

Middle-Level Features for the Explanation of Classification Systems by Sparse Dictionary Methods.

Machine learning (ML) systems are affected by a pervasive lack of transparency. The eXplainable Artificial Intelligence (XAI) research area addresses this problem and the related issue of explaining the behavior of ML systems in terms that are understandable to human beings. In many explanation of XAI approaches, the output of ML systems are explained in terms of low-level features of their inputs. However, these approaches leave a substantive explanatory burden with human users, insofar as the latter are required to map low-level properties into more salient and readily understandable parts of the input. To alleviate this cognitive burden, an alternative model-agnostic framework is proposed here. This framework is instantiated to address explanation problems in the context of ML image classification systems, without relying on pixel relevance maps and other low-level features of the input. More specifically, one obtains sets of middle-level properties of classification inputs that are perceptually salient by applying sparse dictionary learning techniques. These middle-level properties are used as building blocks for explanations of image classifications. The achieved explanations are parsimonious, for their reliance on a limited set of middle-level image properties. And they can be contrastive, because the set of middle-level image properties can be used to explain why the system advanced the proposed classification over other antagonist classifications. In view of its model-agnostic character, the proposed framework is adaptable to a variety of other ML systems and explanation problems.

[The results of the experimental prospective study on the effectiveness and efficiency of the implementation of clinical pathways]. / I risultati dello studio sperimentale prospettico di efficacia ed efficienza dell'implementazione dei percorsi assistenziali.

Our study was undertaken to determine how the use of care pathways in hospital affected the quality of the care of the patients. We performed a cluster-randomized trial. The use of diagnostic procedures and of medical treatments was more appropriate in the care pathways group, as well as the discharge process. As a consequence the outcomes indicators adopted in our study showed better performances in the care pathways group when compared to the usual care group. Our study added evidences on the value of clinical pathways that can be effectively used to improve the quality of hospital care. The use of CP helped to create a constant dialogue within the clinicians, ensured that important areas of treatment were not overlooked and unnecessary delays were prevented by timely interventions. We think that our results are reliable because we adopted a cluster-randomized controlled trial design that is widely accepted as the most reliable method of determining effectiveness of complex interventions in healthcare.

Oxygen absorption data of multilayer oxygen scavenger-polyester films with different layouts.

Oxygen absorption measurements in continuous regard active multilayer films with different layouts, all incorporating a PET/Oxygen scavenger (OS) layer, operating as active O2 barrier, inserted between two PET inert layers, acting as passive O2 barrier. The data set is related to "Transport properties of multilayer active PET films with different layers configuration" by Apicella et al. (2018) [1]. A set of four multilayer films, with different relative thickness of the active and inert layers, was produced using a laboratory scale co-extrusion cast-film equipment and was analyzed in terms of oxygen scavenging performance. Single layer active and inert layers were also produced for comparison. The results have shown a longer exhaustion time for all the active multilayer films, respect to the active monolayer one. Moreover, at constant thickness of the active layer, the exhaustion time increases by increasing the thickness of the inert layers, whereas, at constant thickness of the inert layers, the residual oxygen concentration decreases by increasing the thickness of the active layer.

Surgical treatment with Ligasure Precise of schwannoma of brachial plexus: case report.

English version We present a case of bulky schwannoma arising from the brachial plexus treated by a new surgical device. A 38-year-old man presented with a slow-growing left-sided supraclavicular mass and complained paresthesia of the third and forth fingers of the hand and forearm weakness. Physical examination revealed Tinel's sign. A CT-scan revealed a solid mass situated in the left profound supraclavicular fossa. The tumour was resected with the utilization of bipolar vessel sealing system (Ligasure Precise). This device is very useful in sutureless removal of masses localized in deep supraclavicular fossa. During the operation, care was taken to preserve the nerve function.

Evaluation of the biomechanical behavior of maxillary central incisors restored by means of endocrowns compared to a natural tooth: a 3D static linear finite elements analysis.

OBJECTIVE: The present study aimed at evaluating different restoring configurations of a crownless maxillary central incisor, in order to compare the biomechanical behavior of the restored tooth with that of a sound tooth. MATERIALS AND METHODS: A 3D FE model of a maxillary central incisor is presented. An arbitrary static force of 10 N was applied with an angulation of 125 degrees to the tooth longitudinal axis at level of the palatal surface of the crown. Different material configurations were tested: composite, syntered alumina, feldspathic ceramic endocrowns and glass post resorations with syntered alumina and feldspathic ceramic crown. RESULTS: High modulus materials used for the restoration strongly alter the natural biomechanical behavior of the tooth. Critical areas of high stress concentration are the restoration-cement-dentin interface both in the root canal and on the buccal and lingual aspects of the tooth-restoration interface. Materials with mechanical properties underposable to that of dentin or enamel improve the biomechanical behavior of the restored tooth reducing the areas of high stress concentration. SIGNIFICANCE: The use of endocrown restorations present the advantage of reducing the interfaces of the restorative system. The choice of the restorative materials should be carefully evaluated. Materials with mechanical properties similar to those of sound teeth improve the reliability of the restoartive system.

IGF-II/IGF-I receptor pathway up-regulates COX-2 mRNA expression and PGE2 synthesis in Caco-2 human colon carcinoma cells.

Nonsteroidal anti-inflammatory drugs reduce the risk of colon cancer and this effect is mediated in part through inhibition of type 2 prostaglandin endoperoxide synthase/ cyclo-oxygenase (COX-2). In the present study, we demonstrate that COX-2 expression and PGE2 synthesis are up-regulated by an IGF-II/IGF-I receptor autocrine pathway in Caco-2 colon carcinoma cells. COX-2 mRNA and PGE2 levels are higher in proliferating cells compared with post-confluent differentiated cells and in cells that constitutively overexpress IGF-II. Up-regulation of COX-2 expression by IGF-II is mediated through activation of IGF-I receptor because: (i) treatment of Caco-2 cells with a blocking antibody to the IGF-I receptor inhibits COX-2 mRNA expression; (ii) transfection of Caco-2 cells with a dominant negative IGF-I receptor reduces COX-2 expression and activity. Also, the blockade of the PI3-kinase, that mediates the proliferative effect of IGF-I receptor in Caco-2 cells, inhibits IGF-II-dependent COX-2 up-regulation and PGE2 synthesis. Moreover, COX-2 expression and activity inversely correlate with the increase of apoptosis in parental, IGF-II and dominant-negative IGF-I receptor transfected cells. This study suggests that induction of proliferation and tumor progression of colon cancer cells by the IGF-II/IGF-I receptor pathway may depend on the activation of COX-2-related events.

Cerebrocerebellar relationship during behavioral activation: a PET study.

The effect of behavioral activation on cerebral and cerebellar glucose metabolism was studied in normal subjects when performing either a verbal memory task or a tactile somatosensory task. Each subject was also studied in a resting state control condition, either 1 h earlier or later than the activation task. Compared to the resting state, both tasks produced asymmetrical metabolic activation, which was opposite in direction within the cerebral and cerebellar hemispheres. In both tasks, the difference of activation of CMRglc in the right and left hemispheres in the cerebellum was negatively correlated with that in the sensory-motor region. This apparently coupled metabolic activation of one cerebellum and areas within the opposite cerebral hemisphere represents the inverse of the crossed cerebellar diaschisis phenomenon commonly observed when a vascular lesion affects one cerebral hemisphere and hypometabolism occurs in the opposite cerebellum. Because these correlations were selective and concordant with known anatomical connections, and were found in two different tasks, they suggest strong functional connections between these specific brain regions.

Behavioral activation and the variability of cerebral glucose metabolic measurements.

Variability in cerebral glucose metabolism was examined between and within subjects when paired studies were performed in the resting state or in a behaviorally activated state. Both normal and demented subjects were studied twice each, from 1 to 6 weeks apart, under near-identical conditions, using positron emission tomography (PET) and [18F]fluorodeoxyglucose. Resting state studies were repeated in nine normal and four demented subjects. A picture-viewing test, used for activation during PET, was used repeatedly in seven normal and five demented subjects. Within-subject variability, as assessed by the percent difference in metabolic rates in paired studies, was reduced by 60-70% for activation state compared to resting state studies in normals. It is concluded that PET studies of brain metabolism, which are designed to study the active brain, should indeed be performed in functionally activated states, as in addition to demonstrating metabolism during a defined functional state, activation studies show reduced variability of cerebral metabolic measures.

Sensitivity of cerebral glucose metabolism to age, gender, brain volume, brain atrophy, and cerebrovascular risk factors.

In 76 normal volunteers studied by positron emission tomography, with [18F]fluorodeoxyglucose, CMRglu was significantly lower in the elderly as compared with young subjects and significantly higher in females relative to males. However, in 58 of these subjects who also had magnetic resonance imaging scans, age and gender were found to be unrelated to CMRglu, when the effects of brain volume and brain atrophy on CMRglu were partialed out using covariate analyses. Individually, brain volume was found to have a significant effect on CMRglu, explaining approximately 17% of the variability in CMRglu measures and brain atrophy explaining approximately 8% of the variance in CMRglu. Together these two measures accounted for approximately 21% of the variance. Cerebrovascular risk factors in normal subjects were not found to affect mean CMRglu or the variability of CMRglu measures. In this study almost 80% of the variance in CMRglu could not be explained by any of the factors that had been considered. This implies a lack of sensitivity of absolute values of global CMRglu to the mild effects of brain dysfunction. Although some of the unexplained variance is probably methodological in origin, physiological factors that are difficult to quantify, such as the state of arousal, are likely to be contributory as well.

Predominant left hemisphere metabolic dysfunction in dementia.

Thirty-one patients with probable Alzheimer's disease and 11 patients with memory disorders, attributable to multiple cerebral infarctions, were studied using 18-F-fluorodeoxyglucose-positron emission tomography scans. Asymmetry in cerebral glucose metabolism within these diagnostic groups was assessed by comparison with the metabolic rates obtained in age-equivalent healthy control subjects. A significantly greater number of individuals in both patient groups exhibited predominant left rather than right hemisphere hypometabolism. In addition, for patients with Alzheimer's disease, the degree of asymmetry was not related to either the severity or duration of dementia. These findings could be explained by greater susceptibility of the left hemisphere to degenerative or ischemic brain disease, by a specific sampling effect, or most likely, by greater metabolic deficits resulting from left rather than right hemisphere impairment.

Two behavioral states studied in a single PET/FDG procedure: theory, method, and preliminary results.

We have developed a method that allows two sets of regional cerebral metabolic rates of glucose (rCMRglc) to be obtained in a single extended procedure using positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG). This is an adaptation of the deoxyglucose method, with the addition of a second injection of FDG immediately after completion of the first scan, then followed 30 min later by a second scan. A model has been developed to allow for correction of measured tracer concentration in the second scan by subtracting the predicted remnant from the first scan. The possible applications of this method in studying behavior-metabolism relationships are demonstrated. The preliminary results show 6%-12% changes in rCMRglc values for appropriate brain regions when the behavioral state is altered, but show 0%-5% change in rCMRglc values when the behavioral state is unchanged. The method can contribute significantly to the understanding of behavior-metabolism relationships by allowing the noninvasive study of two behavioral states in a single PET procedure.

Two behavioral states studied in a single PET/FDG procedure: error analysis.

In a previous publication the theory, procedure, and results of a method were described for making two sequential measurements of cerebral metabolic rate for glucose (CMRglc), within a 2-hr period, using [18F]fluorodeoxyglucose. The error that is specific to this technique was estimated using computer simulations. CMRglc for the second state was sensitive to errors in (a) the values of the rate constants, (b) alignment of PET slices between the two scans, and (c) subtraction of one PET image from another. The root mean square of the average error from each error source was 6.4%, which gives the theoretical reliability of this method. The measured reproducibility, taken from our previous publication, was 4.2-6.2%, which is in good agreement with the present result. This method contributes a small additional error above that expected for two independent scans. However, independent scans done on different days are likely to be subject to larger physiological variations in CMRglc than would occur using this method.

Poly(ethylene oxide) (PEO) and different molecular weight PEO blends monolithic devices for drug release.

An interpretation of the drug release from monolithic water-swellable and soluble polymer tablets is presented. A convenient parameter, alpha, which compares the drug-diffusive conductance in the gel layer with the swelling and dissolving characteristics of the unpenetrated polymer was used to describe the release behaviour of beta-hydroxyethyl-theophylline (etofylline) from compression-moulded tablets of hydrophilic pure semicrystalline poly(ethylene oxides) of mol wt 600,000 and 4,000,000 and of two blends of the two molecular weights of poly(ethylene oxides). The water swelling and dissolution characteristics of two polymers and two blends were analysed, monitoring the thickness increase of the surface-dissolving layer and the rates of water swelling and penetration in the tablets. The drug diffusivities in the water-penetrated polymer gels were measured by carrying out permeation tests. Finally, drug release tests were performed to investigate the release kinetics of the different systems in an aqueous environment at 37 degrees C. The drug release from the high molecular weight poly(ethylene oxide) is principally related to the material swelling rather than polymer dissolution, leading to a progressive decrease of the drug's diffusive conductance in the growing swollen layer, and hence to a non-constant release induced by the prevailing diffusive control. Conversely, drug release from the low molecular weight poly(ethylene oxide) is strictly related to the polymer dissolution mechanism. The achievement of stationary conditions, in which the rate of swelling equals the rate of dissolution, ensures a constant release rate, even in the case of very low drug-diffusive conductance in the external gel layer. Intermediate behaviours were detected in the case of the two blends.

Asymmetric somatosensory activation with right- vs left-hand stimulation: a positron emission tomographic study.

Metabolic activation of the right and left somatosensory cortices (SSC) in response to an active sensorimotor task (palpation and sorting of mah jongg tiles) was studied in 16 right-handed normal volunteers using positron emission tomography (PET) and a double-injection [18F]fluorodeoxyglucose strategy. In 8 subjects with right-hand stimulation, cerebral metabolic rate for glucose (CMRglc) in the contralateral SSC increased by 16.7 +/- 5.1% (mean +/- S.D.); the increase in the ipsilateral SSC was 4.8 +/- 3.2%. In contrast, in the 8 subjects with left-hand stimulation, the contralateral increase was 12.0 +/- 2.9% and the ipsilateral increase was 5.9 +/- 1.5%. Thus, contralateral SSC activation was significantly higher with stimulation of the right hand, while the ipsilateral/contralateral symmetry of activation was greater when the left hand was stimulated.

Canalicular adenoma of the parotid gland: a case report.

Canalicular adenoma is an uncommon benign neoplasm that occurs almost exclusively in the upper lip and, very rarely, in other sites. We describe a case arising in the left parotid gland as a firm, painful mass, in order to underline morphological and immunohistochemical findings, particularly in relation to differential diagnosis with low-grade carcinomas of the salivary glands.