Inter-rater reliability of classification systems of scapular dyskinesis.

Prevalence of scapular dyskinesis varies across records, with overhead athletes being more frequently affected than non-overhead athletes A number of methods have been described to evaluate scapular kinematics and scapular dyskinesis. The "yes/no" and the "4-type" classification systems are widely accepted and diffusely used among orthopaedics and physical therapists. The inter-rater reliability for both the "yes/no" and the "4-type" classification systems may be different. Moreover, differences between physical therapists and orthopaedic surgeons may exist. Seven examiners (2 orthopaedic surgeons and 5 physical therapists) were asked to evaluate a mixed sequence of video recordings of healthy subjects and patients affected by shoulder, scapular or clavicular disorders and to assess scapular dyskinesis using the "yes/no" and the "4-type" classification systems. Cohen's kappa coefficient (κ) and weighted kappa were used to measure inter-rater reliability. Twenty-four subjects were enrolled. In general, the "4- type" system has higher κ values than ''yes/no'' classification system and orthopaedic surgeons achieve higher reliability than physical therapists for both systems. The clinical evaluation of active shoulder movements permits reproducible assessment and classification of scapular dyskinesis, in particular for the "4-type" classification system. The "4-type" classification system can be used to assess and classify scapular dyskinesis, especially among orthopaedic surgeons.

Volume Fabrication of Quantum Cascade Lasers on 200 mm-CMOS pilot line.

The manufacturing cost of quantum cascade lasers is still a major bottleneck for the adoption of this technology for chemical sensing. The integration of Mid-Infrared sources on Si substrate based on CMOS technology paves the way for high-volume low-cost fabrication. Furthermore, the use of Si-based fabrication platform opens the way to the co-integration of QCL Mid-InfraRed sources with SiGe-based waveguides, enabling realization of optical sensors fully integrated on planar substrate. We report here the fabrication and the characterization of DFB-QCL sources using top metal grating approach working at 7.4 µm fully implemented on our 200 mm CMOS pilot line. These QCL featured threshold current density of 2.5 kA/cm² and a linewidth of 0.16 cm-1 with a high fabrication yield. This approach paves the way toward a Mid-InfraRed spectrometer at the silicon chip level.

Wavelength conversion of complex modulation formats in a compact SiGe waveguide.

We report a nonlinear signal processing system based on a SiGe waveguide suitable for high spectral efficiency data signals. Four-wave-mixing (FWM)-based wavelength conversion of 10-Gbaud 16-Quadrature amplitude modulated (QAM) and 64-QAM signals is demonstrated with less than -10-dB conversion efficiency (CE), 36-dB idler optical signal-to-noise ratio (OSNR), negligible bit error ratio (BER) penalty and a 3-dB conversion bandwidth exceeding 30nm. The SiGe device was CW-pumped and operated in a passive scheme without giving rise to any two-photon absorption (TPA) effects.

Mid-infrared nonlinear optical response of Si-Ge waveguides with ultra-short optical pulses.

We characterize the nonlinear optical response of low loss Si(0.6)Ge(0.4) / Si waveguides in the mid-infrared between 3.3 µm and 4 µm using femtosecond optical pulses. We estimate the three and four-photon absorption coefficients as well as the Kerr nonlinear refractive index from the experimental measurements. The effect of multiphoton absorption on the optical nonlinear Kerr response is evaluated and the nonlinear figure of merit estimated providing some guidelines for designing nonlinear optical devices in the mid-IR. Finally, we compare the impact of free-carrier absorption at mid-infrared wavelengths versus near-infrared wavelengths for these ultra-short pulses.

Nonlinear optical response of low loss silicon germanium waveguides in the mid-infrared.

We have investigated the nonlinear optical response of low loss Si(0.6)Ge(0.4) / Si waveguides in the mid-infrared wavelength range from 3.25- 4.75µm using picosecond optical pulses. We observed and measured the three and four-photon absorption coefficients as well as the Kerr nonlinear refractive index. The dynamics of the spectral broadening suggests that, in addition to multiphoton absorption, the corresponding higher order nonlinear refractive phenomena also needs to be included when high optical pulse intensities are used at mid-infrared wavelengths in this material.

The use of indocyanine green to detect sentinel nodes in breast cancer: a prospective study.

BACKGROUND: Although Indocyanine green (ICG) is used to find sentinel nodes (SN) in patients with breast cancer (BC), its role in clinical practice is still debated, and needs a definitive validation to be included in the standard approach to finding sentinel nodes in breast cancer. MATERIALS AND METHODS: To validate the ICG methods of detecting the SN in BC we have recently concluded a prospective validation trial. Patients with clinically node-negative, invasive early BC scheduled for breast surgery and SN biopsy were included in the trial. All the patients underwent SN detection using both the standard-of-care procedure using radioisotope technetium (99mTc) and the ICG, using the Photodynamic Eye camera. A comparison of the detection rate and the diagnostic accuracy of the two methods was performed to detect the equivalency of the two approaches. RESULTS: At the end of the enrollment, 301 patients were considered eligible and included in the trial, and 589 nodes were removed. Five hundred and eighty-three nodes (99%) were identified with ICG (median 2 nodes per patient) and 452 (76.7%) were identified with 99mTc (median 2 nodes per patient). A concordance index of 98.75% (CI, 95% = 97.1%-99.5%) was detected. The dosage given ranged from 0.3 to 1.4 ml. ICG was used in all patients eligible for SN biopsy without any significant acute side effects. CONCLUSIONS: The index of concordance between 99mTc and ICG seems to be extremely high, suggesting that ICG could be validated as an alternative method to 99mTc in the detection of SN in BC.

Two-stage revision for the treatment of the infected total elbow arthroplasty.

We report our experience of staged revision surgery for the treatment of infected total elbow arthroplasty (TEA). Between 1998 and 2010 a consecutive series of 33 patients (34 TEAs) underwent a first-stage procedure with the intention to proceed to second-stage procedure when the infection had been controlled. A single first-stage procedure with removal of the components and cement was undertaken for 29 TEAs (85%), followed by the insertion of antibiotic-impregnated cement beads, and five (15%) required two or more first-stage procedures. The most common organism isolated was coagulase-negative Staphylococcus in 21 TEAs (62%). A second-stage procedure was performed for 26 TEAs (76%); seven patients (seven TEAs, 21%) had a functional resection arthroplasty with antibiotic beads in situ and had no further surgery, one had a persistent discharge preventing further surgery. There were three recurrent infections (11.5%) in those patients who underwent a second-stage procedure. The infection presented at a mean of eight months (5 to 10) post-operatively. The mean Mayo Elbow Performance Score (MEPS) in those who underwent a second stage revision without recurrent infection was 81.1 (65 to 95). Staged revision surgery is successful in the treatment of patients with an infected TEA and is associated with a low rate of recurrent infection. However, when infection does occur, this study would suggest that it becomes apparent within ten months of the second stage procedure.

Patrones dermatoscópicos de 158 nevos melanocíticos acrales en una población latinoamericana / Dermoscopic Patterns of 158 Acral Melanocytic Nevi in a Latin American Population

Introducción: Los nevos melanocíticos se encuentran con frecuencia en la piel volar acral. La diferenciación entre nevos y melanoma es imprescindible y a veces difícil, aunque la dermatoscopia ha permitido un diagnóstico más preciso de lesiones pigmentadas. Los patrones dermatoscópicos de lesiones en la piel volar acral han sido descritos en su mayoría en poblaciones europeas y asiáticas. La población latinoamericana es heterogénea, y en particular en el caso de los uruguayos, que provienen en gran parte de 3 distintas poblaciones. Objetivo: Describir los patrones dermatoscópicos de nevos melanocíticos acrales y evaluar su aplicabilidad en una población latinoamericana en Uruguay. Pacientes y métodos: Se trata de un estudio observacional, descriptivo y transversal realizado por 2 dermatólogos de 4 clínicas dermatológicas en Uruguay. Se incluyeron pacientes mayores de 18 años con nevos melanocíticos acrales. Las imágenes dermatoscópicas fueron captadas y analizadas de forma conjunta por 2 investigadores. Resultados: Un total de 158 nevos volares acrales en 80 pacientes fueron analizados. El patrón más frecuente fue el patrón paralelo del surco (51,3% de los nevos), seguido por el patrón en celosía (13,3%), el patrón homogéneo (12,7%), el patrón globular (9,5%), el patrón fibrilar (7%), el patrón retículo-globular (3,8%), y el patrón atípico (2,5%). No se observaron los patrones reticular y de transición en nuestra población. Conclusiones: El patrón paralelo del surco, seguido por los patrones en celosía y homogéneo, fueron los más frecuentes en nevos melanocíticos acrales en la población uruguaya. El patrón fibrilar se encuentra exclusivamente en las plantas de los pies. No se observaron nuevos patrones dermatoscópicos. Los patrones descritos en la literatura asiática y europea son aplicables a nuestra población (AU)

Background: Melanocytic nevi are frequently found on acral volar skin. Differentiation between nevi and melanoma is essential and sometimes difficult, although dermoscopy has enabled a more specific diagnosis of pigmented lesions. Dermoscopic patterns of lesions on acral volar skin have mostly been described in European and Asian populations. The Latin American population is heterogeneous, and particularly so in the case of Uruguayans, who largely descend from 3 distinct populations. Objective: To describe dermoscopic patterns of acral melanocytic nevi and evaluate their applicability in a Latin American population in Uruguay. Patients and Methods: This was an observational, descriptive, cross-sectional study conducted by 2 dermatologists from 4 dermatology clinics in Uruguay. Uruguayan patients older than 18 years with acral melanocytic nevi were included. Digital dermoscopic images were captured and jointly analyzed by 2 investigators. Results: A total of 158 acral volar nevi in 80 patients were analyzed. The most-prevalent pattern was the parallel furrow pattern (51.3% of nevi), followed by the latticelike pattern (13.3%), the homogeneous pattern (12.7%), the globular pattern (9.5%), the fibrillar pattern (7%), the globulostreaklike pattern (3.8%), and the nontypical pattern (2.5%). The reticular and transition patterns were not observed in our population. Conclusions: The parallel furrow pattern, followed by the latticelike and homogeneous patterns, was the most-prevalent pattern in acral melanocytic nevi in the Uruguayan population. The fibrillar pattern was found exclusively on the soles. No new dermoscopic patterns were observed. The patterns described in Asian and European literature apply to our population(AU)

Dermoscopic patterns of 158 acral melanocytic nevi in a Latin American population.

BACKGROUND: Melanocytic nevi are frequently found on acral volar skin. Differentiation between nevi and melanoma is essential and sometimes difficult, although dermoscopy has enabled a more specific diagnosis of pigmented lesions. Dermoscopic patterns of lesions on acral volar skin have mostly been described in European and Asian populations. The Latin American population is heterogeneous, and particularly so in the case of Uruguayans, who largely descend from 3 distinct populations. OBJECTIVE: To describe dermoscopic patterns of acral melanocytic nevi and evaluate their applicability in a Latin American population in Uruguay. PATIENTS AND METHODS: This was an observational, descriptive, cross-sectional study conducted by 2 dermatologists from 4 dermatology clinics in Uruguay. Uruguayan patients older than 18 years with acral melanocytic nevi were included. Digital dermoscopic images were captured and jointly analyzed by 2 investigators. RESULTS: A total of 158 acral volar nevi in 80 patients were analyzed. The most-prevalent pattern was the parallel furrow pattern (51.3% of nevi), followed by the latticelike pattern (13.3%), the homogeneous pattern (12.7%), the globular pattern (9.5%), the fibrillar pattern (7%), the globulostreaklike pattern (3.8%), and the nontypical pattern (2.5%). The reticular and transition patterns were not observed in our population. CONCLUSIONS: The parallel furrow pattern, followed by the latticelike and homogeneous patterns, was the most-prevalent pattern in acral melanocytic nevi in the Uruguayan population. The fibrillar pattern was found exclusively on the soles. No new dermoscopic patterns were observed. The patterns described in Asian and European literature apply to our population.

[Manual lifting and manual transport: risk assessment and prevalence of work-related diseases in construction companies in Basilicata]. / Movimentazione manuale dei carichi e trasporto manuale: valutazione del rischio e prevalenza di patologie correlate nelle imprese edili lucane.

BACKGROUND: The Basilicata Regional Headquarters of the Italian Institute for Insurance against Occupational Accidents and Disease (INAIL) and the Basilicata association of small building enterprises (Edilcassa di Basilicata) promoted a research project to assess the risk of manual lifting and manual transport in construction enterprises in the Basilicata Region and estimate the prevalence of related diseases. METHODS: Manual lifting risk assessment was performed by calculating the VLI of 204 working days in as many building workers. Manual transport risk assessment was carried out comparing the weights transported (on the 204 days tested) with the reference values of the "Snoock and Ciriello" tables. RESULTS: Manual Ifting risk was present on 195 of the 204 days, with an average value of VLI equal to 2.1 (min 0.4, max 8.5), with higher values in the restructuring sector (VLI average of 2.3, min 0.4, max 8.5), and no significant differences between the different tasks. Manual transport risk was present on 129 of the 204 days, with average values of 1.2 (min 0.2, max 3.3), with no significant differences between the different tasks analyzed For both risks additional factors were present that were not analyzed by the methods of assessment used (for manual lifting: 8.8% of the geometries in the critical area; for manual transport: 39% of transport on shoulders, 42.5% on a route with uneven surface and 31.9% on a sloping route), so it is likely that the actual risk is greater than that indicated by the synthetic indices of exposure. The medical questionnaire showed from the case histories that 148 out of 546 subjects were positive for the threshold forpain or discomfort in the lumbosacral spine area and 99 out of 546 subjects reported suffering from an already diagnosed herniated spinal disk. Only 18% of osteoarticular diseases was reported to the Insurance Institute, al though there was widespread awareness that the diseases in question might be related to work. Diseases of the spine were responsible for 1.9% of absenteeism, equal to 30-40% of total absenteeism ofworkers enrolled in "Edilcassa di Basilicata". CONCLUSIONS: The method used provides a solid basis for evaluating the two risks in the construction industry, where employment is subject to extreme organizational, environmental and structural (machines, tools, operators involved) variability. Employment in the construction industry involves significant exposure to the two risks, counting for 30-40% of total absenteeism in this sector.

VEGF and VEGFR polymorphisms affect clinical outcome in advanced renal cell carcinoma patients receiving first-line sunitinib.

BACKGROUND: Currently, sunitinib represents one of the therapeutic strongholds for renal cell carcinoma, but the criteria for treatment selection are lacking. We assessed the role of vascular endothelial growth factor (VEGF) and VEGF receptor (VEGFR) polymorphisms in the prediction of the clinical outcome in metastatic renal cell carcinoma (mRCC) patients. METHODS: A total of 84 tumour samples from mRCC patients receiving first-line sunitinib were tested for VEGF and VEGFR single-nucleotide polymorphisms (SNPs). The SNP results were correlated with progression-free survival (PFS) and overall survival (OS). RESULTS: Median PFS was 8.22 months, although whereas median OS was 32.13 months. The VEGF A rs833061 resulted significant in PFS (17 vs 4 months; P<0.0001) and OS (38 vs 10 months; P<0.0001). The VEGF A rs699947 was significant for PFS (18 vs 4 months; P=0.0001) and OS (37 vs 16 months; P<0.0001). The VEGF A rs2010963 was significant in PFS (18 vs 8 vs 2 months; P=0.0001) and OS (31 vs 36 vs 9 months; P=0.0045). The VEGR3 rs6877011 was significant in PFS (12 vs 4 months; P=0.0075) and OS (36 vs 17 months; P=0.0001). At multivariate analysis, rs833061, rs2010963 and rs68877011 were significant in PFS, and rs833061 and rs68877011 were independent factors in OS. CONCLUSIONS: In our analysis, patients with TT polymorphism of rs833061, CC polymorphism of rs699947, CC polymorphism of rs2010963 and CG polymorphism of rs6877011 seem to have a worse PFS and OS when receiving first-line sunitinib.

Clinical, dermoscopic and histopathologic features of genital and extragenital lichen sclerosus.

BACKGROUND: Little is currently known about the dermoscopic patterns of genital and extragenital lichen sclerosus (LS). In order to evaluate and compare the dermoscopic and histopathologic patterns of genital and extragenital lichen sclerosus, a retrospective analysis of clinical, dermoscopic and histopathologic features of genital and extragenital LS, collected between March 2010 and December 2011 at four dermatology clinics in Greece, Italy, Serbia and Uruguay was performed. OBSERVATIONS: A total of 29 lesions from 14 (mean age 62.8 years) and 12 (mean age 53.5 years) patients with genital and extragenital LS, respectively were analyzed. Mean duration of disease was 3.5 years for genital and 1.8 years for extragenital LS. White-yellowish structureless areas were seen in all cases of genital and extragenital LS; however linear vessels occurred at higher frequency in genital than in extragenital lesions (85.7% vs. 33.3%, respectively). Extragenital LS revealed two different time-related patterns: keratotic plugs were more prevalent in lesions with short duration (<2 years), whereas longer persisting lesions appeared atrophic and revealed fine chrysalis structures. CONCLUSIONS: Our morphologic study provides novel insights into the morphologic diversity of LS at different body sites and different stages of progression.

High rejection bandpass optical filters based on sub-wavelength metal patch arrays.

We report the study of a resonant bandpass filter made of a very thin subwavelength metal patch array coupled to a high index dielectric waveguide. The spectral properties of those filters can easily be tuned by playing on the lateral dimensions of the grating. They exhibit high and narrow transmission peaks together with very good rejection of light out of the pass-band and low angular dependance. An experimental demonstration using standard large scale silicon microelectronics processes is presented in the mid infrared spectral range. This concept of filters can easily be scaled throughout the optical spectrum, and can be integrated within focal plane arrays of various imaging technologies, down to visible wavelengths.

Aligned carbon nanotube based ultrasonic microtransducers for durability monitoring in civil engineering.

Structural health monitoring of porous materials such as concrete is becoming a major component in our resource-limited economy, as it conditions durable exploitation of existing facilities. Durability in porous materials depends on nanoscale features which need to be monitored in situ with nanometric resolution. To address this problem, we put forward an approach based on the development of a new nanosensor, namely a capacitive micrometric ultrasonic transducer whose vibrating membrane is made of aligned single-walled carbon nanotubes (SWNT). Such sensors are meant to be embedded in large numbers within a porous material in order to provide information on its durability by monitoring in situ neighboring individual micropores. In the present paper, we report on the feasibility of the key building block of the proposed sensor: we have fabricated well-aligned, ultra-thin, dense SWNT membranes that show above-nanometer amplitudes of vibration over a large range of frequencies spanning from 100 kHz to 5 MHz.

[Use of premapping of risks data sheet in artistic ceramics industries]. / Utilizzo della scheda di premappatura dei pericoli nel comparto delle ceramiche artistiche.

BACKGROUND: In 2006 there were more than 10,000 people working in artistic ceramics industries in Italy. The jobs in these industries that attracted most attention were work at the potter's wheel and decorating. OBJECTIVES: To test the premapping of risks data sheet in these enterprises. METHODS: We tested the data sheet in 3 craft industries: one was mainly artistic, one had a semi-industrial setting and in the third jobs were non-specific. RESULTS: In the semi-industrial craft industry the risks for potter's wheel workers were higher due to the repetitive movements required and to work organization aimed at achieving maximum productivity. CONCLUSIONS: The premapping of risks data sheet is a very sensitive tool. It can sometimes overestimate the risks, but in this way identifies situations that call for more in-depth analysis using tools that comply with international standards.

[Premapping of risks: guide to inspection by occupational physician]. / Premappatura dei rischi: guida al sopralluogo del medico competente.

Art. 25 of Law Decree 81/08 sets obligation for occupational physician to collaborate with employer for risk assessment (also in view of health surveillance planning) and to inspect "workplaces at least once a year or at different times according to risk assessment". Hence, collaboration to risk assessment, periodical inspection at workplace and definition of health surveillance protocols are extremely important in occupational physician's activity also in view of preventive effectiveness. An easily readable information technology tool is developed, in the frame of the most recent WHO activities: a toolkit for rapid and complete identification of the presence of possible risk inductors. This tool, already tested in several crafts, can be easily used also by occupational physician during periodical inspection.

Lipoplatin monotherapy: A phase II trial of second-line treatment of metastatic non-small-cell lung cancer.

Lipoplatin is a liposome encapsulated form of cisplatin. phase i studies on lipoplatin have demonstrated that the compound has an excellent toxicity profile. therefore we performed a phase ii trial in heavily pre-treated patients with advanced non-small-cell lung cancer (NSClC), performance status 0-2 in which the primary endpoint was response rate and secondary endpoints were safety and overall survival.Nineteen patients, average age 64 years old, with stage iV NSClC, were treated with lipoplatin 100 mg/m(2) every two weeks, as second line chemotherapy.We observed 1 partial remission (5.2%) and 3 stable diseases (15.9%). Time to progression (ttp) was 16 weeks and median overall survival (OS) was 31 weeks (7.2 months). We observed G1-G2 toxicity during chemotherapy, mainly gastrointestinal with nausea and vomiting (4 patients), asthenia (3 patients), mucositis (2 patients) and anemia (4 patients).Our phase ii study does not support a more extensive use of lipoplatin in phase III studies. An increase of dosage and a better selection of patients are mandatory to understand the real therapeutic activity of lipoplatin.

[Upper-limb work-related musculoskeletal disorders (UL-WMSDs) and latency of effect]. / Movimenti ripetuti degli arti superiori: considerazioni sul tempo di latenza degli effetti.

BACKGROUND: Trends in work-related upper limb musculoskeletal disorders appear to be in constant increase in industrialized countries. In Europe claims and compensation for these disorders have significantly increased. OBJECTIVE: The aim of this study was to investigate the temporal relationship between the beginning of occupational exposure to repetitive movements and exertions of upper limbs, assessed through the OCRA index, and the manifestation of the disorders. METHODS: Clinical and questionnaire information about 557 cases of UL-WMSDs in the upholstered furniture industry were analyzed in order to investigate the mean latency period of the disorders and to verify to what extent different levels of exposure influence the latency time. RESULTS AND CONCLUSIONS: The latency of UL-WMSDs is influenced by the level of exposure to risk, measured by means of the OCRA index. Shorter latency times were found for wrist/hand tendonitis, with a mean latency time of 5.4 years and with a greater sensitivity to the level of exposure assessed with the OCRA index value. This might support a sort of predictive value with reference to other UL-WMSDs with longer latency. Probably a latency period of 12 years may be suggested as the cut-off limit to assess a causal relationship between tendon or canalicular WMISDs and occupational exposure to repetitive movements and exertions of upper limbs.

[Risk assessment of work-related upper limb musculoskeletal disorders in thirty factories in the upholstered furniture industry]. / Valutazione del rischio da movimenti e sforzi ripetuti degli arti superiori in trenta aziende del comparto del mobile imbottito.

BACKGROUND: One of the most common procedures for risk assessment of upper limb work-related musculoskeletal disorders (UL-WMSDs) in Italy is the OCRA synthetic index, which is recommended as the preferred method in the ISO standard 11228-3. OBJECTIVE: The aim of the survey was to assess the risk of UL-WMSDs due to repetitive strain and movements in thirty factories of the sofa industry located in a large geographic area of southern Italy. METHODS: The most characteristic working tasks of the manufacturing process were studied: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. The single tasks were carried out almost exclusively manually, with features of a handicraft approach. Data were collected through questionnaires and video tape recordings in each factory. The mean value of the OCRA index of every group of factories was calculated by weighting the values of the index of each single task group with the number of the workers. RESULTS: Figures obtained in the different factories showed values of the OCRA index ranging between 4 and 15. A 2,9 OCRA value was attributed to a low exposure group. CONCLUSIONS: Even though the work tasks analyzed were characterized by long duration of the manufacturing cycle (between 5 and 60 min), a particular but rigorous application of the OCRA procedures made it possible for a detailed risk assessment to be made for each of the working groups analysed.