Do Lifestyle Interventions in Pregnant Women with Overweight or Obesity Have an Effect on Neonatal Adiposity? A Systematic Review with Meta-Analysis.

Excessive body fat at birth is a risk factor for the development of childhood obesity. The aim of the present systematic review with meta-analysis was to evaluate the effect of lifestyle interventions in pregnant women with overweight or obesity on neonatal adiposity. The PubMed, Embase, Web of Science, Scopus, and LILACS databases were used as information sources. Original articles from randomized clinical trials of lifestyle intervention studies on pregnant women with excessive body weight and the effect on neonatal adiposity were considered eligible. The risk of bias was assessed using Cochrane criteria. The meta-analysis was calculated using the inverse variance for continuous data expressed as mean difference (MD), using the random effect model with a 95% confidence interval (CI). The outcomes were submitted to the GRADE evaluation. Of 2877 studies, four were included in the qualitative and quantitative synthesis (n = 1494). All studies were conducted in developed countries, with three including pregnant women with overweight or obesity, and one only pregnant women with obesity. The interventions had no effect on neonatal adiposity [Heterogeneity = 56%, MD = -0.21, CI = (-0.92, 0.50)] with low confidence in the evidence, according to GRADE. Studies are needed in low- and medium-developed countries with different ethnic-racial populations. PROSPERO (CRD42020152489).

Functional and dysfunctional impulsivities changes after subthalamic nucleus-deep brain stimulation in Parkinson disease.

OBJECTIVES: We investigated changes of impulsivity after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) patients, distinguishing functional from dysfunctional impulsivity and their contributing factors. METHODS: Data of 33 PD patients treated by STN-DBS were studied before and 6 months after surgery: motor impairment, medication (dose and dopaminergic agonists), cognition, mood and occurrence of impulse control disorders. Impulsivity was assessed by the Dickman Impulsivity Inventory, which distinguishes functional impulsivity (FI), reflecting the potential for reasoning and rapid action when the situation requires it, and dysfunctional impulsivity (DI), reflecting the lack of prior reasoning, even when the situation demands it. The location of DBS leads was studied on postoperative MRI using a deformable histological atlas and by compartmentalization of the STN. RESULTS: After STN-DBS, DI was significantly increased (mean pre- and postoperative DI scores 1.9±1.6 and 3.5±2.4, P<0.001) although FI was not modified (mean pre- and postoperative FI scores 6.2±2.7 and 5.8±2.6). Factors associated with a DI score's increase≥2 (multivariable logistic regression model) were: low preoperative Frontal Assessment Battery score and location of the left active contact in the ventral part of the STN. CONCLUSION: Our study suggests that STN-DBS may have a different impact on both dimensions of impulsivity, worsening pathological impulsivity without altering physiological impulsivity. The increase in dysfunctional impulsivity may be favoured by the location of the electrode in the ventral part of the STN.

Effect of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers among women with thrombophilia or previous venous thromboembolism.

OBJECTIVE: To assess the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on standard cardiovascular risk markers among women with thrombophilia and/or previous venous thromboembolism (VTE). METHODS: A prospective cohort study enrolled women aged 18-45 years with thrombophilia and/or a history of VTE who received the 52-mg LNG-IUS (20 µg/d initial release) at the University of Ribeirão Preto Medical School, Brazil, from January 2006 to December 2015. Before and 12 months after LNG-IUS placement, the following cardiovascular risk markers were assessed: lipid profile, body mass index (BMI), blood glucose, systolic blood pressure, diastolic blood pressure, and waist circumference. The primary outcome was changes in cardiovascular risk markers. A subanalysis of anticoagulant users versus non-users was also conducted. RESULTS: In total, 45 women were enrolled. BMI increased by 2.3% after 12 months of LNG-IUS placement (P < 0.01), but the other risk factors did not change. Cardiovascular risk markers were similar between anticoagulant users and non-users after 12 months of LNG-IUS use. CONCLUSION: Among women with thrombophilia and/or previous VTE, cardiovascular risk markers were not found to change significantly after 12 months of LNG-IUS use. The study adds safety information regarding use of the LNG-IUS for women at risk of thromboembolism.

Neurologist knowledge about interactions between antiepileptic drugs and contraceptive methods.

OBJECTIVE: To evaluate neurologists' knowledge of contraceptive counseling for women receiving antiepileptic drugs (AEDs). METHODS: An interview-based survey was conducted from February 2 to June 30, 2015, among neurologists working in Ribeirão Preto, Brazil. Direct interviews were conducted using a questionnaire that assessed knowledge of the pharmacological interactions between various contraceptive methods and six AEDs (carbamazepine, phenobarbital, topiramate, phenytoin, lamotrigine, and valproate) on the basis of WHO medical eligibility criteria for contraceptive use. RESULTS: Among 42 neurologists who participated, 32 (76%) stated that they treated women with epilepsy and provided them with counseling for family planning. Overall, 34 (81%) recommended the use of a copper intrauterine device irrespective of the AED used, and 26 (60%) stated that they co-prescribed AEDs and hormonal contraceptives. Although 39 (93%) neurologists had knowledge that AEDs might contraindicate the use of some contraceptives, their knowledge regarding the specific drug interactions was lacking. Furthermore, 34 (81%) had no knowledge of WHO medical eligibility criteria for contraceptive use. CONCLUSION: Although most neurologists interviewed had knowledge of interactions between AEDs and hormonal contraceptives, they did not know which specific AEDs interacted with these agents.

Causes of late failure after heart transplantation: a ten-year survey.

BACKGROUND: Little is known about the causes of death of heart transplant recipients who survive long-term. METHODS: The pathologic and clinical records of 97 patients who underwent heart transplantation in Italy from 1985 to 1995 and died (85 of 97) or underwent retransplantation (12 of 97) at least 2 years after transplantation were surveyed. Graft failures were classified as late (occurring between 2 and 5 years after transplantation) and belated (more than 5 years). RESULTS: Graft vasculopathy was the single most common cause of death (40.0%) and the only cause of late retransplantation. Tumors ranked second (23.5% of deaths), but the expected non-Hodgkin's lymphomas and Kaposi's sarcoma were accompanied by a high number of lung cancers (especially metastasizing adenocarcinomas). They were followed by the emergence or recurrence of pretransplantation diseases (9.4%), fatal infections (exclusively bacterial) (4.7%), the development of transmissible diseases (viral hepatitis and acquired immunodeficiency syndrome, 4.7%), and late acute rejection (2.3%). The distribution of failures differed in the late and belated periods: death and organ loss proportions for graft vasculopathy, respectively, fell and rose from the late to the belated period; some types of malignancy and fatal acute rejection were never observed in the belated period, whereas the emergence of pretransplantation diseases prevailed in the belated period. Graft vasculopathy was more frequent and tumors were less frequent among patients undergoing transplantation for ischemic heart disease. CONCLUSIONS: The reasons why heart transplant recipients die or undergo retransplantation, respectively, in the late and belated periods slightly differ from one another and are widely different than in short-term survivors.

[Radiotherapy of non-neoplastic diseases: the situation in Piedmont]. / La radioterapia delle affezioni non neoplastiche: la situazione in Piemonte.

The authors report the results of a census among the Piedmont region radiation therapy departments during the period 1980-1991 concerning non antineoplastic radiotherapy. Eight out of eleven centers respond to the questionnaire. During the period considered 36,480 patients were treated, with an annual mean of 4056; the number of treated patients varies from 1.2% to over 71.3% in the different centers when compared to the number of neoplastic patients. Arthrosis, osseous angioma, cheloides and verruca were the most treated diseases. Plesioroentgentherapy and roentgentherapy were normally employed; telecesium and telecobalt therapy were also used; only two centers used electron beams or brachytherapy. The doses of radiotherapy were not uniform; also patients' information and follow-up criteria were quite different in the various centers. The authors conclude with a guidelines for future radiotherapy in benign diseases.

[The current role of radiotherapy in immunogenic exophthalmos]. / Il ruolo attuale della radioterapia nell'esoftalmo immunogenico.

In this study, the value of radiation therapy was investigated in 41 patients with Graves' ophthalmopathy treated with orbital irradiation at the Radiotherapy Department of Mauriziano Hospital in Turin, 1986 through 1993. Our series consisted of 41 patients (32 women and 9 men), whose mean age was 53.6 years (range: 26-72 years). All patients had a high index of endocrine ophthalmopathy, based on the American Thyroid Association classification-NOSPECS classes III and IV. Irradiation was administered with two opposed convergent beams tilted posteriorly 5-10 degrees with 20 Gy/12 fractions/2 weeks. The total dose delivered to the lens was than 5%. The follow-up consisted of endocrinologic and ophthalmologic tests and, if possible, of pre/post-irradiation orbital US. A positive result was obtained in 31 patients, which was very good in 22 of them. Severe complications, i.e., 1 corneal ulceration and 3 cataracts, were observed in the patients with associated ocular conditions and were treated simultaneously with high-dose corticosteroids so that no direct and unquestionable correlation can be made between irradiation and complications. To conclude, our data show that radiation therapy can improve the signs and symptoms of Graves' disease, as many authors report.

[Prognostic factors in adenocarcinoma of the endometrium]. / Fattori prognostici nell'adenocarcinoma dell'endometrio.

We report the results of the combined use of surgery and radiation therapy in the treatment of endometrial carcinoma. From January 1974 to December 1989, 89 cases were treated by means of abdominal hysterectomy followed by external radiation therapy. Actuarial survival at 5 years is 100% for stage I, 75% for stage II, and 42.86% for stage III; stage IV patients could not be evaluated. Prognostic factors were statistically significant. In stages II and III survival rates were directly related to histological grading (G1: 90.91%; G2: 81.82%; G3: 25%) and to myometrial infiltration (M1: 85.71%; M2: 81.82%; M3: 70%). Generally, survival was related to age, and prognosis was better in younger patients (under 55) and depended on lymph nodal involvement (N-: 88.24%, versus N+: 25%). Vaginal and pelvic recurrences were 8 (10.1%), and deaths were 13. The identification of high-risk patients will make it possible to select an even more adequate treatment.

[Postoperative radiotherapy in endometrial adenocarcinoma]. / Radioterapia postoperatoria nell'adenocarcinoma dell'endometrio.

We present the results of the association of surgery and radiotherapy in endometrial adenocarcinoma. We have 151 cases of which we know FIGO classification, pTNM, histological grading and myometrium infiltration. Follow-up is considered between 6 months and 10 years. We report the survival graphic lines for a five year period relative to every single prognostic factor.

[Optimization of the radiotherapy dosage in vertebral metastases]. / Ottimizzazione della dose nella radioterapia delle metastasi vertebrali.

The authors describe the radiation therapy treatment planning used in the Department of Radiotherapy of Mauriziano Hospital, Turin, to treat bone metastases from various tumors. The study population consisted of 33 patients with vertebral metastases. Treatment with a 60Co therapy unit was performed following either a conventional or a concentrated schedule. The association of a direct posterior field and a rotational technique with the same center and swing angle varying from 120 degrees and 150 degrees is described. The dose percentage given with the two techniques, the field width and the arching angle variables related to depth and volume of the target are discussed. We present some examples elaborated with a dedicated computer by calculating the integral area dose to the whole body and to the target, towards the best treatment planning for every kind of treatment proposed in two groups of six patients with vertebral and sacral metastases. The technique allows a homogeneous dose distribution to the target, thus reducing the area dose to the whole body, which means good radiotherapeutic results.

[Role of radiotherapy in the treatment of carcinoma of the thyroid gland]. / Ruolo della radioterapia nel trattamento dei carcinomi della tiroide.

A series of 92 thyroid cancer patients treated in collaboration between the Nuclear Medicine and the Oncological Radiotherapy Departments of the Turin Mauriziano Hospital is reported. The age, sex, histotype and stage of the various groups of patients subdivided by therapeutic indications were analysed. In 17 patients, treatment was carried out for pain killing purposes on particularly painful secondary bone localisations with good results symptomatologically and from the point of view of functional recovery. In 21 patients with unfavourable histology who did not take up radioiodine, external radiation treatment was carried out for palliative reasons with, in some case, a lasting effect. In the other 44 patients although generally speaking, at advanced stages of the disease and often in the presence of invasive and anaplastic secondary manifestations, total survival with the two treatments combined was about 55% (24 cases) of whom 75% (18 cases) are alive 5 years later.

[Dosimetric study in vivo, using a computer, of Co-60 irradiation of patients with breast prosthesis made of silicone]. / Studio dosimetrico in vivo e a calcolatore di irradiazioni con 60Co di protesi mammarie in silicone.

This work studies the dose distribution through the chest wall in radiation therapy after mammary reconstruction with silicone prostheses. TLD experimental dosimetry has been done on patient with silicone prostheses, on patient without prostheses and on Alderson phantom. Various conditions of treatment have been theorically simulated on a computer. At least authors show the results evaluating the dose distribution through the chest wall, the skin and the local complications.

[Homogeneous dose distribution in the moving-strip technic]. / Omogeneizzazione della dose nella tecnica di moving-strip.

The moving-strip technique employing a 60Co beam, is used in radiotherapy for whole abdominal irradiation in ovarian tumours and lymphomas. With this technique the spread of received dose from single strip, around an average value, is very high. Our paper suggest a computerized method for a more homogeneous dose distribution in central strips and a lower dose in out-side tissues.