Italian midwives in Europe: a qualitative study on the experiences of professional migration.

Aim: To explore the reasons for Italian midwives' decision to migrate, and their lived professional and emotional experiences. Methods: A descriptive phenomenological study was conducted recruiting Italian midwives who were working abroad in European countries. We offered a telephone or web interview. Two researchers conducted, audio-recorded, and fully transcribed the interviews and other two researchers, independently, performed a content analysis. Results: Thirty-two midwives having professional experiences in the UK, Ireland, Germany, Switzerland, and Spain were interviewed. Five themes emerged: 1) Education, 2) Migration decision-making, 3) Professional experience abroad, 4) Midwives' perceptions of their role, 5) Satisfaction versus desire to return. Our findings show a general dissatisfaction with Italian job opportunities in terms both of access to employment and work conditions. This scenario is complicated by the status of the professional midwifery in Italy. Conclusion: Stakeholders should ensure that the migration of Italian midwives is not synonymous with dispersion but is a channel of professional growth and mutual exchange.

Regenerative Endodontic Therapy using a New Antibacterial Root Canal Cleanser in necrotic immature permanent teeth: Report of two cases treated in a single appointment.

A case of regenerative endodontics: (a) before treatment; (b) post-treatment Xray; (c) follow-up at 6 months; (d) follow-up at 12 months.

The effects of a new decontaminant solution on root canal bleeding during endodontic treatment: a randomized controlled study.

Blood contamination of the canal during preparation and obturation can be a problem in Endodontics; this may result in apical microleakage. The purpose of this investigation was to observe and evaluate the hemostatic properties of biofilm decontaminant material (sulfonic/sulphuric acid solution, HybenX, EPIEN Medical) used in teeth with necrotic pulp and unstoppable bleeding after root canal shaping. A prospective study was designed with 2 randomized parallel groups: decontaminant material (experimental group) and sodium hypochlorite 5% (control group). The analysis of the root canal bleeding was evaluated by the clinician before and after the application of the sulfonic/sulphuric solution or sodium hypochlorite 5%, by measuring the millimeters of blood on a sterile paper point introduced in the root canal. Sixty patients with necrotic pulp and unstoppable bleeding were enrolled in this study and randomly divided into 2 groups: decontaminant material in 30 patients (experimental group) or sodium hypochlorite 5% in 30 patients (control group). T-test showed that the percentage change in millimeters of blood detected in the root canal was statistically greater for experimental group [mean difference: 0.74 (IC: 0.66-0.82); p less than 0.0001]. The hemostatic properties were better in the experimental group than in the sodium hypochlorite 5% group (control). Further research may be needed to confirm the results of this study..

Genetic deletion or small-molecule inhibition of the arginine methyltransferase PRMT5 exhibit anti-tumoral activity in mouse models of MLL-rearranged AML.

The hematological malignancies classified as mixed lineage leukemias (MLL) harbor fusions of the MLL1 gene to partners that are members of transcriptional elongation complexes. MLL-rearranged leukemias are associated with extremely poor prognosis, and response to conventional therapies and efforts to identify molecular targets are urgently needed. Using mouse models of MLL-rearranged acute myeloid leukemia, here we show that genetic inactivation or small-molecule inhibition of the protein arginine methyltransferase PRMT5 exhibit anti-tumoral activity in MLL-fusion protein-driven transformation. Genome-wide transcriptional analysis revealed that inhibition of PRMT5 methyltransferase activity overrides the differentiation block in leukemia cells without affecting the expression of MLL-fusion direct oncogenic targets. Furthermore, we find that this differentiation block is mediated by transcriptional silencing of the cyclin-dependent kinase inhibitor p21 (CDKN1a) gene in leukemia cells. Our study provides pre-clinical rationale for targeting PRMT5 using small-molecule inhibitors in the treatment of leukemias harboring MLL rearrangements.

A diagnostic dilemma: endodontic lesion or odontogenic keratocyst? A case presentation.

AIM: To present a clinical case of odontogenic keratocyst (OKC) simulating a lateral periodontal cyst. SUMMARY: A 39-year-old female complaining of swelling and pain in the left mandibular premolar area was found to have a radiolucent lesion between teeth 34 and 35 (FDI). Both teeth had incomplete root fillings, and orthograde re-treatment of both premolars was performed. At 2-year follow-up, radiographic examination showed an increase in the radiolucent defect with respect to the previous examination. A surgical treatment of tooth 34 was then performed, with histological examination of the lesion. Histological features were consistent with an OKC, and the lesion was successfully treated by complete enucleation and application of Carnoy's solution. At 2-year follow-up, no clinical signs or symptoms were found and the radiolucent area had disappeared. KEY LEARNING POINTS: Odontogenic keratocysts may mimic endodontic lesions. Clinicians should carefully review their cases and consider surgical intervention with biopsy in cases that do not heal.

Mineral trioxide aggregate in the treatment of external invasive resorption: a case report.

AIM: To describe the management of external invasive resorption using mineral trioxide aggregate (MTA). SUMMARY: External invasive root resorption may occur as a consequence of trauma, orthodontic treatment, intracoronal bleaching and surgical procedures, and may lead to the progressive and destructive loss of tooth structure. Depending on the extent of the resorptive process, different treatment regimens have been proposed. A 19-year-old male patient presented with tooth 11 (FDI) showing signs and symptoms of irreversible pulpitis, external invasive resorption and periodontal pocket on the disto-palatal. After root canal treatment, the defect was accessed coronally. The resorption area was chemo-mechanically debrided using ultrasonic tips and irrigant solution. MTA was used to fill the resorptive defect, and the coronal access was temporarily sealed. The definitive coronal restoration was performed after 3 days. Radiographs at 1, 2 and 4 years showed adequate repair of the resorption and endodontic success. Clinically, the tooth was asymptomatic, and no periodontal pocket was found. KEY LEARNING POINTS: *Mineral trioxide aggregate was successfully used to restore a small area of external invasive resorption. *A coronal approach can sometimes be successfully used in order to avoid surgery and periodontal complications.

A novel mutation in the SDHD gene responsible for familial paraganglioma. Medical and psychological implications.

Familial paragangliomas/pheochromocytomas are dominantly inherited disorders characterized by the development of highly vascularized tumors of the head and neck, derived from non-chromaffin cells of the extra-adrenal paraganglia, and tumors with endocrine activity, derived from chromaffin cells, usually located in the adrenal medulla and pre- and para-vertebral thoracoabdominal regions. Germline inactivating heterozygous mutations in one of the genes encoding for succinate dehydrogenase subunits B, C or D (SDHB, SDHC or SDHD) are responsible for hereditary paragangliomas (PGLs), accounting for nearly 70% of familial cases. Particularly in the SDHD gene, different types of mutations have been found, nevertheless, alterations other than point mutations and deletion leading to missense/nonsense/splicing mutations are extremely rare. Here we report a family with multiple cases of PGL which co-segregates with a novel SDHD gene mutation predictable to give rise to an abnormal gene product (CybS). The identification of the molecular event responsible for PGL in our family made genetic counseling particularly useful for younger first degree relatives at risk to develop this late-onset disease.

Apical plug technique using mineral trioxide aggregate: results from a case series.

AIM: To examine the clinical and radiographic appearance of teeth that suffered premature interruption of root development and were treated by an mineral trioxide aggregate (MTA) apical plug technique. SUMMARY: Eleven teeth with immature root apices in 11 patients were treated nonsurgically by the manual application of MTA in the apical portion of the root canal under microscopic vision. Follow-up evaluations were performed at 1-2 years after treatment. KEY LEARNING POINTS: Mineral trioxide aggregate appears to be a valid material to obtain periradicular healing in teeth with open apices and necrotic pulps. Ten out of 11 cases were associated with periradicular health at follow-up evaluation.

Electrochemical detection of tobramycin or gentamicin according to the European Pharmacopoeia analytical method.

Tobramycin and gentamicin are two aminoglycosidic antibiotics used in lung infection, ophthalmic treatments as well as in skin infections. Pharmaceutical companies which produce remedies containing tobramycin and gentamicin need an analytical method for their internal quality control. For several years a simple chromatographic method based on anion exchange separation coupled with amperometric detection was proposed for aminoglycosides. This analytical approach was partially used in the last edition of the European Pharmacopoeia (EP) for tobramycin and gentamicin analysis. In fact they use integrated pulsed amperometric detection (IPAD) on a gold electrode while the separation is obtained on a polymeric wide pore reversed phase instead of anion exchange in alkaline conditions. Such coupling seems to be cumbersome and not so easy to realize and to reproduce from one laboratory to another. Besides, the described method lacks some of the details as important as the waveform steps duration. Unfortunately the quality control (QC) laboratories have to use exactly the method described in the EP, so they complained about the troubles. Therefore, the EP authors published recently a paper regarding the guidelines for good practice in the method application, but the suggestion was not yet resolutive. In our work we evaluated the eluent composition and the kind of amperometric cell, work electrode diameter and cell volume. Mainly we optimized the amperometric waveform. In addition, for tobramycin analysis another chromatographic phase was explored in order to achieve better efficiency and to separate all the impurities confirming the effectiveness of the detection. The conditions described in the paper seem to allow the analyst to operate in conformity with the EP method.

The percentage of gutta-percha-filled area in simulated curved canals when filled using Endo Twinn, a new heat device source.

AIM: To compare the percentage of gutta-percha-filled area (PGP) in simulated root canals when varying the penetration depth and function of the pluggers (heat versus heat plus vibration) using Endo Twinn. METHODOLOGY: Sixty-four resin blocks with simulated 34-35 degrees curved canals were randomly divided into two groups in order to obtain two canal shapes: group A with 0.8 taper and group B with 0.4 taper. The apical portion of each canal was prepared to a size 20 K-file. The canals were filled with gutta-percha in combination with a root canal sealer. In each group 16 canals were filled using the Endo Twinn heat function and 16 canals by means of both the heat and the vibration function. All samples were sectioned horizontally at three levels (1.25, 2.5 and 4.0 mm from the working length) and the PGP was measured. Data were analysed using ANOVA test. RESULTS: At the 1.25 mm level PGP was significantly greater using the vibration function (P = 0.0329) and in 0.8 taper canals (P < 0.0001). At the 2.5 mm level the PGP was greater in the canals with 0.8 taper compared with a 0.4 taper with or without vibration (vibration, P = 0.0056; interaction taper-vibration, P = 0.0020). In 0.4 taper canals the PGP was greater when the vibration function was activated. At the 4 mm level in 0.8 taper canals there was no significant difference in PGP with or without the vibration (P = 0.6742). CONCLUSIONS: 0.8 taper canals had significantly greater PGP than 0.4 taper canals. At the 1.25 mm level there was significantly greater PGP when the vibration function was activated.

Expression of gp20, a human sperm antigen of epididymal origin, is reduced in spermatozoa from subfertile men.

gp20, a sialylglycoprotein of human sperm homologous to CD52, is present everywhere on the surface of the freshly ejaculated sperm but is prevalently localized in the equatorial region of the head of capacitated sperm. In the present study, we confirmed this feature on large scale and correlated equatorial exposure of the antigen to the presence of serum albumin (SA) in the capacitation medium. Furthermore, we analyzed the relationship between the presence of the antigen and its equatorial exposure after capacitation and fertility, by comparing immunostaining for gp20 in the motile fraction of spermatozoa from fertile and subfertile men. A significantly higher percentage of nonimmunostained spermatozoa before capacitation (38.5% +/- 23 vs. 12% +/- 7, P < 0.0001) and a lower increase in the percentage of sperm with equatorial localization after capacitation (19.3% +/- 25 vs. 34.6% +/- 22, P = 0.039) were observed in subfertile men (n = 60) compared to fertile men (n = 15). In the whole study group, a positive correlation was also found between the percentage of spermatozoa exhibiting equatorial localization in capacitated samples and normal head forms (R = 0.50; P < 0.0001).

[The clinical efficacy of magnetic resonance with diffusion-weighted sequences in the assessment of acute cerebral ischemia]. / Efficacia clinica della Risonanza Magnetica con sequenze pesate in diffusione nella valutazione dell'ischemia cerebrale acuta.

PURPOSE: To evaluate the efficacy of diffusion weighted Magnetic Resonance Imaging in the diagnosis of acute ischemic infarction and correlate the signal changes observed in the acute phase with final brain damage. MATERIAL AND METHODS: Fifteen patients (six women and nine men: mean age 68 years) with acute ischemic stroke (within 12 hours) underwent diffusion MRI. All the patients were selected on the basis of sudden focal neurologic symptoms and CT findings excluding other conditions than ischemia. MRI was performed with a 1.5 T magnet with echo-planar gradients. All the patients underwent follow-up CT and/or MRI. RESULTS: Diffusion MRI, performed in the acute phase, showed signal changes in all the patients whose infarction was later confirmed by CT or MRI. In 10 of 12 patients with positive diffusion imaging, CT was normal. FLAIR sequences showed the lesions in 4 of 12 cases. In the 2 patients with transient ischemic attack diffusion MRI was normal as well as follow-up examinations. Apparent Diffusion Coefficients values in the infarcted area were almost half those of the contralateral normal brain. Final damage (as assessed by CT or MRI) was larger than observed in acute diffusion images in all cases but one. CONCLUSION: Because of its high sensitivity and specificity, diffusion MRI is going to play a more important role in the management of acute ischemic stroke patients.

What's new in mammography.

Early diagnosis of breast cancer plays the leading role in reducing mortality rates and improving the patients' prognosis: mammography is the most sensitive technique currently available for the detection of nonpalpable lesions and therefore the method of choice. However, mammography has some limitations and the technique must be improved with technological devices without affecting image quality. This could be the target to increase diagnostic accuracy. Mammography sensitivity and specificity are now improved with the digital computer assisted technique, teleradiology, digital tomosynthesis or digital angiography--used to study microvascularization--3D imaging or synchrotron light, and laser mammography. Such other technological devices as Mammospot reduce breast thickness and provide better breast compression. Digital mammography can be carried out with film or direct digitization. The advantages of the digital technique are a shorter examination time, less storage space, electronic image recording, with image 'adjustments' made by the radiologist, and especially computerized analysis. The computer aided diagnosis can be defined as the diagnosis made by the radiologist who considers the results of computerized analysis as a 'second opinion'. In this way incidental mistakes made by radiologists, can be corrected by the computer analysis. Computers are a basic element also in teleradiology, which needs immediate and simultaneous admittance to the patient's history and permits radiology optimization in rural areas too. As for tomosynthesis, it permits to study a single slice of the breast without glandular tissue overlapping, which is useful in dense breasts where the diagnosis can be made with a lower X-ray dose. Moreover, this method fits the current mammographic systems easily. 3D imaging is still a work in progress. Synchrotron mammography is used only on surgery specimens, where it exhibits high resolution and contrast, depicting structures and details missed by conventional mammography. Breast DSA allows the study of vessels < 0.20 mm in diameter and of fine microvascular details; it can also demonstrate neoangiogenesis. Laser mammography permits bilateral examinations of the breast in 10-15 mins and is currently used also for breast cancer therapy, although only in animal trials. To conclude, after reviewing new techniques and evaluating the real cost/benefit ratio for each of them, conventional mammography remains the most sensitive tool for breast cancer diagnosis.

[Description and preliminary clinical assessment of a digital chest radiographic system with selenium detector (Thoravision)]. / Descrizione e valutazione clinica preliminare di un sistema radiografico digitale del torace con rivelatore al selenio (Thoravision).

The authors describe an innovative digital chest imaging system (Thoravision, Philips Medical System) based on a selenium detector directly converting X-rays in electric charges detectable by electrometers, amplified and digitalized to be sent to the imaging processor. The study was performed on a series of up to 7000 digital chest X-ray examinations and a sample of 173 cases was selected on the basis of particular diseases and pathologic patterns. In the latter case, digital and conventional radiographic techniques were compared. According to this analysis, the digital system was slightly superior in detecting anatomical details, small pleural effusions (3 cases) and slight low contrast interstitial pathologic changes, mainly in apical (12 cases) and retrocardiac (19 cases) lung areas. The conventional screen-film system better showed small hilar calcifications (2 cases). From the protection viewpoint, at equivalent entrance doses, .15-.26. Gy/cm2 of dose-area product (DAP) values were reported with the digital system, using a tension of 150 kV in orthogonal projections, which are considerably lower than .25-.70 Gy/cm2 measured with the conventional technique. Moreover, Thoravision permitted to perform up to 100 exposures/hour, using a phantom, and 15-20 digital chest examinations/hour, versus the average 12-15 with the conventional screen-film system. The initial results are very encouraging from the clinical and cost-effectiveness viewpoints, thanks to higher Thoravision productivity and to exam optimization, even though wider and prolonged experience plus a careful study of diagnostic accuracy, sensitivity and specificity in each group of chest conditions is advisable, to assess the real innovative impact of this digital chest imaging system.

[Clinico-radiological correlations in pulmonary pathology caused by immunosuppression]. / Correlazione clinico-radiologica nella patologia polmonare da immunosoppressione.

Lung is the most involved site by infective manifestations in immunodepressed patients. In these patients the variability of pathogenic and opportunistic agents is expressed in the lungs with interstitial and alveolar changes, which are not pathognomonic. CT is the appropriate method to study lung parenchyma. CT by means of fast scans and high resolution algorithms (HRCT) allows an accurate and detailed representation of the lung parenchyma, detecting the secondary lobe, the anatomic and functional unit of the lung and its pathological changes. Our study aim to show the clinical-radiological correlation among the various types pulmonary infections in immunocompromised host.

Age-related macular degeneration and vitreous hemorrhage.

Age-related macular degeneration led to vitreous hemorrhage (VH) in six eyes of four patients. Macular involvement was bilateral in three patients and fluorescein angiography performed before VH showed extensive subretinal hemorrhage in the macular region in all eyes. We examine the possible causal mechanisms of VH resulting from age-related macular degeneration. Local risk factors, as outlined in our series by fluorescein angiography, are discussed and systemic risk factors are considered. Three out of the six eyes underwent pars plana vitrectomy for removal of intravitreal blood, and had severe inflammatory reactions in the postoperative period. In the three non-operated eyes spontaneous reabsorption of VH was observed at the end of follow-up.

Effect of intravenous supplementation of a new essential amino acid formulation in hemodialysis patients.

Protein energy undernutrition (PEU) and abnormalities of amino acid (AA) metabolism are common in maintenance hemodialysis patients (MHP). A new EAA formulation (BS695), enriched with valine and threonine, containing some histidine, and low in phenylalanine and methionine was recently developed. We randomly supplemented 11 MHP with this solution (treated group, TG) and 10 MHP with a standard AA solution containing both essential and non-essential AA (control group, CG). Both groups received 3.65 g of nitrogen, i.v. three times per week during hemodialysis for six months. During treatment, dietary intake remained stable in both groups. Before treatment, after three and six months of treatment, and six months after the end of treatment, we determined routine blood chemistries, anthropometry, serum protein levels (albumin, transferrin), delayed cutaneous sensitivity (Multi-test), protein catabolic rate (PCR), plasma AA content and motor nerve conduction velocity (MNCV). Before treatment PEU, predominantly of marasmic type, was common. After treatment anthropometry and immune response were unchanged in both groups; PCR increased more in CG than in TG; serum albumin levels decreased significantly only in CG; MNCV improved in TG and worsened in CG. These preliminary results suggest that this new EAA formulation may have beneficial effects on some nutrition related abnormalities of MHP. Better results might occur with long-term AA supplementation, particularly if it is associated with a higher energy intake.

[The use of a new antibiotic for local administration in burns]. / Osservazioni sull'impiego di un nuovo antibiotico per uso locale nelle ustioni.

A new antibiotic already available on the market (meclocyclin) was experimented on 27 patients aged 45 days to 66 yr with burns due to various causes. Tolerance was excellent in all cases and the average hospital stay was 16 days. Two ointments (one containing meclocyclin, the other containing a different bacteriostatic) were applied on symmetrical sites. The results were practically the same. The meclocyclin ointment can be regarded as preferable, however, owing to its excellent tolerance, and non-absorption into the circulation, so that sensitisation cannot occur even during protracted administration. Another ointment, containing meclocyclin and fluochinolone, was also used in the presence of hypertrophic or keloid pathological scars. Useful results were obtained with regard to both the extent of the damaged areas and the functional limitations sometimes observed. Treatment in these cases, however, was sometimes prolonged for months.