Quality of life and psychopathology in candidates to bariatric surgery: relationship with BMI class.

PURPOSE: This cross-sectional study aimed at comparing the quality of life (Qol), the prevalence of psychiatric diagnosis and pharmacological treatment in 104 candidates to bariatric surgery according to the degree of obesity (class 2 vs. class ≥ 3 obesity). METHODS: All surgical candidates underwent a detailed psychiatric interview based on DSM-5 criteria, including sociodemographic, clinical, psychological and psychiatric data. Participants completed the Binge Eating Scale (BES) and the 12-Item Short Form Health Survey (SF-12). RESULTS: Overall, bariatric candidates reported a significant impairment in the physical (PCS 38.8 [95% CI 36.2-41.5]) and mental (MCS 42.2 [95% CI 40.4-43.9]) components of Qol compared to population norms (p < 0.001 for both). Subjects with class 2 obesity scored significantly lower in the MCS compared to those with class 3 (38.7 (8.1) vs. 43.6 (8.4), p = 0.008). No other statistically significant differences were found between the two groups in terms of sociodemographic and clinical variables. CONCLUSION: These data support the usefulness of Qol assessment in bariatric candidates as a sensible screening parameter, especially in patients with lower BMI, in whom MCS could identify the need for early psychosocial intervention. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Numerical integration strategies of PFR dynamic models with axial dispersion and variable superficial velocity: the case of CO2 capture by a solid sorbent.

In order to integrate mole balances (partial differential equations) of an Axial Dispersion Plug Flow Reactor (ADPFR) model, the overall superficial velocity is usually considered constant, a hypothesis which fits well only null or negligible variations of volumetric flow rate, e.g. feeding flow strongly diluted by inert species. This work proposes a numerical-integration approach (based on the method of lines) for ADPFR dynamic modelling, applied to simulate the CO2 capture in an isothermal-isobaric packed bed, made of purposely synthesized and experimentally characterized CaO-mayenite sorbent particles. This approach proved to be suitable for both constant and variable superficial velocity with respect to time and space. With the latter option, velocity profiles agreed with simulated reactive phenomena, while discrepancies between solutions from the two options became increasingly evident as dilution of inlet CO2 decreased. N2 flow rate and CO2 mole balances obtained from numerical-integrations with variable superficial velocity appeared as the most physicochemically reasonable.

Impact of vaccination programs against measles, varicella and meningococcus C in Italy and in Tuscany and public health policies in the last decades.

The World Health Organization (WHO) has established specific targets for control, elimination or eradication of some vaccine preventable infectious diseases, which were periodically updated. In Italy, WHO recommendations have been endorsed and implemented over time, through the national and regional health prevention plans. The aim of the study was to assess the impact of the immunization practices against measles, varicella and Neisseria meningitidis type C (Men C) in Italy and in Tuscany Region, during the last decades, by analyzing national and regional surveillance databases. Benefits of vaccination strategies were discussed from different points of view (clinical, epidemiological, economic, ethical, social and communicative). The implementation of measles, varicella and Men C vaccination, caused a considerable decrease of incidence rates over the years in Italy and in Tuscany too. However, in the last years, notifications of measles and Men C cases in subjects not targeted by immunization campaigns, in Italy and in Tuscany, are a cause for concern for public health and for the achievement of the elimination goals. Achieving and maintaining high vaccine coverage guarantees a decrease in the incidence of serious diseases and their clinical and economic consequences, but it is necessary to strengthen surveillance system of infectious diseases in order to monitor epidemiological trends. Moreover, outreach campaigns are necessary to raise awareness in the general population and create the culture of prevention with the same nationwide health goals for all.

Music-listening habits with MP3 player in a group of adolescents: a descriptive survey.

BACKGROUND: Listening to music through portable MP3 players has become a very popular mode among young people and adolescents. The aim of this study is to investigate the behaviors of adolescents engaged in listening to music with MP3 player and the attendance at clubs (pubs, discotheques) where music is played at high volume. METHODS: Among the 1470 students attending a secondary school in Scandicci (FI) during the school year 2009/2010, 1278 (86.9%) were at school the day of the examination and 1276 completely filled in the questionnaire. Descriptive analysis and univariate and multivariate logistic regression were performed to calculate the degree of association (OR) among the sociodemographic characteristics, listening habits and some factors identified as risky or protective as regards the possibility of developing health disorders. RESULTS: MP3 player users are 88.2% of the sample. Among these, a high proportion engaged behaviours that increase the risk of presenting disorders, including the exposure to high-volume (27.4%). Furthermore, 44.6% use the MP3 while driving. From the regression analysis it emerges that MP3 users showed a sort of addiction: by increasing the time and the occasions of exposure to music, they increased the volume, used maximum or medium-high volume, did not take breaks and did not decrease the volume. CONCLUSIONS: The study points out the spread of risky behavior in music listening, so it is necessary to better inform especially the youngsters and achieve specific preventive interventions.

The EGFR family members sustain the neoplastic phenotype of ALK+ lung adenocarcinoma via EGR1.

In non-small cell lung cancer (NSCLC), receptor tyrosine kinases (RTKs) stand out among causal dominant oncogenes, and the ablation of RTK signaling has emerged as a novel tailored therapeutic strategy. Nonetheless, long-term RTK inhibition leads invariably to acquired resistance, tumor recurrence and metastatic dissemination. In ALK+ cell lines, inhibition of ALK signaling was associated with coactivation of several RTKs, whose pharmacological suppression reverted the partial resistance to ALK blockade. Remarkably, ERBB2 signaling synergized with ALK and contributed to the neoplastic phenotype. Moreover, the engagement of wild-type epidermal growth factor receptor or MET receptors could sustain cell viability through early growth response 1 (EGR1) and/or Erk1/2; Akt activation and EGR1 overexpression prevented cell death induced by combined ALK/RTK inhibition. Membrane expression of ERBB2 in a subset of primary naive ALK+ NSCLC could be relevant in the clinical arena. Our data demonstrate that the neoplastic phenotype of ALK-driven NSCLC relays 'ab initio' on the concomitant activation of multiple RTK signals via autocrine/paracrine regulatory loops. These findings suggest that molecular and functional signatures are required in de novo lung cancer patients for the design of efficacious and multi-targeted 'patient-specific' therapies.

[Mass communication during the "H1N1 flu"]. / La comunicazione di massa durante l'evento "influenza H1N1".

Nowadays communication plays a key role in healthcare, especially when a detailed risk analysis is important for correct information, as in the case of the H1N1 flu virus A. Through our study we have analyzed how the event "H1N1 flu" was addressed by the media, considering the period April 2009-June 2010. We collected the information from "Il Corriere della Sera", "La Repubblica" and "City", in addition to an online site for general information such as "TGCOM". The analyzed peak of daily news was seen a few weeks before the pandemic peak; in addition, after the peak of the pandemic, the interest of the press has completely collapsed, and eventually disappeared altogether. The media can influence the thought and consequentially how the recipients act, leading to a misperception of risk ('risk') and danger ('hazard'). Moreover the institutions and health professionals are not always able to communicate effectively to meet the needs for correct information. It is desirable in the future a greater degree of collaboration between media and authorities to have a clearer simpler and less misleading communication in the health field, helping recipients to act properly.

TP53INP1 decreases pancreatic cancer cell migration by regulating SPARC expression.

Tumor protein 53 induced nuclear protein 1 (TP53INP1) is a p53 target gene that induces cell growth arrest and apoptosis by modulating p53 transcriptional activity. TP53INP1 interacts physically with p53 and is a major player in the p53-driven oxidative stress response. Previously, we demonstrated that TP53INP1 is downregulated in an early stage of pancreatic cancerogenesis and when restored is able to suppress pancreatic tumor development. TP53INP1 downregulation in pancreas is associated with an oncogenic microRNA miR-155. In the present work, we studied the effects of TP53INP1 on cell migration. We found that TP53INP1 inactivation correlates with increased cell migration both in vivo and in vitro. The impact of TP53INP1 expression on cell migration was studied in different cellular contexts: mouse embryonic fibroblast and different pancreatic cancer cell lines. Its expression decreases cell migration by the transcriptional downregulation of secreted protein acidic and rich in cysteine (SPARC). SPARC is a matrix cellular protein, which governs diverse cellular functions and has a pivotal role in regulating cell-matrix interactions, cellular proliferation and migration. SPARC was also showed to be upregulated in normal pancreas and in pancreatic intraepithelial neoplasia lesions in a pancreatic adenocarcinoma mouse model only in the TP53INP1-deficient animals. This novel TP53INP1 activity on the regulation of SPARC expression could explain in part its tumor suppressor function in pancreatic adenocarcinoma by modulating cellular spreading during the metastatic process.

The internal morality of clinical medicine: a paradigm for the ethics of the helping and healing professions.

The moral authority for professional ethics in medicine customarily rests in some source 'external' to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, 'internal' morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship.

Philosophy of medicine: should it be teleologically or socially construed?

This response to Kevin Wildes's article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.

The Institute on Human Values in Medicine: its role and influence in the conception and evolution of bioethics.

For ten years, 1971-1981, the Institute on Human Values in Medicine (IHVM) played a key role in the development of Bioethics as a field. We have written this history and analysis to bring to new generations of Bioethicists information about the development of their field within both the humanities disciplines and the health professions. The pioneers in medical humanities and ethics came together with medical professionals in the decade of the 1960s. By the 1980s Bioethics was a fully recognized discipline. We show the role that IHVM programs played in defining the field, training faculty and helping schools to develop programs. We review, the beginnings of the IHVM in the crucible of social and technological change that led to the establishment of the IHVM's parent organization, the Society for Health and Human Values. We then turn to the IHVM programs through which Faculty members received fellowships to explore new crossovers between the humanities and the health professions. We have not only described the Fellows Program as it existed in 1973-1980, but have completed a survey of the fellows a quarter of a century after they held their fellowships. We describe other IHVM programs designed to facilitate the initiation and development of new humanities programs, to explore conceptual issues between medicine and five humanities fields, to conduct issue driven or educational method conferences and to advance humanities programs into graduate education through the Directors of Medical Education.

Thromboembolic risk in atrial flutter. The FLASIEC (FLutter Atriale Società Italiana di Ecografia Cardiovascolare) multicentre study.

AIMS: Patients with atrial flutter are believed to be at lower risk of thromboembolism than patients with atrial fibrillation. However, the incidence of atrial thrombi and the need for anticoagulation in patients with atrial flutter is not well established. METHODS AND RESULTS: A prospective observational multicentre study was undertaken to assess the frequency of atrial thrombi and spontaneous echocontrast and the prevalence for aortic complex atherosclerotic lesions in a cohort of unselected patients with atrial flutter. We evaluated 134 patients (102 male, aged 70+/-9 years); exclusion criteria were history of atrial fibrillation, rheumatic mitral valve disease and mitral mechanical prosthesis. The median of atrial flutter duration was 33 days. Twelve patients had been taking warfarin for more than 7 days. One hundred and twenty-four patients (94%) underwent a transoesophageal echocardiogram, which revealed left atrial appendage thrombi in two patients (1.6%) and right atrial thrombi in one patient (1%). At least moderate left atrial echocontrast was found in 16/124 patients (13%). Complex atherosclerotic aortic plaques were detected in 10 patients (8%). Atrial flutter conversion was attempted in 93/134 patients (69%). At the 1-month follow-up, two patients experienced a thromboembolic event following restoration of sinus rhythm. CONCLUSIONS: Atrial thrombi and echocontrast, and complex aortic atherosclerotic plaques are relatively uncommon in patients with atrial flutter. Post-cardioversion embolism was observed in two patients in our study population.

Commentary: value neutrality, moral integrity, and the physician.

The commentator agrees, in part, with Beckwith and Peppin that value neutrality is an illusion, both ethically and legally. He asserts, however, that a physician's moral autonomy does not sanction proselytizing to promote the physician's own values.