The Tutor of Resilience Program with Children Who Have Experienced Maltreatment: Mothers' Involvement Matters.

Resilience is a dynamic process involving the presence and interaction of personal and environmental factors that modify the impact of adversity. Resilience-building interventions are therefore important for improving trauma-related outcomes in children and caregivers exposed to adversity. This study examines the impact of the Tutor of Resilience (TOR) program on beneficiaries' trauma-related symptoms and on mother-child interactions in a group of children exposed to maltreatment (N = 186; mean age = 11.95; SD = 2.50). Assessments were completed at baseline and post-intervention. RM-ANOVAs indicated significant improvements for most trauma symptoms (anxiety, anger, post-traumatic stress, and disassociation, but not depression) in the intervention group relative to a control group (N = 88; mean age = 10.76; SD = 2.57), and indicated further improvements to anxiety and dissociation for the intervention group when mothers were involved. Mother-child interactions also improved over time, as did their overall trauma symptoms and distress. Findings support the effectiveness of the ToR, especially when involving mothers.

Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet.

AIM: To assess the feasibility of magnetic resonance defaecography (MRD) in pelvic floor disorders using an open tilting magnet with a 0.25 T static field and to compare the results obtained from the same patient both in supine and orthostatic positions. MATERIALS AND METHODS: From May 2010 to November 2011, 49 symptomatic female subjects (mean age 43.5 years) were enrolled. All the patients underwent MRD in the supine and orthostatic positions using three-dimensional (3D) hybrid contrast-enhanced (HYCE) sequences and dynamic gradient echo (GE) T1-weighted sequences. All the patients underwent conventional defaecography (CD) to correlate both results. Two radiologists evaluated the examinations; inter and intra-observer concordance was measured. The results obtained in the two positions were compared between them and with CD. RESULTS: The comparison between CD and MRD found statistically significant differences in the evaluation of anterior and posterior rectocoele during defaecation in both positions and of rectal prolapse under the pubo-coccygeal line (PCL) during evacuation, only in the supine position (versus MRD orthostatic: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p = 0.008; versus CD: rectal prolapse p < 0.0001; anterior rectocoele p < 0.001; posterior rectocoele p = 0.01). The value of intra-observer intra-class correlation coefficient (ICC) ranged from good to excellent; the interobserver ICC from moderate to excellent. CONCLUSION: MRD is feasible with an open low-field tilting magnet, and it is more accurate in the orthostatic position than in the supine position to evaluate pelvic floor disorders.

The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging.

OBJECTIVE: To asses the value of second-look ultrasound (US) for identifying BIRADS 3 (Breast Imaging Reporting Data System) mammary lesions detected by breast Magnetic Resonance imaging (MRI). MATERIALS AND METHODS: From April 2008 to May 2009 330 breast MRI were performed of which 60 patients are classified as BIRADS 3. 84 lesions underwent second-look US and percutaneous vacuum biopsy Vacora system US-guided. STATISTICAL ANALYSIS: lesions were stratified into two groups: visible on US (Group 1) and not visible on US (Group 2). The clinical impact of second-look US was studied in terms of negative predictive value (NPV). RESULTS: The positive predictive value (PPV) of category 3 BIRADS MRI was found to be 89%. Second look-US results detected lesions in 51% of the MRI enhancing lesions. The second look-US showed a NPV of 97%. The NPV of second look-US was significantly greater than the NPV of MRI BIRADS 3 (97% vs 89%, p<0.05). The logistic regression analysis showed a higher number of malignant lesions in group 1 than in group 2 (7vs 2, OR 3.7, p<0.05). CONCLUSIONS: The second-look US permitted the correct management of subcentimetric MRI BIRADS 3 lesions not visible with conventional imaging tecniques.

Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders.

PURPOSE: This study was undertaken to explore the capabilities of an open-configuration, low-field, tilting, magnetic resonance (MR) system for investigating pelvic floor disorders and to compare the results obtained with the patient in the semiorthostatic and supine positions. MATERIALS AND METHODS: Eighteen female patients with a diagnosis of pelvic floor disorder (physical examination and conventional defecography) underwent dynamic MR defecography (MRD) with a 0.25-T tilting MR system (G-scan, Esaote). Images were obtained after administration of contrast agent into the rectum, bladder and vagina in both the orthostatic and supine positions. Three-dimensional T2-weighted hybrid contrast-enhanced (HYCE) sequences and dynamic T1-weighted gradient echo (GE) sequences were acquired at rest, during maximal contraction of the anal sphincter, straining and defecation. RESULTS: Good image quality was obtained in 15/18 patients; three presented severe artefacts due to motion, and three had incontinence, which hampered the functional studies. Better anatomical detail was obtained with MRD compared with conventional defecography. Three prolapses were observed in the semiorthostatic position only, and seven were found to be more severe in the orthostatic than in the supine position. CONCLUSIONS: Dynamic MRD with an open-configuration, low-field, tilting MR system is a feasible and promising tool for studying the pelvic floor. Larger series are necessary to assess its real diagnostic value.

An artificial intelligence approach to classify and analyse EEG traces.

We present a fully automatic system for the classification and analysis of adult electroencephalograms (EEGs). The system is based on an artificial neural network which classifies the single epochs of trace, and on an Expert System (ES) which studies the time and space correlation among the outputs of the neural network; compiling a final report. On the last 2000 EEGs representing different kinds of alterations according to clinical occurrences, the system was able to produce 80% good or very good final comments and 18% sufficient comments, which represent the documents delivered to the patient. In the remaining 2% the automatic comment needed some modifications prior to be presented to the patient. No clinical false-negative classifications did arise, i.e. no altered traces were classified as 'normal' by the neural network. The analysis method we describe is based on the interpretation of objective measures performed on the trace. It can improve the quality and reliability of the EEG exam and appears useful for the EEG medical reports although it cannot totally substitute the medical doctor who should now read the automatic EEG analysis in light of the patient's history and age.

p53 oncoprotein overexpression correlates with mutagen-induced chromosome fragility in head and neck cancer patients with multiple malignancies.

In this study, we analysed immunocytochemically p53 expression in first primary and second primary cancers from 25 head and neck cancer patients (HNCPs) with multiple malignancies in comparison with oncoprotein expression in tumour tissues from 25 historical HNCP controls with single cancer in a match-paired analysis. Moreover, we investigated bleomycin-induced chromosome fragility in both groups of HNCPs and in 21 additional healthy controls. Thirty-nine out of 75 tumour specimens analysed (52%) showed positive p53 immunostaining. Eleven out of 25 (44%) from single cancer patients and 28 out of 50 (56%) tumours from HNCPs with multiple malignancies were p53 positive. In the group of multiple primary cancers, nine patients (36%) showed positive staining of both first and second primaries, whereas six (24%) had positive labelling of first primary cancer but not of the subsequent second primary, four (16%) patient showed p53 expression only in the second primary cancer and six (24%) patients showed no p53 immunoreactivity in both tumours. Chromosomal analysis demonstrated a higher sensitivity to clastogens of HNCPs with multiple tumours than of HNCPs with a single cancer (P < 0.01), and a significant correlation between chromosome fragility and p53 overexpression (P < 0.01) only in HNCPs with multiple malignancies more than in those with single head and neck cancer (P = 0.11). Moreover, we found that patients with p53-positive staining of both first and second primaries showed a statistically significant higher mutagen sensitivity than those with a single p53 immunoreactive tumour or those in whom both cancers were p53 negative (P < 0.01). Our data suggest that subjects with increased susceptibility to carcingogens after exposure to tobacco or alcohol are at higher risk for multiple cancers in which one of the most common genetic events is aberrant p53 expression.

Reconstructive laryngectomy.

Reconstructive laryngectomy, the aim of which is to leave the patient without a tracheostoma, thus preserving the normal pneumophonic function relative to vocal articulation, is a link between the various techniques suggested for conservative laryngeal surgery and classic total laryngectomy. The aim of this technique is to restore continuity to the airways, so that the patient is able to breathe naturally and subsequently can speak without having to resort to the use of esophageal voice.